Epidural analgesia and the course of delivery in term primiparas

OBJECTIVES: Epidural analgesia provides the most effective pain control during labor. Of great concern is its influence on the course of delivery and perinatal complications. DESIGN: The aim of the study was to assess the effect of epidural analgesia on the course of delivery and perinatal outcome. MATERIALS AND METHODS: 609 deliveries among 1334 (323 women with epidural analgesia (53%) and 548 without epidural analgesia (47%)) met the following criteria: primipara, singleton, live pregnancy, > =37 weeks' gestation, cephalic presentation of a fetus, lack of contraindication for vaginal delivery. The incidence of instrumental deliveries and fetal distress, duration of the first, second and third stage of labor, perinatal outcome, perinatal complications and perinatal blood loss and were analyzed. RESULTS: The incidence of fetal distress during second stage of labor was significantly higher in the epidural group (12.69 vs. 6.99%, P=0.02). The incidence of fetal distress during first stage of labor did not differ in both groups (10.53% vs. 8.74%, NS). Cesarean sections rate was similar in epidural and non-epidural group (17.7 vs. 18.2%, NS). Among vaginal deliveries duration of the first and second stage of labor was longer in epidural group (6.5+/-2.4 vs. 5.4+/-2.5 godz., P=0,000003 and 47.3+/-34.8 vs. 29.1+/-25.8 min., P=0.000003) and this was independent of period of time between onset of first stage of labor and epidural analgesia. Oxitocin use was significantly more frequent in the epidural group (20.6 vs. 10.3%, P<0.004). There were no statistically significant differences in the rates of instrumental vaginal deliveries, 1 and 5-minute Apgar scores, length of third stage of labor and perinatal blood loss in patients with and without epidural analgesia. Perinatal outcome did not depend on previous use of epidural analgesia or mode of analgesia for the operation in cesarean section subgroup. CONCLUSION: Epidural labor analgesia is associated with slower progress of labor but has no adverse effect on perinatal outcome and perinatal complications.     

Outcome after successful resuscitation of babies born with apgar scores of 0 at both 1 and 5 minutes

OBJECTIVE: Our purpose was to evaluate the outcome of infants who underwent successful resuscitation after initial Apgar scores of 0 at both 1 and 5 minutes.Study Design: Eligible infants were identified through the perinatal database at the University of Tennessee, Memphis. Hospital records and long-term outcomes, where available, of babies who met the above criteria occurring between January 1986 and February 1999 were reviewed. RESULTS: Thirty-three of 81,603 infants (0.4/1000 births) met our study criteria. Twenty-two (67%) babies died during hospitalization. Mortality decreased significantly from 100% for babies with a birth weight of <750 g to 38% for those weighing > or =2500 g at birth (P =.03). All 6 babies delivered before 26 weeks' gestation died. The incidence of 10-minute Apgar scores >0 was significantly higher among survivors than among those who subsequently died (82% vs 33%, P <.05). Nine survivors had hypoxic-ischemic encephalopathy diagnosed before discharge. Of the 7 infants with available follow-up, 4 had significant persisting morbidity. Two infants had normal neurologic examinations at follow-up. CONCLUSION: Survival in babies born with 1- and 5-minute Apgar scores of 0 is predicted by birth weight, gestational age, and 10-minute Apgar score. Long-term sequelae are common but not ensured.     

