Journal of perinatal medicine
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The experience of mature, singleton, vaginal breech delivery over the last decade in our hospital is reviewed. This constitutes the largest series of breech delivery reported for over twelve years. Unlike all but two previous reports, we analyze our results by management policy; elective cesarean section, trial of vaginal breech delivery and cesarean section as soon as the diagnosis of breech delivery was made on labor ('expedite' cesarean operations). ⋯ It is shown that, from the point of view of maternal mortality and morbidity in the current pregnancy, trial of vaginal delivery maybe the more dangerous maternal option. Thus a low threshold for cesarean section in labor leads to greater fetal safety at the mother's expense. It is nevertheless concluded that maternal attitude and the long-term effects of a uterine scar should be considered in the final decision.
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Two real-time ultrasound instruments were used simultaneously for comprehensive recording of "total" fetal motor activity in 50 patients in the second half of pregnancy. Synchronously, cardiotocographic findings and maternal perception of fetal movements were stored on magnetic tape. In most cases fetal "gross" movements were perceived by the mothers (mean: 63%). ⋯ In 30% of all cases the mothers perceived movements without sonographic confirmation. The findings of this study suggest that maternal perception of major fetal body movements is accurate in the majority of cases. However, the relatively high rate of false positive maternal perception should be taken into consideration if the maternal record of daily fetal movements is to be used for fetal monitoring.
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Vasoconstriction of the uterine arteries, hypertonus of the uterus, and the direct toxic effects of a local anesthetic on the fetus or a combination of the above have been presented as etiological factors of fetal bradycardia following paracervical block. The reduce fetal side-effects a superficial and lowdosage technique of PCB have been advocated. We have studied the effects of 25 mg of bupivacaine PCB using the above technique on fetal heart rate pattern (FHR), fetal acid-base balance, uterine activity, placental blood flow and maternal and fetal plasma levels of bupivacaine in 38 patients. ⋯ However, an obvious uterine hypertonus was observed after PCB was observed in three cases of fetal bradycardia but not in two other cases of bradycardia or in the 8 cases of silent FHR pattern. Mean maternal bupivacaine concentration 20 minutes after PCB was 0.14 +/- 0.06 microgram/ml and 0.07 +/- 0.04 microgram/ml at birth. Simultaneous fetal and umbilical venous and arterial concentrations were correspondingly 0.04 +/- 0.02 microgram/ml, 0.03 +/- 0.01 microgram/ml and 0.03 +/- 0.01 microgram/ml, and they were significantly lower than respective maternal concentrations.(ABSTRACT TRUNCATED AT 400 WORDS)
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Comparative Study
Serum calcium and 25-OH-D3 in mothers of newborns with craniotabes.
Serum calcium and 25-OH-D3 in mothers of newborns with craniotabes. The aim of this study was to investigate whether calcium or vitamin D balance during late pregnancy have influence on the outcome of newborn craniotabes. 27 mothers and their fullterm newborns with craniotabes in two series were studied for clinical findings, course of pregnancy and calcium and vitamin D metabolism after the pregnancy. Calcium and phosphorus balance were studied in the first 16 mother-newborn pairs and were studied in the first 16 mother-newborn pairs and compared to a control group. ⋯ The values of serum 25-OH-D3 were at the same level in mothers and newborns with craniotabes as compared to controls but the values of mothers were lower (p less than 0.001) as compared to unpregnant controls In conclusion, craniotabes of the newborns seems to have no unique etiologic factor. The changes of calcium and vitamin D metabolism during pregnancy may be considered as predisposing factors in some cases and early engagement in some other. Perhaps also other reasons can be found.