OBJECTIVE: The purpose of this study was to compare four strategies for treating patients with a previous classic cesarean delivery by medical outcomes and quality-adjusted life years. STUDY DESIGN: A decision tree was designed that compared four strategies for a hypothetical cohort of 10,000 women with a previous classic cesarean ...

We performed a cross-sectional study of all Thames maternity units, 1994-96, including 540,834 live and stillbirths. In contrast to recent media speculation, no association of caesarean section rates with midwifery staffing levels was found after adjustment for confounders. The only association with staffing was with levels of junior obstetric staffing, ...

OBJECTIVE: To examine prospectively the effect on pregnancy outcome of a management protocol, that adds ultrasonographic weight estimation in fetuses suspected clinically as large. STUDY DESIGN: Prospective follow up study of all singleton deliveries during a 1 year period. All patients underwent routine clinical estimation of fetal weight. When clinical ...

OBJECTIVE: In prior studies, mood disturbance has been associated with poor obstetric outcomes. The purpose of this study was to determine whether depression during pregnancy is associated with a higher frequency of cesarean or assisted vaginal delivery. STUDY DESIGN: A mood disorders questionnaire, which included the standardized Center for Epidemiologic ...

OBJECTIVE: To determine whether postpartum x-ray pelvimetry can be used to calculate the fetal-pelvic index (FPI) in future pregnancies. STUDY DESIGN: In stage I of the study, 10 gravid women, after 36 completed weeks' gestation, underwent x-ray pelvimetry before delivery. Pelvimetry was repeated within two days after delivery. Comparisons between ...

BACKGROUND: The aim of this study is to check whether there exists a difference in restitutio ad integrum of the uterus after myomectomy performed during Caesarean section and out of pregnancy. METHODS: Two different groups are considered: Group A (n=8) that underwent myomectomy during Caesarean section; Group B (n=10) in ...

OBJECTIVE: To study the effect of different delivery modes on immunoprophylaxis efficacy so as to clarify whether or not cesarean section reduces immunoprophylaxis failure. METHODS: Mothers with positive hepatitis B surface antigen (HBsAg) were selected in the third trimester of pregnancy. Their babies were inoculated with hepatitis B immunoglobulin at ...

A case of secondary pulmonary hypertension complicating twin pregnancy and necessitating caesarean section is presented. A planned team approach involving senior consultants in obstetrics, cardiology, neonatology and cardiac and obstetric anaesthesia resulted in successful perioperative management. Continuous spinal anaesthesia was the chosen technique to give adequate operating conditions with least ...

Effective rehabilitation and modern reproductive technology may increase the number of women considering pregnancy who have spinal cord injuries (SCIs). It is important that obstetricians caring for these patients are aware of the specific problems related to SCIs. Autonomic dysreflexia is the most significant medical complication seen in women with ...

A 23-year old second gravida presented with 8 1/2 months of amenorrhoea. The fundal height corresponded with 36 weeks of pregnancy with a single live foetus. Ultrasonography revealed a live foetus and a cystic mass over lower sacral region. Emergency caesarean section was performed and the baby was delivered with ...

Colorectal carcinoma during pregnancy is a rare event. We report a 23-year-old primigravida with advanced stage adenocarcinoma of the sigmoid colon diagnosed at 34 weeks of gestation. A healthy female infant was delivered by cesarean section. The treatment of choice was chemotherapy. The patient died 3 months after delivery.

Implantation of a pregnancy within the scar of a previous cesarean delivery is the rarest of ectopic pregnancy locations. Only 19 cases have been reported in the English medical literature since 1966. If diagnosed early, treatment options are capable of preserving the uterus and subsequent fertility. However, a delay in ...

In pregnancy the feto-placental unit is the major source of activin A. However, the role(s) of activin A in late pregnancy remain uncertain and controversial. In particular, whether activin A levels alter in association with labour is unclear. In a cross-sectional cohort study, maternal serum samples were collected from women ...

