Oxorn-Foote HUMAN LABOR & BIRTH, Sixth Edition by Posner Glenn & Black Amanda & Jones Griffith & Dy Jessica

Oxorn-Foote HUMAN LABOR & BIRTH, Sixth Edition by Posner Glenn & Black Amanda & Jones Griffith & Dy Jessica

Author:Posner, Glenn & Black, Amanda & Jones, Griffith & Dy, Jessica
Language: eng
Format: epub
Publisher: McGraw-Hill Education
Published: 2013-02-21T16:00:00+00:00


Miscellaneous

ELDERLY PRIMIGRAVIDITY Elderly primigravidity is difficult to define. Although the age varies from 35 to 40 years, other factors are equally important. These include the presence or absence of a good lower uterine segment, elasticity or rigidity of the cervix and the soft tissues of the birth canal, ease of becoming pregnant, number of abortions, fetal presentation, and coordination of the uterine powers. When all of these points are favorable, vaginal delivery should be considered. When the adverse factors are present, cesarean section may be the wiser and safer procedure.

PREVIOUS VAGINAL REPAIR Fear that vaginal delivery will cause a recurrence of cystocele, rectocele, and uterine prolapse may lead to an elective cesarean section. A history of pelvic surgery for fistulas because of inflammatory bowel disease may be an indication for cesarean section.

CONGENITAL UTERINE ANOMALY Not only does an abnormal uterus often function badly, but in the case of anomalies such as a bicornuate uterus, one horn may block the passage of the baby from the other. In such cases, cesarean section must be performed.

POOR OBSTETRIC HISTORY When a previous delivery has been difficult and traumatic with extensive injury to the cervix, vagina, and perineum or when the baby has been injured, cesarean section may be selected for subsequent births.

FAILED INSTRUMENTAL ASSISTED VAGINAL DELIVERY Failed forceps or failed vacuum delivery is an indication for cesarean section. It is wiser to turn to abdominal delivery than to drag a baby through the pelvis by force.

ELECTIVE CESAREAN SECTION OR CESAREAN DELIVERY ON MATERNAL REQUEST This is a controversial topic where some women prefer a cesarean delivery. The reasons for this include avoiding pelvic floor injury, fear of labor, convenience, and perceived reduced risk to the fetus. The National Institutes of Health held a conference on this subject, and insufficient data are available to permit recommendations currently. The conclusions drawn to date are that more research is required in this area and that cesarean section should be performed after 39 weeks of gestation and should be avoided in women desiring several children because of the risk of placental invasion in future pregnancies.



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