European journal of obstetrics, gynecology, and reproductive biology
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In a series of 460 consecutive deliveries there were 55 caesarean sections (mainly under epidural anaesthesia) without evidence of fetal distress and with a cephalic presentation. There was no statistically significant difference in the frequency of resuscitation in this group compared with 296 spontaneous vertex deliveries. It is concluded that a paediatrician is not routinely required at caesarean section under epidural provided there is no fetal distress and the presentation is cephalic.
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Seventeen cases of uterine rupture in late pregnancy managed over an eight-year period in one hospital in Hong Kong were analysed. Labour was associated with rupture in 16 cases, including ten with one or more previous caesarean section scars. ⋯ Labour should be closely monitored in multiparous patients with or without a uterine scar, and oxytocics should be used carefully. Patients with previous sections who are scheduled for repeat elective sections should be delivered before 39 weeks.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · May 1987
Comparative StudyA prostaglandin analogue (ONO-802) in treatment of missed abortion, intrauterine fetal death and hydatiform mole: a dose-finding trial.
Forty-eight patients affected with missed abortion, intrauterine fetal death and hydatiform mole were treated with vaginal suppositories containing 1 mg of 16,16-dimethyl-trans-delta 2-PGE1 methyl ester (ONO-802). The patients were divided into two treatment groups. The first, Group A, was given one vaginal suppository every 3 h to a maximum of five suppositories. ⋯ In Group B the maximum number of suppositories was reduced to three. The product of conception was expelled in 100% of cases and the average duration of treatment was similar to that for the first group. Although side-effects were mild in both groups, they were reduced in the patients of Group B.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Apr 1987
The fibrinolytic enzyme system in normal menstruation and excessive uterine bleeding and the effect of tranexamic acid.
The fibrinolytic enzyme system of menstrual and peripheral blood was studied in three groups of women: Group 1, 20 subjects (mean age 37.2 years) with normal menstrual loss; Group 2, 20 patients (mean age 39 years) with dysfunctional uterine bleeding studied before treatment, and Group 3, during treatment with a fibrinolytic inhibitor, tranexamic acid (AMCA) (1 g 8-hourly). The fibrinolytic activity (plasminogen activator and plasmin) of menstrual blood was significantly higher than that of peripheral blood in the three groups (p less than 0.001). Both plasminogen activator and plasmin were higher in the menstrual blood of patients with menorrhagia (Group 2) compared with the control subjects (Group 1) (p less than 0.001 and p less than 0.1 respectively). ⋯ No significant differences in fibrinolytic activity were found in peripheral blood between Groups 1 and 2; however, both plasminogen activator and plasmin were significantly lower (p less than 0.01) in Group 3 than in Group 2. Plasmin activity was also significantly lower (p less than 0.05) in Group 3 compared to Group 1. These findings confirm the presence of increased fibrinolytic activity in the uterus in excessive (dysfunctional) bleeding.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Dec 1986
Comparative StudyNeonatal advantage of epidural anesthesia in elective and emergency cesarean sections: a report of 531 cases.
In 147 elective and 384 non-elective cesarean sections, the need for neonatal respiratory assistance at birth was significantly greater for babies born under general anesthesia compared to epidural anesthesia, and the differences could not be explained by differences in pre-operative risk factors. For 114 babies on whom blood gas data were gathered prospectively, a greater proportion born under general anesthesia were acidemic and hypercarbic. Our results complement a growing body of retrospective and clinical data suggesting that epidural anesthesia is preferable to general in all but a few cesarean sections. Ideally, this suggestion should be tested in a randomized clinical trial.