[Breech presentation: infant versus mother]. / Stuitligging: kind versus moeder.

The increase in incidence of Caesarean sections in the Netherlands has resulted in improved infant outcomes in breech infants. About two hundred extra caesarean sections are needed to 'save' one baby. However, maternal outcome is impaired, with increased risks of uterine rupture, placenta praevia and placenta increta in subsequent pregnancies. Data from the Netherlands indicate that for every infant saved by a caesarean section, one woman will experience a uterine rupture during a subsequent pregnancy. These factors have to be taken into account when counselling women. Future reproductive considerations and the motivation of the woman and the gynaecologist for a vaginal breech delivery should be discussed during counselling.

Dinoprostone priming of the cervix prior to termination of midgestation pregnancy with sulprostone.

OBJECTIVE: To determine if cervical ripening with the prostaglandin E2 analogue dinoprostone effectively shortens the induction-to-delivery interval in midpregnancy terminations with sulprostone. STUDY DESIGN: We retrospectively studied 100 women admitted for pregnancy termination at midgestation because of fetal anomalies between September 1989 and January 1993. Three regimens were used: 27 women received intramuscular sulprostone only, 29 women received intravenous sulprostone only, and 44 women received intravenous sulprostone after cervical priming with dinoprostone. Wilcoxon's rank sum test was used for statistical analysis. RESULTS: Dinoprostone priming did not significantly reduce the induction-to-delivery interval in either parous or nulliparous women. However, when divided into first and subsequent pregnancies, we found that primigravidae, but not multigravidae, had an induction-to-delivery interval that was significantly shorter by approximately 10.5 h when pretreated with dinoprostone. CONCLUSION: Dinoprostone priming of the cervix prior to termination of midgestation pregnancy with sulprostone (Nalador) effectively shortens the induction-to-delivery interval in women in their first pregnancy.

PIP: The authors retrospectively studied 100 women admitted for pregnancy termination at midgestation because of fetal anomalies between September 1989 and January 1993 to determine if cervical ripening with the prostaglandin E2 analog dinoprostone shortens the induction-to-delivery interval in midpregnancy terminations with sulprostone. 27 women received intramuscular sulprostone only, 29 women received intravenous sulprostone only, and 44 women received intravenous sulprostone after cervical priming with dinoprostone. Dinoprostone priming failed to significantly reduce the induction-to-delivery interval in neither parous nor nulliparous women. Dividing into first and subsequent pregnancies, however, it was found that primigravidae and not multigravidae women had an induction-to-delivery interval which was significantly shorter by approximately 10.5 hours when pretreated with dinoprostone. Dinoprostone priming of the cervix prior to termination of midgestation pregnancy with sulprostone (Nalador) therefore effectively shortens the induction-to-delivery interval in women during their first pregnancy.

Adult patients with spina bifida cystica: genetic counselling, pregnancy and delivery.

With more aggressive surgical management, patients born with spina bifida may now reach adulthood and achieve pregnancies. Any female patient with spina bifida is strongly recommended to have preconceptional genetic counselling. The risk for parents with spina bifida of having affected offspring (approx. 4%) is considerably increased compared with the general population (0.1-0.3%). This risk may be lowered when periconceptional folic acid supplements are given. In pregnancy, special care is needed in the management of urological, obstetric, neurological and anaesthetic problems. Urological complications like neurogenic bladder, incontinence, chronic infection, increased chance of developing bladder carcinoma and impaired renal function are common in the spina bifida patient. In case of urinary diversion, obstruction may complicate the pregnancy. The incidence of premature labour is increased. Clinical assessment of the pelvis is necessary because of a possibly contracted pelvis. If the head engages normally, vaginal delivery should be allowed if possible. Caesarean section should be performed for obstetric reasons only. Cerebrospinal fluid shunts may give neurological problems during pregnancy. In most cases reported, symptoms improved spontaneously after delivery. In case of a shunt, vaginal delivery is preferable, pushing during second stage not contra-indicated, and in case of caesarean section, prophylactic antibiotics and thorough irrigation of the peritoneal cavity are indicated.

Metabolism and transport of maternal serine by the ovine placenta: glycine production and absence of serine transport into the fetus.

The present study compares the transplacental transport of L-[l-13C]serine and L-[l-13C]leucine in sheep. An in vivo preparation using twin gestations was set up such that the arterial circulation to one uterine horn, including its placenta and fetus, was infused with tracer serine and leucine while the umbilical circulations of both fetuses were sampled. Uterine and umbilical blood flows were measured in each horn. Plasma serine enrichments were 14.6 +/- 2.7% and 4.3 +/- 1.6% in the uterine veins draining the experimental and control horns, respectively. Fetal plasma leucine enrichments in the umbilical veins were 50 and 55% of the uterine venous enrichments in the control and experimental fetuses, respectively. By contrast, during 280 min of infusion, there was no detectable serine enrichment in either fetal circulation. However, significant plasma glycine enrichment was present in the fetal circulation of the experimental horn and venous glycine enrichments in the experimental horn were significantly greater than arterial glycine enrichments for both the umbilical (p < 0.02) and uterine (p < 0.001) circulations. We conclude that under conditions in which leucine transport is easily demonstrable there is no significant transplacental transport of maternal serine and that maternal plasma serine is used within the uteroplacental tissues for producing glycine, some of which is delivered into the fetal circulation.