Fetal gastroschisis and omphalocele: is cesarean section the best mode of delivery?

Article Abstract:

Improvements in prenatal diagnostic methods have allowed for better management of many birth defects. For example, the advisability of cesarean delivery can be evaluated for infants with gastroschisis or omphalocele (defects of the abdominal wall, often resulting in abnormal location of the structures in the abdomen). To this end, a review was carried out of the medical records of all infants treated for either condition who met certain criteria (56 infants) at three medical institutions during a six-year period. The factors analyzed in order to compare cesarean delivery with vaginal delivery included prenatal diagnosis; gestational age at delivery; method of delivery; birth weight; delay in repair of the defect after birth; length of stay in the hospital; Apgar scores (a measure of physical function in the newborn); and mortality. No differences were found between infants delivered vaginally (23) and those delivered via cesarean section (33) in terms of gestational age, birth weight, five-minute Apgar score, length of stay in hospital, or delay in repair of the defect. Nor were there differences in complication or death rates. Patients delivered by cesarean section, however, had a higher frequency of prenatal diagnosis of the defect; in fact, the diagnosis was one of the reasons the operation was elected. Results from other studies that suggested vaginal delivery placed infants with such defects at higher risk may have been affected by the need to transport the infants to more fully-equipped facilities (level III institutions), such as the ones studied here. In cases in which optimal perinatal, neonatal, and pediatric surgical care are readily available, cesarean delivery appears to offer no advantage for infants with gastroschisis and omphalocele. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Birth defects, Hernia, Navel, Umbilical hernia

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Pulmonary injury associated with antepartum pyelonephritis: can patients at risk be identified?

Article Abstract:

An investigation was performed of medical records from two medical centers to determine whether pregnant patients with pyelonephritis (kidney infection) who are also at risk for developing pulmonary (lung) injury can be identified prior to the onset of respiratory symptoms. In 130 cases of antepartum (before delivery) pyelonephritis, 11 cases of pulmonary injury (labored, rapid breathing, need for oxygen, and abnormal chest X-rays) occurred, all of which developed within 72 hours of admission to the hospital. Pulmonary injury occurred after 20 weeks' gestation in all cases. Heart rate of 110 or more beats per minute and a maximum temperature of 103 degrees Fahrenheit or higher were highly predictive of the development of respiratory symptoms; these events typically occurred 12 to 24 hours before the onset of the other symptoms. Increased breathing rates (more than 28 breaths per minute) characterized the patients with pulmonary injury, but these abnormalities were not apparent prior to the onset of other signs of the disorder. Pulmonary injury was also associated with reduced urinary output (increased fluid retention), the use of tocolytic agents (drugs used to inhibit uterine contractions), and with treatment with the antibiotic ampicillin, although the association with ampicillin was not found to be significant. A review of the medical literature concerning pulmonary injury in pregnant patients with pyelonephritis is presented. The results suggest that such patients should be monitored for fluid retention, and tocolytic drugs should only be administered if absolutely necessary. Warning signs of high fever and rapid heartbeat should be heeded. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Risk factors, Physiological aspects, Development and progression, Lung diseases, Pregnancy, Complications of, Pregnancy complications, Pyelonephritis

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A "bloodless cesarean section" and perinatal transmission of the human immunodeficiency virus

Article Abstract:

A bloodless cesarean section appears to substantially lower the risk of HIV transmission to the baby. During a bloodless cesarean, all surgical incisions are cauterized to stop the bleeding. This minimizes the chance that the baby will be exposed to the mother's blood. Researchers compared this technique to vaginal delivery or a regular cesarean in 108 pregnant women. Six percent of infants delivered by bloodless cesarean became infected compared to 20% of the infants delivered by other means. This represents a 72% reduction in risk, which is comparable to zidovudine use.

Methods, Prevention, HIV (Viruses), HIV, HIV infection in children, Pediatric HIV infections, Disease transmission

Similar abstracts:

• Abstracts: Gastroschisis and omphalocele: does either antenatal diagnosis or route of delivery make a difference in perinatal outcome?
• Abstracts: Bacterial vaginosis as a risk factor for post-cesarean endometritis. Amoxicillin treatment of bacterial vaginosis during pregnancy
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