Decreased amniotic fluid index in low-risk pregnancy

OBJECTIVE: To evaluate the perinatal outcomes of pregnancies complicated by isolated decreased amniotic fluid volume (AFI) after 30 weeks' gestation (AFI < or = 5 or > 5 cm but < 2.5th percentile). STUDY DESIGN: We retrospectively studied 150 low-risk singleton pregnancies > 30 weeks' gestation with decreased AFI. We also compared the outcomes of 57 pregnancies with AFI < or = 5 cm to those of 93 pregnancies with AFI > 5 cm but < 2.5th percentile (borderline AFI). Pregnancy outcome was assessed with respect to antepartum, intrapartum and neonatal measures. Statistical significance (P < .05) between groups was determined by means of the Student t test and chi 2 analysis. RESULTS: There were no statistically significant differences between pregnancies with AFI < or = 5 cm and those with AFI > 5 cm but < 2.5th percentile with respect to labor induction for an abnormal nonstress test (7.0% vs. 7.5%, overall 7.3%), cesarean sections for fetal heart rate abnormalities (7.0% vs. 7.5%, overall 7.3%), presence of meconium (16.1% vs. 15.7%, overall 16%) and Apgar score < 7 at five minutes (0 vs. 1.1%, overall 0.66%). There were no perinatal deaths in either group. Antepartum variable decelerations were more common in pregnancies with AFI < or = 5 cm as compared to those with AFI > 5 cm but < 2.5th percentile (63.1% vs. 45.1%, P = .007; overall 53.3%). CONCLUSION: With antepartum monitoring, perinatal outcome in low-risk pregnancies with an isolated decreased AFI after 30 weeks' gestation (< or = 5 or > 5 cm but < 2.5th percentile) appears to be good.     

Morbidity and mortality associated with pre-eclampsia at two tertiary care hospitals in Sri Lanka

AIM: To report the occurrence of morbidity and mortality associated with carefully phenotyped pre-eclampsia in a sample of nulliparous Sinhalese women with strictly defined disease. METHODS: A phenotyping database of 180 nulliparous women with pre-eclampsia and 180 nulliparous normotensive pregnant women who were recruited for a study into genetics of pre-eclampsia was analyzed. RESULTS: Women who developed pre-eclampsia had significantly higher systolic blood pressure (SBP; P = 0.002) and diastolic blood pressure (DBP; P = 0.002) at booking (at approximately 13 weeks of gestation). 38.3%, 28.3% and 33.3% of women delivered at <34 weeks, at 34-36 weeks, and at term, respectively. 78% required a cesarean section. Complications included SBP > or = 160 mmHg (75.5%); DBP > or = 110 mmHg (83.8%); proteinuria > or =3 + (150 mg/dL) in the urine protein heat coagulation test (87%); renal failure requiring dialysis (2%); platelet counts <100 x 10(9)/L (13%); > or =70 U/L in aspartate and/or alanine aminotransaminase (15%); placental abruption (4%); eclampsia (9%); and one maternal death. Maternal complications indicative of severe disease, apart from the incidence of SBP > or = 160 mmHg and DBP > or = 110 mmHg, were not significantly different in early and late-onset pre-eclampsia; fetal outcome was better with late-onset disease. 48% of babies were small for gestational age. Only 80 of 135 babies of women with pre-eclampsia whose condition could be confirmed at 6 weeks post-partum were alive. CONCLUSIONS: Pre-eclampsia in Sinhalese women is associated with severe maternal morbidity and fetal morbidity and mortality, suggesting that modification of the Western diagnostic criteria and/or guidelines for medical care may be necessary. There is an urgent need to improve neonatal intensive care services in Sri Lanka.     

Maternal obesity as a risk factor in gestational diabetes

Maternal obesity has been associated with both gestational diabetes mellitus (GDM) and neonatal macrosomia. Most studies of obesity in pregnancy have demonstrated an increased risk for GDM. However, the contribution of obesity as an added risk in GDM has not been examined. The purpose of this study was to examine the contribution of obesity as a risk factor to perinatal morbidity in gestationally diabetic women by comparing the maternal and neonatal outcome in obese and nonobese gestationally diabetic women. From 1979 to 1983, the maternal, intrapartum, and neonatal characteristics of all prepartum gravid patients with GDM were examined. Of the 158 patients with documented GDM, 62 (39%) were obese (weight greater than 90 kg). There was no difference in maternal age (obese 29.3 +/- 5.4 years, nonobese 28.7 +/- 6.5 years) parity, or prepartum risk score between the obese and nonobese patients. The incidence of prematurity, pre-eclampsia, fetal distress, and primary cesarean sections were not different between the groups. There were no differences in Apgar scores, gestational age, or perinatal morbidity. However, the obese patients delivered heavier neonates expressed as mean birthweight (obese 3667 +/- 682 gms, nonobese 3331 +/- 750 gms. P less than .01), the number of macrosomic (greater than 4 kg) neonates (obese 37%, nonobese 14%, P less than .001) and K-score, (obese 0.8 +/- 1, nonobese 0.4 +/- 9, P less than .05). These data indicate that obese patients with GDM have an increased risk of neonatal macrosomia.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cesarean delivery for twins: a systematic review and meta-analysis

