Little has been reported concerning post-operative hypoglycemia in previously asymptomatic individuals. Post-operative hypoglycemic coma is one of the most perplexing problems and must be differentiated from other conditions accompaning coma. We experienced a case of hypoglycemia following emergency cesarean section in primigravida with cephalopelvic disproportion on the fourth post operative day. The comatous state appeared abruptly and developed repeatedly. The causes of post-hypoglycemic coma are discussed and the prolonged starvation before and after operation was suspected to be the cause of coma.
Cephalopelvic Disproportion ; Cesarean Section* ; Coma ; Emergencies ; Female ; Hypoglycemia* ; Pregnancy ; Starvation

PURPOSE: First, to describe a new method of assessing cephalopelvic disproportion by measuring the retropubic tissue thickness (RTT), and second, to determine whether RTT was associated with an eventual delivery by cesarean section. METHODS: Three-dimensional transperineal ultrasound scans were performed on 129 laboring nulliparous women to obtain 3-dimensional volume datasets for assessing RTT. RTT was measured off-line by three operators (A, B, and C) as the shortest distance between the capsule of the pubic symphysis and the outer border of the fetal skull. The intraoperator repeatability of operator A and the interoperator reproducibility among A, B, and C were determined. The RTT in women who were delivered by cesarean section due to failure to progress was compared to that of women who had a vaginal delivery. RESULTS: The intraoperator repeatability for RTT was 1.2 mm. The overall RTT interoperator interclass correlation was 0.97 (0.95-0.98). The RTT in women who had a spontaneous, instrumental, or cesarean delivery was 1.16±0.32 cm, 1.12±0.25 cm, and 0.94±0.25 cm, respectively. Women who were delivered by cesarean section had a significantly smaller RTT than women who had a spontaneous delivery (P=0.008). There was no statistically significant difference in RTT between patients who had a normal vaginal delivery and patients who had an instrumental delivery (P=0.990), or between those who had an instrumental delivery and those who had a cesarean delivery after the Bonferroni correction (P=0.120). CONCLUSION: RTT can be measured with satisfactory intraoperator repeatability and interoperator reproducibility. RTT was significantly smaller in women who eventually had a cesarean delivery than in those who had a vaginal delivery.
Cephalopelvic Disproportion* ; Cesarean Section ; Dataset ; Female ; Humans ; Methods ; Pregnancy ; Pubic Symphysis ; Skull ; Ultrasonography*

OBJECTIVE: To estimate the rates at which women with a previous cesarean delivery were offered and consented to trial of labor (TOL) and to investigate the factors affecting the decision making about mode of delivery METHODS: For 12 months duration, pregnant women with one previous cesarean were enrolled prospectively in this study. Eligibility to TOL was defined as pregnancy after 36 weeks of gestation without medical or obstetric indication of cesarean section. Patients were received counseling and consented to the process of TOL. The social and obstetric factors were collected through interview and the medical records were analyzed. RESULTS: Among the initial 185 patients with one previous cesarean, 106 were considered eligible to TOL. Seventy-two patients out of the 106 delivered with elective repeat cesarean while 34 patients tried TOL; 24 were delivered with vaginal birth after cesarean (VBAC), while 10 were received emergency cesarean section. The indications of cesarean section were cephalopelvic disproportion (CPD, 7 cases) and fetal distress (FD, 1 case). Two received emergency cesarean without definite obstetric indication. The rate of high education, college greaduate or more was higher in the group of TOL than in those of elective cesarean (50% vs 68%, p=0.04). The rates of patients with indication of previous cesarean, CPD, FD, or abnormal placentation were more frequent among the patient with TOL (23% vs 48%, p=0.007). CONCLUSION: These result provides clinical information about the decision making about mode of delivery among the patients eligible to TOL with one previous cesarean. More clinical studies about TOL and VBAC are required in the different setting of hospital or institute.
Cephalopelvic Disproportion ; Cesarean Section ; Counseling ; Decision Making* ; Education ; Emergencies ; Female ; Fetal Distress ; Humans ; Medical Records ; Placentation ; Pregnancy ; Pregnant Women* ; Prospective Studies ; Trial of Labor ; Vaginal Birth after Cesarean

