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Fetal Distress (fetal + distress)

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Medical Sciences	100%

Selected Abstracts

Fetal distress increases interleukin-6 and interleukin-8 and decreases tumour necrosis factor-, cord blood levels in noninfected full-term neonates

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2000
Mickael Jokic MD
Objective To assess the influence of fetal distress on interleukin-1,, interleukin-6, interleukin-8 and on tumour necrosis factor-, blood levels in noninfected full-term neonates. Study design In a multicentre prospective study, cord blood samples were obtained at time of delivery from 234 noninfected full-term neonates for the purposes of measuring serum levels of interleukin-1,, interleukin-6, interleukin-8 and tumour necrosis factor-, using immunoassays. Women were classified into four groups according to the mode of delivery (vaginal delivery or caesarean section) and the presence or absence of fetal distress. The role of labour was also investigated. Results No significant relationship was found between cytokine cord blood levels and the mode of delivery. Fetal distress was associated with an increase in interleukin-6 (P= 0.01) and interleukin-8 (P < 0.001) levels, and a decrease in tumour necrosis factor-, (P < 0.001). Labour was also associated with a significant increase in interleukin-6 and interleukin-8 cord blood levels (P= 0.01 and P < 0.001, respectively). Conclusion Fetal distress and labour were each associated with elevated interleukin-6 and interleukin-8 cord blood levels in noninfected full term neonates while only fetal distress was associated with decreased tumour necrosis factor-, levels. [source]

Maternal and neonatal outcomes and time trends of gestational diabetes mellitus in Sweden from 1991 to 2003

DIABETIC MEDICINE, Issue 4 2010
H. E. Fadl
Diabet. Med. 27, 436,441 (2010) Abstract Aims, To determine maternal and neonatal outcomes for women with gestational diabetes mellitus (GDM) in Sweden during 1991,2003, and to compare the outcomes in the two time periods. Methods, This is a population-based cohort study using the Swedish Medical Birth Register data for the period 1991,2003. There were 1 260 297 women with singleton pregnancies registered during this time, of whom 10 525 were diagnosed with GDM, based on a 75 g oral glucose tolerance test. The main diagnostic criteria were fasting capillary whole blood glucose , 6.1 mmol/l and 2 h blood glucose , 9.0 mmol/l. Results, Maternal characteristics differed significantly between the GDM and non-GDM group. Adjusted odds ratios (OR) were as follows: for pre-eclampsia, 1.81 (95% confidence interval (CI) 1.64,2.00); for shoulder dystocia, 2.74 (2.04,3.68); and for Caesarean section, 1.46 (1.38,1.54). No difference was seen in perinatal mortality, stillbirth rates, Apgar scores, fetal distress or transient tachypnoea. There was a markedly higher risk of large for gestational age, OR 3.43 (3.21,3.67), and Erb's palsy, OR 2.56 (1.96,3.32), in the GDM group, and statistically significant differences in prematurity < 37 weeks, birth weight > 4.5 kg, and major malformation, OR 1.19,1.71. No statistically significant improvement in outcomes was seen between the two study periods. Conclusions, Women with GDM have higher risks of pre-eclampsia, shoulder dystocia and Caesarean section. Their infants are often large for gestational age and have higher risks of prematurity, Erb's palsy and major malformations. These outcomes did not improve over time. [source]

Tocolysis and delayed delivery versus emergency delivery in cases of non-reassuring fetal status during labor

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 3 2007
Leonel Briozzo
Abstract Aim:, To determine whether fetal intrauterine resuscitation using tocolysis and delayed delivery is better for the fetus than emergency delivery when fetal hypoxia is suspected because of a non-reassuring fetal heart-rate (FHR) pattern using conventional heart rate monitoring. Methods:, This was a prospective and randomized study, conducted between 2001 and 2004 at Pereira Rossell Hospital, Montevideo, Uruguay. The population consisted of 390 fetuses, in which intrauterine distress was diagnosed using electronic FHR monitoring. Of these, 197 were randomly assigned to the emergency delivery group and 193 to the fetal intrauterine resuscitation group. The inclusion criteria were: term singleton pregnancy, in labor, cephalic presentation, and no placental accidents. Results:, The time between randomization and birth was 16.9 ± 7.6 min (mean ± SD) for the emergency delivery group, and 34.5 ± 11.7 min (mean ± SD) for the resuscitation group. The relative risk (RR) of acidosis in the umbilical artery (pH < 7.1) in the emergency delivery group was 1.47 (0.95,2.27). The RR of base deficit ,12 mEq/L in the emergency delivery group was higher than in the resuscitation group (RR = 1.48 [1.0,2.2], P = 0.04). When considering the need for admission to the neonatal care unit, the relative risk was higher in the emergency delivery group than in the resuscitation group (RR = 2.14 [1.23·3.74], P = 0.005). No maternal adverse effects were reported. Conclusion:, Tocolysis and delayed delivery renders better immediate neonatal results than emergency delivery when fetal distress is suspected because of a non-reassuring fetal heart pattern. In addition, it may decrease the need for emergency delivery without increasing maternal and fetal adverse side-effects. [source]

