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Alexander S, Wildman K, Zhang W, Langer M, Vutuc C, Lindmark G. Maternal health outcomes in Europe. Eur J Obstet Gynecol Reprod Biol 2004; 111 Suppl 1:S78-87. [PMID: 14642322 DOI: 10.1016/j.ejogrb.2003.09.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To use PERISTAT data on indicators of maternal mortality and morbidity to explore maternal health outcomes in Europe, and to discuss the implications of variations in the data sources for these indicators. STUDY DESIGN The PERISTAT feasibility study provides the source for this descriptive study, covering 15 European countries. Maternal mortality ratios are calculated, and data to describe maternal mortality by age, cause of death and mode of delivery are pooled for the countries that provided data. RESULTS Data presented show an increased risk of maternal death among older mothers and for caesarean sections compared with other modes of delivery, and the three most prevalent causes of maternal deaths reported were embolism, hypertensive diseases of pregnancy, and haemorrhage. CONCLUSIONS Variations in maternal mortality ratios reflect different data sources with varying levels of ascertainment in addition to differences in the number of maternal deaths. Further development is needed to construct comparable indicators of maternal morbidity.
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Affiliation(s)
- Sophie Alexander
- Reproductive Health Unit, School of Public Health, Université Libre de Bruxelles, 808 Route de Lennik, 1070 Brussels, Belgium.
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Rozenberg P. L’élévation du taux de césariennes : un progrès nécessaire de l’obstétrique moderne. ACTA ACUST UNITED AC 2004; 33:279-89. [PMID: 15170423 DOI: 10.1016/s0368-2315(04)96456-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
During the last 10 Years, the cesarean section (CS) rate was increased despite of the recommendations of the World Health Organization to keep it below 10-15%. The purpose of this review of the literature was to demonstrate how the concept of CS rate limitation has become obsolete. The increase in the CS rate is mainly justified by the decrease in maternal mortality and morbidity following elective CS: surgery-related risks have decreased and the confusion that was made between the risks of vaginal delivery and those of trial of labor has to be clarified to show that maternal mortality and morbidity are not increased by elective CS. However, instrumental delivery and CS during labor remain two situations at high risks both for the mother and her fetus. There is also an association between the increase in the CS rate and the decrease in perinatal mortality and morbidity, but this effect would only become clinically significant after a dramatic increase in the CS rate: this is the preventile principle of "marginal death". Numerous articles have been published reporting on the effects of vaginal delivery for the pelvic floor: urinary incontinence, pelvic organ prolapse, and especially fecal incontinence. All these publications concluded that CS has a protective effect. The rising duty to provide information to patients in high risk obstetrical situations such as a history of CS also contributes to the overall increase in CS rate mainly through the elective CS rate. Indeed, when faced with the alternative choices of potentially severe complications either for themselves or their child, women are likely to choose what appears to be the safest mode of delivery for their child and thus to opt for a CS. Finally, widespread delivery of information to the patients about trial of labor itself and the risks of vaginal delivery is the first step towards a "principle of preference", which consists in giving an important place to the patient's choice in the decision-making process, and thus to recognize her right to ask for an elective CS.
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Affiliation(s)
- P Rozenberg
- Département de Gynécologie-Obstétrique, Centre Hospitalier Poissy-Saint-Germain, rue du Champ-Gaillard, 78303 Poissy.
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Collaris RJ, Oei SG. External cephalic version: a safe procedure? A systematic review of version-related risks. Acta Obstet Gynecol Scand 2004; 83:511-8. [PMID: 15144330 DOI: 10.1111/j.0001-6349.2004.00347.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Term Breech Trial has considerably increased the number of cesareans. External cephalic version (ECV) might be an effective method of lowering the rate of cesareans; its efficacy has been well established. However, although in the absence of anesthesia the risks are thought to be low, most studies have used populations too small to allow definite conclusions on version-related risks. METHODS In an attempt to make an inventory of these risks, we have systematically analyzed 44 studies, covering a total of 7377 patients from 1990 to 2002. The studies used were derived from a Medline and Embase search. RESULTS The most frequently reported complications were transient abnormal cardiotocography (CTG) patterns (5.7%). Persisting pathological CTG readings (0.37%) and vaginal bleeding occur rarely (0.47%). The incidence of placental abruption was even lower, at 0.12%. Fetomaternal transfusion was absent in five out of seven studies, with a mean incidence of 3.7%. Emergency cesareans were performed in 0.43% of all versions. Perinatal mortality was 0.16%. CONCLUSIONS External cephalic version seems to be a safe procedure.
