Showing papers on "Vaginal delivery published in 1996"
TL;DR: The relation between obstetric factors and the prevalence of urinary incontinence three months after delivery is examined to find out if these factors influence the likelihood ofinence in new mothers.
385 citations
TL;DR: The bladder neck was significantly lower at rest in women after vaginal delivery than in those who had an elective cesarean delivery and in nulligravid controls, and the ability of the pelvic muscles to elevate the urethra in some women was reduced.
187 citations
TL;DR: There is no reason for all fetuses in breech presentation at term to be delivered by elective caesarean section, and a prospective randomised trial is urgently needed to provide definitive evidence on the safest method of delivering fetuses with severe handicap.
Abstract: Objective: To compare the long term outcome of infants delivered in breech presentation at term by intended mode of delivery. Design: A population based comparison of outcomes up to school age. Data obtained from maternity, health visitor, and school medical records and handicap register. Setting: Grampian region 1981-90. Subjects: 1645 infants delivered alive at term after breech presentation. Main outcome measures: Handicap, developmental delay, neurological deficit, psychiatric referral. Results: Elective caesarean section was performed in 590 (35.9%) cases. The remainder (1055; 64.1%) were intended vaginal deliveries. Handicap or other health problem was recorded in 269 (19.4%) of 1387 infants for whom records were available. Proportions of elective caesarean sections and intended vaginal deliveries in this group were 37.2% (100 cases) and 62.8% (169) respectively, almost the same as in the total cohort. There were no significant differences between elective caesarean section and planned vaginal delivery in terms of severe handicap or any other outcome measure. Case records were obtained for 23 of 27 infants with severe handicap. 11 (47.8%) were delivered by elective caesarean section. Of these, three had undiagnosed congenital abnormalities and seven were unexplained. Of the 12 (52.2%) planned vaginal deliveries, in only one was handicap possibly attributable to delivery and four cases were unavoidable even if elective caesarean section had been planned. Conclusion: In selected cases of breech presentation at term planned vaginal delivery with caesarean section if necessary remains as safe as elective caesarean section in terms of long term handicap. It was not possible to determine whether particular babies would have fared better had they been delivered by elective caesarean section. Key messages There is no reason for all fetuses in breech pres- entation at term to be delivered by elective caesar- ean section A prospective randomised trial is urgently needed to provide definitive evidence on the safest method of delivering fetuses in breech presentation at term
135 citations
TL;DR: A trial of labor after one cesarean section should be encouraged in most women who are willing to attempt it, provided no obstetric contraindication exists, and a scoring system that may help to identify women with a greater chance for vaginal delivery is proposed.
134 citations
TL;DR: To compare the safety, efficacy and acceptability of a continuous low dose oestradiol releasing vaginal ring with conjugated equine oestrogen vaginal cream in the treatment of postmenopausal urogenital atrophy.
123 citations
Journal Article•
TL;DR: The high incidence of fecal incontinence by 6 months postpartum in all women is surprising and deserves further investigation, specifically regarding occult sphincter rupture.
Abstract: BACKGROUND:Rupture of the anal sphincters at childbirth is considered rare in obstetric literature. Long-term effects are sparingly mentioned. In clinical practice, however, it is not uncommon to m ...
120 citations
TL;DR: It is strongly suggest that early discharge (at younger than 24, 36, or 48 hours of age) from the hospital is not associated with hospital readmission within the first 3 weeks of life.