The effect of the obstetrician group and epidural analgesia on the risk for cesarean delivery in nulliparous women

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2000
Y. Beilin
Background: The effects of regional anesthesia and of the obstetrician on the risk of cesarean delivery remain controversial. The purpose of this study was to determine whether epidural analgesia or the obstetrician group is associated with an increase in the risk for cesarean delivery in nulliparous women. Methods: Data were collected for a two-year period from the medical records of all nulliparous women who had a private obstetrician who delivered >20 babies per year, and who presented with a singleton gestation in the vertex presentation for a trial of labor. Results: Data were collected for 3699 women of whom 1832 were nulliparous. Of the 1832 nulliparous women, data were analyzed for the 1278 women who met our study criteria, representing 14 separate obstetrician groups. Excluding the 50 women whose babies were delivered for fetal distress (leaving 1228 women for analysis), the epidural rate was 93%, range 81,98%, and the cesarean delivery rate was 14%, range 8,34%. Logistic regression analyses revealed that (odds ratio, 95% confidence interval) patient age (1.7, 1.2,2.4), birth weight (1.001, 1.001,1.002), induction of labor (1.9, 1.3,2.7), non-Caucasian (1.9, 1.2,2.9) and the obstetrician group, (P=0.002), were independently associated with the risk of cesarean delivery, but epidural analgesia was not (1.6, 0.7,3.6). Conclusions: The obstetrician group is independently associated with the risk of cesarean delivery in nulliparous women, but we could not demonstrate this association with epidural analgesia. We suggest that in future studies regarding epidural analgesia and cesarean delivery, the obstetrician group should be included as a variable ( ,). [source]

Maternal Death Following Cardiopulmonary Collapse After Delivery: Amniotic Fluid Embolism or Septic Shock Due to Intrauterine Infection?

AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 2 2010
Roberto Romero
Citation Romero R, Kadar N, Vaisbuch E, Hassan SS. Maternal death following cardiopulmonary collapse after delivery: amniotic fluid embolism or septic shock due to intrauterine infection? Am J Reprod Immunol 2010; 64: 113,125 Problem, The amniotic fluid embolism (AFE) syndrome is a catastrophic complication of pregnancy frequently associated with maternal death. The causes and mechanisms of disease responsible for this syndrome remain elusive. Method of study, We report two cases of maternal deaths attributed to AFE: (1) one woman presented with spontaneous labor at term, developed intrapartum fever, and after delivery had sudden cardiovascular collapse and disseminated intravascular coagulation (DIC), leading to death; (2) another woman presented with preterm labor and foul-smelling amniotic fluid, underwent a Cesarean section for fetal distress, and also had postpartum cardiovascular collapse and DIC, leading to death. Results, Of major importance is that in both cases, the maternal plasma concentration of tumor necrosis factor-, at the time of admission to the hospital and when patients had no clinical evidence of infection was in the lethal range (a lethal range is considered to be above 0.1 ng/mL). Conclusion, We propose that subclinical intraamniotic infection may be a cause of postpartum cardiovascular collapse and DIC and resemble AFE. Thus, some patients with the clinical diagnosis of AFE may have infection/systemic inflammation as a mechanism of disease. These observations have implications for the understanding of the mechanisms of disease of patients who develop cardiovascular collapse and DIC, frequently attributed to AFE. It may be possible to identify a subset of patients who have biochemical and immunological evidence of systemic inflammation at the time of admission, and before a catastrophic event occurs. [source]

