This chapter reviews the role for instrumental delivery in current practice and gives a critical account of current techniques of operative vaginal delivery by forceps. Important issues, including case choice, documentation, forceps application, avoidance of complications, and training and education are included.
Recovery of nucleated cord blood cells after storage in liquid nitrogen was evaluated. Red cells were depleted using Ficoll-Paque or Puregene red cell lyses. Freeze Medium contained 10% dimethylsulfoxide and 20% serum for cryoprotection. Recovery of the original cell population remaining serviceable for fluorescence activated cell sorting (FACS) was 12 +/- 10% (average +/- standard deviation), with a range of 1% to 55%. Viability measured by FACS analysis after freezing was significantly lower than that of the same specimens prior to freezing, 62 +/- 20% compared to 91+/-11% (p<0.001). Percentage CD45+34+ cells were the same for fresh and frozen cells. Gestational age at which specimens were collected had no effect on the percent cells carrying the CD45+34+ markers. We conclude that better cryoprotective supplements are needed to insure consistent high recovery of viable nucleated umbilical cord blood cells after preservation in liquid nitrogen.
Seubert, David E. MBA, MD; Perry, Sandy; Hoffman, Despina E.; Markenson, Glenn R. MD; Bsat, Fadi A. MD Author Information
OBJECTIVE: This study compares pyridoxine–metoclopramide combination therapy to prochlorperazine and promethazine monotherapies in the outpatient treatment of nausea and vomiting in pregnancy. STUDY DESIGN: In total, 174 first trimester, singleton pregnancies were evaluated for nausea and vomiting. Patients were prospectively randomized into three treatment groups: pyridoxine–metoclopramide, prochlorperazine, or promethazine. Prior to, and on the third day, patients recorded their subjective responses to the given treatment and their number of emesis episodes. The three treatment groups were compared for therapy response. RESULTS: There were no differences in the number of emesis episodes prior to treatment. Both subjective and objective responses to treatment differed among the three groups when comparing the combination therapy to the monotherapies (p<0.05). CONCLUSION: Combination therapy with pyridoxine and metoclopramide appears to be superior to either monotherapy in the treatment of nausea and vomiting in pregnancy.
OBJECTIVE: To use the polymerase chain reaction (PCR) to detect the presence of bacteria and Mycoplasma in amniotic fluid at the time of genetic amniocentesis and to assess their relationship to amniotic fluid interleukin-6 (IL-6) concentration and preterm delivery.STUDY DESIGN: A prospective study was performed on 78 asymptomatic pregnancies presenting for genetic amniocentesis. Amniotic fluid samples were analyzed by PCR for the detection of bacterial 16S ribosomal RNA, by PCR/enzyme-linked immunosorbent assay (ELISA)for Mycoplasma and by ELISA analysis for IL-6 concentration.RESULTS: All 78 samples were analyzed, and bacterial RNA was detected in 18% of them. However, no sample tested positive for Mycoplasma. The mean IL-6 concentration was 435 pg/mL. There was no difference in IL-6 levels or gestational age between bacteria-positive and -negative groups.CONCLUSION: Amniotic fluid may not be sterile in the midtrimester, yet the presence of bacteria, as detected by PCR, does not always result in an inflammatory response or adverse perinatal outcome.
Uterine rupture complicates approximately 1% of trials of labor after cesarean. Classic signs and symptoms include loss of station, cessation of labor, vaginal bleeding, fetal distress, and abdominal pain. Other signs are also possible. We report a case of uterine rupture at VBAC trial that includes an unusual clinical sign of uterine rupture: vernix caseosa observed in the urine of the parturient. During labor, a bladder catheter was inserted to evaluate oliguria. Vernix caseosa and blood were found in the tubing. Prompt cesarean delivery followed. A tear extending from the original transverse scar into the bladder dome was found. Vernixuria is an additional sign of uterine rupture.
This chapter reviews the role for instrumental delivery in current practice and gives a critical account of current techniques of operative vaginal delivery by forceps. Important issues, including case choice, documentation, forceps application, avoidance of complications, and training and education are included.
OBJECTIVE: To determine patterns of immune thrombocytopenia purpura (ITP) progression during pregnancy which may impact the course of clinical care.STUDY DESIGN: Retrospective time course study of all pregnant patients with ITP delivering at UMC-Utrecht from 1980-2000.We applied a 9-point scaled scoring system assessing severity of hemorrhagic diathesis, platelet count and treatment.We evaluated and cmnpared disease severity at six critical time periods: pre-pregnancy, first trimester, third trimester, one year postpartum and the subsequent pregnancy.Wilcoxon matched pairs signed ranks test was used for analysis.RESULTS: There were 21 patients for whom complete data was available.ITP did not improve during pregnancy from pre-pregnancy.However, independent analysis for the first and third trimesters showed a significant improvement in scoring from pre-pregnancy (P< .01 and P< .05,respectively).
