Showing papers on "Vaginal delivery published in 1984"

Catecholamine Surge and Metabolic Adaptation in the Newborn after Vaginal Delivery and Caesarean Section

Abstract: The immediate postnatal metabolic adaptation and sympatho-adrenal activation were studied in infants delivered vaginally or by elective caesarean section. Vaginally delivered infants showed high catecholamine levels at birth compared to infants born by caesarean section under epidural or general anaesthesia. Umbilical arterial glucose levels were significantly higher in the vaginal group than in both caesarean section groups. At 30 min, all groups showed a marked decrease with several infants showing asymptomatic hypoglycaemia in the caesarean section group. C-peptide levels showed no difference at birth but later became significantly higher in the vaginal group. Although the levels of free fatty acids and glycerol were low at birth, they were significantly higher in the vaginal group. In all groups they increased substantially with time. Considering the marked differences in catecholamine levels, the differences in metabolic adaptation were unexpectedly small. This implies an attenuated metabolic response to sympatho-adrenal stimulation in the newborn.

Timing and antecedents of intracranial hemorrhage in the newborn.

Abstract: Fifty newborn infants of less than 33 weeks' gestation were followed prospectively from birth to evaluate the temporal relationships of various clinical factors to the onset and progression of intracranial hemorrhage (ICH) in an inborn population given maximal support. ICH was diagnosed and followed with bedside ultrasound every eight hours. The incidence of intraventricular hemorrhage was 30% and of any ICH was 40% with onset from less than 2 hours to 8 days of age. Grades 2, 3, and 4 ICH correlated with Apgar scores of less than 5 at five minutes, vaginal delivery, longer labors, and intrapartum hemorrhage. There was a significant correlation between ICH and both blood pressure fluctuations of greater than 100% and rapid colloid infusions. Slow transfusions of packed red cells did not appear to precipitate episodes of ICH. In a setting of optimal care, ICH appears to be more related to prenatal stresses than to specific postnatal complications.

Previous cesarean birth. Trial of labor in women with macrosomic infants.

Abstract: Patients with previous cesarean births who delivered macrosomic infants (greater than or equal to 4,000 gm) during the study periods January 1 to December 31, 1980, and July 1, 1982, to June 30, 1983, were analyzed to determine the impact of fetal weight on a trial of labor (TOL) Of 140 women with macrosomic infants given a TOL, 94 (67%) delivered vaginally The most common indication for cesarean delivery was cephalopelvic disproportion (CPD) The dehiscence rates were similar when patients who underwent a TOL were compared with those who did not Factors associated with a successful TOL were a previous vaginal delivery after the original cesarean section, no oxytocin usage during the TOL and an indication for the previous cesarean section other than CPD The risk associated with a TOL in a patient with a previous cesarean birth and a macrosomic infant appears to be no greater than that encountered in a similar group of patients without uterine scars

Vaginal delivery systems and their methods of preparation and use

Abstract: Systems and their methods of preparation and use that release an active agent in a controlled manner for an extended period in a vaginal cavity environment. The systems are capable of delivering the active agent for periods greater than three hours at a predictable rate to a predetermined site, the vaginal cavity.

Vaginal delivery after cesarean section in women with unknown types of uterine scar.

Abstract: Documentation of a prior cesarean and the type of uterine scar has been used as one criterion for permitting patients a trial of labor. In a highly mobile patient population such as ours, these medical facts are often difficult or impossible to obtain. As a result, we retrospectively examined the performance of patients with unknown types of cesarean scar and found no difference between them and a similar population with documented low cervical scars. Although obtaining an old record is useful, its absence probably should not interdict a trial of labor in a patient who desires to attempt vaginal delivery.

The use of prophylactic antibiotics in obstetrics and gynecology. A review.