Safety of endoscopic retrograde cholangiopancreatography during pregnancy

ANZ JOURNAL OF SURGERY, Issue 1-2 2009
Mohammed N. Bani Hani
Abstract Background:, The risk of choledocholithiasis is expected to be higher during pregnancy. This is attributed to alteration in bile composition as well as biliary stasis that take place during gestation. There is significant concern regarding application of endoscopic procedures especially the more invasive ones for treatment of choledocholithiasis during pregnancy. Our aim was to provide an additional support to the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in the management of biliary diseases during pregnancy. Methods:, The medical records of 10 pregnant patients who underwent ERCP at King Abdullah University Hospital, during the period from 2002 to 2007 were reviewed. Pregnancy course and outcomes were followed up in all cases. Results were analysed and compared with published data on safety and efficacy of this procedure. Results:, The mean age for mothers was 24.3 years. The mean duration of gestation was 18.4 weeks. Two patients were in the first trimester, five were in their second trimester and another three in the third trimester. The main indication for ERCP was obstructive choledocholithiasis on ultrasound and liver function tests. Fetal radiation exposure was not routinely measured. During, or after, the procedure there was no need for tocolytic agents. Also there was no intrauterine fetal distress. Screening for congenital anomalies was negative in all cases. Conclusion:, Major complications of biliary obstruction have been prevented through this procedure. Short-term follow up for all neonates whom mothers underwent ERCP during pregnancy supports its safety. However, specific long-term fetal complications of radiation exposure have not been investigated yet. [source]

Castor oil for induction of labour: Not harmful, not helpful

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2009
Machteld Elisabeth BOEL
Background:, Castor oil is one of the most popular drugs for induction of labour in a non-medical setting; however, published data on safety and effectiveness of this compound to induce labour remain sparse. Aim:, To assess the safety and effectiveness of castor oil for induction of labour in pregnancies with an ultrasound estimated gestational at birth of more than 40 weeks. Methods:, Data were extracted from hospital-based records of all pregnant women who attended antenatal clinics on the Thai,Burmese border and who were more than 40 weeks pregnant. The effectiveness of castor oil to induce labour was expressed as time to birth and analysed with a Cox proportional hazards regression model. Measures associated with safety were fetal distress, meconium-stained amniotic fluid, tachysystole of the uterus, uterine rupture, abnormal maternal blood pressure during labour, Apgar scores, neonatal resuscitation, stillbirth, post-partum haemorrhage, severe diarrhoea and maternal death. Proportions were compared using Fisher's exact test. Results:, Of 612 women with a gestation of more than 40 weeks, 205 received castor oil for induction and 407 did not. The time to birth was not significantly different between the two groups (hazard ratio 0.99 (95% confidence interval: 0.81 to 1.20; n = 509)). Castor oil use was not associated with any harmful effects on the mother or fetus. Conclusions:, Castor oil for induction of labour had no effect on time to birth nor were there any harmful effects observed in this large series. Our findings leave no justification for recommending castor oil for this purpose. [source]

Vaginal birth after Caesarean section: A survey of practice in Australia and New Zealand

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2003
Jodie Dodd
Abstract Aims: Women with a single prior Caesarean section (CS) in a subsequent pregnancy will be offered either a planned elective repeat CS or vaginal birth after Caesarean (VBAC). Recent reports of VBAC have highlighted risks of increased morbidity, including uterine rupture, and adverse infant outcome. A survey of practice was sent to fellows and members of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists to determine current care for women in a subsequent pregnancy with a single prior CS, and to assess variations by length and type of obstetric practice. Methods: Questions asked about the safety of VBAC, induction of labour with a uterine scar, and requirements to conduct VBAC and elective repeat CS. Results: A total of 1641 surveys were distributed, with 1091 (67%) returned, 844 from practicing obstetricians (51% of college membership). Almost all respondents (96%) agreed or strongly agreed that VBAC should be presented as an option to the woman, varying from 90% where the indication for primary CS was breech, 88% for fetal distress, and 55% for failure to progress. Forty percent of respondents agreed or strongly agreed that VBAC was the safest option for the woman, and associated with fewer risks than CS. In contrast, 44% of respondents disagreed or strongly disagreed that VBAC was the safest option for the infant, and opinions varied as to whether risks of VBAC outweighed those of CS for the infant. Almost two-thirds of practitioners would offer induction of labour to a woman with a prior CS in a subsequent pregnancy, one-third indicating a willingness to use vaginal prostaglandins, and 77% syntocinon. Most respondents preferred to conduct VBAC in a level two or three hospital (86%); required the availability within 30 min of an anaesthetist (81%), a neonatologist (84%), and operating theatre (97%); recommended continuous electronic fetal heart rate monitoring (86%); intravenous access (90%); and routine group and hold (79%) during labour. For an elective repeat CS, most practitioners request routine blood for group and hold (78%), a neonatologist in theatre (77%), the use of an in-dwelling urinary catheter (96%), and the use of intraoperative antibiotics (82%). Conclusions: Most obstetricians indicated VBAC to be the safest option for the woman, but were less certain about benefits and risks for the infant. The consensus of practice is to present VBAC as an option and induce labour if needed. Vaginal birth after Caesarean is preferred in a level two or three hospital, with an anaesthetist, neonatologist and operating theatre available within 30 min. The use of continuous electronic fetal heart rate monitoring and intravenous access are recommended. In planned CS, a neonatologist in theatre is preferred, and an in-dwelling urinary catheter and intraoperative antibiotics will be used. [source]