OBJECTIVE: We undertook a systematic review and meta-analysis to determine whether a policy of planned cesarean section or vaginal delivery is better for twins. STUDY DESIGN: We searched MEDLINE and EMBASE from 1980 through May 2001 using combinations of the following terms: twin, delivery, cesarean section, vaginal birth, birth weight, and gestational age. Studies that compared planned cesarean section to planned vaginal birth for babies weighing at least 1500 g or reaching at least 32 weeks' gestation were included. We computed pooled odds ratios for perinatal or neonatal mortality, low 5-minute Apgar score, neonatal morbidity, and maternal morbidity. The infant was the unit of statistical analysis. Results were considered statistically significant if the 95% CI did not encompass 1.0. RESULTS: We retrieved 67 articles, 63 of which were excluded. Four studies with a total of 1932 infants were included in the analysis. A low 5-minute Apgar score occurred less frequently in twins delivered by planned cesarean section (odds ratio, 0.47; 95% CI, 0.26-0.88) principally because of a reduction among twins if twin A was in breech position (odds ratio, 0.33; 95% CI, 0.17-0.65). Twins delivered by planned cesarean section spent significantly longer in the hospital (mean difference, 4.01 days; 95% CI, 0.73-7.28 days). There were no significant differences in perinatal or neonatal mortality, neonatal morbidity, or maternal morbidity. CONCLUSION: Planned cesarean section may decrease the risk of a low 5-minute Apgar score, particularly if twin A is breech. Otherwise, there is no evidence to support planned cesarean section for twins.     

'Normal but dead': perinatal mortality in nonmalformed babies of birthweight 2.5 kg and over in the Northern Region in 1983

Summary. The case notes relating to 75 of the 91 perinatal deaths of nonmalformed babies of birthweight ≥2.5 kg born in the Northern Region in 1983 were examined. The major groups involved antepartum deaths of unknown cause (40%), and deaths due to intrapartum anoxia or trauma (35%). A case-control study compared each of the 75 cases with two controls matched for place of birth, obtained by taking the next two babies born in the same maternity unit (excluding perinatal deaths, birthweight <2.5 kg, and malformations). Four factors were found to be significantly associated with risk of perinatal death in this group: primigravidity, parity ≥3, not booked for antenatal care by 20 weeks, and corrected birthweight <3.2 kg (adjusted for gestation). Two further factors were related only to the risk of perinatal death consequent upon intrapartum events: labour post-term and malpresentation in labour. All four factors relevant to the whole group remained independently associated with risk of perinatal death after multivariate analysis by two techniques. Adjusted odds ratios (95% CI) were estimated as: primigravidity 2.1 (1.1 to 4.1); parity three or more 5.7 (1.9 to 17); not booked for antenatal care by 20 weeks 15.7 (3.0 to 81); and corrected birthweight <3.25 kg 2.5 (1.3 to 4.6). An avoidable factor, as defined, was detected in 50% of deaths. In 30% of deaths there was an avoidable factor (grade 2) such that absence may have been expected to lead to a different outcome had all other factors remained equal. Of the avoidable factors detected, 61% related to intrapartum management, as did 76% of the grade 2 factors. Most of these involved failure to respond to evidence of fetal distress in labour. The defined group constituted 21% of all perinatal deaths, suggesting that this is an important category, particularly as their potential for normal survival should otherwise have been high.     

Routine fetal heart rate monitoring in the antepartum period.

