Obstetrics and gynecology
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Obstetrics and gynecology · May 1987
Randomized Controlled Trial Comparative Study Clinical TrialA randomized trial of electronic fetal monitoring in preterm labor.
Intrapartum electronic fetal heart rate (FHR) monitoring and fetal blood gas sampling were compared with periodic auscultation of FHR in a multicentered randomized trial of preterm singleton pregnancies with fetal weights of 700-1750 g. Two hundred forty-six pregnancies were studied (electronic FHR monitoring N = 122, auscultation N = 124). ⋯ No significant differences were noted in the prevalence of low five-minute Apgar scores, intrapartum acidosis, intracranial hemorrhage, or frequency of cesarean section (P greater than .10). Compared with electronic FHR monitoring, intrapartum auscultation as done in this study is unlikely to be associated with detectable differences in perinatal outcomes within the high-risk setting of preterm labor.
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Obstetrics and gynecology · May 1987
Comparative StudyThe effect of epidural analgesia on the frequency of instrumental obstetric delivery.
In a retrospective study, 155 women who had epidural analgesia only for pain relief during labor and delivery were matched by age, parity, and race with 155 women who had either pudendal or local analgesia for delivery. Infant birth weights were similar in the two groups. ⋯ Women having epidural analgesia who delivered their infants in an occiput anterior position also had a significantly higher frequency of instrumental delivery. Thus, epidural analgesia increased the frequency of instrumental delivery, an increase that was not a consequence of larger infants or fetal malposition.
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Obstetrics and gynecology · May 1987
The effects of fellowships on residency training in obstetrics and gynecology.
The impact of subspecialty fellowships on resident training deserves examination. Program directors responded to a nationwide survey assessing their opinions, their residents' views, and the Residency Review Committee's comments about fellowship effects on the residency. The directors agreed that the fellows' teaching and research contact enhances training. ⋯ Residents reportedly benefit from fellows, yet they resent deferring select surgical experiences to them, such as microsurgery and radical pelvic surgery. The majority of the programs the Residency Review Committee reviewed received positive or neutral comments. Programs that grant their fellows junior faculty status and emphasize research over clinical duties recognize the full benefits of a combined residency-fellowship program.
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Obstetrics and gynecology · Mar 1987
Randomized Controlled Trial Comparative Study Clinical TrialContinuous infusion epidural analgesia with lidocaine: efficacy and influence during the second stage of labor.
A randomized double-blind study evaluated the analgesic efficacy and influence of maintaining a continuous epidural infusion of 0.75% lidocaine during the second stage of labor in nulliparous women. When the cervix was 8 cm or more dilated, unidentified study solution was substituted for the known 0.75% lidocaine solution and continued until delivery. The study solution for 26 patients was 0.75% lidocaine; 27 subjects received saline. ⋯ There was no difference between the groups in the duration of the second stage of labor (73 +/- 63 versus 76 +/- 48 minutes). Operative delivery frequency was similar (31 and 37%), as were umbilical cord blood acid-base values. It is concluded that maintenance of the continuous epidural infusion of 0.75% lidocaine did not prolong the second stage of labor, but it also did not significantly differ from saline in quality of second stage analgesia or frequency of perineal anesthesia.
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Obstetrics and gynecology · Mar 1987
Effect of type of anesthesia on blood loss at cesarean section.
Halogenated anesthetic agents have been used to supplement nitrous oxide during balanced general anesthesia for cesarean delivery to decrease maternal awareness. However, these agents can interfere with uterine contractility and hence have the potential to increase blood loss at the time of cesarean section. ⋯ Significantly more women whose balanced general anesthesia for cesarean section was supplemented with a halogenated agent (usually 0.5% halothane) versus those with a conduction or balanced general anesthetic required transfusion therapy, had a postpartum hematocrit less than 30 vol% and had a decrease in the pre- to postdelivery hematocrit of at least 8 vol %. The addition of halogenated anesthetic agents to a balanced nitrous oxide anesthesia for the purpose of decreased maternal awareness must be weighed against the risk incurred from the increased requirement for blood replacement and/or from postpartum anemia.