Abstract: PIP: This review first makes some general comments about prophylactic antibiotics: animal models for antimicrobial prophylaxis, bacterial flora of the female genital tract, timing and duration of prophylactic antibiotic administration, and drug of choice for prophylaxis. Subsequent sections cover the following: prophylaxis for bacterial endocarditis; prophylaxis for vaginal hysterectomy; prophylaxis for elective abortions; prophylaxis for infertility and reconstructive surgery; prophylaxis for cesarean section (risk factor for postoperative infection, antibiotic of choice, timing of administration, duration of administration, and alternatives ot systemic prophylactic antibiotics); prophylactic antibiotics and cervical cerclage; and prophylaxis for preterm rupture of membranes. The recommendations are preceded by a description of the various categories suggested by the Centers for Disease Control, which recognizes that some recommendations are more firmly based on objective data than others: category 1 -- strongly recommended for adoption; category 2, moderately recommended for adoption; and category 3, weakly recommended for adoption. The recommendations include the following: all patients with a prosthetic cardiac valve should receive antibiotic prophylaxis for endometrial biopsy, insertion of IUD, urethral catheterization, dilation and curettage, hysterectomy, normal vaginal delivery, cesarean section, and sigmoidoscopy (category 1); premenopausal patients undergoing vaginal hysterectomy , with or without vaginal repair, should receive prophylactic antibiotics (category 1); and postmenopausal patients, with or without estrogen replacement therapy, may receive prophylaxis (category 2); regarding abdominal hysterectomy, patients with valvular heart disease, low socioeconomic status, cervical conization preceding hysterectomy from 2-21 days, or underlying conditions making a prolonged or difficult operation likely may benefit from prophylaxis (category 2); for elective abortion, patients with valvular heart disease, or a history of acute salpingitis may benefit from prophylaxis (category 2); patients undergoing surgical management of infertility secondary to endometriosis, pelvic adhesions, or distorted tubal architecture may benefit from prophylaxis; and regarding cesarean section, indigent or medically compromised patients with rupture of membranes over 8 hours and labor only 12 hours should receive prophylaxis (category 1).

Maternal and umbilical cord plasma noradrenaline concentrations during labour with and without segmental extradural analgesia, and during caesarean section

Abstract: Serial measurements of maternal and umbilical cord plasma noradrenaline concentrations were obtained in 10 patients undergoing normal vaginal delivery with segmental extradural analgesia, in 10 patients undergoing normal vaginal delivery without extradural analgesia, and in 12 patients undergoing elective Caesarean section under general anaesthesia. Maternal noradrenaline concentrations increased significantly during delivery in all three groups, the peak concentrations occurring at delivery. However, the increase in the maternal noradrenaline concentration during delivery in the extradural group was lower than in the non-extradural group (P less than 0.05). Umbilical venous and arterial concentrations of noradrenaline were lower after Caesarean section than after vaginal delivery. However, extradural analgesia did not affect the fetal noradrenaline concentrations. Since noradrenaline is probably required for the adaptation of the newborn to extrauterine life, the unaltered fetal response may be beneficial.

Oxytocin use during a trial of labor in patients with previous cesarean section.

Abstract: In patients who have had a previous cesarean section (C/S), the use of oxytocin during a trial of labor (TOL) remains controversial. In order to better delineate the risks associated with oxytocin usage in patients with prior C/S undergoing a TOL, a retrospective investigation was undertaken. During the study period, January 1 to December 31, 1980, 308 previous-C/S patients underwent a TOL. Oxytocin was used on 58 (18.8%) for either labor induction (12) or augmentation (46). Vaginal delivery was accomplished in 31 (53.4%) of the patients who received oxytocin. Vaginal delivery was accomplished in 196 (83.8%) of the 292 patients who labored spontaneously. Patients who had no vaginal deliveries after previous C/S and required oxytocin were at a significantly increased risk of undergoing C/S. There was no statistically significant difference between the oxytocin vs. nonoxytocin groups with regard to instruments used in vaginal delivery, uterine scar dehiscence, transfusions, birth trauma or neonatal outcome. In patients with a previous C/S who undergo a TOL, the use of oxytocin in a judicious manner appears to be safe. However, additional studies are required to corroborate this conclusion.

Effect of indication for previous cesarean section on subsequent delivery outcome in patients undergoing a trial of labor.

Abstract: During the period January 1 through December 31, 1980, 308 patients who had undergone previous cesarean sections (C/Ss) underwent a trial of labor (TOL). Hospital records of these patients were examined retrospectively in an effort to correlate delivery outcome with the indication for the prior C/S. Patients with a previous C/S for breech had the highest incidence of subsequent vaginal delivery (81 of 94, or 86%), and patients with a previous C/S for cephalopelvic disproportion or failure to progress had the lowest (22 of 64, or 64%). However, the lower rate of vaginal delivery in the latter group was found only among the subpopulation who had never delivered vaginally. Fetal distress does not appear to be a significant recurring factor in patients given a TOL. Exclusion of patients from a TOL after a previous C/S for cephalopelvic disproportion/failure to progress does not appear to be justified.

Outcome of a trial of labor after prior cesarean delivery.