A total of 4517 successful antepartum nonstress tests (NST) was performed on 2003 high- (28%) and low- (72%) risk obstetric patients. Most patients were monitored from 32 to 34 weeks' gestation onward. A reactive NST was defined as 2 accelerations in 10 minutes--15 beats/min minimum amplitude; 15 seconds minimum duration. The test was repeated at the next visit in low-risk patients with reactive NST or in 1 week in high-risk patients with this response. Nonreactive tests were followed immediately by a stress test in high-risk patients, but only after repeat nonreactive NST within 24 hours in low-risk patients. About 88% of low-risk and 86% of high-risk patients demonstrated ractive NST only. Late decelerations during subsequent stress testing or labor, low Apgar scores, and perinatal deaths were more common in low-risk pregnancies than in high-risk pregnancies and more common in those with nonreactive NST than in those with reactive NST. High-risk/reactive NST babies, however, fared better than low-risk/nonreactive NST babies. Of the 16 perinatal deaths 6 died antepartum, 2 died in labor, and 8 died as neonates. Presumed asphyxia accounted for 6 deaths while significant anomaly accounted for 5; sepsis and trauma accounted for 2 each. In only 2 instances was a reactive NST followed by a death from apparent asphyxia. Routine NST testing appears to improve the resolution of maternal risk classification and may contribute to better perinatal outcome.     

Maternal and neonatal outcomes in advanced maternal age: a retrospective cohort study

Objectives: To describe the effect of extremely advanced maternal age (EAMA) on maternal/neonatal outcomes.

Methods: This was a case-control study in which 127 women ≥40 years at the time of delivery out of 2853 singleton hospital deliveries in Ondokuz Mayis University between 1 January 2008 and 31 August 2010 constituted the study group. One hundred and twenty-seven else were chosen randomly out of 2412, 21–35 years old women, via a computer system as controls. Demographic features of 254 mothers and infants as well as maternal and neonatal complications were recorded.

Results: Mean maternal age was 41.5?±?1.9 (40–49) years in EAMA group and 28.9?±?4.2 (21–35) years in controls. Primigravidity was 19.6% in the EAMA group, whereas 37.8% in controls (p?=?0.003). No difference was found between groups according to route of delivery, stillbirth, preterm birth, congenital abnormalities, gender of babies, NICU admission and respiratory problems (for all p?>?0.05). A 5th min Apgar score <7 was more frequent in babies born to EAMA mothers compared to controls (9.8% versus 4.9%, p?=?0.004).

Conclusion: The present study shows that EAMA mothers and their offsprings have similar peri and neonatal risks compared to younger mothers, except lower 5th minute Apgar scores. We conclude that with good perinatal care, EAMA women and their babies can pass through the perinatal period with similar risks of younger women.     

3. Antenatal care, formal education and child-bearing

Summary. Both formal education and antenatal care had tremendous impact on the results of childbearing. In women who had never had any formal education nor received antenatal care, that is 33% of the survey population, maternal mortality was 29 per 1000 deliveries, perinatal mortality was 258 per 1000 total births and 26% of the babies weighed ≤2.50 kg. With education and antenatal care combined, as was the case in 10% of the survey population, the maternal death rate was 2.5 per 1000 deliveries, perinatal mortality rate was 30 per 1000 total births, and only 8% of the babies were of low birthweight. Among women in their thirties and beyond, the average number of previous births per woman in the illiterate group (5.4) was double that in those who had received post-secondary education and child mortality rate at 25% was three times as high. Formal education, by changing social attitudes, holds the key to improvements in maternal and perinatal health.     

A 10-year population-based study of uterine rupture

OBJECTIVE: To review the incidence, associated factors, methods of diagnosis, and maternal and perinatal morbidity and mortality associated with uterine rupture in one Canadian province. METHODS: Using a perinatal database, all cases of uterine rupture in the province of Nova Scotia for the 10-year period 1988-1997 were identified and the maternal and perinatal mortality and morbidity reviewed in detail. RESULTS: Over the 10 years, there were 114,933 deliveries with 39 cases of uterine rupture: 18 complete and 21 incomplete (dehiscence). Thirty-six women had a previous cesarean delivery: 33 low transverse, two classic, one low vertical. Of the 114,933 deliveries, 11,585 (10%) were in women with a previous cesarean delivery. Uterine rupture in those undergoing a trial for vaginal delivery (4516) was complete rupture in 2.4 per 1000 and dehiscence in 2.4 per 1000. There were no maternal deaths, and maternal morbidity was low in patients with dehiscence. In comparison, 44% of those with complete uterine rupture received blood transfusion (odds ratio 7.60, 95% confidence interval 1.14, 82.14, P =.025). Two perinatal deaths were attributable to complete uterine rupture, one after previous cesarean delivery. Compared with dehiscence, infants born after uterine rupture had significantly lower 5-minute Apgar scores (P <.001) and asphyxia, needing ventilation for more than 1 minute (P <.01). CONCLUSION: In 92% of cases, uterine rupture was associated with previous cesarean delivery. Uterine dehiscence was associated with minimal maternal and perinatal morbidity. In contrast, complete uterine rupture was associated with significantly more maternal blood transfusion and neonatal asphyxia.     

