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Pills protect against PID
in the bleeding patient, no matter how little the bleeding, (6) monitor all patients for hyperglycemia and use with caution in insulin-dependent patients, and (7) do not use P-sympathomimetics at gestational ages greater than 33 weeks.
Trial of Labor Urged After C/S Meier P, Porreco R: Trial of labor following cesarean section: A two-year experience. Am J Obstet Gynecol
144671,
1982.
Over a 2-year period, 207 patients with a single previous cesarean section for a nonrepeating cause were encouraged to undergo a trial of labor, managed in the same manner as any patient with a known risk factor. Of these, 84.5% delivered vaginally. There were no deaths associated with the trial of labor, and maternal and fetal morbidity were negligible. After this positive experience, both patient and physician enthusiasm for this practice increased dramatically. The authors now state that “in properly selected patients, a trial of labor after previous cesarean delivery constitutes the best and safest form of obstetric management.” Other conclusions reached by the authors include: 1. Patients with an adequate trial of labor after a cesarean delivery for a nonrepeating cause can expect a vaginal delivery as often as the nulliparous patient in labor. 2. The diagnosis of failure to progress in labor or cephalopelvic disproportion has no prognostic value from one pregnancy to the next and generally should not exclude a patient from a trial of labor. 3. Physician acceptance and enthusiasm for a trial of labor are directly related to the successful outcomes observed. 4. A trial of labor was highly acceptable to patients. 5. Patients who elect to have a scheduled cesarean section usually do so because of fear or for convenience. 6. A trial of labor in patients with more than one previous cesarean section remains a poorly studied event. In their concluding discussion, the authors question the acceptability of elective repeat cesareans performed on the basis of the patient’s fear and suggest that this does not constitute justification for elective repeat cesareans, but rather,
Journal of Nurse-Midwifery
??
points to areas needing counseling.
education
and
Changes in Urethral Pressure During and After Pregnancy Geelen J, Lemmens W, Eskes T, Martin C: The urethral pressure profile in pregnancy and after delivery in
healthy nulliparous women. Am J Obstet Gynecol 144:636, 1982. The aims of this study were to investigate changes in the urethral pressure profile during pregnancy; to investigate any hormonal relationships; to investigate the effects of obstetric factors such as vaginal delivery versus cesarean section, duration of the second stage of labor, presence or absence of an episiotomy, and the birth weight of the neonate; to evaluate response to stress (i.e., coughing) during pregnancy and postpartum; and to evaluate the effects of a first pregnancy and delivery on the urethral pressure profile. Forty-three healthy nulliparous women volunteered for this study. Among these, seven women were delivered by cesarean section, and 36 were delivered vaginally (including 5 by forceps and 2 by vacuum extraction). In each woman, urethrocystometry was performed serially at about 8, 16, 28, and 36 weeks gestation and at 8 weeks postpartum. Although a statistically significant increase during the course of pregnancy was established for the anatomic urethral length, the total bladder pressure, and the maximum urethral pressure, the continence parameters (functional urethral length and urethral closure pressure) did not change significantly during pregnancy. Among the women with vaginal deliveries, there was no evidence that the duration of the second stage of labor or the birth weight of the neonate was correlated with the postpartum changes in urethral pressure profile parameters. The two groups characterized by the presence or absence of an episiotomy did not show any significant difference in the mean changes in the urethral pressure profile values postpartum. The urethral closure pressure response to stress was found, in general, not to be altered during pregnancy. However, in some women, who early in pregnancy show a low urethral resistance and defective transmission of pressure, these conditions are accentuated during preg-
Vol. 28, No. 3. May/June
1983
nancy and after delivery and eventually lead to stress incontinence. The authors conclude that it must be the passage of the fetus through the birth canal that is the important event and that the size and the relative ease or difficulty of its passage are of minor importance with regard to the effects on the urethral pressure profile.
Pills Protect Against PID Rubin G, Oy H, Layde P: Oral contraceptives and pelvic inflammatory disease. 1982.
Obstet
Gynecol
144:630,
This retrospective analysis of data obtained through the multicenter Women’s Health Study shows a causal relationship in the association between current oral contraceptive use and a 50% reduction in risk of developing an initial episode of PID. For this analysis, 648 sexually active women with discharge diagnoses of PID, with no prior history of PID, were used as case sugjects. They were compared to 2516 controls admitted to hospital for other reasons who had no prior history of PID. Results indicated that, among women currently using oral contraceptives, those who had used them for more than 1 year had only one-third the risk of developing an initial episode of PID compared to women who used no contraceptive method. This association was not accounted for by differences in age, race, gravidity, education, sexual practices, or past gynecologic or medical history. The authors calculate that the protective effect of oral contraceptive use leads to about 50,000 fewer cases of PID a year in the United States and about 12,500 fewer hospitalizations for PID a year. Theoretically, it is suggested that this protective effect is achieved by virtue of the oral contraceptives’ effect on cervical mucus, making it more tenacious and, therefore, more of a barrier to organisms in the lower genital tract.
