Vacuum aspiration of the uterus in therapeutic abortion.
(41/56)
A prospective study of vacuum aspiration in 400 cases of therapeutic abortion is described showing that the procedure was quick, involving little blood loss in most cases, and that the complication rate was low. The routine use of this method in therapeutic abortion is recommended. (+info)
Massive subaponeurotic haemorrhage in infants born by vacuum extraction.
(42/56)
Nine out of 232 infants on whom the vacuum extractor was employed developed subaponeurotic haemorrhage and two of these infants died. In a further 78 infants born by vacuum extraction, all of whom received intramuscular vitamin K(1), four sustained subaponeurotic haemorrhage and one died. This type of haemorrhage was not encountered in over 12,000 infants born by other methods. Its relationship to vacuum extraction was found to be significantly more frequent when the thrombotest level was 10% or below of normal adult activity. It is suggested that infants born by vacuum extraction and with a thrombotest level of 10% or below might be protected from subaponeurotic haemorrhage by the transfusion of fresh frozen plasma. (+info)
Prevention of prolonged labour.
(43/56)
A prospective study of 1,000 consecutive primigravid deliveries has shown that active management in labour can ensure that every woman is delivered within 24 hours. Emphasis is laid on the importance of a correct initial diagnosis of labour based on objective criteria. Amniotomy followed by oxytocin infusion is advocated to simulate the progress of normal labour unless this is evident from an early stage.Oxytocin, the dose of which is limited only by foetal distress, cannot be used effectively unless three popular fallacies are rejected. Firstly, that prolonged labour is often an expression of cephalo-pelvic disproportion; secondly, that oxytocin may rupture the primigravid uterus; and, thirdly, that there is a valid therapeutic distinction between hypotonic and hypertonic uterine action.Stimulation, properly supervised, is safe to mother and child, it eliminates the problem of occipitoposterior position, results in a sharp decline in forceps delivery, and obviates the need for massive analgesia. (+info)
Factors influencing jaundice in immigrant Greek infants.
(44/56)
A study of 887 consecutively born immigrant Greek and 220 Anglo-Saxon Australian infants has shown that serum bilirubin concentrations are influenced by these factors: breast feeding, delivery with forceps, gestation, birthweight, sex of the infant, presence of hypoxia, presence of blood group incompatibility, a positive direct Coombs's test, maternal sepis, and administration to the mother of promethazine hydrochloride, reserpine, chloral hydrate, barbiturates, narcotic agents, diazepam, oxytocin, aspirin, and phenytoin sodium. Apart from the administration of promethazine hydrochloride, reserpine, chloral hydrate, and quinalbarbitone sodium, only two factors, breast feeding and delivery by forceps, occured with different frequencies in the immigrant Greek and the Australian infants. Among the Greek infants with jaundice, there were few where the cause of the jaundice was inapparent. The immigrant Greek and Australian newborn populations were therefore remarkably similar. Since differences of frequency and severity of jaundice do exist in infants born in Greece, this difference must be lost when the parents emigrate, and therefore an environmental factor must be incriminated as the causative agent for jaundice of unknown origin in Greece. (+info)
Should we abandon Kielland's forceps?
(45/56)
To assess the risks associated with the use of Kielland's forceps 2708 consecutive deliveries were studied prospectively and the neonatal outcome related to the mode of delivery. Of the 1191 primigravidas, 279 (23.4%) underwent instrumental delivery, of whom 65 (5.5%) were delivered with Kielland's forceps. There was no difference in early neonatal outcome (as judged by Apgar scores, intubations, and admission to the special care baby unit) between these babies and those delivered normally or by non-rotational forceps, but a higher proportion of the 127 (10.7%) delivered by emergency caesarean section were compromised. Of the 1517 multigravid patients, only 57 (3.8%) underwent instrumental delivery, 15 (1.0%) by Kielland's forceps. Among these babies, also, the outcome was no worse than for those delivered normally, but the babies delivered by caesarean section showed a greatly increased incidence of low Apgar scores, intubations, and admission to the special care baby unit. There were no stillbirths or neonatal deaths among babies delivered by Kielland's forceps, nor were there any cases of severe birth trauma or of obvious neonatal morbidity. (+info)
Fetal distress and the condition of newborn infants.