BACKGROUND: An integral component of developmental toxicity studies is the evaluation of fetal anatomy, which consists of external, visceral, and skeletal examinations. The visceral examination includes an assessment of the fetal head which, in the rat, is typically completed after chemical fixation. Because chemical fixation requires approximately 7 days, a ...

OBJECTIVES: To investigate the antioxidant defense potential of human neonates according to gestational age and mode of delivery. STUDY DESIGN: Four study groups were established, full-term normal spontaneous vaginal delivery (FT-NSVD, n=24), full-term caesarean section (FT-CS, n=19), preterm normal spontaneous vaginal delivery (PT-NSVD, n=15) preterm caesarean section (PT-CS, n=21). The ...

BACKGROUND: Macrophage colony-stimulating factor (M-CSF) stimulates the proliferation and differentiation of placental trophoblasts and may regulate trophoblast invasion into the placental bed. M-CSF levels in peripheral blood show a significant increase in preeclampsia. Thus, the present study examined changes in blood levels of M-CSF before and after cesarean section and ...

Cerebellopontine-angle meningioma is a rare intracranial neoplasm. It presents a difficult problem in pregnancy. A 27-year-old multigravida presented with headache, vomiting and visual disturbances at 30 weeks' gestation and cerebellopontine angle meningioma and hydrocephalus were diagnosed. A ventriculoperitoneal shunt was placed under general anesthesia to reduce the symptoms of raised ...

OBJECTIVE: To compare the success and complication rates of prostaglandin E2 tablets (PGE2) and a Foley catheter for the ripening of the uterine cervix in post-Cesarean section parturients. STUDY DESIGN: The study population in this retrospective cohort study consisted of parturients in their second pregnancy who had undergone Cesarean section ...

We report a case of a viable cesarean scar pregnancy diagnosed at 7 weeks of gestation. The patient was conservatively managed by chemotherapy, intra-amniotic instillation of potassium chloride, and bilateral uterine artery embolization. The gestational sac was not sonographically visible 44 days after the treatment. No surgical treatment was necessary.

OBJECTIVE: To examine the relationship between prior cesarean delivery and placenta previa. METHODS: A hospital-based, case-control study was conducted in which 316 multiparous women with placenta previa were identified. Controls consisted of 2051 multiparous women with spontaneous vaginal deliveries. Information on prior cesarean delivery was examined in three forms: as ...

OBJECTIVE: To determine the mode of the next delivery for primigravid women who have an elective caesarean section for breech presentation. DESIGN: Retrospective cohort study. SETTING: University teaching hospital. POPULATION: All primigravid women who had an elective caesarean section for a singleton pregnancy in the years 1992 to 1997 and ...

OBJECTIVE: To summarize the manifestation, diagnosis, and early management of early pregnancy on a previous cesarean section scar. METHOD: Fifteen cases of early pregnancies implanted on previous cesarean section scars were diagnosed and treated in two obstetrical centers. RESULTS: The 15 patients had light, painless vaginal bleeding and their serum ...

INTRODUCTION: Idiopathic thrombocytopaenic purpura (ITP) is a common haematological disorder in young women. The management of ITP in pregnancy is controversial, particularly with regards to the mode of delivery. To date, there is no systematic study of the outcome of these pregnancies in Singapore. AIM: To study the outcomes of ...

Obstetric intervention originally consisted of extraction of the baby, usually by the breech, to save the mother's life in obstructed labour. Forceps, introduced in the 17th century, were later refined by men-midwives like William Smellie. In Victorian times, Simpson championed chloroform anaesthesia, Lister pioneered antisepsis, and caesarean section was introduced. ...

BACKGROUND: To evaluate the influence of gender on the disappearance of human chorionic gonadotropin by cesarean section after fullterm pregnancies. MATERIALS AND METHODS: Forty-nine uncomplicated pregnancies: 26 had male (male group) and 23 had female (female group) fetuses. RESULTS: Before the cesarean section the serum human chorionic gonadotropin levels were ...

