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A Cesarean delivery may be critical to the health and wellbeing of a newborn. The time required to extract an infant from a hostile in utero environment is a frequent issue in medical negligence cases. The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics suggest a time guideline of 30 minutes from decision for Cesarean delivery to the beginning (incision) of the procedure. This time frame is based on survey data from hospitals throughout the United States and is not based on clinical outcomes or the pathophysiology of obstetric events. This review focuses on specific Cesarean indications as noted by the specialty groups and analyzes them from an outcome point of view. The authors conclude that specific high-risk factors do indeed warrant delivery in as expedient a fashion as possible; however, compliance with the 30-minute guideline does not necessarily lead to a difference in outcome as far as the neonate is concerned.

Severe trauma to an obstetric patient is truly an injury of double magnitude. While being cognizant of the fetus and its well-being, all expediency must be employed to accomplish a thorough evaluation of the injured patient and allow for the prompt employment of appropriate therapeutic measures. The best key to fetal survival is successful maternal therapy.

We studied 212 patients undergoing emergency cesarean section at an urban hospital. Four techniques of antibiotic prophylaxis were used, including single-dose and triple-dose parenteral therapy, parenteral and lavage therapy, and lavage therapy alone. One agent, mezlocillin, was used for all patients. There was no significant difference in surgically related infectious morbidity among the groups. This antibiotic proved efficacious when related to historical controls, and was the most economical of the modalities of administration studied.

In the present research circular sheets of rubber or soft fetal membrane tissue are inflated within the confines of a cylindrical tube under hydrostatic pressure. The resulting deformations, which are surfaces of revolution, are described and analyzed. The experimental method of deforming the membranes was chosen so that the deformation profiles would have physiological similarity to the expansions of the chorioamniotic sac during the period of labor in the final stage of pregnancy. The kinematical response of the fetal membranes is shown to be the same as the kinematical response of rubber. The principal extension ratios are calculated for a rubber membrane for several deformation profiles. From data obtained in deflection experiments with rubber an approximate deflection profile is established. Assuming rubber to be a Mooney material, and using the theory of elastic membranes described by Green and Adkins, displacements, slopes, and second derivatives of a refined deformation profile for rubber are derived as a function of the maximum displacement at the pole. Using these results it is shown that one can evaluate the elastic parameters of human fetal membranes. In this manner one can make a meaningful comparison of the elastic nature of fetal membranes from term pregnancies to the elastic nature of membranes which rupture at various gestational stages.

The following case report reviews the obstetrical course of a patient who had undergone a jejunoileal bypass six years prior to her pregnancy. Documentation of hypomagnesemia and parenteral treatment of this condition are reported along with the successful outcome. Bypass procedures may result in biochemical aberrations which affect pregnancy outcome. The implications of such surgery is reviewed as well as its current status.

Thirty-seven patients who delivered singleton pregnancies were followed by serial sonograms during the first 2 weeks of the puerperal period to evaluate uterine involution. Significant correlation was found between birthweight and uterine size during this period. No correlation was found between regressing uterine size and route of delivery, parity, or method of infant feeding. Variations in normal uterine, endometrial, and adnexal appearance are described as knowledge of these changes is necessary to appreciate pathologic conditions.

We have reported a case of subcapsular hematoma of the liver, diagnosed and observed by ultrasonography, in association with the HELLP syndrome. The patient's condition improved with conservative management, but the hematoma was clearly shown to last for more than 12 weeks, which shows the need for extended postpartum follow-up and appropriate patient consultation.

A case is presented in which a major CM was discovered during routine ultrasound evaluation. Radiographic techniques offered ancillary assistance in establishing the diagnosis. With more frequent use of ultrasound in obstetrics, investigators must be constantly alert to the possibility of anatomic defects that may be identifiable, particularly in high-risk situations.

I N 196 3, L I LE Y 1 suggested that a fetus with duodenal atresia had regurgitated bile into the amniotic fluid and this produced a spurious elevation in the amniotic fluid bilirubin. Although, the child was not Rh immunized in his case, he speculated that “had this rare complication occurred in an Rh-sensitized patient, the opportunity for error is apparent especially since prematurity could be a lethal handicap to operation.” A case is reported of an elevated amniotic fluid bilirubin level in a Rh-immunized twin gestation where the more affected fetus was subsequently demonstrated to have intestinal obstruction, meconium peritonitis, and colonic perforation. Table I. Amniotic fluid bilirubin determinations

In an ultrasonographic laboratory we scanned 545 consecutive obstetric patients for obstetric indications based on the consultative needs of the physicians involved in their care. We attempted to determine the sex on all fetuses. The gestational age ranged from 15 weeks to term. Fetal sex was established in 196 (36%). After the 25th week of gestation, we predicted the sex in greater than 50%. There were no errors in the entire series. The basis of sex determination was the demonstration of male and female genitalia.