Maternal and perinatal outcomes in women with and without hypertensive syndromes submitted to induction of labor with misoprostol

Objectives: To determine maternal and perinatal outcomes according to the mode of delivery in normotensive and hypertensive women bearing a live, full-term fetus, who were submitted to labor induction with misoprostol. Methods: Retrospective cohort study. The endpoints were tachysystole, uterine hyperstimulation, indications for cesarean section, severe maternal morbidity, side effects, maternal death, 1st/5th minute Apgar, neonatal death, requirement for neonatal intensive care, and birth weight (grams). The chi-square or Fisher’s exact test was applied at a significance level of 5%. Risk ratios (RRs) and their 95% confidence intervals (95% CI) were calculated. Results: No significant differences were found in maternal outcome as a function of mode of delivery. First-minute Apgar score <7 was less common with vaginal deliveries in normotensive women (RR = 0.41; 95% CI: 0.18–0.90), this being the only significant difference in perinatal outcome. Conclusion: Maternal and perinatal outcomes were similar in hypertensive and normotensive women submitted to labor induction with misoprostol.     

Kielland's forceps or ventouse—a comparison

Summary. A retrospective study over a 3-year period compared maternal and neonatal outcomes after birth by Kielland's forceps with those by ventouse when there was deep transverse arrest of head. Of the 259 women, 117 were delivered with Kielland's forceps and 142 were delivered with the ventouse. Of the Kielland's forceps deliveries, 15% were performed by a specialist, compared with 41% of the vacuum extractions. There were no differences in maternal morbidity overall, but when groups of operators were compared maternal complications were more frequent in the forceps group with the less experienced operators. There was little early neonatal morbidity (as judged by Apgar score, intubation, admission to the special care baby unit, jaundice and abnormal neurological behaviour) but cephalhaematoma occurred significantly more often in babies born by the ventouse than by Kielland's forceps. There were no perinatal deaths.     

Two-year neurodevelopmental outcome in children conceived by intracytoplasmic sperm injection: prospective cohort study

OBJECTIVE: Primary outcome was to compare neurodevelopmental outcome at two years in intracytoplasmic sperm injection (ICSI) conceived children versus matched controls. Secondary outcome was to determine incidence of major congenital malformations and study perinatal outcome. DESIGN: Prospective cohort study. SETTING: Tertiary care perinatal centre over a period of 13 months. POPULATION: Seventy-six ICSI conceived children and 261 matched controls selected by matching for maternal age, sex, date of delivery, race, plurality and parity. METHODS: Mental Development Index (MDI) and Psychometric Development Index (PDI) of the Bayley's Scale of Development (BSID-II) and Vineland Adaptive Behaviour Scale (VABS) were used to assess the neurodevelopmental and functional outcome. The congenital malformations were classified according to ICD-9 code. MAIN OUTCOME MEASURES: Primary outcome measure--neurodevelopmental and functional outcomes. Secondary outcome measure--congenital malformations and perinatal outcomes. RESULTS: Neurodevelopmental and functional outcome were comparable in both groups. The mean MDI score was 92 [16] versus 90 [14] in the study and control groups respectively. Fourteen (18.4%) in the ICSI group had MDI <85 compared with 87 (33%) controls (P= 0.002). On linear regression the MDI was independently affected by plurality (P= 0.001), maternal education and socio-economic status (P= 0.01). The study group had a lower gestation (36 [3] vs 37.1 [2] weeks; P= 0.005) and a higher incidence of prematurity <34 weeks [19 (25%)] vs [31 (12%)] P= 0.012]. Six (7.9%) of the ICSI babies and seven (2.7%) of the controls had a major congenital malformation (P= 0.05). CONCLUSIONS: Children born by ICSI pregnancies did not have an adverse neurodevelopmental outcome. The incidence of major congenital malformations in ICSI needs further evaluation.     