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Affiliation(s)
- Ronald J Collaris
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, the Netherlands
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Alarab M, Regan C, O'Connell MP, Keane DP, O'Herlihy C, Foley ME. Singleton vaginal breech delivery at term: still a safe option. Obstet Gynecol 2004; 103:407-12. [PMID: 14990399 DOI: 10.1097/01.aog.0000113625.29073.4c] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the obstetric and perinatal outcome of pregnancies with singleton breech presentation at term when selection for vaginal delivery was based on clear prelabor and intrapartum criteria. METHODS The outcomes of all pregnancies with a breech presentation after 37 weeks of gestation were retrospectively reviewed from January 1997 to June 2000. Criteria for prelabor cesarean or trial of vaginal breech delivery included type of breech, estimated fetal weight (more than 3,800 g), maternal preference, and gestation more than 41 weeks. An intrapartum protocol excluded induction and oxytocin augmentation of labor, combined with a low threshold for cesarean delivery for dystocic labor; an experienced obstetrician was in attendance during labor and delivery. RESULTS Of 641 women, 343 (54%) underwent prelabor cesarean, and 298 (46%) had a trial of vaginal delivery, of whom 146 (49%) delivered vaginally. Significantly fewer nulliparas (58 of 158, 37%) than multiparas (88 of 140, 63%; P <.001) achieved vaginal delivery after trial of labor. Significantly more infants weighing more than 3,800 g were selected for prelabor (87 of 343, 25%) and intrapartum (31 of 152, 20%) cesarean than delivered vaginally (15 of 146, 10%). Two neonates (0.7%) had Apgar scores of less than 7 at 5 minutes; both were neurologically normal at 6 weeks. There were no nonanomalous perinatal deaths and no cases of significant trauma or neurological dysfunction; 3 infants delivered vaginally died due to lethal anomalies. CONCLUSION Safe vaginal breech delivery at term can be achieved with strict selection criteria, adherence to a careful intrapartum protocol, and with an experienced obstetrician in attendance. Our protocol effectively selects larger infants for cesarean delivery. LEVEL OF EVIDENCE II-2
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Affiliation(s)
- May Alarab
- Departments of Obstetrics and Gynaecology, University College Dublin, National Maternity Hospital, Holles Street, Dublin 2, Ireland
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55
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Kwee A, Cohlen BJ, Kanhai HHH, Bruinse HW, Visser GHA. Caesarean section on request: a survey in The Netherlands. Eur J Obstet Gynecol Reprod Biol 2004; 113:186-90. [PMID: 15063958 DOI: 10.1016/j.ejogrb.2003.09.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2003] [Revised: 07/27/2003] [Accepted: 09/05/2003] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the opinion of Dutch gynaecologists and registrars on caesarean section (CS) on request. STUDY DESIGN Anonymous postal survey. METHODS A structured survey was send to all 900 gynaecologists and registrars in The Netherlands. They were asked to what extent they were willing to accept a request for an elective caesarean section, without evident medical reason. The survey contained eight simulated cases in which the reason for this request differed (obstetrical history and course of the present pregnancy). In two cases, there was no medical indication at all to perform a caesarean section; and in a third case caesarean section was due to excessive maternal weight relatively contraindicated. RESULTS The response rate was 65%. Willingness to perform an elective caesarean section ranged from 17 to 81% between the cases. Main reasons to perform a caesarean section were: (a). autonomy; (b). an unfavourable course of delivery in the absence of motivation for a natural childbirth; (c). litigation. The main reasons to refuse a request for a caesarean section were: (a). higher maternal morbidity and mortality; (b). no indication for caesarean section. A logistic regression analysis on personal characteristics showed that an experienced doctor is more willing to perform an elective caesarean section then a consultant or registrar with limited experience. The sex of the doctor was of no influence and the same held for the University at which they had been trained. Furthermore, it seems that doctors are more willing to accept the request if it is based upon unfounded, but understandable fear. CONCLUSION In The Netherlands, a woman can always find a gynaecologist willing to perform a caesarean section for non medical reasons. This willingness increases with the age of the doctor. There is a need for guidelines when handling these cases.
