British medical journal
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A prospective study of 1,000 consecutive primigravid deliveries has shown that active management in labour can ensure that every woman is delivered within 24 hours. Emphasis is laid on the importance of a correct initial diagnosis of labour based on objective criteria. ⋯ Firstly, that prolonged labour is often an expression of cephalo-pelvic disproportion; secondly, that oxytocin may rupture the primigravid uterus; and, thirdly, that there is a valid therapeutic distinction between hypotonic and hypertonic uterine action. Stimulation, properly supervised, is safe to mother and child, it eliminates the problem of occipitoposterior position, results in a sharp decline in forceps delivery, and obviates the need for massive analgesia.
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The results of treatment have been analysed in 173 patients with septicaemia during 1962-8. Between 1962 and 1965 various antibiotics were used, and shock was treated with vasopressor agents. ⋯ The reduced mortality in the latter was clearly associated with the use of a central venous manometer to control intravenous fluid therapy, though whether the reduction resulted from specific improvement in intravenous therapy or from the necessary closer observation of the patient is not clear. Staphylococcal septicaemia was common during both periods, and its mortality rate did not fall; hence methicillin together with kanamycin is now given initially in all cases.