Acta obstetricia et gynecologica Scandinavica
-
Acta Obstet Gynecol Scand · Jan 1990
The effect of delayed pushing in the second stage of labor with continuous lumbar epidural analgesia.
We studied primigravid women in spontaneous labor at term and given epidural analgesia. Two hundred such women giving birth in 1983 were compared with similar groups who gave birth in 1985 and 1987 after the introduction of 'delayed pushing' into our labor ward protocol. Four hundred controls were obtained in 1983 and 1985 by selecting from the labor ward register the next normal primigravid woman in spontaneous labor without epidural analgesia. ⋯ Among epidural labors, there was no significant difference between 1983 and 1987 in the incidence of rotational or non-rotational forceps, or of cesarean section. In each epidural group, women who waited more than 60 min were less likely to experience a normal spontaneous delivery than were those who did not (p less than 0.001 in 1983; p = 0.006 in 1985 p = 0.035 in 1987). We conclude that to delay pushing beyond 60 min confers no benefit regarding mode of delivery.
-
Acta Obstet Gynecol Scand · Jan 1989
Maternal deaths related to cesarean section in Sweden, 1951-1980.
During the years 1951-1980 the cesarean section rate in Sweden increased from 1.7% to 11%. In connection with this procedure 103 maternal deaths were reported, of which 49% were related to age as risk factor. ⋯ Half of the deaths were attributed to the surgical procedure. During the 1970s these complications constituted a six-fold risk increase of abdominal over vaginal delivery, and complications attributed to the surgical procedure of abdominal delivery comprised 19% of the maternal mortality during the same period.
-
Acta Obstet Gynecol Scand · Jan 1989
Case ReportsEmergency embolectomy in a patient with massive pulmonary embolism during second trimester pregnancy.
Emergency pulmonary embolectomy was performed successfully on a patient in her second trimester of pregnancy. The patient had severe right ventricular failure due to obstruction of 85% of the pulmonary arterial circulation. ⋯ Thrombolytic therapy during pregnancy imposes considerable risk of bleeding with deleterious effects on both mother and fetus. In our opinion, emergency embolectomy during extracorporeal circulation is the best treatment in case of massive emboli during pregnancy.
-
Acta Obstet Gynecol Scand · Jan 1989
Relief of low back pain in labor by using intracutaneous nerve stimulation (INS) with sterile water papules.
Eighty-three women experiencing low back pain in the 1st stage of labor were given intracutaneous nociceptive stimulation (INS) by means of sterile water papules injected intracutaneously over sacrum. There was instant and complete relief of the low back pain in all but 6 women, this effect lasting in many cases as long as 3 h, after which INS could be repeated. ⋯ The method was well tolerated and 67 of the 83 women said they would like to have INS analgesia for their next delivery. Possible mechanisms behind the analgesic effect of INS are discussed.
-
Acta Obstet Gynecol Scand · Jan 1988
Comparative Study Clinical Trial Controlled Clinical TrialBenefits of continuous infusion epidural analgesia throughout vaginal delivery.
Two groups of nulliparous women with fetuses in singleton vertex presentation received continuous infusion epidural analgesia (EDA) with bupivacaine: group A (90 parturients) without infusion analgesia in the second stage of labor and group B (90 parturients) with infusion analgesia throughout delivery. The groups were compared regarding pain relief, duration of the second stage, persistent malrotation of the fetal head, and rate of instrumental vaginal delivery. The continuous infusion EDA gave satisfactory pain relief in 93.3% of the parturients in group A and 97.8% in group B. ⋯ The rate of instrumental vaginal delivery was 25.5% in both groups. The main cause of operative intervention was delay in the second stage. When the continuous infusion technique is used, it seems unreasonable to discontinue the EDA and thereby deprive the parturient of analgesia during the second stage.