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Benefits of labor before elective cesarean section
effects, problems with diarrhea and vomiting were common (37 of 60 patients, 61%). Estimated blood loss was minimal, ranging from 35 to 250 mL. The authors conclude that prostaglandin suppositories can achieve early pregnancy termination and appear to be safe, but the problem of unpleasant side effects makes this procedure less than ideal in terms of patient acceptability.
Teratogenicity of Progestogens Katz Z, Lancet M, Skornik J, et al: Teratogenicity of progestogens given during the first trimester of p r e g nancy. Obstet Gynecol 65:775, 1985. Possible teratogenic effects of exogenous progestational agents given during early pregnancy were investigated in this study of 2754 infants born to mothers who had bled during the first trimester of pregnancy. All 3 5 , 1 1 4 w o m e n who delivered during a 10-year period were screened for inclusion in the study. Among these, 2754 were newborns of mothers who had bled in the first trimester; 1608 were newborns exposed to progestogens (study group), and 1146 were not (controls). The newborns were screened closely for both major and minor malformations during their hospitalization. There were no significant differences in rates of malformations between the two groups of newborns in any of the ex-
amined systems (central nervous system, bone and joint, genitourinary, circulatory). The authors feel that this study is the only large prospective study in which the details of bleeding and treatment were known and in which both study and control groups were women who had bled during the first trimester. They emphasize this fact because it is accepted that malformation rates are higher among women with first trimester bleeding. They conclude that the administration of progestogens during the first trimester of pregnancy is not accompanied by an increase in teratogenicity.
Benefits of Labor before Elective Cesarean Section C o h e n M, C a r s o n B: R e s p i r a t o r y morbidity benefit of awaiting onset of labor b e f o r e elective c e s a r e a n section. Obstet Gynecol 65:818, 1985. This study was done to assess and compare both the incidence and severity of respiratory morbidity after term delivery by elective cesarean section before or during labor. A study group of 187 neonates was selected from 576 neonates born by cesarean section during 1980. All mothers had reliable evidence of term pregnancy and were devoid of factors that might have predisposed their infants to respiratory morbidity. Of the 187 neonates 107 (57%) were delivered after the onset of labor (mainly for failure to
Journal of Nurse-Midwifery • Vol. 30, No. 5, September/October 1985
progress) and 80 (43%) were delivered before the onset of labor (mainly repeat elective surgery). Nineteen (10.2%) of the neonates were delivered before term according to pediatric evaluation. The overall incidence of respiratory morbidity was 19.3%, occurring in 11.2% of labor neonates compared with 30% of neonates in the no-labor group (p < .002). The incidence of respiratory morbidity among term labor patients was 9% compared with 26% of no-labor patients (p < .002). The risk of respiratory morbidity increased 1.5 times for each week that gestational age decreased. Although the majority of term neonates with respiratory morbidity in both the labor and the no-labor groups had oxygen requirements of less than 4 hours, the severity of the illness was greater for the no-labor groups (both term and preterm). Transient tachypnea of the newborn was classified as mild or severe; the incidence of severe morbidity in the labor group was 0.9% (i of 107), whereas it was 10% in the no-labor group (8 of 80; p < .005. Although the majority of symptomatic neonates had only mild disease, the authors point out the risks of additional morbidity, separation from the mother, subjection of the infant to invasive studies, and the potential complications of oxygen therapy and of transient tachypnea. They conclude that awaiting the onset of labor before delivery by cesarean section is of benefit to the newborn.
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Teratogenicity of Progestogens Katz Z, Lancet M, Skornik J, et al: Teratogenicity of progestogens given during the first trimester of p r e g nancy. Obstet Gynecol 65:775, 1985. Possible teratogenic effects of exogenous progestational agents given during early pregnancy were investigated in this study of 2754 infants born to mothers who had bled during the first trimester of pregnancy. All 3 5 , 1 1 4 w o m e n who delivered during a 10-year period were screened for inclusion in the study. Among these, 2754 were newborns of mothers who had bled in the first trimester; 1608 were newborns exposed to progestogens (study group), and 1146 were not (controls). The newborns were screened closely for both major and minor malformations during their hospitalization. There were no significant differences in rates of malformations between the two groups of newborns in any of the ex-
amined systems (central nervous system, bone and joint, genitourinary, circulatory). The authors feel that this study is the only large prospective study in which the details of bleeding and treatment were known and in which both study and control groups were women who had bled during the first trimester. They emphasize this fact because it is accepted that malformation rates are higher among women with first trimester bleeding. They conclude that the administration of progestogens during the first trimester of pregnancy is not accompanied by an increase in teratogenicity.
Benefits of Labor before Elective Cesarean Section C o h e n M, C a r s o n B: R e s p i r a t o r y morbidity benefit of awaiting onset of labor b e f o r e elective c e s a r e a n section. Obstet Gynecol 65:818, 1985. This study was done to assess and compare both the incidence and severity of respiratory morbidity after term delivery by elective cesarean section before or during labor. A study group of 187 neonates was selected from 576 neonates born by cesarean section during 1980. All mothers had reliable evidence of term pregnancy and were devoid of factors that might have predisposed their infants to respiratory morbidity. Of the 187 neonates 107 (57%) were delivered after the onset of labor (mainly for failure to
Journal of Nurse-Midwifery • Vol. 30, No. 5, September/October 1985
progress) and 80 (43%) were delivered before the onset of labor (mainly repeat elective surgery). Nineteen (10.2%) of the neonates were delivered before term according to pediatric evaluation. The overall incidence of respiratory morbidity was 19.3%, occurring in 11.2% of labor neonates compared with 30% of neonates in the no-labor group (p < .002). The incidence of respiratory morbidity among term labor patients was 9% compared with 26% of no-labor patients (p < .002). The risk of respiratory morbidity increased 1.5 times for each week that gestational age decreased. Although the majority of term neonates with respiratory morbidity in both the labor and the no-labor groups had oxygen requirements of less than 4 hours, the severity of the illness was greater for the no-labor groups (both term and preterm). Transient tachypnea of the newborn was classified as mild or severe; the incidence of severe morbidity in the labor group was 0.9% (i of 107), whereas it was 10% in the no-labor group (8 of 80; p < .005. Although the majority of symptomatic neonates had only mild disease, the authors point out the risks of additional morbidity, separation from the mother, subjection of the infant to invasive studies, and the potential complications of oxygen therapy and of transient tachypnea. They conclude that awaiting the onset of labor before delivery by cesarean section is of benefit to the newborn.
299