(46/56)
In a prospective audit of the obstetric management of 1210 consecutive deliveries the association was investigated between the need for operative delivery for fetal distress during labour and the condition of the newborn infant. Operative delivery was performed for only 11.5% of the newborn infants with severe acidosis at birth (umbilical artery pH less than 7.12, base deficit greater than 12 mmol (mEq)/1), 24.1% of those with an Apgar score less than 7 at one minute, and 15.8% of those with both severe acidosis and a one minute Apgar score less than 7. Most of the infants delivered operatively were in a vigorous condition at birth and did not have severe acidosis. Fetal blood sampling was done in 4.0% of labours. As none of the fetal blood values were less than 7.20 and only three of the infants sampled in utero suffered severe acidosis at birth, fetal blood sampling would have had to be performed much more often to provide a useful guide to metabolic state at birth. While the large majority of "at risk" fetuses had continuous fetal heart rate monitoring in labour, this had not been provided in 48.7% of the labours of infants with severe acidosis, 38.7% of infants with a one minute Apgar score less than 7, and 47.4% of infants with both severe acidosis and a one minute Apgar score less than 7. Continuous fetal heart rate monitoring was associated with a much higher incidence of operative delivery for fetal distress than was intermittent fetal heart rate auscultation. These results suggest an urgent need to review present methods for assessing the intrapartum condition of the fetus, making the diagnosis of fetal distress, and assessing the condition of the infant at birth. (+info)
Which deliveries require paediatricians in attendance?
(47/56)
The mode of delivery and one minute Apgar score were taken from the neonatal records of 2086 full term infants born at one obstetric unit over 12 months. There were 1554 spontaneous vaginal vertex deliveries, 26 vaginal breech deliveries, and 506 operative or instrumental deliveries. The obstetric records of the operative deliveries were reviewed to determine whether fetal distress had been an indication for intervention, and the obstetric records of the spontaneous vaginal vertex deliveries were also reviewed for fetal distress detected antenatally. When fetal distress was present antenatally in spontaneous vaginal vertex deliveries the frequency of a one minute Apgar score below 7 was 10.2%. In operative and instrumental deliveries where fetal distress was the indication for intervention the frequency of one a minute Apgar score below 7 was 15.6% after non-rotational forceps delivery, 13.9% after rotational forceps delivery, and 45.8% after caesarean section. In the absence of fetal distress the frequency of an Apgar score below 7 was 2.4% after spontaneous deliveries, 7.1% after non-rotational forceps delivery, 13.2% after caesarean section, and 18.4% after rotational forceps delivery. The presence of fetal distress considerably increased the frequency of an Apgar score below 7 in each category except rotational forceps deliveries. Paediatric services to an obstetric unit may be organised rationally in the light of local staffing conditions with the help of these findings. (+info)
Vacuum extraction: use in a small rural hospital.
(48/56)
The effectiveness of vacuum extraction with the Silastic Obstetrical Vacuum Cup (SOVC), which has a soft, maleable cup, was assessed by two family physicians in a small rural hospital. Vacuum extraction was attempted in 35 of 231 deliveries over an 18-month period, with an overall success rate of 66%. The main indications for vacuum extraction were fetal distress, followed by a prolonged second stage of labour and malrotation of the occiput. The efficiency of the technique improved with experience. The effects of vacuum extraction on the fetus and mother compared favourably with those reported in the literature. After introduction of the SOVC, the rate of primary cesarean section for cephalopelvic disproportion declined, as did the rate of forceps delivery. Despite careful antenatal screening and referral, and the availability of alternatives, delivery by vacuum extraction with the SOVC was found to be a useful and effective adjunct to obstetric practice. (+info)