The effect of fetal maturity and the delivery method on fetal status in breech presentation

In a retrospective study of 363 pregnancies with one foetus in breech presentation is evaluated the effect of foetal maturity and the route of delivery on the state of the newborn, assessed by the 5 min. Apgar score. The cases are allocated in subgroups according the foetal weight and height, gestational week and the route of delivery. The results show 37% small for gestational age in the subgroup with low birth weight (1500-2500 g). From the group with low weight SGA sustain better the labor and delivery than the eutrophic. The term newborn in breech presentation are with higher Apgar score than delivered by cesarean section. In the group of newborn with low weight the route of delivery has not effect on the Apgar score. The estimated weight and gestational week should be taken in account than managing breech labor.     

Couples'' satisfaction with health care service during labor and delivery

In recent years, favorable results have been achieved in patients suffering from azoospermia by microinsemination of spermatozoa taken from their testes. Microinsemination is being introduced in the treatment of patients who have no spermatozoa in their testes via their spermatid and spermatocyte. There are still doubts relating to immature male germ line-cells, such as whether they have, oocyte activating factors, the level of stability of DNA of cell nuclei, and the differences in chromosome numbers. The relatively few cases of gestation using the human spermatid treatment may be due to embryological problems resulting from the instability of nuclear DNA and the insufficiency of oocyte activating factors, which are the result of imperfect microinjection techniques. Improvements in techniques for the clinical application of spermatid and secondary spermatocyte, as well as the collection of basic data to confirm embryological safety are therefore necessary.     

Neonatal outcome depending on the mode of delivery and fetal presentation in twin gestation

A retrospective analysis of 301 twin deliveries managed at The Second Department of Obstetrics and Gynecology, Warsaw Medical Academy, from January 1, 1986 to December 31, 1995 was undertaken in order to investigate the impact of the mode of delivery and twin presentation on neonatal outcome. Vertex presentation of both twins was the most common with an incidence of 47.5% followed by vertex-non-vertex (27.6%) and nonvertex presentation of the first twin (24.9%). 186 (61.8%) patients delivered vaginally, while 115 (38.2%) women underwent caesarean section including 6 operations performed after the vaginal delivery of the first twin. In vertex presentation of the first twin and breech second twin there was no significant difference in neonatal outcome measured by 5-minute Apgar score and birth trauma incidence between second twins delivered vaginally and second twins delivered by caesarean section. Vaginal delivery with internal podalic version of the second twin in vertex-transverse presentations was related to increased risk of lower 5-minute Apgar score and increased risk of birth trauma occurrence compared to caesarean section. Time interval between vaginal delivery of twins had no significant impact on neonatal outcome.     

Avoiding labor problems during vaginal birth after cesarean delivery

Dopamine has been proposed to mediate some of the behavioral effects of caffeine. This review discusses cellular mechanisms of action that could explain the role of dopamine in the behavioral effects of caffeine and summarizes the results of behavioral studies in both animals and humans that provide evidence for a role of dopamine in these effects. Caffeine is a competitive antagonist at adenosine receptors and produces a range of central and physiological effects that are opposite those of adenosine. Recently, caffeine has been shown to enhance dopaminergic activity, presumably by competitive antagonism at adenosine receptors that are colocalized and interact functionally with dopamine receptors. Thus, caffeine, as a competitive antagonist at adenosine receptors, may produce its behavioral effects by removing the negative modulatory effects of adenosine from dopamine receptors, thus stimulating dopaminergic activity. Consistent with this interpretation, preclinical behavioral studies show that caffeine produces behavioral effects similar to classic dopaminergically mediated stimulants such as cocaine and amphetamine, including increased locomotor activity, increased turning behavior in 6-hydroxydopamine-lesioned animals, stimulant-like discriminative stimulus effects, and self-administration. Furthermore, caffeine potentiates the effects of dopamine-mediated drugs on these same behaviors, and some of caffeine's effects on these behaviors can be blocked by dopamine receptor antagonists. Although more limited in scope, human studies also show that caffeine produces subjective, discriminative stimulus and reinforcing effects that have some similarities to those produced by cocaine and amphetamine.     