Abstract: Objective: To assess the relationship between early discharge, breast-feeding, and other factors on hospital readmission of newborns. Design: Retrospective record review. Setting: An urban, private community hospital. Patients: All newborns born over a 1-year period who were readmitted to the hospital within the first 3 weeks of life (n=117). The control group consisted of a systematic sampling of newborns born over the same period who were not readmitted (n=147). Results: Early discharge, defined as discharge when younger than 24, 36, or 48 hours of age, does not seem to contribute to readmission. However, newborns whose initial stay was longer than 72 hours were at significantly lower risk for readmission ( P =.02, χ 2 ). Factors in the initial hospitalization associated with readmission included vaginal delivery and length of stay less than 72 hours (difference, 12 percentage points; 95% confidence interval [CI], 4% to 20%; P =.005), need for performance of a complete blood count (CBC) (difference, 16 percentage points; CI 6% to 26%; P =.002), presence of jaundice (difference, 17 percentage points; CI, 5% to 29%; P =.005), and gestational age 37 weeks or less (difference, 10 percentage points; CI, 2% to 18%; P =.02), discharge weight less than 3 kg (difference, 11 percentage points; CI, 0 to 22%; P =.05). However, almost all newborns delivered vaginally were discharged within less than 72 hours, so our ability to comment on the independent effect of delivery mode on readmission is limited. A trend toward significance was noted between breast-feeding and readmission (difference, 9 percentage points; CI, 0% to 18%; P =.07). However, when only vaginal deliveries were considered, this association was statistically significant (difference, 13 percentage points; CI, 4% to 22%; P =.02). A significant association was noted between breast-feeding and jaundice or dehydration. Of babies admitted with jaundice or dehydration, 94% were breast-fed, compared with 67% of babies admitted with neither jaundice nor dehydration (difference, 27 percentage points; CI, 13% to 41%; P Conclusions: These findings strongly suggest that early discharge (at younger than 24, 36, or 48 hours of age) from the hospital is not associated with hospital readmission within the first 3 weeks of life. Factors associated with readmission included breast-feeding, vaginal delivery and length of stay less than 72 hours, jaundice or need for a CBC, gestational age of 37 weeks or less, and discharge weight less than 3 kg. (Arch Pediatr Adolesc Med. 1996;150:373-379)
112 citations
TL;DR: Practice patterns reflect differences in residency training; the more recently trained Fellows more often were taught and use vacuum for delivery.
77 citations
TL;DR: Oral acyclovir prophylaxis in late pregnancy for women with recurrent genital herpes is more costeffective than the current strategy of cesarean delivery for all women presenting with genital herpes lesions.
73 citations
TL;DR: Vaginal misoprostol is a cost-effective alternative to current labor-induction protocols and no evidence of harm to mother or newborn in substantive outcomes is found, and it is found that oxytocin infusion was used less frequently.
73 citations
TL;DR: The reduced rate of infection observed in infants born by cesarean section underlines the urgent need for randomized controlled trials to evaluate the protective role of surgical delivery in preventing perinatal HIV-1 transmission.
Abstract: Some data suggest that cesarean section reduces mother-to-child HIV-1 transmission. To assess the influence of mode of delivery and other maternal and infant factors on the rate of transmission, we analyzed the data of 1,624 children prospectively followed from birth. Of these, at the last visit 1,033 were > 18 months of age or would have been had they not died of HIV-related illness. Among the 975 first singleton children, 180 [18.5%; 95% confidence limits (CL), 16.1-20.9] acquired infection, as did 8 of 56 (14.3%; 95% CL, 5.1-23.5) second-born children. Multivariate stepwise analysis showed that vaginal delivery and development of symptoms in the mother were significantly and independently associated with a higher transmission rate (vaginal delivery; odds ratio, 1.69; 95% CL, 1.14-2.5; symptoms: odds ratio, 1.61; 95% CL, 1.12-2.3). In contrast, a history of maternal drug use, birth weight, breast-feeding (only 37 infants were breast-fed), and child's sex did not have a significant impact on viral transmission. The percentage of infected children was highest (30.7%) among very premature infants (< or = 32 weeks of gestation); this significant trend subsequently decreased to 11.9% at the week 42 (p < 0.001), suggesting a parallel reduction in peripartum transmission. The reduced rate of infection observed in infants born by cesarean section underlines the urgent need for randomized controlled trials to evaluate the protective role of surgical delivery in preventing perinatal HIV-1 transmission.
TL;DR: A high rate of perineal involvement seems to follow vaginal delivery with episiotomy in patients with Crohn's disease, highlighting an intriguing relationship that deserves further and more rigorous study.