BACKGROUND: Previous cesarean section, oxytocin administration, and fetal macrosomia increase the risk of uterine rupture or dehiscence (URD). METHODS: All 25,718 deliveries at Riverside Regional Medical Center from January 1990 to June 2000 were reviewed to describe complications and identify risk factors for URD. RESULTS: Eleven uterine ruptures and 10 ...

OBJECTIVES: To present the indications for myomectomy during pregnancy and to discuss complications possibly related and unrelated to the procedure. METHOD AND RESULTS: A 33-year-old patient at 18 weeks of gestation underwent removal of a 1,570-gram symptomatic fundic myoma. Histologically the patient had a leiomyomatous neoplasm of uncertain malignant potential. ...

OBJECTIVE: To compile and make available essential data on symphysiotomy for evaluation in the struggle against maternal and fetal mortality and morbidity from obstructed labour, which causes the death of 50,000 women each year in low-resourced countries. DESIGN: Retrospective review of literature. SAMPLE: Five thousand symphysiotomies and 1200 caesarean sections ...

Maternal deaths from cesarean sections in Nigeria are exceptionally high and result from avoidable causes such as hemorrhagic shock, sepsis and hypertensive disorders in pregnancy. Increased involvement of specialists in the care and improved intra and post-operative management of cases are advocated to reduce the high maternal mortality rate.

BACKGROUND: The maintenance of health registers has become routine. The main prerequisite for their use is that registers be complete and that their contents correspond to reality. METHODS: Data on all primiparous women who gave birth between 1987 and 1989 (N=73009) and on their second (N=55388) and third births (N=22904) ...

OBJECTIVE: To probe into the clinical manifestation, diagnosis, as well as treatment of pregnancy on the cicatrix of a previous cesarean section at the uterine isthmus in the first trimester. METHODS: Analysis of 14 patients with pregnancy on the cicatrix of a previous cesarean section at the uterine isthmus in ...

Patients with infantile spinal muscular atrophy rarely decide to have their own children especially if there is major respiratory impairment. We studied prospectively the pregnancy course and outcome of a 34-year-old woman with spinal muscular atrophy type II who delivered a healthy boy. Pregnancy was entirely uneventful, except that for ...

OBJECTIVE: Risks of circulatory diseases are increased substantially during late pregnancy and around the time of delivery. This study was undertaken to determine whether preeclampsia, multiple pregnancy, or cesarean delivery account for the majority of pregnancy-related risks of pulmonary embolism and stroke (caused by hemorrhage, infarction, and intracranial venous thrombosis). ...

The purpose of this research was to devise a method for transforming the cross-section of the hollow super-elastic Ti-Ni alloy round wire and to examine the changes in its bending properties for clinical orthodontic application. The specimen wires were pressed with the use of heated pliers to transform the cross-sectional ...

We report observation of lasing in the scarred modes in an asymmetrically deformed microcavity made of liquid jet. The observed scarred modes correspond to morphology-dependent resonance of radial mode order 3 with their Q values in the range of 10(6). Emission directionality is also observed, corresponding to a hexagonal unstable ...

PURPOSE: Sacral neuromodulation is effective for lower urinary tract dysfunction. However, despite its increasing use and a preponderance of female patients treated to our knowledge its effect in pregnant women and developing fetuses remains unknown. Therefore, we obtained information on patients on sacral neuromodulation who then achieved pregnancy. MATERIALS AND ...

A massive cervicothoracal lymphangioma was diagnosed in a fetus at 25 weeks of gestation. On ultrasound study, the mass showed septated, cystic components and extended from the right submandibular region to the right anterolateral thoracic wall including the right axilla and right scapula. Close sonographic follow-up revealed an increase in ...

Fetal lacerations occurred in 1.5% of caesarean sections carried out in our institution. The incidence was independent of type of caesarean section, fetal presentation, cervical dilatation, presence of intact membranes or operator grade. We advocate that this complication should be included in the preoperative counselling of all patients undergoing caesarean ...