Fluctuation of cardiotocographic tracings during labor in fetal growth retardation

The objective of our study was to analyse the fluctuation of cardiotocographic scores during labor in fetal growth retardation (FGR). The study took place at the University hospital "Principe de Asturias", Alcalá de Henares, Madrid, Spain. 170 at term FGR fetuses and 170 at term fetuses without FGR as control group were compared using modified Fischer scores, which were blindly performed at 3, 5 and 10 cm of cervical dilatation. As results we found out that the mean value of the Fischer score was significantly lower in FGR at 3 cm of cervical dilatation (8.1 +/- 1 vs 8.7 +/- 0.6), as well as at 5 cm (7.6 +/- 0.9 vs 8.1 +/- 0.7) and at 10 cm (6.7 +/- 0.8 vs 7.4 +/- 0.8). Poor prognosis cardiotocograms were also more common in FGR than in the control group in the three cut-offs points studied (7.5% vs 0.6% at 3 cm, 9.8 vs 1.8 at 5 cm and 37.9 vs 11.6 at complete cervical dilatation). The afore mentioned differences were more remarkable as labor advanced. Conclusions are that poor fetal heart rate recordings were detected in FGR at the beginning of labor when compared with control group fetuses and the differences between both groups increased while the labor prolonging.     

Prognostic value of amniotic fluid index estimated during labor during chronic fetal acidosis]

There were performed measurements of AFI in 32 women during labour and they were referred to pH of neonatal umbilical vein. It was proved by significant statistic relation p = 0.034 (r = 0.375) between AFI and pH of umbilical vein blood. In anticipation of fetal acidosis with AFI < or = 5 cm with pH < or = 7.25 it was determined that: sensitivity 66.7%, specificity 58.6%, positive predictive value 14.3%, negative predictive value 94.4%, false positive 85.7%, false negative 5.6%, accuracy 59.4%. Obtained data do not differ from those given in literature. Measurements of AFI < or = 5 cm help in identification of the risk group (fetus in danger, of acidosis during labour) but due to low specificity and low positive predictive value (66.7% and 14.3% respectively). Clinical decisions should be made after consideration the result of the other tests of fetal well-being.     

Variable presentation of cerebrovascular disease in monovular twins

We describe twin girls with bilateral cerebrovascular disease. In one child, a diagnosis of moyamoya disease was made after presentation in infancy with an acute hemiparesis; her asymptomatic sibling was found to have significant bilateral cerebrovascular disease after neuropsychological evaluation and assessment with transcranial Doppler ultrasound. Both subjects showed a discrepancy between verbal and performance IQ and deficits on a test of frontal-lobe function suggesting that these domains should be targeted in cognitive assessment. Family members of subjects with moyamoya are at risk of cerebrovascular disease. Clinical symptoms do not reliably predict disease and those at risk should be offered screening with non-invasive vascular imaging.     

Women's evaluation of the labor and delivery experience

The purpose of this study was to identify how women described and evaluated their labor and delivery experience and what factors were related to their responses. Sixty Lamaze-prepared, married multigravidae, aged 21 to 37 years, participated in this qualitative field study. Detailed, open-ended tape-recorded interviews were conducted on the postpartum unit of a community hospital or in the women's homes early during the postpartum period. Women evaluated their labor and delivery experience according to how well they perceived they had managed their own childbirth performance. Women who managed well viewed childbirth as positive, whereas women who had difficulty or managed poorly viewed it as both positive and negative. Women who managed well thought their own performance and the nature of labor and delivery (physical aspects) went well; women who had difficulty thought labor and delivery and the performance of others went well, but women who managed poorly had problems identifying anything that went well. There was overall agreement that the baby was the best part of the experience and that pain and pushing were the worst parts. Since women's evaluation of their labor and delivery experience may be related to the quality of their subsequent mothering, it is important to enhance their perceptions of their own performance, and thus their evaluation of the childbirth experience.     

Determination of fetal umbilical artery flow velocity during induction of term labor by mifepristone

OBJECTIVE: To evaluate the effects of mifepristone for induction of term labor on blood supply of placenta. METHODS: 97 pregnant women (38-42 gestational weeks) were recruited, and randomly allocated into 2 groups, group 1 (n = 49) mifepristone was given orally 50 mg q12h for 2 days followed by misoprostol intravaginally (25 micrograms q12h); group 2 (n = 48), Sodium prasterone sulfate intravenous injection of 200 mg qd for 3 days followed by oxytocin intravenous infusion. Fetal umbilical artery flow velocity was determined before and 36-48 hours after treatment to observe the variation of S/D value in both groups. RESULTS: There were no significant variations of S/D value in both groups (P > 0.05). CONCLUSIONS: Mifipristone for induction of term labor (50 mg q12h for 2 days) is effective, and has no significant influence on the blood supply of placenta.     