Abstract: Objective : Crohn's disease frequently affects the perineum, but it is unknown if such involvement poses a heightened risk to a woman with Crohn's disease undergoing vaginal delivery and possibly episiotomy. This study attempts to elucidate whether vaginal delivery with or without episiotomy : 1) predisposes to perineal involvement in women with Crohn's disease ; 2) reactivates quiescent perineal Crohn's disease ; or 3) worsens preexisting perineal Crohn's disease. Methods : Data were culled from questionnaires returned by 117 respondents contacted through newsletters of the Crohn's and Colitis Foundation of America. These surveys were then reviewed and tabulated to determine if any temporal and causal relationship existed between perineal Crohn's disease and vaginal delivery. Results : Four groups were identified : group 1 (n = 56), with 128 pregnancies, had no history of perineal disease or subsequent perineal complication. Group 2 (n = 24) had 51 pregnancies. This group had no preexisting perineal disease, but 67.6% said they developed perineal Crohn's disease postpartum, 60% of which occurred within 2 months of vaginal delivery. Groups 3 and 4 were too small to evaluate (n = 4 and 5, respectively) and represented patients with preexisting perineal disease who had varying results after delivery. Overall, the rate of developing perineal involvement after vaginal delivery, usually with episiotomy, in patients with Crohn's disease and no preexisting perineal involvement (combining groups 1 and 2) was 17.9%. Conclusions : A high rate of perineal involvement seems to follow vaginal delivery with episiotomy in patients with Crohn's disease. Although this study has substantial methodological limitations, it does raise questions as to the proper obstetrical management of patients with Crohn's disease and highlights an intriguing relationship that deserves further and more rigorous study.
TL;DR: The data analysis suggest that the correction of mullerian anomalies does not improve the pregnancy rate, but only the pregnancy outcome of the patients.
TL;DR: Repeated vaginal deliveries have a long-term adverse effect on anorectal physiology in a population of randomly selected healthy perimenopausal women.
Abstract: PURPOSE: This study was undertaken to determine the long-term effects of vaginal deliveries on anorectal function in healthy perimenopausal women. METHODS: An observational study of 144 perimenopausal women living in the county of Aarhus, Denmark, aged 45 to 57 (mean, 50) years were randomly selected from the National Register. All women had delivered 0 to 6 (mean, 2) times 10 to 34 years before the investigation. Examinations describing pelvic floor function were measurements of perineal position at rest and descent during straining, anal mucosa electrosensitivity, maximum resting pressure and maximum squeeze pressure of the anal sphincters, and pudendal nerve terminal motor latency. All tests were performed by one of the authors (AMR) and without knowledge of parity. Data were analyzed using the multiple regression technique, and all associations between anorectal function and parity were corrected for age and hysterectomy status. RESULTS: Increasing parity correlated with a lowered perineal position at rest (correlation coefficient (r)=0.26;P=0.003), an increased descent during straining (r=0.24;P=0.006), an increased threshold of anal mucosa electrosensitivity (r=0.22,P=0.008), and an increased pudendal nerve terminal motor latency on both sides (r=0.27;P=0.002). No effect of parity on the maximum resting pressure (r=0.06;P=0.70) and maximum squeeze pressure (r=0.06;P=0.36) was found. The number of vaginal deliveries account for only a minor fraction of the total variability seen in the tests of pelvic floor function (between 1.6 and 5.7 percent). CONCLUSION: Repeated vaginal deliveries have a long-term adverse effect on anorectal physiology in a population of randomly selected healthy perimenopausal women.
TL;DR: In this paper, the endocrine profile (umbilical venous plasma) of three groups of infants was compared, and the results suggest that labour reduces plasma thyroid hormone concentrations at birth in association with a rise in cortisol.
