W. Gruber

Epidural Anaesthesia in Labour: Influence on Surgical Delivery Rates, Intrapartum Fever and Blood Loss

We retrospectively analyzed 7,317 fully documented deliveries to assess the effect of epidural anaesthesia (EA) on surgical delivery rates, on the incidence of intrapartum fever and on peripartal blood loss. 1,056 (14.4%) had EA and 6,261 (85.6%) had no or other analgesia. The use of EA was associated with a decreased spontaneous delivery rate (50.0 vs. 79.2%), increased forceps delivery rate (30.7 vs. 4.0%) and increased vacuum extraction rate (3.5 vs. 0.7%). The caesarean section rate was not significantly changed in patients with EA (14.4 vs. 13.0%). Fever greater than 38 degrees C during labour and intrapartum haemorrhage exceeding 500 ml were associated with the use of EA.

Breech infants : vaginal or cesarean delivery ?

Background. This study was undertaken to determine whether planned vaginal or elective cesarean delivery is better for singleton term breech infants and their mothers.

Management of supraventricular tachycardia during hexoprenaline therapy for preterm labour : benefit of cardioselective beta blockade ?

A 29-year-old woman presented with preterm labour at 32 weeks of gestation. Tocolytic treatment was started with intravenous hexoprenaline. Twenty-four hours after initiation of treatment, the patient developed supraventricular tachycardia, resistant to digoxin and verapamil. Medical treatment with metoprolol finally restored sinus rhythm. We observed no adverse effects on the fetal heart rate nor on the umbilical cord blood flow.

[Rheography in pregnancy--a noninvasive method of early detection of placental insufficiency].

UNLABELLED Intrauterine growth retardation (IUGR) is a major obstetrical problem. About 20% of stillbirths are growth retarded. Increased vascular resistance is suspected to cause preeclampsia and IUGR. Our study used rheography 1. to show the change of vascular resistance during pregnancy, 2. to scrutinize any connections between maternal peripheral perfusion and the development of IUGR. For the first part of the study 168 healthy pregnant women of different gestational age were studied to examine the physiological conditions of peripheral haemoperfusion. In the second part we employed rheography in 177 cases of last trimester pregnancies. The parameter used was the rheographic quotient (RQ), defined as the volume of the pulse wave. To compare RQ values of patients with different heart frequencies these values were multiplied by the pulse rate per second (relative pulse volume, Pr). RESULTS 1. RQ values remained nearly constant during the first trimester (0.7%). During the second trimester a noticeable increase in RQ was found, leading to RQ values of about 1.3% in the third trimester. From the 28th week until delivery no further significant changes occurred. Using Pr, our data showed increased values from the 16th gestational week onwards. Early-stage values (0.8%/sec) increased more than twofold (1.7%/sec) until delivery. 2. Out of 177 pregnancies, 26 led to newborn below the 10th percentile (mean = 2230 g). Rheographic data showed highly significant differences between the AGA and SGA groups: the mean RQ values of the AGA sample was 1.2 +/- 0.4%, of the SGA sample 0.6 +/- 0.35% (p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)