American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Sep 1989
The effect of continuous epidural analgesia on cesarean section for dystocia in nulliparous women.
Epidural analgesia in labor is generally accepted as safe and effective and therefore has become increasingly popular. However, little is known regarding the effect of epidural analgesia on the incidence of cesarean section for dystocia in nulliparous women. During the first 6 months of 1987 we studied 711 consecutive nulliparous women at term, with cephalic fetal presentations and spontaneous onset of labor. ⋯ The incidence of cesarean section for fetal distress was similar (p greater than 0.20) in both groups. There were no clinically significant differences in frequency of low Apgar scores at 5 minutes or cord arterial and venous blood gas parameters between the two groups. This study suggests that epidural analgesia in labor may increase the incidence of cesarean section for dystocia in nulliparous women.
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Am. J. Obstet. Gynecol. · Aug 1989
Comparative StudyConcurrence of mouthing movement and rapid eye movement/non-rapid eye movement phases with advance in gestation of the human fetus.
To evaluate whether mouthing movement in the human fetus is related to advance in gestational age and whether such movement is concurrent with rapid eye movement or non-rapid eye movement phases, 26 fetuses from 28 to 41 weeks' gestation were observed for 60 continuous minutes with real-time ultrasonography. It was evident that regular mouthing movement every 300 to 600 msec concurred with the non-rapid eye movement period, from 35 weeks' gestation to term. Random mouthing movements that occurred at a wide range of intervals from 300 msec to approximately 525 seconds were observed predominantly during the rapid eye movement period and were unrelated to advance in gestational age. These observations were discussed in relation to biologic implications.
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Am. J. Obstet. Gynecol. · Jul 1989
Case ReportsNeuromuscular blockade with magnesium sulfate and nifedipine.
A patient who received tocolysis with nifedipine developed neuromuscular blockade after 500 mg of magnesium sulfate was administered. This reaction demonstrates that nifedipine can seriously potentiate the toxicity of magnesium. Caution should be exercised when these two tocolytics are combined.
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Am. J. Obstet. Gynecol. · May 1989
Comparative StudyCardiac output in women undergoing cesarean section with epidural or general anesthesia.
Cardiac output during cesarean section and for 24 hours after delivery was estimated by using a noninvasive ultrasonic Doppler technique and was compared between term pregnant patients who underwent either epidural or general anesthesia. Cardiac output peaked by 36.7% and 26.3% of baseline values at 15 and 30 minutes after delivery, respectively, with epidural anesthesia and by 28% and 17.2%, respectively, with general anesthesia. ⋯ This study demonstrates a similar pattern of increase in cardiac output with epidural and general anesthesia and a return by 60 minutes to preoperative levels, which persisted for up to 24 hours after delivery. The applicability of this noninvasive technique can be extended in various circumstances during pregnancy, labor, delivery, and the postpartum period to further define cardiac output in pregnancy.