Comparability of the amniotic fluid index and single deepest pocket measurements in clinical practice

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2003
Everett F. Magann
Abstract Two ultrasound techniques, the amniotic fluid index (AFI) and the single deepest pocket (SDP), are currently used to detect oligohydramnios, predict variable decelerations, risk of Caesarean delivery for fetal distress, Apgar scores, umbilical cord artery pH, perinatal mortality, and cerebral palsy. Both techniques poorly identify oligohydramnios. Both techniques identify pregnancies at risk for variable decelerations, low Apgar scores, and Caesarean delivery for fetal distress. Only the SDP is predictive of a compromised fetus,umbilical artery pH, as a stand-alone test, has been correlated with perinatal mortality, and as part of the biophysical profile has been linked to cerebral palsy. This brief communication reviews the comparability of these two techniques and which method, if either, is superior in the identification of oligohydramnios, the predictability of these techniques to identify an adverse pregnancy outcome, and the ability to predict cerebral palsy and perinatal mortality. [source]

Cesarean Delivery in Native American Women: Are Low Rates Explained by Practices Common to the Indian Health Service?

BIRTH, Issue 3 2005
Sheila F. Mahoney CNM
ABSTRACT:,Background: Studying populations with low cesarean delivery rates can identify strategies for reducing unnecessary cesareans in other patient populations. Native American women have among the lowest cesarean delivery rates of all United States populations, yet few studies have focused on Native Americans. The study purpose was to determine the rate and risk factors for cesarean delivery in a Native American population. Methods: We used a case-control design nested within a cohort of Native American live births, , 35 weeks of gestation (n = 789), occurring at an Indian Health Service hospital during 1996,1999. Data were abstracted from the labor and delivery logbook, the hospital's primary source of birth certificate data. Univariate and multivariate analyses examined demographic, prenatal, obstetric, intrapartum, and fetal factors associated with cesarean versus vaginal delivery. Results: The total cesarean rate was 9.6 percent (95% CI 7.2,12.0). Nulliparity, a medical diagnosis, malpresentation, induction, labor length > 12.1 hours, arrested labor, fetal distress, meconium, and gestations < 37 weeks were each significantly associated with cesarean delivery in unadjusted analyses. The final multivariate model included a significant interaction between induction and arrested labor (p < 0.001); the effect of arrested labor was far greater among induced (OR 161.9) than noninduced (OR 6.0) labors. Other factors significantly associated with cesarean delivery in the final logistic model were an obstetrician labor attendant (OR 2.4; p = 0.02) and presence of meconium (OR 2.3; p = 0.03). Conclusions: Despite a higher prevalence of medical risk factors for cesarean delivery, the rate at this hospital was well below New Mexico (16.4%, all races) and national (21.2%, all races) cesarean rates for 1998. Medical and practice-related factors were the only observed independent correlates of cesarean delivery. Implementation of institutional and practitioner policies common to the Indian Health Service may reduce cesarean deliveries in other populations. [source]

Effect of Managed Care Enrollment on Primary and Repeat Cesarean Rates Among U.S. Department of Defense Health Care Beneficiaries in Military and Civilian Hospitals Worldwide, 1999,2002

BIRTH, Issue 4 2004
Andrea Linton MS
However, little conclusive evidence exists to support this solution. We undertook a study of the Department of Defense health care beneficiary population to assess the impact of enrollment in TRICARE Prime, the Department's managed care health plan, on cesarean delivery rates. Methods: Pooled hospital discharge records from 1999,2002 for live, singleton births were analyzed to calculate primary and repeat cesarean rates for TRICARE Prime and non-Prime beneficiaries in the military and civilian hospitals that comprise the Department of Defense health care network. Stepwise logistic regression was used to calculate adjusted odds ratios for clinical indicators for each combination of health plan and hospital setting using the,2difference(p < 0.05)to eliminate nonsignificant variables from the model. Total primary and repeat cesarean rates were compared with primary and repeat cesarean rates for women with no reported clinical complications to account for differences in case mix across subgroups. Statistical significance of the differences calculated for subgroups was assessed using,2. Results: Primary cesarean rates were significantly lower for TRICARE Prime enrollees relative to non-Prime beneficiaries for all race subgroups and three of five age subgroups in military hospitals and four of five age subgroups in civilian hospitals. No significant differences in repeat cesarean rates were observed between Prime and non-Prime beneficiaries within any race or age subgroup. Breech presentation followed by dystocia, fetal distress, and other complications were significant predictors for primary cesarean. Previous cesarean delivery was the leading predictor for repeat cesarean delivery. Primary and repeat cesarean rates observed for military hospitals were consistently lower than rates observed for civilian hospitals within each health plan type and age group. Conclusions: Enrollment in the managed care health plan was significantly associated with lower risk of primary cesarean delivery relative to membership in other health plans offered to Department of Defense health care beneficiaries. Repeat cesarean rates in this population varied independently of health plan type. Primary cesarean delivery was generally associated with clinical complications, whereas previous cesarean delivery was the strongest indictor for a repeat cesarean delivery. A clear explanation of reduced cesarean rates for Prime enrollees remains elusive, but it is likely that factors beyond individual practitioner decision-making were at work. [source]

