ABSTRACT
BACKGROUND: Angular placentation may be a cause of retained placenta and may require hysterotomy. CASE: A 33-year-old woman with a prior cesarean section underwent an uncomplicated vaginal delivery, had a retained placenta with postpartum hemorrhage and required hysterotomy because the placenta was inaccessible due to its angular location. CONCLUSION: Antepartum ultrasound diagnosis may be possible in some cases of angular placentation.
Subject(s)
Hysterotomy , Placenta, Retained/surgery , Placenta/anatomy & histology , Adult , Female , Humans , Pregnancy , Vaginal Birth after CesareanABSTRACT
We attempted to determine the etiology and clinical significance of unexpected acidemia in otherwise healthy neonates. A retrospective review was performed of the umbilical cord pH in 11,203 deliveries performed at Denver General Hospital, with an umbilical artery pH < 7.13 (3 SD below the mean) selected as the definition of neonatal acidemia. Among those neonates weighing > 2.5 kg with umbilical artery pH < 7.13, 76 were expected to have acidemia because of signs of severe fetal distress. There were 59 neonates with unexpected acidemia, having umbilical artery pH < 7.13, with no definite etiology found. In 96% of cases of unexpected acidemia, the neonates were discharged with their mothers, while 84% of the expected cases went home with their mothers. In excess of $880,000 was spent performing routine umbilical blood pH determinations without any apparent clinical or legal benefit. Routine umbilical blood gas studies on all neonates does not appear to be indicated for either clinical or legal reasons.
Subject(s)
Acidosis/blood , Fetal Blood/chemistry , Acidosis/diagnosis , Blood Gas Analysis , Diagnostic Tests, Routine/economics , Humans , Hydrogen-Ion Concentration , Infant, Newborn , Retrospective Studies , Umbilical Arteries/physiologyABSTRACT
Intrapartum electronic fetal heart rate monitoring of the high-risk obstetric patient is thought to improve the perinatal outcome. A prospective randomized study of 483 high-risk obstetric patients in labor was carried out comparing the effectiveness of electronic fetal monitoring with auscultation of fetal heart tones. The infant outcome was measured by neonatal death, Apgar scores, cord blood gases, and neonatal nursery morbidity. There were no differences in the infant outcomes in any measured category between the electronically monitored group and the auscultated group. The cesarean section rate was markedly increased in the monitored group (16.5 vs. 6.8 per cent in the auscultated patients). The presumptive benefits of electronic fetal monitoring for improving fetal outcome were not found in this study.
