The Australian & New Zealand journal of obstetrics & gynaecology
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Aust N Z J Obstet Gynaecol · Nov 1986
Study of vaginal delivery in patients with one previous lower segment caesarean section.
This retrospective study evaluated the prospects of having a vaginal delivery following a lower segment Caesarean section in Nehru Hospital; 685 (52%) of 1,315 patients with a previous Caesarean section were given a trial of vaginal delivery with a success rate of 69%. Vaginal breech delivery was allowed in 14 patients without affecting the outcome of term babies and without maternal morbidity or mortality. There were 12 cases (1.7% incidence) of scar disruption of which 4 were of scar rupture. ⋯ Pitocin was used in 144 (21%) patients. Of the 12 cases of scar disruption 5 patients had received pitocin. There was no favourable influence of prior vaginal delivery on the success of the trial, and 3 patients with scar disruption had already had a vaginal delivery in addition to a lower segment Caesarean section.
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Two rooms where women with puerperal psychiatric illness could be admitted together with their babies were provided in a general psychiatric unit. Over a 21-month-period demand for joint admission far exceeded capacity and most referrals could not be accepted. Women with various psychiatric disorders were referred to and managed in the unit. Greatest demand was for young women suffering from psychosis following childbirth.
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Aust N Z J Obstet Gynaecol · Feb 1986
Randomized Controlled Trial Comparative Study Clinical TrialPreoperative cervical dilatation: a trial of laminaria tents and prostaglandin F2 alpha gel.
Surgical damage to the cervix in patients undergoing termination of pregnancy may be responsible for serious complications in subsequent pregnancies. Sixty nulliparous women undergoing first trimester termination of pregnancy were randomly allocated to 3 treatment groups, one using laminaria tents preoperatively, one using intracervical PGF2 alpha gel preoperatively and one using no pretreatment. ⋯ There were no differences in blood loss or postoperative complications among the 3 groups. Laminaria tents provide a cheap, effective and safe method of reducing the risk of cervical damage in women undergoing surgical termination of pregnancy.
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In the years since 1939 there has been a marked change in the nature and results of obstetric practice at the Royal Women's Hospital, Melbourne. The noteworthy changes have been a reduction in the number of maternal deaths (from 12.2 per 1,000 in the 1940's to 0.2 per 1,000 in the 1980's), especially those due to septic abortion, and an increase in the Caesarean section rate (from 2% to 14%). The increase in the operative delivery rate has been matched by a decrease in mortality in patients thus delivered, the maternal and perinatal mortality rates changing from 5.5 and 88.9 per 1,000 to 0 and 7.6 per 1,000 respectively in the case of forceps delivery and from 24.7 and 162.5 per 1,000 to 0.15 and 10.6 per 1,000 respectively in the case of Caesarean delivery.
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Aust N Z J Obstet Gynaecol · Feb 1985
Comparative Study Clinical Trial Controlled Clinical TrialThe birthing chair in the second stage of labour.
A prospective study of 56 primigravidas was performed to assess the advantages, disadvantages and acceptability of the upright posture during the second stage of labour. Twenty-seven patients laboured in the second stage in a birthing chair, in an upright position. ⋯ No differences were detected in the condition of the neonates between the 2 groups. This birthing chair was found to be an acceptable mode of delivery to most of those patients using it.