Gary R. Cohen

The effect of intrapartum epidural analgesia on nulliparous labor: A randomized, controlled, prospective trial

OBJECTIVE Our purpose was to determine the effect of epidural analgesia on nulliparous labor and delivery. STUDY DESIGN Normal term nulliparous women in early spontaneous labor were randomized to receive either narcotic or epidural analgesia. RESULTS When compared with the group receiving narcotic analgesia (n = 45), the group receiving epidural analgesia (n = 48) had a significant prolongation in the first and second stages of labor, an increased requirement for oxytocin augmentation, and a significant slowing in the rate of cervical dilatation. Epidural analgesia was associated with a significant increase in malposition (4.4% vs 18.8%, p < 0.05). Cesarean delivery occurred more frequently in the epidural group (2.2% vs 25%, p < 0.05), primarily related to an increase in cesarean section for dystocia (2.2% vs 16.7%, p < 0.05). CONCLUSIONS In a randomized, controlled, prospective trial epidural analgesia resulted in a significant prolongation in the first and second stages of labor and a significant increase in the frequency of cesarean delivery, primarily related to dystocia.

Complications of Laparoscopic Sterilization: Comparison of 2 Methods

A retrospective study of 5346 cases of laparoscopic sterilization with special reference to early and late complications was undertaken. In the 6-year period from 1972 to 1978, 846 patients were sterilized by the elasticized silicone-ring technique and 4500 patients were sterilized by the electrocautery method. The electrocautery method was complicated by electrical burns in 13 cases (0.29%); 3 of these patients required bowel resections. Mechanical complications occurred in 1.6% of the Silastic-ring cases, but none of the patients required additional surgery. The Silastic-ring patients had greater postoperative abdominal pain than the electrocautery patients, but it usually abated within 48 hours. There were 15 cases of postoperative pelvic infection in the electrocautery group, and none in the Silastic-ring group. Bleeding from the mesosalpinx occurred in both groups and occurred more often with coincident suction D&C. Technical failure to perform the sterilization procedure was principally related to previous abdominal surgery. A substantial number of patients complained of menstrual irregularity and/or dysmenorrhea following these sterilization procedures. The majority of women reported unchanged or improved sexual relations. Improvement in sexual relations was reported by significantly more patients in the Silastic-ring group than in the electrocautery group.

The risk of pulmonary edema and colloid osmotic pressure changes during magnesium sulfate infusion

OBJECTIVES The purposes of this study were to evaluate the effect of magnesium sulfate therapy on colloid osmotic pressure and to determine whether changes in colloid osmotic pressure increased the risk of pulmonary edema. STUDY DESIGN During a 1-year time period 294 patients received parenteral magnesium sulfate for the treatment of preterm labor or preeclampsia. Both changes in colloid osmotic pressure and magnesium sulfate values and their relationship to clinical outcome parameters were analyzed. RESULTS Serum magnesium levels were similar for both patients with preeclampsia and patients with preterm labor. Pulmonary edema developed in only four patients, all of whom had preeclampsia and low colloid osmotic pressure values. CONCLUSIONS This study demonstrated that parenteral magnesium sulfate therapy does not cause significant changes in colloid osmotic pressure values until nearly 48 hours of continuous therapy.

Epidural analgesia in labor and cesarean delivery for dystocia

Published studies assessing the effect of epidural analgesia in nulliparous labor on the frequency of cesarean delivery for dystocia are reviewed. There are at least four retrospective studies and two prospective studies that suggest that epidural analgesia may increase the risk of cesarean delivery for dystocia in first labors. The potential for epidural to increase the frequency of cesarean delivery for dystocia is likely influenced by multiple variables including parity, cervical dilatation at epidural placement, technique of epidural placement, management of epidural during labor, and the obstetrical management of labor after placement of epidural analgesia. Two studies suggest that delaying placement of the epidural until 5 cm of cervical dilatation or greater may reduce the risk of cesarean birth. Epidural is safe and may be a superior labor analgesic when compared with narcotics. However, patients should be informed that epidural analgesia may increase the risk of cesarean birth in first labors.

Antenata Diagnosis of Body Stalk Anomaly

A case of body stalk anomaly in a dizygotic twin gestation, in which only one twin was affected, is discussed. Clinical and sonographic findings are presented.

Fetal Ovarian Cyst and Subsequent Torsion Prenatal Sonographic Changes and Progression

This case illustrates the sonographic changes seen in and the progression of a fetal adnexal cyst with torsion.

Antenatal Diagnosis of Absent Pulmonary Valve Syndrome

With the widespread use of antenatal ultrasonography and the rising popularity of fetal echocardiography, complex cardiac anomalies are being diagnosed more frequently during the antenatal period. This is a case report of an absent pulmonary valve syndrome in a fetus with an intact ventricular septum and a patent ductus arteriosus. This combination of cardiac defects is very rare.

Antenatal Diagnosis of Infantile Polycystic Kidney Disease in a Twin Gestation

Infantile polycystic kidney disease is an autosomal recessive disorder characterized by bilateral and symmetric enlargement of the kidneys. The renal parenchyma is characteristically replaced by cystic dilatation of the collecting tubules.1 This case report discusses the sonographic criteria used to antenatally diagnose infantile polycystic kidney disease.