Amniotomy for Shortening Spontaneous Labour

BIRTH, Issue 2 2001
W.D. Fraser
A substantive amendment to this systematic review was last made on 25 June 1999. Cochrane reviews are regularly checked and updated if necessary. ABSTRACT Background: Early amniotomy has been advocated as a component of the active management of labour. Several randomised trials comparing routine amniotomy to an attempt to conserve the membranes have been published. Their limited sample sizes limit their ability to address the effects of amniotomy on indicators of maternal and neonatal morbidity. Objectives: To study the effects of amniotomy on the rate of Cesarean delivery and on other indicators of maternal and neonatal morbidity (Apgar less than 7 at 5 minutes, admission to NICU). Search strategy: The register of clinical trials maintained and updated by the Cochrane Pregnancy and Childbirth Group. Selection criteria: All acceptably controlled trials of amniotomy during first stage of labour were eligible. Data collection and analysis: Data were extracted by two trained reviewers from published reports. Trials were assigned methodological quality scores based on a standardised rating system. Typical odds ratios (ORs) were calculated using Peto's method. Main results: Amniotomy was associated with a reduction in labour duration of between 60 and 120 minutes. There was a marked trend toward an increase in the risk of Cesarean delivery: OR = 1.26; 95% Confidence Interval (CI) = 0.96,1.66. The likelihood of a 5-minute Apgar score less than 7 was reduced in association with early amniotomy (OR = 0.54; 95% CI = 0.30,0.96). Groups were similar with respect to other indicators of neonatal status (arterial cord pH, NICU admissions). There was a statistically significant association of amniotomy with a decrease in the use of oxytocin: OR = 0.79; 95% CI = 0.67,0.92. Reviewers' conclusions: Routine early amniotomy is associated with both benefits and risks. Benefits include a reduction in labour duration and a possible reduction in abnormal 5-minute Apgar scores. The meta-analysis provides no support for the hypothesis that routine early amniotomy reduces the risk of Cesarean delivery. Indeed there is a trend toward an increase in Cesarean section. An association between early amniotomy and Cesarean delivery for fetal distress is noted in one large trial. This suggests that amniotomy should be reserved for women with abnormal labour progress. Citation: Fraser WD, Turcot L, Krauss I, Brisson-Carrol G. Amniotomy for shortening spontaneous labour (Cochrane Review). In: The Cochrane Library, 1, 2001. Oxford: Update Software. MeSH: Amnion/*surgery; Cesarean Section; Female; Human; *Labor; Labor Complications/*prevention & control; Pregnancy The preceding reports are abstracts of regularly updated, systematic reviews prepared and maintained by the Cochrane Collaboration. The full text of the reviews are available in The Cochrane Library (ISSN 1464-780X). The Cochrane Library is prepared and published by Update Software Ltd. All rights reserved. See www.update-software.com or contact Update Software, info@update.co.uk, for information on subscribing to The Cochrane Library in your area. Update Software Ltd, Summertown Pavilion, Middle Way, Oxford OX2 7LG, United Kingdom. (Tel: +44 1865 513902; Fax: +44 1865 516918). [source]

Cesarean Delivery in Shantou, China: A Retrospective Analysis of 1922 Women

BIRTH, Issue 2 2000
Wang-ling Wu MD
Background:In China the cesarean section rate increased significantly during the past four decades. This study examined the frequency and indications of cesarean birth in Shantou, a southern city in China.Methods:An analysis was conducted of the medical records of 1922 women who had cesarean deliveries at Shantou City 2nd People's Hospital between January 1990 and December 1997. The medical records of 10,490 women who gave birth during this period were examined.Results:The average rate of cesarean delivery during the 8-year period was 19.4 ± 2.3 percent (means ± standard error). From 1990 to 1997 the cesarean delivery rates ranged from 11.05 to 29.9 percent, respectively, although during this period the total annual number of deliveries decreased significantly from 1683 to 951. The rates of the most common indications per 100 women for cesarean delivery were failure to progress (23%), premature rupture of membranes (20%), fetal distress (19.4%), breech presentation (18.1%), uterine scar (14.6%), and prolonged pregnancy (11.3%).Conclusion:The cesarean delivery rate in Shantou, China, has increased steadily and significantly between 1990 and 1997, despite a decrease in the total number of births during the same period. This study showed that on an individual basis vaginal delivery was often possible and reduction of the cesarean delivery rate could be achieved safely by paying greater heed to appropriate indications. [source]