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Affiliation(s)
- Anneke Kwee
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, WKZ, KE.04.123.1, Lundlaan 6, 3584 EA Utrecht, The Netherlands.
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Abstract
Breech presentation is the most common malpresentation, with about 3-4% of singleton fetuses presenting breech at delivery. Management of breech presentation has been a contentious issue with a lowering threshold for cesarean section in recent years. Perinatal mortality and morbidity are estimated to be three times that of comparable infants with vertex presentation. Breech presentation is commonly associated with certain adverse maternal and fetal factors which inherently give rise to increased perinatal morbidity and mortality. At present, most obstetricians favor cesarean delivery for uncomplicated pre-term breech. Controlled prospective studies have shown that the outcome of breech fetuses weighing more than 1500 g was not dependent on the mode of delivery. A more recent review from the Cochrane database by Grant does not justify a policy of elective cesarean section for pre-term breech. Vaginal delivery is preferred if the following criteria are met: frank breech only, estimated fetal weight of 2500-3500 g, adequate pelvimetry without hyperextended head, normal progression of labor, no evidence of fetal hypoxia under continuous fetal monitoring, and maternal weight under 90 kg. Vaginal delivery of frank breech at term may be just as safe as cesarean section when careful selection criteria are used. If these criteria are not fulfilled, or fetal monitoring cannot be performed, cesarean section is advisable.
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Affiliation(s)
- Zoltán Papp
- I. Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
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57
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Hofmeyr GJ, Mathai M. Techniques for caesarean section. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2004. [DOI: 10.1002/14651858.cd004662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
OBJECTIVE This analysis considers the usefulness of maternal mortality ratio (MMR) as an indicator of obstetric care in the context of low overall maternal mortality. We explore whether variation in the level of MMR among European countries reflects differences in obstetric care. DESIGN The data presented in this article were collected as part of the European Concerted Action on Mothers' Mortality and Severe morbidity (MOMS). In this study, a panel of experts followed a protocol to determine cause of death and whether it was pregnancy-related. This analysis uses the expert panel's confirmation of cause of death and obstetric attribution. SETTING All maternal deaths within 11 European countries. POPULATION Two hundred and ninety obstetric deaths occuring between 1992 and 1995. METHODS We present the results of a multivariable analysis that controls for cause of death, moment of death, place of death, pregnancy outcome, women's age and nationality. MAIN OUTCOME MEASURES We test the hypothesis that countries with higher MMR would have proportionally more cases of direct obstetric death due to thromboembolism, hypertension, haemorrhage or infection compared with other countries in the study. We examine timing of death and maternal age to measure whether there are differences between country groups for older mothers. RESULTS We find distinct patterns in cause and timing of death and age-specific mortality ratios between countries with different levels of MMR. CONCLUSIONS Despite low rates of maternal mortality in Europe, between-country differences follow patterns with respect to cause and timing of death and maternal age. In addition to representing an important indicator of health status in a country, differences in MMR among European countries provide insight to where obstetric care plays a role maternal deaths.
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Affiliation(s)
- Katherine Wildman
- Epidemiological Research Unit on Perinatal and Women's Health, Unité 149 INSERM, France
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59
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Abstract
Cesarean section without medical indication is cited as a factor in the increase in the rate of cesarean delivery in modern obstetric practice. Individual obstetricians often express strong views supporting or refuting the right of women to request operative delivery and their rights to decline or fulfill this request. Such strong opinions may be misplaced as the available evidence does not conclusively support either view-point.
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Affiliation(s)
- L Penna
- Department of Obstetrics and Gynaecology, St George's Hospital, London, UK.