Vaginal delivery after one caesarean section in Nigerian women.

A total of 120 Nigerian women at term pregnancy with one previous caesarean delivery were studied between June 1988 and May 1993. Elective caesarean section was performed in 3 (2.5%). Vaginal delivery was achieved in 101 (86.5%) of those allowed a trial of labour. Intrapartum caesarean section was done in 16 (13.7%) cases. Rupture of the uterus occurred in 3 cases (2.6%) with perinatal loss of 2 babies. There was no maternal mortality. There was no significant correlation between vaginal delivery and birth weight, gestational age or initial indication for the primary caesarean section. It is concluded that trial of labour is safe after a previous caesarean section in selected patients.     

Kielland's forceps or ventouse--a comparison

A retrospective study over a 3-year period compared maternal and neonatal outcomes after birth by Kielland's forceps with those by ventouse when there was deep transverse arrest of head. Of the 259 women, 117 were delivered with Kielland's forceps and 142 were delivered with the ventouse. Of the Kielland's forceps deliveries, 15% were performed by a specialist, compared with 41% of the vacuum extractions. There were no differences in maternal morbidity overall, but when groups of operators were compared maternal complications were more frequent in the forceps group with the less experienced operators. There was little early neonatal morbidity (as judged by Apgar score, intubation, admission to the special care baby unit, jaundice and abnormal neurological behaviour) but cephalhaematoma occurred significantly more often in babies born by the ventouse than by Kielland's forceps. There were no perinatal deaths.     

'Normal but dead': perinatal mortality in non-malformed babies of birthweight 2.5 kg and over in the northern region in 1983

The case notes relating to 75 of the 91 perinatal deaths of nonmalformed babies of birthweight greater than or equal to 2.5 kg born in the Northern Region in 1983 were examined. The major groups involved antepartum deaths of unknown cause (40%), and deaths due to intrapartum anoxia or trauma (35%). A case-control study compared each of the 75 cases with two controls matched for place of birth, obtained by taking the next two babies born in the same maternity unit (excluding perinatal deaths, birthweight less than 2.5 kg, and malformations). Four factors were found to be significantly associated with risk of perinatal death in this group: primigravidity, parity greater than or equal to 3, not booked for antenatal care by 20 weeks, and corrected birthweight less than 3.2 kg (adjusted for gestation). Two further factors were related only to the risk of perinatal death consequent upon intrapartum events: labour post-term and malpresentation in labour. All four factors relevant to the whole group remained independently associated with risk of perinatal death after multivariate analysis by two techniques. Adjusted odds ratios (95% CI) were estimated as: primigravidity 2.1 (1.1 to 4.1); parity three or more 5.7 (1.9 to 17); not booked for antenatal care by 20 weeks 15.7 (3.0 to 81); and corrected birthweight less than 3.25 kg 2.5 (1.3 to 4.6). An avoidable factor, as defined, was detected in 50% of deaths. In 30% of deaths there was an avoidable factor (grade 2) such that absence may have been expected to lead to a different outcome had all other factors remained equal. Of the avoidable factors detected, 61% related to intrapartum management, as did 76% of the grade 2 factors. Most of these involved failure to respond to evidence of fetal distress in labour. The defined group constituted 21% of all perinatal deaths, suggesting that this is an important category, particularly as their potential for normal survival should otherwise have been high.     

