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Giving women growth hormone for up to one week after a cesarean delivery may strengthen the uterine scar, making it less likely to rupture in a future pregnancy. This was the conclusion of a study of pregnant rats.

An in vivo microdialysis technique was used to study adrenal medullary function in 6 euglycemic and 6 hyperglycemic anesthetized Sprague-Dawley rats exposed to hypoxia. After stabilization of an adrenal dialysis [...]

To determine the risk of catastrophic complications (including death) among pregnant women who have undergone a previous cesarean section, the medical records of all deliveries (10,835) at one hospital in a three-year period were reviewed. Seven hundred and eleven deliveries (6.6 percent) involved women with a previous cesarean section. Four hundred twenty-four women in this group attempted vaginal delivery, of whom 312 succeeded. Catastrophic complications included: maternal or fetal death; hemorrhage that required transfusion of five or more units of blood; hysterectomy (removal of the uterus); ligation (tying) of a major artery; or uterine rupture. By these criteria, 17 women with a previous cesarean section (eight had more than one) suffered catastrophic complications. These included two maternal and three fetal deaths. Eleven women had serious hemorrhage, eight of whom underwent hysterectomy. Nine had uterine rupture, and eight had placenta previa (attachment of the placenta near the opening of the uterus, associated with bleeding during delivery) or other abnormal conditions of the placenta. The overall rate of very serious complications of pregnancy after cesarean section was 1 patient out of 42, with a risk of maternal or fetal death in 1 out of 143 such pregnancies. These results indicate much higher rates than have been reported in other studies, and may partly be the result of the population studied (primarily black and Hispanic, and poor). The criteria for inducing labor in these women were the same criteria used for women without a prior cesarean, another factor that might have led to the high rate of uterine rupture. The overall frequency of catastrophic complications in this group of women with previous cesarean sections was 2.4 percent. Awareness of this possibility should affect decision-making when a patient's first cesarean section is contemplated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Malpractice fears are believed to influence various aspects of obstetrical practice. They seem to have contributed in small part to the rising primary caesarean section rate, but have also played a considerable role in the downtrend in vaginal birth after caesarean statistics. The rising vaginal birth after caesarean section rate between 1981 and 1995 was interrupted by a spate of lawsuits associated with broadened indications for vaginal birth after caesarean section in conjunction with requirements for immediate clinician availability. These factors dramatically reduced the availability of hospitals and clinicians willing to offer vaginal birth after caesarean section. This reversal, however, has not diminished the demand for vaginal birth after caesarean section from various stakeholders in the name of patient autonomy, clinician beneficence and optimal care. Nevertheless, as long as stringent requirements remain for clinician attendance during vaginal birth after caesarean section, and as long as the spectre of preventable error and the lingering dread of lawsuits retain their hold on obstetrical practice, caesarean section trends are unlikely to change.

Counseling patients about pregnancy at advanced maternal age is a difficult process. This is true both because our knowledge of the attendant risks is incomplete and still evolving, and because of the difficulties of assigning risks and addressing counterbalancing benefits for individual patients.

Optimal interpretation of the events of labor requires integration of information about cervical changes, fetal descent, uterine contractions, fetal position and attitude, as well as fetal heart rate monitoring and maternal condition. The use and understanding of labor curves is a vital part of this process. The complexity and diversity of labor data lend itself to computer storage and analysis.

This study was undertaken to determine whether or not metabolic acidemia per se stimulates catecholamine (CA) secretion from the adrenal medulla in fetal sheep. The potential confounding effect of low O2 content, occasioned by the right shift in the oxyhemoglobin dissociation curve with acidemia, was taken into account in experimental design. Hemodynamic values, blood gases, O2 content, lactate and glucose concentrations and adrenal CA secretion rates and plasma CA levels were studied in fetal sheep at baseline and during control (saline infusion) and acidemic (15 and 30% lactic acid infusion) periods. Experiments were conducted after recovery from preparative operations performed under general anesthesia. Arterial pH did not change with saline infusion. During 15 and 30% lactic acid infusions, pH fell to 7.23 and 7.09, respectively, as lactate concentrations increased 4.7 and 10 times. Arterial PCO2 increased from 50 to 58 torr during 30% lactic acid infusion. Fetal CA secretion and plasma concentrations did not change during saline, or 15 or 30% lactic acid infusions. Moreover, hemodynamic parameters did not indicate increased CA secretion. In conclusion, we found no evidence for stimulation of adrenal CA secretion by metabolic acidosis.

Traditional methods of diagnosing fetal distress have become obsolete. This diagnosis should be suggested by fetal heart rate patterns that demonstrate recurrent late or severe variable decelerations. Based upon our understanding of these patterns, methods of treating fetal distress in utero have evolved. This paper presents several cases in which elevation of the fetal presenting part was employed in an attempt to improve severe variable decelerations. It is suggested that this might be a salutary procedure when other methods of intrauterine resuscitation have failed.

The relationship between maternal age and the frequency of dysfunctional labor patterns was assessed retrospectively in a population of 6248 gravid women. A significant correlation between age and protraction disorders was observed in nulliparas. This could not be accounted for by patterns of anesthetic use, and it is speculated that a decrease in myometrial efficiency may accompany aging during the reproductive years.

MANIFESTATIONS of arteriosclerotic cardiovascular disease are rare in pregnant women. We describe a case of acute myocardial infarction in a woman at 39 weeks' gestation. General guidelines for management of pregnancy associated with this complication are suggested.Report of a CaseA 42-year-old woman (gravida 7, para 6) had a massive anterior-wall myocardial infarction within the 39th week of an otherwise normal pregnancy. Shortly after the onset of her first episode of chest pain, she sustained ventricular fibrillation and was resuscitated successfully. Twenty-four hours later, after severe postarrest congestive heart failure was treated, she was transferred to Beth Israel Hospital, Boston.The patient's first pregnancy had been complicated by preeclampsia, but her others had been uneventful. She had a 20-year history of mild hypertension (treated intermittently with diuretics and propranolol hydrochloride), a five-pack-year smoking history, and a family history of arteriosclerotic cardiovascular disease. Results of her serum lipid profile were