European journal of obstetrics, gynecology, and reproductive biology
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Dec 1991
ReviewInvasive hemodynamic monitoring in pregnancy.
Invasive hemodynamic monitoring is indicated in the critically ill pregnant or postpartum patient, whose hemodynamic state cannot be reliably determined by clinical observation and noninvasive methods. In addition, precise hemodynamic information must be indispensable to determine and monitor treatment. Complications of central hemodynamic monitoring using the Swan-Ganz catheter appear to be rare in experienced hands. To maintain and expand the necessary skills and experience, invasive hemodynamic monitoring should be centralized in obstetric intensive care units.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Oct 1991
Fetal heart rate and neonatal condition related to epidural analgesia in women reaching the second stage of labour.
The relationship between epidural analgesia and a number of labour and delivery factors, relevant to fetal and neonatal condition, was considered in a prospective study of 200 labours reaching the second stage of labour. The group was representative of the hospital population with regard to the proportion of nulliparous women, the incidence of instrumental vaginal deliveries and the incidence of epidural analgesia (37%). ⋯ Nulliparity (55%), induced labour (34%), a first stage longer than eight hours (37%), a second stage longer than 60 min (43%), maternal pushing for longer than 36 min (50%), forceps delivery (28%) and a 1 min Apgar score less than 7 (12%) were also factors associated with significantly higher rates of epidural analgesia whereas meconium (15%), a small baby (16%) and umbilical arterial metabolic acidaemia (13%) were not. FHR decelerations in labours reaching the second stage with an epidural reflect adjustments to fetal cardiovascular control and not acidaemia.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Jan 1991
Comparative StudyUmbilical artery flow velocity waveforms during spinal anesthesia.
The umbilical artery Doppler flow velocity waveform was recorded during spinal anaesthesia prior to elective caesarean section in 15 uncomplicated pregnancies. Although spinal anaesthesia was associated with a significant fall in maternal systolic and diastolic blood pressure, there was no change in the umbilical artery Pulsatility Index either after preloading the maternal circulation with 750-1000 ml of Hartman's solution or for the first 15 min after subarachnoid injection of 0.5% bupivacaine. ⋯ There was a weak negative correlation between fetal heart and the umbilical artery Pulsatility Index. These observations suggest that in normal pregnancy, spinal anaesthesia has no detrimental effect on the umbilical artery Pulsatility Index.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Jan 1991
Comparative StudyInfluence of the mode of delivery on initiation of breast-feeding.
The initiation and the prevalence of breast-feeding after discharge from hospital was investigated in 370 singleton parturients and compared to the mode of delivery. Infants delivered by vacuum extraction or by caesarean section started suckling later, they were more often given formula prescription during the first 4 days, they were less often breast-fed during the night, and their mother's milk 'came in' later, but it did not affect the prevalence of breast-feeding after discharge. A sleepy infant, which was not very willing to suckle, was the most frequent nursing-problem mentioned by the mothers 4 days after delivery. Failure to start breast-feeding occurred in only 2.2% of the women, and after 6 months 52% were still breast-feeding their children.