BACKGROUND: Papillary adenocarcinomas are rare tumors of the gastrointestinal tract. There are few reports of this neoplasm diagnosed during pregnancy. CASE: A case of adenocarcinoma of the papilla of Vater was diagnosed by sonographically guided biopsy during pregnancy. The patient underwent radical resection of the tumor at 25 weeks' gestation; ...

OBJECTIVE: To compare intensive and conventional therapy for severe fear of childbirth. METHODS: In Finland, 176 women who had fear of childbirth were randomly assigned at the 26th gestational week to have either intensive therapy (mean 3.8 +/- 1.0 sessions with obstetrician and one with midwife) or conventional therapy (mean ...

We report the course and outcome of a pregnancy involving a giant fetal neck teratoma which was diagnosed at 23 weeks of gestation. Sonographic surveillance of the fetal neck revealed continuing growth of the tumor with development of polyhydramnios. Three-dimensional ultrasound provided additional detailed information on the external extent of ...

OBJECTIVE: To apply an existing diagnostic imaging test (saline infusion sonohysterography) to characterize the "filling defect" of a previous cervical cesarean delivery scar in the nonpregnant uterus. METHODS: Forty-four patients with histories of cesarean delivery who underwent saline infusion sonohysterography for a variety of gynecologic indications were included. During the ...

Forms were sent to members of the Obstetric Anaesthetists' Association requesting information on cardiorespiratory disease in pregnancy. Reports of 274 pregnancies in 259 women were received over four years (1997-2000). There were 83 valve lesions, 52 complex congenital heart disease, 112 miscellaneous heart disease and 27 respiratory disease. Half the ...

PURPOSE: The effect of position on the spread and the onset time of epidural anesthesia has not been well documented. This study was undertaken to assess the effect of modified Trendelenburg position on the spread of epidural anesthesia for Cesarean section. METHODS: Seven hundred thirty-nine parturients underwent epidural anesthesia for ...

OBJECTIVE: This study reported pregnancy complications and neonatal outcomes for 49 live births in a group of women with eating disorders who were prospectively followed. METHOD: Subjects were recruited from 246 women participating in a longitudinal study of anorexia nervosa and bulimia nervosa, now in its 12th year. Subjects were ...

OBJECTIVE: To evaluate obstetric risk factors associated with a failed trial of vacuum extraction and to assess its pregnancy outcome. STUDY DESIGN: All attempted vacuum extractions between the years 1990 and 1998 were identified, and a comparison of successful and failed trials of vacuum extraction in singleton, vertex deliveries was ...

OBJECTIVE: We sought to describe the peripartum outcome of women weighing >300 pounds (135 kg) who were candidates for trial of labor after a prior cesarean delivery. STUDY DESIGN: All pregnant women who weighed in excess of 300 pounds and had a prior cesarean delivery were included in this prospective ...

A 28-year-old pregnant woman presented at 35 weeks' gestation to obstetric triage with vague abdominal symptoms, stable vital signs and a non-reassuring fetal heart rate. During Cesarean section, intraperitoneal hemorrhage was noted, secondary to spontaneous rupture of a liver hemangioma. We present the perioperative management of a patient with liver ...

OBJECTIVES: Identifying characteristics associated with vaginal birth after cesarean. STUDY DESIGN: Case-control study based on medical records. Study population: women with previous cesarean, who had delivered in a public Rio de Janeiro maternity hospital between 1992 and 1996. Sample: 141 cases (vaginal births after cesarean) and 304 controls (a new ...

Pregnancy at high altitude is associated with maternal hypoxaemic hypoxia with resultant intervillus blood hypoxia. Maternal haemoglobin concentration and blood gases were measured in pregnant women in two cities in Peru; Lima at sea level (n=18) and Cerro de Pasco at 4300 metres above sea level (n=12). Following delivery, placental ...