Abstract: In the United States over 90% of patients with a history of cesarean delivery in the prior pregnancy undergo repeat cesarean delivery in a subsequent pregnancy. The costs of the nearly universal approach to this issue are staggering and have been addressed by a recent National Institutes of Health consensus development conference. In 1979 at the Women's Hospital of Los Angeles County/University of Southern California Medical Center we initiated a policy of permitting a trial of spontaneous labor and vaginal delivery in selected patients with prior cesarean deliveries. Patients selected for a trial of labor (TOL) were those with a history of one prior uterine incision known to be low transverse. During 1980 there were 13,292 deliveries and 13,147 live births; 871 of these patients had a history of prior cesarean delivery. Of the 871 women, 308 (35%) were permitted a TOL. There were 240 vaginal deliveries, for a success rate of 78%. Twenty-two perinatal deaths occurred among the 871 patients, none directly attributable to the TOL. There were three ruptured uteri, one directly attributable to a TOL. Seven hysterectomies were performed in this group, none directly attributable to a TOL. This experience has encouraged us to expand the patient group offered a TOL after prior cesarean delivery under carefully controlled conditions.

Postterm pregnancy after previous cesarean section.

Abstract: In order to assess the current management of, and to develop a management scheme for, patients with postterm pregnancy and previous cesarean section (C/S), a retrospective analysis of 112 patients was done. All patients with postdates pregnancy and previous C/S were followed in a postdates clinic according to a previously published protocol. Thirty-four patients (30.4%) underwent elective repeat C/S, and 78 (69.6%) were permitted a trial of labor (TOL). Of these TOL patients, 57 (73.1%) delivered vaginally. Sixteen (42.2%) of 37 patients with a history of prior C/S for cephalopelvic disproportion delivered vaginally. Excluding 34 patients who underwent elective repeat C/S, the remaining 41 patients who had previous C/Ss for other indications delivered vaginally. This difference was statistically significant (p less than 0.001). Other factors--the number of previous vaginal deliveries, type of previous-C/S incision, the complications of the prior C/S and the interval since the previous C/S occurred--had no effect on vaginal delivery. There was no marked difference in perinatal morbidity between infants delivered vaginally and those delivered abdominally. The maternal morbidity, in terms of postpartum fever and requirement for transfusion, in patients with repeat C/S was significantly higher than that in women with vaginal deliveries. Postdates pregnancy was not associated with an increased risk of uterine rupture. On the basis of this experience we think that postterm pregnancy should not be considered a contraindication to a TOL.

Use of the soft, silicone obstetric vacuum cup for delivery of the fetal head at cesarean section.

Abstract: Delivery of the fetal head at cesarean section can sometimes be very difficult, and serious maternal and fetal complications may occur. Recently a new soft, silicone obstetric vacuum cup was introduced for use on the fetal head at vaginal delivery. In 35 cases the cup was used for delivery of the fetal head at cesarean section. It is an effective, harmless alternative to conventional devices, especially in aiding the delivery of the high-floating head occurring spontaneously or occurring after the head impacted deep in the pelvis is dislodged.

Nurse-midwifery intrapartum management

Abstract: A retrospective chart review was done to identify differences between nurse-midwifery (CNM) and medical intrapartum management. Eighty-five subjects were admitted to the hospital in labor at term with no history of medical or obstetrical complications. The clinic call schedule provided nonpurposeful assignment of such patients to either CNM or medical management. Age, gravidity, parity, and admission, and admission hematocrit values were similar in both groups. Major differences in management were less routine use of electronic monitoring and intravenous fluids and smaller doses of pain medication in the CNM group. The incidence of amniotomy and pitocin augmentation of labor was similar in the two groups, although amniotomies were performed later in labor by the CNMs. CNM management included a higher frequency of spontaneous vaginal delivery performed under local or no anesthesia, and a lower incidence of instrument-assisted vaginal delivery, epidural anesthesia, episiotomy, and lacerations. Except for a shorter mean second stage in the CNM group, length of labor and length of hospitalization during labor were similar in two groups, as were infant Apgar scores. Implications for parturients, cost-effectiveness, and health care planning are discussed.

VAGINAL DELIVERY IN A PATIENT WITH A PHAEOCHROMOCYTOMA: A case report

Abstract: In pregnancy complicated by phaeochromocytoma, successful management has usually entailed elective Caesarean section followed by removal of the tumour. We report a successful vaginal delivery, undertaken under extradural blockade, in a patient with proven phaeochromocytoma

Omentum Presenting at the Vulva After a Normal Labor and Delivery: An unusual late complication of induced abortion

Abstract: A case is described where omentum prolapsed through a uterine fenestration and presented at the vulva after a normal vaginal delivery. The patient had been aborted three times in the past, and it is postulated that the uterus had been perforated on one of these occasions.