American journal of perinatology
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A cohort of 3110 women anticipating delivery were interviewed after their first prenatal visit at private obstetric practices and HMOs in Connecticut. In all 19.57% reported a prior induced abortion. The research participants were followed to determine whether the pregnancy was miscarried or delivered. ⋯ The association of a prior induced abortion on risk for late miscarriage was analyzed by pregnancy history. Women who aborted their first pregnancy had no increased risk (RR = 0.56, 95% CI = 0.16, 1.92) of miscarriage compared with women pregnant for the first time, or compared with women experiencing their second pregnancy after delivering the first (RR = 0.69, 95% CI = 0.18, 2.60). No evidence was found for an increased risk of multiple induced abortion on subsequent miscarriage.
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Comparative Study
Effect of Lamaze childbirth preparation on maternal plasma beta-endorphin immunoreactivity in active labor.
Previous studies have documented a reduction in plasma beta-endorphin levels with the use of various analgesic techniques in labor, such as segmental epidural anesthesia or intrathecal morphine. The Lamaze method of childbirth preparation, which has been found to reduce the need for medication during childbirth and to decrease the subjective perception of pain during labor and delivery, has not been studied in this regard. ⋯ The Lamaze group had significantly lower plasma beta-endorphin immunoreactivity (37.2 vs. 68.5 pg/ml; P less than 0.001) and significantly shorter first stages of labor (8.28 hrs. vs. 9.86 hrs; P less than 0.02). It can be theorized that both lower beta-endorphin immunoreactivity and shorter labor in patients in the Lamaze group were related to the reduction of fear, tension, and the emotional stress of labor.
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The files of 220 obstetric closed-claim cases were reviewed by five obstetricians to determine whether information could be collected an analyzed to identify common predisposing factors to claims and to suggest preventative measures. The data suggests these cases contain common easily identified obstetric risk factors, most of which occurred in labor and delivery (66%). Fifty-four percent of the risks were recognized, 32% correctly managed, and a high percentage of risks were considered by the reviewers to be directly related to the obstetric outcome leading to the claim (66%). ⋯ Recognition and management guidelines are imperative in ensuring good obstetric outcome. These two physician-controlled factors played important parts in the majority of cases reviewed. It would appear from this study that obstetric malpractice closed claims are amenable to study; physicians and their patients would benefit from better data collection systems to identify risks in individual pregnancies; physicians need readily available resources to aid their management of patients; only through modification of physician behavior can suits be avoided.
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A new, practical approach to perinatal data processing for a large obstetric population is described. This was done with a microcomputer for data entry and a mainframe computer for data reduction. ⋯ The Statistical Analysis System (SAS) program was used for statistical analyses and report generations. This approach was found to be most practical, flexible, and economical.
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Traumatic pneumothoraces in ventilated premature infants are mostly related to high applied airway pressures. We report five cases of pneumothorax after endotracheal tube suctioning that illustrate two different mechanisms by which this may occur. Following suggested preventive measures, such complications have not recurred.