Successive relationships between maternal attitudes during pregnancy, analgesic medication during labor and delivery, and newborn behavior.

Asked 85 primiparous mothers in their last trimester of pregnancy to respond to a questionnaire assessing fears regarding pregnancy as well as generalized tension and depression. At delivery, information was obtained regarding obstetric analgesic medication and duration of labor. Two days following delivery, neonatal behavior was described in terms of sleeping and waking behavior. Sequential relationships between each of the 3 phases were examined. Three questionnaire scales were related to 1 of 4 drug variables. Three of the 4 drug variables were related to duration of 1st-stage labor. Three drug variables were correlated with neonatal behavior. Duration of labor was unrelated to neonatal behavior. Multiple regression analyses using pregnancy, drug, and labor variables as predictors did not yield impressive relationships to neonatal behavior. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acute and chronic fetal hypoxia in monochorionic and dichorionic twins

OBJECTIVE: To assess the risk for acute and chronic fetal hypoxia in twin pregnancies. METHODS: We investigated 50 sets of twins (24-38 weeks' gestation, 660-3200 g birth weight) admitted consecutively to our neonatal intensive care unit. Seventy-six infants were appropriate for gestational age (AGA; tenth to 90th percentile), 20 were small for gestational age (SGA; below the tenth percentile), and four were large for gestational age (above the 90th percentile). Twenty-six singleton AGA term newborns served as controls. Umbilical arterial pH was used as a marker for acute and umbilical venous erythropoietin concentration for chronic fetal hypoxia. The results are given as median followed by quartiles. RESULTS: We identified 40 sets of diamniotic-dichorionic twins and ten sets of diamniotic-monochorionic twins with transplacental vascular shunts. In the second-born twin, umbilical arterial pH was lower (7.29, 7.23-7.33) than in the firstborn (7.31, 7.25-7.34) (P = .03), and the incidence of a low pH (less than 7.20) was higher (19 versus 11%). Two second-born twins and none of the firstborn twins had an umbilical arterial pH less than 7.05. In SGA twins, the erythropoietin concentration was elevated (34.8, 22.8-325 mU/mL) compared with that in AGA twins (16.2, 8.2-26.6 mU/mL) (P < .01). In AGA twins, erythropoietin concentration did not differ from that in AGA singleton newborns (19.6, 14.7-31.6 mU/mL). In 12 of 17 twin sets with weight discordancy greater than 15% and in all five twin sets with weight difference greater than 25%, erythropoietin concentration was higher in the smaller twin. The proportion of infants and of complete sets with elevated erythropoietin levels was higher (P < .01) in monochorionic than in dichorionic pregnancies. CONCLUSION: The second-born twin is at increased risk for acute birth asphyxia. Fetal growth restriction in twin pregnancies is associated with chronic fetal hypoxia. Monochorionic twins are at higher risk for chronic fetal hypoxia than are dichorionic twins.     

Cesarean delivery: a randomized trial of epidural versus patient-controlled meperidine analgesia during labor

Barrett's esophagus is found in about 1% of the older population and in 3% to 5% of persons with gastroesophageal reflux. It is acquired more commonly by men and the prevalence increases with age. Most cases in the population remain undiagnosed. The incidence of adenocarcinoma of the esophagus and esophagogastric junction is increasing, both being related to Barrett's esophagus. Small areas of intestinal metaplasia are common but of uncertain significance.     

The relation between indirect fetal electrocardiogram and blood gas analysis of umbilical cord artery during labor

OBJECTIVE: To observe the relation between indirect fetal electrocardiogram (FECG) and blood gas analysis of umbilical cord artery blood during labor and discuss the possibility of using FECG for labor monitoring. METHODS: Indirect FECG was used for fetal monitoring in 80 cases during the second stage of labor and cord umbilical artery blood was taken immediately after delivery for blood gas analysis. Cases were retrospectively divided into normal and abnormal groups according to the results of FECG. RESULTS: The success rate of FECG test was 91.95%. Significant differences were noted in mean values of pH, PCO2, PO2, actual base excess (ABE) and standard base excess (SBE) of umbilical artery between the 2 groups, so were the percentages of cases with pH < 7.20, PCO2 > 8.00 kPa, PO2 < 2.10 kPa. CONCLUSIONS: Indirect FECG can be used for fetal monitoring during labor. FECG is obviously correlated with acid-base equilibrium and blood gas concentration of umbilical cord artery blood, it is a sensitive index of fetal and neonatal hypoxia.     