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60
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Kayihura V, Osman NB, Bugalho A, Bergström S. Choice of antibiotics for infection prophylaxis in emergency cesarean sections in low-income countries: a cost-benefit study in Mozambique. Acta Obstet Gynecol Scand 2003; 82:636-41. [PMID: 12790845 DOI: 10.1034/j.1600-0412.2003.00205.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is a need to assess the cost-benefit of different models of antibiotic administration for the prevention of post cesarean infection, particularly in resource-scarce settings. DESIGN Randomized, nonblinded comparative study of a single combined preoperative dose of gentamicin and metronidazole vs. a post cesarean scheme for infection prophylaxis. METHODS Pregnant women (n = 288) with indication for emergency cesarean section were randomly allotted to two groups. Group 1 (n = 143) received the single, combined dose of prophylactic antibiotics and group 2 (n = 145) received, over 7 days, the postoperative standard scheme of antibiotics followed in the department. Both groups were followed up during 7 days for detection of signs of wound infection, endometritis, peritonitis and urinary tract infection. MAIN OUTCOME MEASURES Prevalence of postoperative infection, mean hospital stay and costs of antibiotics used. RESULTS Women completing the study (n = 241) were distributed into group 1 (n = 116) and group 2 (n = 125). No significant difference was found neither in the prevalence of postoperative infection nor in the mean hospital stay. No death occurred. The cost of the single dose of prophylactic antibiotics was less than one-tenth of the cost of the standard postoperative scheme. CONCLUSION In our setting, the administration of a single dose of 160 mg of gentamicin in combination with 500 mg of metronidazole before emergency cesarean section for prevention of infection is clinically equivalent to existing conventional week-long postoperative therapy, but at approximately one-tenth of the cost.
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Affiliation(s)
- Vicente Kayihura
- Department of Obstetrics and Gynecology, Maputo Central Hospital, Maputo, Mozambique
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61
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Abstract
BACKGROUND In Italy the proportion of births by cesarean section rose from 11.2 percent in 1980 to 27.9 percent in 1996 and 33.2 percent in 2000. The aim of this study was to identify factors, other than medical and obstetrical risk, that may influence the method of delivery and to analyze mother's preference for vaginal versus cesarean delivery among women after the birth of their first baby in university hospitals in Italy. METHODS Primiparous women were selected from 100 consecutive deliveries in 23 university hospitals in 1999. To determine antenatal, delivery, and postnatal history, and women's preference for method of delivery, trained health personnel interviewed 1986 women. RESULTS Of the 1986 women who were interviewed (response rate 95%), 1023 primiparas comprised the study sample. The cesarean section rate was 36 percent. Ninety-one percent of the women who delivered spontaneously and 73 percent of those who underwent a cesarean section would have preferred a vaginal delivery. CONCLUSIONS Most of the interviewed women in this study preferred, or were satisfied with, vaginal birth.
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Affiliation(s)
- Serena Donati
- Department of Epidemiology and Biostatistics, Istituto Superiore di Sanità, Rome, Italy
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62
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Rietberg CC, Elferink-Stinkens PM, Brand R, Loon AJ, Hemel OJ, Visser GH. Term breech presentation in The Netherlands from 1995 to 1999: mortality and morbidity in relation to the mode of delivery of 33,824 infants. BJOG 2003. [DOI: 10.1046/j.1471-0528.2003.01507.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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63
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McGregor JA. Recognition of preterm labour as a set of ‘complex diseases’ increases efficacy of tocolytic treatment. BJOG 2003. [DOI: 10.1046/j.1471-0528.2003.00043.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Affiliation(s)
- Howard Minkoff
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA
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65
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Vangen S, Stray-Pedersen B, Skrondal A, Magnus P, Stoltenberg C. High risk of cesarean section among ethnic Filipinos: an effect of the paternal contribution to birthweight? Acta Obstet Gynecol Scand 2003; 82:192-3. [PMID: 12648185 DOI: 10.1034/j.1600-0412.2003.00075.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Siri Vangen
- Department of Obstetrics and Gynecology, the National Hospital, Oslo, Norway.
