ABSTRACT
OBJECTIVES: To assess the proportion of breech presentations diagnosed in labour and to compare their outcomes with those diagnosed prior to the onset of labour. DESIGN: Retrospective casenote review. SETTING: Mill Road Maternity Hospital, a teaching hospital in central Liverpool. SUBJECTS: Three hundred and five singleton breech presentations delivered in the hospital between January 1988 and July 1991; 226 cases prior to the onset of labour and 79 cases diagnosed for the first time in labour. MAIN OUTCOME MEASURES: Rates of vaginal delivery and caesarean section, birthweight, short term morbidity as assessed by trauma, signs of cerebral irritation and admission to the newborn intensive care unit (NBICU), and Apgar scores. RESULTS: Breech presentations diagnosed for the first time in labour were more likely to deliver vaginally than those assessed and allowed to go into labour (odds ratio 1:68 95% CI 1.0-3.0). This difference was not due to demographic variables or differences in birthweight. There was no short term morbidity attributable to vaginal breech delivery. CONCLUSION: A significant number of breech presentations are not detected until labour despite rigorous antenatal surveillance. Our results show that undiagnosed breeches may not be important as they are more likely to deliver vaginally, with no excess morbidity or mortality, compared to diagnosed breeches in labour, carefully assessed for vaginal delivery. There are, therefore, no grounds for delivering all undiagnosed breeches by caesarean section.
Subject(s)
Breech Presentation , Delivery, Obstetric/methods , Adolescent , Adult , Birth Weight , Cesarean Section , Female , Gestational Age , Humans , Parity , Pregnancy , Pregnancy Outcome , Prenatal Diagnosis , Retrospective StudiesSubject(s)
Gastrointestinal Diseases/therapy , Pregnancy Complications/therapy , Bacterial Infections/drug therapy , Celiac Disease/therapy , Colitis/therapy , Colonic Diseases, Functional/therapy , Constipation/therapy , Crohn Disease/therapy , Dysentery, Amebic/drug therapy , Female , Heartburn/therapy , Hemorrhoids/therapy , Humans , Nausea/therapy , Peptic Ulcer/therapy , Pregnancy , Pregnancy Complications, Infectious/drug therapy , Vomiting/therapyABSTRACT
A randomised crossover trial was performed in 55 pregnant women who complained of heartburn to see whether alkali or acid treatment alleviated it. Each woman was given a week's treatment with an acid mixture, an alkali mixture, and a placebo in randomised order. Both acid and alkali mixtures were better than placebo, but there was no significant difference between the acid and alkali treatments. Together with the inconsistent reports of some patients, these findings suggest that both acid reflux and bile regurgitation may cause heartburn in pregnant women and that other factors may also play a part. Because the cause of heartburn may be difficult to determine, treatment should be empirical. If the patient does not respond to seven days' acid treatment an alkali mixture should be prescribed; there is a 98% chance that one of these treatments will relieve symptoms.
Subject(s)
Bicarbonates/therapeutic use , Heartburn/drug therapy , Hydrochloric Acid/therapeutic use , Pregnancy Complications/drug therapy , Clinical Trials as Topic , Double-Blind Method , Drug Combinations , Female , Humans , PregnancyABSTRACT
Among 1954 pregnant women who booked before the end of the 14th week of gestation the uterus was retroverted in 220 (11.2%). The incidence of bleeding in early pregnancy and spontaneous abortion was significantly higher in the retroverted group. Only three patients (1.4%) with a retroverted gravid uterus developed acute retention of urine. Patients with retroverted uteri did not have a higher incidence of previous infertility, nor any increase in the incidence of common obstetric abnormalities.