Effects of intravenous meperidine and meperidine with promethazine on uterine activity and fetal heart rate during labor

A prospective study of the effects of the i.v. injection of 75 mg meperidine, alone or combined with 25 mg promethazine, was conducted by continuous and direct monitoring of the fetus and of intrauterine pressure. The study was carried out in 16 primiparas and 24 multiparas in active spontaneous labor with cervical dilatation of 3 to 4 cm. Administration of meperidine and of meperidine with promethazine was associated with an increase in uterine activity of 31 to 45% (Montevideo units), respectively. The most marked effects were on the amplitude of the uterine contractions. There was no significant change in uterine tone. A tetanic response was recorded in two patients who vomited after the administration of meperidine with promethazine and was followed by slowing of the fetal heart rate. In no other cases were there significant changes in fetal heart rate. Except for the latter two patients, no adverse effect of meperidine or of meperidine with promethazine on the fetal heart rate was noted. The condition of the newborns at birth was excellent in all but three cases, in two of which maternal amniotic infection and high fever were present.     

Alterations in myelin formation in fetal brains of twins

AIM: To study the epidemiology of invasive pneumococcal infections in infants and young children in Santiago, Chile, as a representative pediatric population in a newly industrializing country where pneumococcal conjugate vaccines may be used in the future. METHODS: A 5-year retrospective laboratory-based review (1989 to 1993) was followed by a 3-year prospective laboratory and hospital surveillance study in two of the six health administrative areas of Santiago to detect all hospitalized cases of invasive pneumococcal disease (defined as Streptococcus pneumoniae isolated from blood, cerebrospinal fluid or another normally sterile site) among infants and children (0 to 23 months of age in the retrospective and 0 to 59 months of age in the prospective study). RESULTS: During the 5-year retrospective survey the incidence of invasive pneumococcal disease was 90.6 cases per 10(5) infants 0 to 11 months old and 18.5 cases per 10(5) toddlers 12 to 23 months old. Similar rates (60.2 per 10(5) infants and 18.1 per 10(5) toddlers) were recorded during the 3 years of prospective surveillance. Among the 110 cases in children 0 to 59 months of age detected during the 3-year prospective surveillance, 2 clinical forms, pneumonia and meningitis, accounted for 87.2% of all cases; 13 of the 49 pneumonia patients (26%) had empyema as a complication. Notably 40 of the 110 cases (36.4%) occurred before 6 months of age (63.4% of the 63 infant cases). Serotypes 1, 14, 5 and 6B were the most prevalent. Overall 76 and 69%, respectively, of S. pneumoniae isolates were antigenic types that would be covered by the 11- or 9-valent conjugate vaccines under development. CONCLUSIONS: Invasive pneumococcal infections in Santiago, Chile, exhibit an epidemiologic pattern intermediate between that of developing and industrialized countries. The high burden of disease in early infancy dictates that an accelerated immunization schedule (beginning in the perinatal period) or maternal immunization with pneumococcal vaccines should be explored.     

The correlation of glucose-concentration and acid-base-balance of the maternal and fetal blood during labor (author''s transl)

The aim of the present paper was to investigate if the glucose concentration of the fetal blood is reduced already during parturition. It was further of interest if there is a relationship between the glucose concentration in the maternal blood and the acid-base-balance of the maternal and the fetal blood, respectively. The observations comprised 40 patients during labor. Blood was sampled from the hyperemized fetal scalp and the umbilical artery. The maternal blood was collected from the hyperemized earlobe and fingertip, respectively. The blood was analyzed for pH, PCO2, base excess and blood glucose. The dip area (DA) was taken from the cardiogram and measured by planimetry. During labor the blood glucose increased in the fetal blood from 67 mg% (SD 12) to 87 mg% (SD 23) (2 alpha less than 0,001) and in the maternal blood from 88 mg% (SD 14) to 113 mg% (SD 29) (2 alpha less than 0,02). There was a significant correlation between the fetal and maternal blood glucose concentrations. The increase of the fetal glucose concentration is, however, less with increasing maternal blood glucose. (b = 0,66). The base excess in the maternal and fetal blood fell significantly. The rise of the maternal and fetal base excess (= base deficit) was related to the increase of the glucose concentration (2 alpha less than 0,001). If the base excess was zero, the fetal and the maternal blood glucose was 46 mg% and 78 mg%, respectively. The difference between the maternal and fetal blood glucose was 28 mg%. With increasing DA the fetal blood glucose increased (2 alpha less than 0,001.). From the observations it is concluded that there developes no hypoglycemia during parturition. This is due to the correlation found between fetal and maternal blood glucose and due to the rise in fetal blood glucose during hypoxia. Obviously, the decrease in fetal glucose following delivery is caused by a lack of glycogen which is enduced during labor and strengthened by a deficit of enteral glucose supply.     