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66
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Roosmalen J, Rosendaal F. There is still room for disagreement about vaginal delivery of breech infants at term. BJOG 2002. [DOI: 10.1111/j.1471-0528.2002.01005.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- Susan Bewley
- Women's Health Services, Guy's and St Thomas' Hospitals Trust, London, UK
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Scheepers HC, de Jong PA, Essed GG, Kanhai HH. Fetal and maternal energy metabolism during labor in relation to the available caloric substrate. J Perinat Med 2002; 29:457-64. [PMID: 11776675 DOI: 10.1515/jpm.2001.064] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To discuss maternal and fetal metabolic events during labor and the possible role of glucose administration. RESULTS The oxidative pathway covers the largest part of the energy demand of labor, although in the second stage or, in polysystolic labor, the non-oxidative pathway becomes important as well. Glucose is the main maternal energy source, but the rise in ketobodies, even during normal labor, suggests a relative shortage. In the first stage of labor, a combination of a respiratory alkalosis, and to a lesser extent, a metabolic acidosis, result in a rise in the maternal pH. In the second stage of labor, the maternal pH decreases due to an increasing metabolic acidosis. Glucose is also the main fetal energetic fuel. In fetal hypoxia, lactate is produced, which in most cases is transferred to the maternal circulation. High maternal lactate concentrations, however, may interfere with this process. Furthermore, fetal hyperglycemia may lead to an increased fetal lactate production. CONCLUSIONS Maternal hyperglycemia, may lead to an increase in maternal and fetal lactate production resulting in metabolic acidosis. Unlike high dosage intravenous glucose administration, it is not likely that oral intake of carbohydrates leads to maternal and fetal hyperglycemia and subsequently to metabolic acidosis, but studies are rare.
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Affiliation(s)
- H C Scheepers
- Department of Gynecology and Obstetrics, Leyenburg Hospital, The Hague, The Netherlands.
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69
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Scheepers HCJ, Thans MCJ, de Jong PA, Essed GGM, Le Cessie S, Kanhai HHH. A double-blind, randomised, placebo controlled study on the influence of carbohydrate solution intake during labour. BJOG 2002; 109:178-81. [PMID: 11911101 DOI: 10.1111/j.1471-0528.2002.t01-1-01062.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Although there has been much debate on whether women should be allowed to eat and drink during labour, little scientific data are available on the effects of caloric intake on the course of labour. DESIGN Double-blind, randomised, placebo controlled. SETTING Leyenburg Hospital, The Hague, The Netherlands. POPULATION Two hundred and one consecutive nulliparous women, pregnant of a single fetus in cephalic presentation. METHODS All women were included in early labour (2cm-4cm of cervical dilatation) and were allowed to drink at will. MAIN OUTCOME MEASURES The duration of labour, the need for augmentation and pain medication and the incidence of abdominal and vaginal instrumental deliveries. RESULTS Drinking of carbohydrate solutions was well tolerated, but did not show any beneficial effects regarding labour outcome when compared with the control group. In the carbohydrate group, a higher caesarean section rate was observed (RR 2.9, 95% CI 1.29-6.54). CONCLUSIONS Women in the carbohydrate group had worse labour outcome. It is unclear whether a statistical coincidence, a negative effect of the carbohydrate intake or an incorrect carbohydrate intake strategy is responsible for these results. Further studies are necessary before any definite conclusion can be drawn.
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Abstract
Prominent American and British obstetricians have been advocating for performing more Cesareans. They argue that Cesarean section is as safe or nearly as safe as vaginal birth, eliminates pelvic floor damage and the consequent symptoms caused by vaginal birth, is safer for the infant, and is desired by many women; however, abundant evidence in the medical literature refutes the validity of those claims.