Evaluation of 280 000 cases in Dutch midwifery practices: a descriptive study

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2008
MP Amelink-Verburg
Objective, To assess the nature and outcome of intrapartum referrals from primary to secondary care within the Dutch obstetric system. Design, Descriptive study. Setting, Dutch midwifery database (LVR1), covering 95% of all midwifery care and 80% of all Dutch pregnancies (2001,03). Population, Low-risk women (280 097) under exclusive care of a primary level midwife at the start of labour either with intention to deliver at home or with a personal preference to deliver in hospital under care of a primary level midwife. Methods, Women were classified into three categories (no referral, urgent referral and referral without urgency) and were related to maternal characteristics and to neonatal outcomes. Main outcome measures, Distribution of referral categories, main reasons for urgent referral, Apgar score at 5 minutes, perinatal death within 24 hours and referral to a paediatrician within 24 hours. Results, In our study, 68.1% of the women completed childbirth under exclusive care of a midwife, 3.6% were referred on an urgency basis and 28.3% were referred without urgency. Of all referrals, 11.2% were on an urgency basis. The main reasons for urgent referrals were fetal distress and postpartum haemorrhage. The nonurgent referrals predominantly took place during the first stage of labour (73.6% of all referrals). Women who had planned a home delivery were referred less frequently than women who had planned a hospital delivery: 29.3 and 37.2%, respectively (P < 0.001). On average, the mean Apgar score at 5 minutes was high (9.72%) and the peripartum neonatal mortality was low (0.05%) in the total study group. No maternal deaths occurred. Adverse neonatal outcomes occurred most frequently in the urgent referral group, followed by the group of referrals without urgency and the nonreferred group. Conclusions, Risk selection is a crucial element of the Dutch obstetric system and continues into the postpartum period. The system results in a relatively small percentage of intrapartum urgent referrals and in overall satisfactory neonatal outcomes in deliveries led by primary level midwives. [source]

Early onset severe pre-eclampsia: expectant management at a secondary hospital in close association with a tertiary institution

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 1 2005
Charl Oettle
Objectives Early onset severe pre-eclampsia is ideally managed in a tertiary setting. We investigated the possibility of safe management at secondary level, in close co-operation with the tertiary centre. Design Prospective case series over 39 months. Setting Secondary referral centre. Population All women (n= 131) between 24 and 34 weeks of gestation with severe pre-eclampsia, where both mother and fetus were otherwise stable. Methods After admission, frequent intensive but non-invasive monitoring of mother and fetus was performed. Women were delivered on achieving 34 weeks, or if fetal distress or major maternal complications developed. Transfer to the tertiary centre was individualised. Main outcome measures Prolongation of gestation, maternal complications, perinatal outcome and number of tertiary referrals. Results Most women [n= 116 (88.5%)] were managed entirely at the secondary hospital. Major maternal complications occurred in 44 (33.6%) cases with placental abruption (22.9%) the most common. One maternal death occurred and two women required intensive care admission. A mean of 11.6 days was gained before delivery with the mean delivery gestation being 31.8 weeks. The most frequent reason for delivery was fetal distress (55.2%). There were four intrauterine deaths. The perinatal mortality rate (,1000 g) was 44.4/1000, and the early neonatal mortality rate (,500 g) was 30.5/1000. Conclusions The maternal and perinatal outcomes are comparable to those achieved by other tertiary units. This model of expectant management of early onset, severe pre-eclampsia is encouraging but requires close co-operation between secondary and tertiary institutions. Referrals to the tertiary centre were optimised, reducing their workload and costs, and patients were managed closer to their communities. [source]

Deterioration in cord blood gas status during the second stage of labour is more rapid in the second twin than in the first twin