Epidural analgesia in labor and cesarean delivery for dystocia

Published studies assessing the effect of epidural analgesia in nulliparous labor on the frequency of cesarean delivery for dystocia are reviewed. There are at least four retrospective studies and two prospective studies that suggest that epidural analgesia may increase the risk of cesarean delivery for dystocia in first labors. The potential for epidural to increase the frequency of cesarean delivery for dystocia is likely influenced by multiple variables including parity, cervical dilatation at epidural placement, technique of epidural placement, management of epidural during labor, and the obstetrical management of labor after placement of epidural analgesia. Two studies suggest that delaying placement of the epidural until 5 cm of cervical dilatation or greater may reduce the risk of cesarean birth. Epidural is safe and may be a superior labor analgesic when compared with narcotics. However, patients should be informed that epidural analgesia may increase the risk of cesarean birth in first labors.     

Prostaglandin E2 induction of labor for fetal demise

Intrauterine fetal demise is a source of anxiety to both patient and physician. Heretofore, the standard treatment was either careful observation until the patient went into labor or attempt at induction of labor with oxytocin. Unfortunately, oxytocin stimulation has not proven to be uniformly successful for this problem. Prostaglandin E2 suppositories have been shown to be effective in inducing uterine evacuation after intrauterine fetal demise. In the opinion of the authors, this approach will in the future replace the sometimes dangerous and emotionally laden convention of watchful delayed therapy.     

Changes in fetal plasma corticotropin-releasing hormone during androstenedione-induced labor in the rhesus monkey: lack of an effect on the fetal hypothalamo-pituitary-adrenal axis

Androstenedione infusion to pregnant monkeys leads to premature labor and live delivery. Androstenedione-induced labor also increased placental CRH messenger RNA and peptide to concentrations observed at term in pregnant monkeys. Placental CRH may modulate fetal pituitary-adrenal function during pregnancy in primates. This study tested the hypothesis that androstenedione-induced premature delivery in pregnant monkeys results from androstenedione-induced increases in placental CRH, which stimulate premature activation of the fetal pituitary-adrenal axis. The hypothesis was tested by comparing fetal umbilical vein (FUV) plasma CRH, ACTH, dehydroepiandrosterone sulfate, and cortisol concentrations at cesarean section in fetuses from mothers undergoing spontaneous, term labor (group I), with those in fetuses from mothers undergoing androstenedione-induced, premature labor (group II) and with those from mothers not in labor (group III). In addition, gestation-related changes in maternal plasma CRH concentrations were investigated, and CRH immunoactivity was characterized by Sephadex G50 chromatography in pooled maternal plasma extracts. FUV CRH concentrations were similarly elevated in group I and group II fetuses, compared with group III fetuses. Despite similar FUV blood gases in all fetuses, FUV ACTH and dehydroepiandrosterone sulfate concentrations were higher in group I fetuses than in group II or group III fetuses. The majority of CRH immunoactivity coeluted with synthetic human CRH. Maternal plasma CRH concentrations showed a modest increase with gestation in the rhesus monkey. These data: 1) demonstrate that androstenedione treatment of pregnant monkeys at 0.8 of gestation elevates fetal plasma CRH to similar concentrations measured at term; 2) do not support the hypothesis that androstenedione-induced delivery in the monkey results from premature activation of the fetal pituitary-adrenal axis by placental CRH; but 3) do support a role for activation of the fetal hypothalamo-pituitary-adrenal axis in association with spontaneous term labor in the monkey; and 4) demonstrate important interprimate species differences in maternal CRH physiology.