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71
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Scheepers HC, Thans MC, de Jong PA, Essed GG, Le Cessie S, Kanhai HH. Eating and drinking in labor: the influence of caregiver advice on women's behavior. Birth 2001; 28:119-23. [PMID: 11380383 DOI: 10.1046/j.1523-536x.2001.00119.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although there is much debate about eating and drinking during labor, little scientific data about its influence on the course of labor exist. In The Netherlands, most midwives and obstetricians allow women to eat and drink during normal labor. The objective of this study was to examine whether or not women were actively advised to eat and drink and if this advice affected eating and drinking behavior. METHODS A randomly selected group of midwives and obstetricians from across The Netherlands identified 211 consecutive nulliparous women to participate in the study. In a questionnaire with open-ended questions, women were asked after their delivery whether or not they were advised about eating and drinking during labor, and if so, about the nature of this advice and what they had consumed. Data were analyzed at the Leyenburg Hospital in The Hague. RESULTS Sixty-six percent of the women were not given advice about eating and drinking during labor. Women who were given advice usually followed it. In the total group, 37 percent of the women had intake other than water and of these, 75 percent ate solid food. After adjusting for other prognostic factors, the incidence of an instrumental delivery due to a nonprogressing second stage was lower in women with caloric intake (13% vs 24%, p = 0.04). CONCLUSION The study design did not enable us to draw conclusions about the cause and effect between caloric intake and labor progress. Scientific data with respect to the giving of evidence-based advice about eating and drinking during labor are lacking. Should such advice become available, women are likely to follow it.
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Affiliation(s)
- H C Scheepers
- Leyenburg Hospital, PO Box 40551, 2504 LN The Hague, The Netherlands
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72
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Faucher P, Batallan A, Bastian H, Matheron S, Morau G, Madelenat P, Benifla JL. [Management of pregnant women infected with HIV at Bichat Hospital between 1990 and 1998: analysis of 202 pregnancies]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2001; 29:211-25. [PMID: 11300046 DOI: 10.1016/s1297-9589(00)00076-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe medical and obstetrical prenatal care of pregnant women infected by HIV-1 emphasizing the role of cesarean section. DESIGN A retrospective study of 202 pregnancies followed between 1990 and 1998 in a french hospital in Paris. RESULTS 56.9% of the women were born in subsaharian Africa; 80.2% were infected by sexual intercourse and the seropositivity was discovered during the pregnancy in 51% of the cases. Viral coinfections by hepatitis B virus, hepatitis C virus and Human papillomavirus were found respectively in 14.7%, 16.5% and 13% of the pregnancies. Prematurity occurred in 15% of the deliveries. Efficacy of antiretroviral therapy was confirmed in this study: 5.7% of the children were infected despite the antiretrovial treatment versus 19.3% without treatment (p < 0.03). Prophylactic cesarean section was proposed to the patients since 1994; the morbidity of cesarean was 8.8% (69 cesarean sections). CONCLUSION The policy of the association of prophylactic cesarean section and monotherapy by Zidovudine is validated by recent studies. The extension of prophylatic cesarean section to all the pregnant women infected by HIV is proposed. However the evaluation of the morbidity of the cesarean section in HIV infected women needs a prospective case-control study.
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Affiliation(s)
- P Faucher
- Service de gynécologie obstétrique, hôpital Bichat-Claude Bernard, 46, rue Henri-Huchard, 75018 Paris, France.
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Scheepers HC, Essed GG, Brouns F. Aspects of food and fluid intake during labour. Policies of midwives and obstetricians in The Netherlands. Eur J Obstet Gynecol Reprod Biol 1998; 78:37-40. [PMID: 9605447 DOI: 10.1016/s0301-2115(98)00007-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study outlines the current policies on food and fluid intake during labour in The Netherlands and discusses the pro's and con's of food-restriction. STUDY DESIGN 50 midwives and 30 obstetricians were asked about their actual policy on food and fluid-intake during labour. RESULTS A restrictive policy during normal labour is followed by 20% of the midwives and 14% of the obstetricians. About 75% leaves the decision on food and fluid-intake to the women themselves. CONCLUSIONS Despite the non-restrictive policy in The Netherlands, the mortality due to the Mendelson-syndrome is not higher than in countries where a restrictive policy is followed. During normal labour there are no conclusive reasons for food or fluid-restriction. From a metabolic point of view it is hypothesized that the intake of energy-rich substrates may have a positive influence on labour progression. Further study on the subject seems indicated.
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Affiliation(s)
- H C Scheepers
- Department of Gynecology and Obstetrics, Leyenburg Hospital, The Hague, The Netherlands.
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