ABSTRACT
OBJECTIVES: Our study was designed to evaluate the effects of routine elective amniotomy on the frequency and severity of abnormal fetal heart rate patterns and on the course of labor and the need for oxytocin augmentation. STUDY DESIGN: A randomized, controlled trial was conducted at term in patients in active labor who were randomly selected to undergo elective amniotomy (amniotomy group) or left intact with amniotomy reserved for specific indications (intact group). RESULTS: Four hundred fifty-nine patients were studied (235 in the amniotomy group vs 224 in the intact group). Average cervical dilatation at rupture was 5.5 cm in the amniotomy group and 8.1 cm in the intact group. Analysis of fetal heart rate revealed more mild and moderate variable decelerations in the active phase of labor in the amniotomy group but no difference in the frequency of more severe decelerations or operative deliveries. In the intact group the need for oxytocin was twice as common (76 in the intact group vs 36 in the amniotomy group, p = 0.000005), and the active phase of labor was considerably longer (5 hours 56 minutes in the intact group vs 4 hours 35 minutes in the amniotomy group). Neonatal outcome was similar in the two groups. CONCLUSIONS: Elective amniotomy appears to increase the likelihood of umbilical cord compression in the active phase of labor and results in more mild and moderate variable decelerations, but it does not result in more severe abnormal fetal heart rate patterns or more operative intervention. Elective amniotomy does, however, shorten the active phase of labor and decreases the need for oxytocin augmentation.
Subject(s)
Amnion/surgery , Heart Rate, Fetal , Labor, Obstetric , Female , Humans , Pregnancy , Pregnancy Outcome , Prospective Studies , Time FactorsSubject(s)
Infant, Low Birth Weight , Infant, Premature , Female , Fetal Growth Retardation , Humans , Infant, Newborn , PregnancyABSTRACT
The antepartum death of a fetus in a multiple gestation can be associated with mortality or major morbidity in the survivor. To evaluate the risk after death of one fetus, all cases of multiple gestation complicated by a fetal death were evaluated. There were 17 multiple gestations in which one fetus died, with 19 surviving infants. The incidence of fetal death in multiple gestation was 2.6%. There was one case of major morbidity in a monochorionic gestation.
Subject(s)
Fetal Death , Pregnancy, Multiple , Adult , Female , Fetal Death/diagnosis , Follow-Up Studies , Humans , Infant, Newborn , Male , Pregnancy , Pregnancy Trimester, Third , Prenatal Diagnosis , Risk , Triplets , TwinsABSTRACT
Urethral prolapse in the premenarcheal female manifests as vaginal bleeding and a periurethral mass. In the past, the recommended management was surgical excision or cautery. However, conservative management has been shown to have excellent results. Five premenarcheal patients with urethral prolapse treated by conservative therapy are presented. Treatment regimen consisted of local hygiene with sitz baths, hexachlorophene soap, topical providone iodine and estrogen cream. There were no complications or recurrences. Surgery is not warranted in the treatment of urethral prolapse in the premenarcheal female. Medical management is equally effective and less traumatic in this age group.
Subject(s)
Urethral Diseases/therapy , Child , Child, Preschool , Female , Humans , ProlapseABSTRACT
Category Test performance of 41 bright aged normals was compared with the performance of 40 young normals and a group of 43 patients with suspected neurological dysfunction. The aged normals were not only as deficient as the neurologic patients but showed a similar pattern of deficits on Category subtests. The extreme difficulty experienced by aged normals and patients on Subtests III and IV was explained as a function of task complexity rather than of conceptual difficulty of conceptual principles and task complexity in a variety of impaired groups was suggested.