Clinical condition of newborns from water birth at the Perinatology Clinic, Institute Of Gynecology and Obstetrics of the Medical University in Łódź, in the years 1996-2001

OBJECTIVE: The objective of the paper was the estimation of the babies from the water births. DESIGN: The comparison of newborns from water births to neonates from conventional deliveries. MATERIALS AND METHODS: Mature babies, who were born in the Clinics of Perinatology in the Institute of Gynecology and Obstetrics of the Medical University in ?ód?, in the years 1996-2001. Neonates whose mothers were living in ?ód? district were taken into consideration and datas were gained from the medical documentation. RESULTS: Women who delivered in water were mainly intellectual and primiparas. Among the newborns from water births many of them got from 8 to 10 points by Apgar score (92.9%), and only 7.1% were estimated for 6 to 7 points. Birth weight in babies from water deliveries varied from 2300 grams to 4050 grams and the majority (59.5%) was composed of newborns weighting 3500 grams or more. Birth weight from 2500 grams to 3499 grams referred to 33.3% of the babies. In the control group from conventional deliveries, estimation by Apgar score was similar, but the body mass equal or higher than 3500 grams was seen only in 19.7% and the majority--80.3% was composed of babies with lower birth weight (2500 g-3499 g). The clinical condition of all the newborns delivered in water was good; they were healthy and only one baby suffered from inborn pneumonia, and another one from diaper dermatitis. There were no perinatal traumas in analysed babies. CONCLUSION: Taking into consideration such parameters as high Apgar score estimation, good clinical condition and absence of traumas, water delivery is to be judged as the advantageous one for newborns.     

Maternal and perinatal morbidity associated with classic and inverted T cesarean incisions

OBJECTIVE: To estimate the maternal and perinatal morbidity associated with cesarean delivery involving the upper uterine segment compared with that of low transverse cesarean delivery. METHODS: A 19-year review of a perinatal database and the relevant charts was used to determine the maternal and perinatal morbidity associated with low transverse cesarean, classic cesarean, and inverted "T" cesarean deliveries. RESULTS: Over the 19 years, 1980-1998, there were 19,726 cesarean deliveries: low transverse cesarean, 19,422 (98.5%); classic cesarean, 221 (1.1%); and inverted T cesarean, 83 (0.4%). As a proportion of all cesarean deliveries, the rates of low transverse cesarean and classic cesarean have remained stable, whereas the rate of inverted T cesarean has risen from 0.2% to 0.9%. Maternal morbidity (puerperal infection, blood transfusion, hysterectomy, intensive care unit admission, death) and perinatal morbidity (stillborn fetus, neonatal death, 5 minute Apgar less than 7, intensive care) were significantly higher in classic cesarean compared to low transverse cesarean. Some maternal morbidity (puerperal infection, blood transfusion) and perinatal morbidity (5 minute Apgar less than 7, intensive care) were also significantly higher for inverted T cesarean compared to low transverse cesarean. CONCLUSION: Classic cesarean section has a higher maternal and perinatal morbidity than inverted T cesarean and much higher than low transverse cesarean. There is no increased maternal or perinatal morbidity if an attempted low transverse incision has to be converted to an inverted "T" incision compared to performing a classic cesarean section.     

Maternal fever in term labour in relation to fetal tachycardia, cord artery acidaemia and neonatal infection

Objective To determine 1. whether maternal fever during term labour is associated with acidaemia at birth and neonatal infection and 2. whether fetal tachycardia precedes maternal fever and is associated with neonatal infection.
Design Retrospective matched-pair case-control study.
Subjects Two hundred and forty-eight newborn infants whose mothers developed fever during term labour (cases) and 248 control infants. The women were matched for parity and duration of labour.
Main outcome measures Cord artery acid-base status, Apgar scores, neonatal infections, and fetal heart rate before maternal fever.
Results Mean pH, as well as the rate of cord artery acidaemia at birth (pH < 7.10) was equal in cases and controls (in both groups 7.24% and 6%, respectively). Signs of septicaemia and/or pneumonia were identified in 17 case newborns (7%) and in one control (0.4%; OR 17.0,   P < 0.001  ). Of 212 pairs with complete heart rate data, fetal tachycardia preceded maternal fever in 39 cases (18%) and in 16 controls (8%) (OR 2.6,   P = 0.003  ). Tachycardia before maternal fever was not associated with increased neonatal infectious morbidity.
Conclusions Maternal fever during term labour was associated with perinatal infection, but not with acidaemia at birth. Elevated fetal heart rate preceded maternal fever in a minority of cases and was not associated with perinatal infection.