Abstract: The endocrine profile (umbilical venous plasma) of three groups of infants was compared. Samples were taken after eight vaginal deliveries, 11 emergency caesarean sections during labour, and 13 elective caesarean sections before labour. Mean umbilical plasma concentrations of thyroxine and triiodothyronine were significantly higher and cortisol concentration were lower after elective caesarean section compared with the two labour groups. Mean umbilical plasma thyroid stimulating hormone (TSH) concentration was significantly lower after vaginal delivery compared with elective caesarean section. These results suggest that labour reduces plasma thyroid hormone concentrations at birth in association with a rise in cortisol. These adaptations may be the stimulus for the subsequent surge in triiodothyronine previously reported to occur over the first few hours after birth in vaginally delivered infants.
TL;DR: In this paper, a literature review was performed to analyze and define the current state of operative vaginal delivery and it was concluded that outlet and low forceps deliveries with 45 degrees of rotation will be abandoned in the future.
TL;DR: The AD-BPD difference was greater in borderline macrosomic fetuses of diabetic mothers who experienced shoulder dystocia than in those who had uncomplicated vaginal deliveries.
TL;DR: It is suggested that cesarean delivery for twins with estimated fetal weights less than 1000 g together with a more liberal use of vaginal delivery for twin births would have a net effect of increasing perinatal survival while lowering the overall cesAREan delivery rate.
TL;DR: It appears that pregnancy, labor, and delivery do not pose inordinate obstetric and medical risk to the very young adolescent primipara, and obstetric concerns regarding pregnancy in early adolescence may be unfounded.
Abstract: The purpose of this study was to determine if early adolescence imparts a significant obstetric risk in young primiparas relative to adult primiparas. The records of 239 young primiparas (< 16 years) and 148 older primiparas (18-29 years) were reviewed for demographic information, antepartum complications, mode of delivery, length of labor, episiotomy, lacerations, birthweight, and length of gestation. The young adolescents were shorter, had an earlier age at menarche, a lower pregravid body mass index, and a higher gestational weight gain. The young teens were less likely to smoke cigarettes but were more likely to be Medicaid recipients. The incidence of most antenatal complications (chronic hypertension, pregnancy-induced hypertension, placental abruption, placenta previa, premature rupture of the membranes, urinary tract infections, and anemia) were similar between the two groups. Preterm labor and contracted pelvis were more common among the young adolescent, while gestational diabetes was less common. The young primiparas were significantly (P < .05) less likely to have a Cesarean delivery and to lacerate with vaginal delivery. The length of labor and its stages were similar, as were overall birthweight and length of gestation. Thus, obstetric concerns regarding pregnancy in early adolescence may be unfounded. With the exception of an increased risk for preterm labor, it appears that pregnancy, labor, and delivery do not pose inordinate obstetric and medical risk to the very young adolescent primipara.
TL;DR: Utilization of this protocol resulted in reduction of neonatal intubation and meconium aspiration syndrome did not occur in the nonintubated group.
TL;DR: Pregnancy is safe in women with an ileal pouch-anal anastomosis and functional results are altered minimally, suggesting vaginal delivery is safe and obstetric reasons should determine whether a caesarian section is performed.
Abstract: Objective: To evaluate the pregnancies, deliveries and functional results of patients who have undergone and ileal pouch-anal anastomosis.Design: A retrospective survey by questionnaire.Setting: The study was conducted at a university hospital.Subjects: Twelve women who had undergone an ileal pouch-anal anastomosis at the Inflammatory Bowel Disease Centre, Mount Sinai Hospital and who had subsequently become pregnant, were identified from the hospital records. A follow up questionnaire was completed by all subjects.Results: Twelve patients had 16 deliveries. There were 10 vaginal deliveries and 6 caesarian sections. There were no pouchrelated complication during the 16 pregnancies and there were two postpartum complications.Conclusions: Pregnancy is safe in women with an ileal pouch-anal anastomosis. Functional results are altered minimally. Vaginal delivery is safe and obstetric reasons should determine whether a caesarian section is performed.
TL;DR: Patients with a suspected macrosomic fetus should be given the same opportunity to achieve a vaginal delivery as patients with smaller fetuses, and higher obstetrician group cesarean rates did not result in improved newborn outcomes.