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2004
Tak-Yeung Leung
Objective To compare in twin pregnancy the rate of deterioration in umbilical blood gas status during the second stage of labour, and to investigate whether the duration of the first twin's delivery has any effect on the blood gas status of the second twin. Design A retrospective study. Setting Department of Obstetrics and Gynaecology in a university teaching hospital. Population Twin pregnancies with both of the twins delivered by normal cephalic vaginal mode, at or beyond 34 weeks of gestation, over a period of seven years. Twins with any maternal or fetal complications including discordant growth, intrauterine growth restriction, intrauterine death, fetal malformations, fetal distress, pre-eclampsia and diabetes were excluded. Methods The first twins' second stage was defined as from the start of maternal pushing to his/her delivery, while the second twins' second stage started after the delivery of the first twin and ended by his/her delivery. The total duration of the second stage was the sum of the above two intervals. The correlations between the first twins' umbilical cord blood gas parameters and the duration of their own second stage, the second twins' umbilical cord blood gas parameters and the duration of their own second stage, as well as that of the total second stage, were studied. Main outcome measures The changes of umbilical arterial pH of each twin with the duration of the corresponding second stage of labour, and the difference among them. Results A total of 51 cases were reviewed. The median gestation at delivery was 37 weeks. The median duration of first twins' second stage was 10 minutes (range 1,75) while that of the second twins' was 10 minutes (range 3,26). The first twins' second stage was inversely correlated with their arterial pH, venous pH and base excess [BE] (P < 0.01). Both the second twins' second stage and the total second stage were inversely correlated with both of their arterial and venous pH and BE (P < 0.01). However, further multiple regression analysis suggested that the correlation of the total second stage with the second twins' cord blood parameters could be solely explained by their own second stage. The rate of reduction in the second twins' arterial pH was 4.95 × 10,3 per minute, and was significantly faster than that of the first twins', which was 1.55 × 10,3 per minute (P < 0.05). Conclusions During normal vaginal delivery, the umbilical cord blood gas status of both the first and the second twins deteriorated with the duration of their corresponding second stages, but the effects are greater in the latter. Furthermore, the duration of the first twins' second stage does not affect the blood gas status of the second twins'. These observations support the postulation of a diminished uteroplacental exchange function after the delivery of the first twin. Close monitoring and expeditious delivery of the second twins are important. [source]

High incidence of obstetric interventions after successful external cephalic version

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2002
Louis Yik-Si Chan
Objective To investigate the delivery outcome after successful external cephalic version (ECV). Design Case,control study. Setting University teaching hospital. Population The study group consisted of 279 consecutive singleton deliveries at term over a six-year period, all of which had had successful ECV performed. The control group included 28,447 singleton term deliveries during the same six-year period. Methods Between group differences were compared with the Mann,Whitney U test or Student's t test where appropriate. Odds ratio and 95% confidence interval (CI) were calculated for categorical variables. Main outcome measures Incidence of and indications for obstetric interventions. Results The risk of instrumental delivery and emergency caesarean section was higher in the ECV group (14.3%vs 12.8%; OR 1.4; 95% CI 1.0,2.0, and 23.3%vs 9.4%; OR 3.1; 95% CI 2.3,4.1, respectively). The higher caesarean rate was due to an increase in all major indications, namely, suspected fetal distress, failure to progress in labour and failed induction. The higher incidence of instrumental delivery was mainly due to an increase in prolonged second stage. The odds ratio for operative delivery remained significant after controlling for potential confounding variables. There were also significantly greater frequencies of labour induction (24.0%vs 13.4%; OR 2.0; 95% CI 1.5,2.7) and use of epidural analgesia (20.4%vs 12.4%; OR 1.8; 95% CI 1.4,2.4) by women in the ECV group. The higher induction rate is mainly due to induction for post term, abnormal cardiotocography (CTG) and antepartum haemorrhage (APH) of unknown origin. Conclusion The incidence of operative delivery and other obstetric interventions are higher in pregnancies after successful ECV. Women undergoing ECV should be informed about this higher risk of interventions. [source]

Expectant management of early onset, severe pre-eclampsia: perinatal outcome

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 10 2000
D. R. Hall Consultant
Objective To evaluate the perinatal outcome of expectant management of early onset, severe pre-eclampsia. Design Prospective case series extending over a five-year period. Setting Tertiary referral centre. Population All women (n= 340) presenting with early onset, severe pre-eclampsia, where both mother and the fetus were otherwise stable. Methods Frequent clinical and biochemical monitoring of maternal status with careful blood pressure control. Fetal surveillance included six-hourly heart rate monitoring, weekly Doppler and ultrasound evaluation of the fetus every two weeks. All examinations were carried out in a high care obstetric ward. Main outcome measures Prolongation of gestation, perinatal mortality rate, neonatal survival and major complications. Results A mean of 11 days were gained by expectant management. The perinatal mortality rate was 24/1000 (, 1000 g/7 days) with a neonatal survival rate of 94%. Multivariate analysis showed only gestational age at delivery to be significantly associated with neonatal outcome. Chief contributors to neonatal mortality and morbidity were pulmonary complications and sepsis. Three pregnancies (0.8%) were terminated prior to viability and only two (0.5%) intrauterine deaths occurred, both due to placental abruption. Most women (81.5%) were delivered by caesarean section with fetal distress the most common reason for delivery. Neonatal intensive care was necessary in 40.7% of cases, with these babies staying a median of six days in intensive care. Conclusion Expectant management of early onset, severe pre-eclampsia and careful neonatal care led to high perinatal and neonatal survival rates. It also allowed the judicious use of neonatal intensive care facilities. Neonatal sepsis remains a cause for concern. [source]