IUD Perforation Risk Heartwell S, Schlesselman S: Risk of uterine perforation among users of intrauterine devices. Obstet Gynecol 61:31, 1983. To determine which attributes of the IUD and which user characteristics contribute 35
Trial of Labor Urged After C/S Meier P, Porreco R: Trial of labor following cesarean section: A two-year experience. Am J Obstet Gynecol
144671,
1982.
Over a 2-year period, 207 patients with a single previous cesarean section for a nonrepeating cause were encouraged to undergo a trial of labor, managed in the same manner as any patient with a known risk factor. Of these, 84.5% delivered vaginally. There were no deaths associated with the trial of labor, and maternal and fetal morbidity were negligible. After this positive experience, both patient and physician enthusiasm for this practice increased dramatically. The authors now state that “in properly selected patients, a trial of labor after previous cesarean delivery constitutes the best and safest form of obstetric management.” Other conclusions reached by the authors include: 1. Patients with an adequate trial of labor after a cesarean delivery for a nonrepeating cause can expect a vaginal delivery as often as the nulliparous patient in labor. 2. The diagnosis of failure to progress in labor or cephalopelvic disproportion has no prognostic value from one pregnancy to the next and generally should not exclude a patient from a trial of labor. 3. Physician acceptance and enthusiasm for a trial of labor are directly related to the successful outcomes observed. 4. A trial of labor was highly acceptable to patients. 5. Patients who elect to have a scheduled cesarean section usually do so because of fear or for convenience. 6. A trial of labor in patients with more than one previous cesarean section remains a poorly studied event. In their concluding discussion, the authors question the acceptability of elective repeat cesareans performed on the basis of the patient’s fear and suggest that this does not constitute justification for elective repeat cesareans, but rather,
Journal of Nurse-Midwifery
??
points to areas needing counseling.
education
and
Changes in Urethral Pressure During and After Pregnancy Geelen J, Lemmens W, Eskes T, Martin C: The urethral pressure profile in pregnancy and after delivery in
healthy nulliparous women. Am J Obstet Gynecol 144:636, 1982. The aims of this study were to investigate changes in the urethral pressure profile during pregnancy; to investigate any hormonal relationships; to investigate the effects of obstetric factors such as vaginal delivery versus cesarean section, duration of the second stage of labor, presence or absence of an episiotomy, and the birth weight of the neonate; to evaluate response to stress (i.e., coughing) during pregnancy and postpartum; and to evaluate the effects of a first pregnancy and delivery on the urethral pressure profile. Forty-three healthy nulliparous women volunteered for this study. Among these, seven women were delivered by cesarean section, and 36 were delivered vaginally (including 5 by forceps and 2 by vacuum extraction). In each woman, urethrocystometry was performed serially at about 8, 16, 28, and 36 weeks gestation and at 8 weeks postpartum. Although a statistically significant increase during the course of pregnancy was established for the anatomic urethral length, the total bladder pressure, and the maximum urethral pressure, the continence parameters (functional urethral length and urethral closure pressure) did not change significantly during pregnancy. Among the women with vaginal deliveries, there was no evidence that the duration of the second stage of labor or the birth weight of the neonate was correlated with the postpartum changes in urethral pressure profile parameters. The two groups characterized by the presence or absence of an episiotomy did not show any significant difference in the mean changes in the urethral pressure profile values postpartum. The urethral closure pressure response to stress was found, in general, not to be altered during pregnancy. However, in some women, who early in pregnancy show a low urethral resistance and defective transmission of pressure, these conditions are accentuated during preg-
Vol. 28, No. 3. May/June
1983
nancy and after delivery and eventually lead to stress incontinence. The authors conclude that it must be the passage of the fetus through the birth canal that is the important event and that the size and the relative ease or difficulty of its passage are of minor importance with regard to the effects on the urethral pressure profile.
Pills Protect Against PID Rubin G, Oy H, Layde P: Oral contraceptives and pelvic inflammatory disease. 1982.
Obstet
Gynecol
144:630,
This retrospective analysis of data obtained through the multicenter Women’s Health Study shows a causal relationship in the association between current oral contraceptive use and a 50% reduction in risk of developing an initial episode of PID. For this analysis, 648 sexually active women with discharge diagnoses of PID, with no prior history of PID, were used as case sugjects. They were compared to 2516 controls admitted to hospital for other reasons who had no prior history of PID. Results indicated that, among women currently using oral contraceptives, those who had used them for more than 1 year had only one-third the risk of developing an initial episode of PID compared to women who used no contraceptive method. This association was not accounted for by differences in age, race, gravidity, education, sexual practices, or past gynecologic or medical history. The authors calculate that the protective effect of oral contraceptive use leads to about 50,000 fewer cases of PID a year in the United States and about 12,500 fewer hospitalizations for PID a year. Theoretically, it is suggested that this protective effect is achieved by virtue of the oral contraceptives’ effect on cervical mucus, making it more tenacious and, therefore, more of a barrier to organisms in the lower genital tract.
IUD Perforation Risk Heartwell S, Schlesselman S: Risk of uterine perforation among users of intrauterine devices. Obstet Gynecol 61:31, 1983. To determine which attributes of the IUD and which user characteristics contribute 35