Cesarean section en caul and asphyxia in preterm infants
Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.Acta Obstetricia Et Gynecologica Scandinavica (Impact Factor: 2.43). 12/2012; 92(3). DOI: 10.1111/aogs.12066
We reviewed the outcome for 211 patients undergoing a planned 'en caul' (within intact membranes) cesarean section and for 836 control patients with conventional lower segment section, in the period 2001-2010 at a university affiliated hospital in China, where the former technique has been practiced. Of the intended 'en caul' sections there were 141 successful deliveries (66.8%) and 70 that failed and were converted to conventional lower segment cesarean section. Maternal blood loss was similar for both operation types, but the rate of asphyxia was significantly lower among preterm infants delivered by the 'en caul' method than in the control cases. Multivariate logistic regression revealed that the volume of amniotic fluid, a low Bishop score and high birthweight were associated with failed 'en caul' deliveries. Cesarean section 'en caul' can be a safer option than lower segment section when preterm delivery is required. © 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica © 2012 Nordic Federation of Societies of Obstetrics and Gynecology.
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ABSTRACT: Premature rupture of the membranes (PROM) is the condition in which the chorioamnion is disrupted before the onset of labor. This condition creates a dilemma for the practicing obstetrician, because once the membranes have broken the risk of fetal or maternal infection, or both, increases. Preterm PROM adds to this management challenge, mainly because of the added problem of prematurity. Although the epidemiology of PROM has been well defined, the exact etiology has yet to be understood. However, using the associated clinical risk factors of PROM, researchers in this field have contributed to our understanding of the causes. Various mechanisms have been proposed, including mechanical, as well as infectious or inflammatory processes. The purpose of this article is to review the various proposed mechanisms of PROM. Maternal risk factors for PROM are presented, mainly to place into context the current literature involving both in-vitro and in-vivo research. It is apparent that a single pathophysiologic mechanism is not responsible for all cases of PROM, but rather a combination of processes is in operation.Current Opinion in Obstetrics and Gynecology 05/1995; 7(2):140-5. DOI:10.1097/00001703-199504000-00012 · 2.07 Impact Factor
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ABSTRACT: The etiology of PROM is multifactorial. It is clear that maternal enzymes, maturational and mechanical forces, chorionicamniotic membrane phospholipid content, collagen disruption, amniotic cell cytokines induced by fetal signals, and bacterial phospholipases and collagenases all play major and interrelated roles. It is also clear that the production of oxytocic prostaglandins is a major, if not exclusive, common pathway leading to PROM and preterm delivery. The increasing awareness of the fetal role, i.e., fetal interleukins, fetal polymorphonuclear leukocytes and type V collagenase, make this area of research ripe for further investigation. The complex host defense mechanisms and biologic variability make any universal treatment impossible. Even with a specific etiology determined, the reduced availability of pharmacologic interventions for the fetal compartment portend suboptimal success. Therefore, it appears that continued research and aggressive measures to optimize the quality and availability of prenatal care are the best foci of our efforts.Clinical Obstetrics and Gynecology 01/1999; 41(4):810-6. · 1.77 Impact Factor
- Proceedings of the National Academy of Sciences 10/2006; 103(36):13267-8. DOI:10.1073/pnas.0606017103 · 9.67 Impact Factor
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