Fetal distress increases interleukin-6 and interleukin-8 and decreases tumour necrosis factor-, cord blood levels in noninfected full-term neonates

First trimester exposure to cefuroxime: a prospective cohort study

BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 2 2000
Matitiahu Berkovitch
Aims There are no published studies on the safety of cefuroxime use during pregnancy. We therefore investigated prospectively the possible teratogenic effect of intrauterine exposure to cefuroxime. Methods One hundred and six women who received cefuroxime during the first trimester of pregnancy were recruited from three teratogen information centres in Israel. Exposed women were paired for age, smoking habits and alcohol consumption with references being exposed to nonteratogenic antibiotics administered for the same indications. Results Maternal history, birthweight, gestational age at delivery, rates of live births, spontaneous abortions and fetal distress were comparable among the two groups. Rates of major malformations in the cefuroxime group (3.2%) did not differ from references (2%) (P = 0.61, relative risk = 1.56, 95% confidence interval 0.27,9.15). There was a significantly higher rate of induced abortions among the cefuroxime exposed women as compared to the references (P = 0.04, relative risk = 3.33, 95% confidence interval 0.94,11.77). Conclusions Our data may suggest that exposure to cefuroxime during the first trimester is probably not associated with an increased risk for malformations or spontaneous abortions; however, in light of the small sample size and the broad confidence limits, larger studies are needed to confirm these findings. [source]

Management of a pregnant patient with Graves' disease complicated by thionamide-induced neutropenia in the first trimester

CLINICAL ENDOCRINOLOGY, Issue 4 2001
S. Davison
A 31-year-old woman presented with neutropenia due to thionamide drug therapy for Graves' disease. She also reported 8 weeks of amenorrhoea and had a positive pregnancy test. Her drug therapy was discontinued and her neutropenia resolved uneventfully. The hyperthyroidism recurred a week later. After consideration of all treatment options, it was decided to observe until 14 weeks when an elective thyroidectomy was planned. Mother and fetus were monitored closely and both tolerated moderate hyperthyroidism well. At 14 weeks the patient underwent a total thyroidectomy after rendering her euthyroid with a short course of sodium ipodate. Labour was induced at 41 weeks. Delivery was complicated by fetal distress and precipitated a forceps delivery. A 3250 g male infant was born with poor Apgar score and required 2 h of ventilation. At 1 year, the child had reached all developmental milestones at appropriate times. Both mother and fetus may tolerate moderate thyrotoxicosis well in early pregnancy, an alternative that should be considered when thionamide drug therapy is contraindicated. [source]

Women's expectations of management in their next pregnancy after an unexplained stillbirth: An Internet-based empirical study

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 6 2009
Stephen J. ROBSON
Background:, Unexplained stillbirth is the largest contributor to perinatal death, accounting for one-third of stillbirths. There appears to be no increase in perinatal death rates in the pregnancies that follow an unexplained stillbirth. However, these pregnancies have increased rates of induced labour and elective caesarean section, as well as preterm birth, low birthweight, instrumental delivery, ,fetal distress' and postpartum haemorrhage. Aim:, To study the wishes for future pregnancy management in women who have suffered an unexplained stillbirth. Methods: An Internet-based survey of women after an unexplained stillbirth, seeking demographic information and reproductive history, details of management of the index stillbirth and information about their wishes for subsequent pregnancy management (antenatal surveillance, early delivery and caesarean delivery). Results:, Of the total respondents included in the study, 93% wanted ,testing' over and above normal pregnancy care in their next pregnancy. Of the respondents, 81% wanted early delivery and 26% wanted a Caesarean delivery, irrespective of obstetric indications. These wishes were not influenced by socio-demographic factors, management of the index stillbirth (with the exception of having had a Caesarean delivery) or advice received on management of the next pregnancy (with the exception of being advised to have an early or Caesarean delivery). Conclusions:, The women surveyed wanted increased fetal surveillance and early delivery, but not necessarily elective caesarean section. [source]