The Australian & New Zealand journal of obstetrics & gynaecology
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Aust N Z J Obstet Gynaecol · Aug 1993
Comparative StudyCaesarean section anaesthesia and the Apgar score.
Retrospective comparison of epidural and general anaesthesia by a multivariate analysis of 1 and 5 minute Apgar scores did not show that general anaesthesia improves operating conditions for Caesarean section or reduces fetal trauma for preterm and term infants.
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Intrapartum cardiotocography (CTG) has a high false positive rate and, in the absence of facilities for fetal scalp blood sampling, is associated with increased operative deliveries for 'fetal distress'. It is presently possible to obtain a representative fetal ECG signal using the fetal scalp electrode. There is renewed interest in fetal ECG waveform analysis in the hope that it will improve the specificity of detecting intrapartum fetal hypoxia when there is an abnormal fetal heart rate pattern. ⋯ Clinical studies have shown poor correlation between the T wave changes and fetal heart rate changes. There is also concern that the sensitivity of the ST waveform changes for fetal acidaemia may be poor. More information is required before its use is incorporated into routine clinical practice.
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In a prospective study of 318 consecutive pregnancies complicated by previous Caesarean section, 193 (61%) had an elective repeat Caesarean section, 125 (39%) had a trial of labour and 80 (64%) of these women achieved a vaginal delivery. The incidence of uterine rupture was 0.8% (1 of 125). ⋯ Patients having a vaginal deliver spent significantly less time in hospital. We conclude that vaginal delivery after lower segment Caesarean section is safe and should be considered in most patients after a critical review of the indication for the first Caesarean section.