Morbidity among breech infants according to method of delivery

Article Abstract:

There is an increased risk for complications when an infant is delivered feet- or buttocks-first (breech). In an effort to minimize complications of breech delivery, cesarean section is often performed. However, it is unclear whether a cesarean improves the overall maternal and infant outcome of breech deliveries. The risk for complications was determined by evaluating the outcomes of 1,240 single fetuses in the breech position who were delivered vaginally (314 deliveries) or by cesarean (926 deliveries). All fetuses without congenital abnormalities weighing 2.2 pounds (1,000 grams) or more were included in the analysis. Medical records were reviewed up to the fourth year of life to determine the risk for complications and injuries occurring during delivery and complications and neurological damage developing after birth. The relative risks experienced by the vaginally delivered group were estimated for each complication and compared with those of the cesarean-delivered group. There was no increased risk for asphyxia (diminished oxygen supply to the fetus), head injury, newborn seizures, cerebral palsy and developmental delay in when breech infants were delivered vaginally. Although the risk for developmental delay was increased among the vaginally delivered infants, when results were adjusted for confounding factors such as low birth weight, this difference became insignificant. When complications such as head trauma, seizures, cerebral palsy, mental retardation or spasticity were combined, the relative risk for vaginally-delivered breech infants was 0.5, i.e. half that of the other group. When all the adverse outcomes were combined, the overall estimated risk for vaginally-delivered breech deliveries was 0.9. It is concluded that carefully selected breech presentation pregnancies can be delivered vaginally without increasing the risk for complications. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Statistics, Breech delivery, Breech birth

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The significance of bleeding patterns in Norplant implant users

Article Abstract:

Norplant is a long-acting effective contraceptive method in which thin tubes containing a drug, levonorgestrel, are implanted under a woman's skin. The drug is released at a constant rate over a five-year period. Norplant is associated with a pregnancy rate of 0.4 per 100 woman-years, a lower failure rate than the oral contraceptive or intrauterine device. Changes in women's normal bleeding patterns (lack of bleeding or irregular periods) are the most common side effect of Norplant. To better characterize these effects, 234 Norplant users were studied over a 5-year period. Records of bleeding patterns were kept by 215 women in the first year, and the number of women who maintained records decreased to 20 percent in the fifth year. The percentage of women reporting regular bleeding patterns increased from 27 percent in the first year to 63 percent in the fifth year. Irregular bleeding was noted by 66 percent of the women during the first year, and by 38 percent during the fifth year. Amenorrhea (failure to bleed) decreased from seven percent to zero percent during the study period. Ten pregnancies occurred, eight in women with regular bleeding patterns in the six months prior to pregnancy. The greater risk was due to more frequent ovulatory cycles. Three of the pregnancies were ectopic (implanted outside the uterus). All but one of the Norplant failures occurred in women given implants made of a dense type of tubing, which resulted in lower blood levels of levonorgestrel; current implants are now made with different tubing. Physicians should suspect pregnancy in women using Norplant who have regular cycles and who have missed a period. Ectopic pregnancy, a potentially serious condition, should be ruled out as soon as possible in users of these contraceptives. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Product/Service Evaluation, Causes of, Physiological aspects, Uterine bleeding, Uterine hemorrhage, Norplant (Contraceptive), Contraceptive drug implants

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