Routine use of external cephalic version in three hospitals.

BACKGROUND: External cephalic version has been advocated as a safe alternative to vaginal breech delivery or cesarean birth. The purpose of this study was to determine the efficacy of routine use of external cephalic version at 36 weeks or more of gestation in three different levels of hospitals. METHODS: External cephalic version was performed on 923 women with a single breech fetus at three hospitals in Italy. The procedure was attempted with a tocolytic agent for uterine relaxation and with no maternal analgesia. The version technique adopted was the "forward roll." RESULTS: Version was successfully performed on 579 fetuses (62.7%); each hospital had a similar success rate, and 56.9 percent of the women delivered vaginally. The procedure was more successful in multiparas and in women with an incomplete type of breech, polyhydramnios, and posterior localization of the placenta. Vaginal bleeding was experienced by 14 women; eight cesarean sections were performed for suspected abruptio placentae, confirmed in four cases. Two cephalic-turned fetuses experienced an episode of persistent bradycardia and were turned again to breech; in five cases a nonstress test recorded after the version showed repeated variable decelerations and in one case a cesarean section was performed. Neonatal outcomes were good in 922 infants. A fracture of the femur attributable to the version was observed in one newborn. CONCLUSIONS: External cephalic version is effective in reducing the number of cesarean deliveries in term breech infants in different obstetric settings, with no major neonatal adverse outcomes.

Cervical priming and labor induction by multiple doses of intracervical prostaglandin E2 gel.

One hundred seventy-two term pregnant women with medical or obstetric conditions requiring induction of labor were treated with intracervical administration of 0.5 mg prostaglandin E2 in tylose gel. Multiple administrations were necessary in 42 cases (24.4%), two administrations in 31 cases (18.0%) and three administrations in 11 cases (6.4%). Intracervical administration of PGE2 tylose gel (0.5 mg dose) is useful to prime the cervix, induce labor, and significantly modify Bishop score.

[Obstetric/neonatological integration and care of healthy newborn infants]. / L'integrazione ostetrico/neonatologica e l'assistenza al neonato sano.

We report how we changed the model of the organization and the assistance in our Department of healthy newborns (2200-2400/years). After we have realized that mothers were not satisfied of the rules of the hospital and personnel was not satisfied of the job, we decided to begin a process of analysis and review of the procedures on full term newborn. During this process we found out that the most important thing was to have clear in mind the problems and the needs of the mother and the baby, and not those of nurses and doctors. A similar process took place in the Department of Obstetrics. In this way we, Obstetrics and Neonatologist together, began to offer a more human approach to birth, and rooming-in began. We stopped to attend every normal delivery, to separate immediately mother and baby, to feed the baby at fixed time, to give him supplementations. We tried to have with the mother a better relationship, visiting the baby in presence of the mother an receiving grom Obstetrics as soon as possible every information about pregnancy. We realized that this was possible only if the Neonatologist and the Obstetric were of the same opinion about a more human approach to birth. We stress this point, well aware that it's impossible to reach this goal unless everybody in any way involved in birth work in great harmony with all the others. A further result of this "new" way of working has been the program of early discharge: if desired, and whenever possible, the mother and the baby go home 48-72 hours after delivery. We report here preliminary data.