Reducing cesarean sections at a teaching hospital

Article Abstract:

Since 1964, the rate of cesarean section has quintupled to a point where, in 1988, it was performed for more than 25 percent of all deliveries in the United States. The cesarean section rate is considered too high from several viewpoints, and a report of efforts to lower it in one teaching hospital is presented. The facility, one of 10 regional perinatal centers in Florida, serves an indigent population, with obstetric patients attended by resident physicians and nurse-midwives. In 1987, new guidelines regarding cesarean section were introduced by a perinatologist. These allowed women meeting certain criteria who had previous cesareans to consider a trial of labor in subsequent pregnancies. This trial of labor included continuous monitoring of the fetal heart rate. New guidelines to determine when cesarean section should be performed were also established; difficult labor, fetal distress, and fetal malposition were paramount considerations. Results showed a decrease in the cesarean rate between 1986 and 1989 from 27.5 percent of all deliveries to 10.5 percent. First-time cesareans fell from 19.5 percent to 7.2 percent; repeat procedures fell from 8 to 3.3 percent. During the same time, the proportion of patients with previous cesarean deliveries who attempted labor more than doubled, from 32 to 84 percent. This was achieved concomitant with an improvement in the perinatal (earlier than 28 days after birth) mortality from 31.8 to 14.9 infant deaths per 1,000 live births. Neonatal mortality also decreased by more than half. Rates of neonatal complications remained stable. The success of the new program is attributed mainly to the centralized approach used in decision-making during labor and delivery. In many facilities, cesarean rates vary markedly for individual physicians. It appears that standardized approaches are beneficial for reducing cesarean rates. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Evaluation, Statistics, Labor (Obstetrics), Cesarean section

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Randomized trial of two doses of the prostaglandin E(sub)1 analog misoprostol for labor induction

Article Abstract:

A lower dose of a labor-inducing medication called misoprostol may be safer for the infant even though the higher dose may speed up the delivery process. Labor and delivery statistics were analyzed among 399 women given either 25 micrograms or 50 micrograms of misoprostol to induce labor. Infants born to mothers given the higher dose had more rapid heart beats and a more acidic cord pH than those given the lower dose. Women given the higher dose delivered in 826 minutes compared to 970 minutes in those given the lower dose. More women given one dose of 50 micrograms of misoprostol delivered vaginally than those given one 25 microgram dose.

Methods, Dosage and administration, Labor, Induced (Obstetrics), Induced labor, Misoprostol

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Maternal death caused by midgut volvulus after bariatric surgery

Article Abstract:

A 31-year-old woman in the 25 6/7 weeks of gestation with a history of laparoscopic Roux-en-Y gastric bypass surgery complained about severe abdominal pains. In the following days her condition was unstable and maternal death followed midgut volvulus, perforation and septic shock.

United States, Case studies, Complications and side effects, Intestines, Mothers, Maternal mortality, Intestinal obstruction, Gastric bypass

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