Effects of epidural anesthesia on I and II delivery stage and on a newborn

Background/Aim. Epidural anesthesia (EA) is the most efficient method of pain reduction and its total elimination during delivery. The aim of this study was to establish an influence of EA on the first and the second part of delivery process, frequency of vacuum extractor and forceps appliance, and the effect of EA on the newborn. Methods. A total of 360 patients with EA were analyzed at delivery and 1 130 controls without EA. Both groups had vaginal delivery. In both groups deliveries were stimulated by 10 IU of oxytocin in 500 mL of crystalloid solvent, with 15-20 drops per minute. As anaesthetic, Bupivacain (0,25% or 0, 125%) was used by the 18 G catheters Braun and Wigon. Level of application was L2-L3 part of spine. Results. The results of this study indicate that deliveries with EA were shorter in duration, but also had much more vacuum extractor and forceps appliance (over 2.5 times) than those without EA. Apgar score was significantly higher in the experimental group with multiple deliveries. However, there was no significant deference between average Apgar score of newborns of patients with EA and that of newborns of patients without EA. Conclusion. Application of EA decreases duration of delivery, and has no any adverse effects on newborns

Preterm delivery in a patient with frontal lobe brain tumor

Introduction/Aim. Brain tumors are very rare in pregnancy. Diagnosis could be very simple if one consider brain tumor alongside blurred symptoms of headache, repetitive vomiting and/or epileptic attacks during pregnancy. The aim of this paper was to emphasize the importance of such pregnancy expert control and completion. Case report. We presented a 45-year-old pregnant woman at 30 weeks of gestation, and with brain tumor recidive in frontal lobe, hystologicaly confirmed as astrocytoma. The patient was newly diagnosed with tumor in 1995, and monitored until 2003, when she was operated. Due to malignant profile and a partial removal of tumor masses, postoperative gamma-ray therapy was recommended. Because of the continuous need for that kind of therapy, termination of pregnancy was also recommended. It was carried out by the application of PGE2 vaginal tablets. Delivery lasted for 8 hours and 50 minutes, and with auxilium manuale sec. Bracht, due to the breech presentation, newborn was delivered 1 550 grams in weight and 39 cm length. Apgar score was 6/7. Conclusion. Pregnancy in patient with brain tumors can be intensively monitored by neurosurgeons and obstetricians, and with the use of the symptomatical therapy almost up to the delivery term. Surgical intervention is recommended to be performed during the second and/or third trimester if the condition requires. The way of delivery in these patients should be individually determined in the most appropriate way both for the mother and the newborn, under given circumstances

Frequency of uterine rupture at delivery and accompanying risks for the mother and the newborn

Background/Aim. Uterine rupture at delivery is a severe life threatening complication for both matter and the newborn. The aim of the study was to determine the frequency of total number uterine rupture within the deliveries, to perceive circumstances and causes that lead to rupture, to establish perinatal and maternal mortality and to present our therapeutic procedure. Methods. In the group of 37 ruptures at 59 660 deliveries from the period 1991-2000 included in this retrospective study we analyzed age, level of education, gestational age, parity, previous caesarian section and other operations on uterus, time of diagnosing rupture, grade and place of rupture, use of Syntocinon and Prostaglandin at delivery, perinatal and maternal mortality, as well as therapeutic procedures at rupture that occurred. Results. The highest influence on uterine rupture in our group had been exerted by previous caesarian section and myomectomy in relation 33 : 4. Incomplete uterine ruptures were more frequent, 26 (70.27%), in relation to complete ones, 11 (29.75%). The most frequent place of uterine rupture was the front wall, 34 (91.89%), two ruptures occurred on the fundus and one on the back wall. The most frequently applied therapeutic procedures were rupture suture in 31 (83.78%) cases, and in six (l6.22%) cases hysterectomy. Perinatal mortality was three times higher than average (17.78‰) in that period and was 51.28‰. Conclusion. We emphasize that rupture frequency in the total number of deliveries was one rupture at 1 612 deliveries, whereas rupture frequency on the intact uterus was 1 : 17 269, and frequency of uterine rupture after caesarian section was one rupture at 245 deliveries. Our research as well as researches of other authors, showed that a previous caesarian section is the most frequent cause for the occurrence of uterine rupture. Therefore, caesarian section should be avoided whenever possible, not just because of a potential rupture, but also because of more frequent hysterectomy that interrupts woman's reproductive ability

Reference values of capillary blood saturation in neonates and its difference from pulse oximetry

Introduction Haemoglobin saturation is an obligatory oxygen parameter in the assessment of neonatal oxygenation. Although, pulse oximetry is currently one of the major methods in the determination of haemoglobin saturation, capillary blood saturation is still present in the diagnostic process. As well known, haemoglobin saturation value of capillary blood is insufficiently accurate, but not as much as the difference in relation to the values determined by pulse oximetry. Until now published studies have reported that capillary samples are obtained according to a protocol by the principle of free blood outflow, which is practically almost unachievable in the neonate. Objective Determination of the reference values of oxygen saturation (ScO2) and partial pressure (pcO2) of capillary blood by squeezing of the foot. The determination of difference between ScO2 and pulse oximetry (SpO2). Methods In 134 term newborns, we determined SpO2 . Subsequently, we measured the values of ScO2 and pcO2 from the same extremity. While withdrawing a capillary sample, we exerted multiple squeezing of the foot. The mean value of ScO2, pcO2, SpO2 and the difference between ScO2 and SpO2 were determined. Results Mean ScO2 value was 80.5}8.5%, pcO2 was 48.2}11.4 mm Hg and SpO2 was 98}1.9%. The difference between ScO2 and SpO2 values was 17.5}8.6% (t=23.568; p=0.000). Conclusion There is a statistically highly significant difference between the values of ScO2 and SpO2. Having the knowledge of this difference can increase the accuracy of clinical evaluation and further diagnostics. Comparison in up-to-now conducted studies suggests that the squeezing of the foot for obtaining a capillary sample in relation to free blood outflow does not bear any significant influence on the resultant values of haemoglobin saturation.