TL;DR: In a selected,Low-risk, low-income population, mother-infant discharge 24 hours after delivery with a home follow-up visit is safe and cost-effective and net cost savings to hospital for 24-hour discharge was $506,139 during a 2-year period.
TL;DR: The forceps is used more commonly, but vacuum is the preferred instrument in about one-third of training programs, and instruction in midpelvic delivery is offered in 64% of programs, but a declining trend is noted.
TL;DR: Although differences in episiotomy rates mainly reflect clinical circumstances, important site-to-site variations and interspecialty differences point to potential areas where physician behaviors influence the performance of episiotome.
TL;DR: In the absence of funicular compression signs by colour-doppler, and under the cover of flawless obstetrical conditions, vaginal delivery can only be authorized for cases when both presentations are cephalic.
TL;DR: The relation between peak active (above baseline) head‐to‐cervix force (paHCF) and peak active intrauterine pressure (paIUP) in labour is compared to compare the relation between labours progressing well and ending in vaginal delivery and those labours Progressing slowly and Ending in caesarean section.
TL;DR: The algorithm shows that when cesarean delivery is requested and well supported solely in autonomy-based clinical judgment, the physician should repeat the recommendation for vaginal delivery and either perform cesar delivery or make a referral.
TL;DR: The first vaginal delivery causes a permanent lowering of resting anal pressures, and the possible reasons for this are discussed.
Abstract: BACKGROUND: Recently interest in idiopathic (neurogenic) faecal incontinence has swung from denervation of the external anal sphincter to the internal sphincter. AIMS: To evaluate the effects of vaginal delivery on the internal sphincter. SUBJECTS: 1372 mothers were studied antenatally and 1202 were accepted into the study. METHODS: Sphincter pressures were measured antenatally, in the early postnatal period, and six to 10 weeks later in selected patients. RESULTS: 755 of 1202 subjects assessed antenatally were primiparous women and 447 multiparous women. Some 320 previous spontaneous vaginal deliveries (SVD) (mean 59 mm Hg) and 67 previous forceps deliveries (mean 58 mm Hg) had lower resting pressures than 755 primiparous women (mean 66 mm Hg) (p < 0.01). A total of 493 subjects were reassessed postnatally. There were 372 SVDs, 47 vacuum extractions, 20 forceps, and 54 caesarean deliveries. All vaginal deliveries but not caesarean sections dropped their resting anal pressures from antenatal values (p < 0.001). Some 227 first SVDs had a much greater fall than 145 subsequent SVDs. In 162 subjects who had undergone their first vaginal delivery and who were followed up there was some recovery but the resting pressures were still lowered at six to 10 weeks post partum. CONCLUSIONS: The first vaginal delivery causes a permanent lowering of resting anal pressures. The possible reasons for this are discussed.
TL;DR: It is demonstrated that laparoscopic surgery decreases the number of laparotomies necessary for patients with no previous vaginal delivery who require hysterectomy.
Abstract: The great majority of hysterectomies in nulliparous patients have been carried out via laparotomy. The purpose of this study was to establish whether laparoscopic surgery can be of use in an attempt to reduce the number of laparotomies when hysterectomy is indicated in patients without previous vaginal delivery. A retrospective study was carried out on 66 women who had not had a previous vaginal delivery who underwent hysterectomy from January 1993 to May 1995. Laparotomy was required for only 19.7% of cases (13 patients). For the 53 patients (80.3%) who underwent laparoscopic hysterectomy, the average duration of the operation was 152.24 +/- 45.7 min, and the average weight of the uterus was 238.3 +/- 154.1 g. The duration of the laparoscopic operation was correlated in a statistically significant fashion with the weight of the uterus (P = 0.0005), the necessity of associated procedures during the hysterectomy (P = 0.01) and the surgeons' experience (P = 0.01). These results demonstrated that laparoscopic surgery decreases the number of laparotomies necessary for patients with no previous vaginal delivery who require hysterectomy. When vaginal access is poor, simple laparoscopic preparation is inadequate and the only possibility of avoiding laparotomy is to carry out the hysterectomy entirely via the laparoscopic route.