American journal of obstetrics and gynecology
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The circulatory effects of postural change in late pregnancy were investigated in 20 healthy pregnant women. Maximum stroke volume (93.2 +/- 11.9 ml) was recorded with the subject in the left lateral position and was significantly (p less than 0.001) reduced in the supine, right lateral, and lithotomy positions, but was largely unchanged in the standing motionless position (89.9 +/- 12.6 ml). ⋯ The following factors were found to be significantly correlated to the hemodynamic response to the supine recumbent position: maternal age (p less than 0.05), the position of the fetus in the uterus (p less than 0.05), and systolic (p less than 0.001) and diastolic (p less than 0.001) blood pressures measured with the subject in the left lateral position. The implications of the present findings for modern obstetric delivery care and the etiology of the supine hypotensive syndrome are discussed.
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Am. J. Obstet. Gynecol. · Mar 1984
Abdominovaginal delivery: modification of the cesarean section operation to facilitate delivery of the impacted head.
The abdominovaginal delivery is a modification of the cesarean section operation in the presence of an impacted fetal head, usually after a prolonged second stage of labor with ruptured membranes. With the legs abducted in either the "Whitmore" or the "frog" position, the wedged vertex is gently lifted with the cupped hand into the open transverse uterine incision, thereby reducing injury to the fetal head and the uterus. With the greater use of cesarean section operation and the sharp reduction in rotational and midforceps deliveries, the abdominovaginal procedure has an increasingly important place in our obstetric armamentarium.
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Am. J. Obstet. Gynecol. · Mar 1984
Vaginal delivery following cesarean section: use of oxytocin augmentation and epidural anesthesia with internal tocodynamic and internal fetal monitoring.
The cesarean section rate continues to rise, and, as new indications for the operation continue to be proposed, a method for safely decreasing the rate is truly needed. Less than 1% of patients in the United States are allowed a trial of labor after a cesarean section, in spite of the thousands of (safe) vaginal deliveries after cesarean section now reported in the literature. Few reports in the literature mention the use of oxytocin or regional anesthesia in these patients. ⋯ One hundred eighty-one patients (79%) were delivered vaginally, 73 patients (32%) received epidural anesthesia, and 94 patients (41%) received oxytocin augmentation of labor. Internal tocodynamic and fetal heart monitoring was used in all patients. Our rationale for this controversial management is discussed.