With the sharply increasing practice of cesarean section(C/S), formerly known as a landmark of developing medical technology, appropriateness of the procedure has been widely inquired into. Appropriateness of a specific procedure could be an indicator for quality, at the individual or organizational level. Cesarean section rate is regarded as a sensitive indicator reflecting clinical quality at the hospital level. We are interested in the validity and significance of C/S rate as a quality indicator in Korean hospitals, in addition to the current status of the practice. This study was carried out retrospectively based on the clinical records of cesarean sections in 32 hospitals nationwide from March to May 1996. Standardized survey format was distributed, and reviews were performed by volunteer surveyors from each hospital after two sessions of pre-survey education. The results were as follows : 1. There were 13,241 deliveries with 4,599 cases of cesarean sections, giving an incidence of 38.5%. This result shows the incidence of cesarean section was 1.6 times higher than U.S. and about four times higher than European countries. 2. The monthly incidence of cesarean section was not variable, but it shows great differences among the hospitals. 3. The incidences of cesarean sections were variable among different age groups with marked higher rate in older one. 4. Most of deliveries were with gestational period from 37 to 44 weeks(91%), in which C/S rate was 39%. For pregnancies with less than or equal to 32 weeks, the rate was 21% and for more than or equal to 45 weeks the rate was 25%. 5. The most frequent indication of cesarean birth was previous cesarean section(37.7%), followed by cephalopelvic disproportion and dystocia(24.4%). 6. There were no statistical differences in cesarean section rates by hospital variables such as ownership, teaching status, proportion of specialists, number of physicians per bed, number of nurses per bed, regional location, and number of beds. Exceptionally, hospitals with independent obstetrics department, separated from gynecology, showed significant lower rate than hospitals with conventional obstetrics-gynecology department. We could confirm higher C/S rate than any other countries. However, C/S rate, not significantly different among hospitals with variable quality level in structural aspect, was not acceptable as a sensitive indicator for clinical quality at the hospital level. Different rates between comparable organizational settings, sometimes indirectly related to the clinical quality, suggested that more studies focused on other aspects of quality than structure should be needed.
Cephalopelvic Disproportion ; Cesarean Section* ; Education ; Female ; Gynecology ; Humans ; Incidence ; Obstetrics and Gynecology Department, Hospital ; Ownership ; Parturition ; Pregnancy ; Quality Indicators, Health Care* ; Retrospective Studies ; Specialization ; Volunteers

Ilioinguinal and iliohypogastric (II/IH) nerve injury is one of the most common nerve injuries following pelvic surgery, especially with the Pfannenstiel incision. We present a case of intractable groin pain, successfully treated with a continuous II/IH nerve block. A 33-year-old woman, following emergency cesarean section due to cephalopelvic disproportion, presented numbness in left inguinal area and severe pain on the labia on the second postoperative day. The pain was burning, lancinating, and exacerbated by standing or movement. However, she didn't want to take additional medicine because of breast-feeding. A diagnostic II/IH nerve block produced a substantial decrease in pain. She underwent a continuous II/IH nerve block with a complete resolution of pain within 3 days. A continuous II/IH nerve block might be a goodoption for II/IH neuropathy with intractable groin pain in breast-feeding mothers without adverse drug reactions in their infants.
Adult ; Burns ; Cephalopelvic Disproportion ; Cesarean Section ; Drug-Related Side Effects and Adverse Reactions ; Emergencies ; Female ; Groin* ; Humans ; Hypesthesia ; Infant ; Mothers ; Nerve Block* ; Pregnancy

Most elective cesarean sections are conducted under spinal anesthesia. Regional anesthesia has become the preferred technique, because general anesthesia is associated with a greater risk of maternal morbidity and mortality. In patients without absolute contraindication, spinal anesthesia is avoided, when procedural difficulty is increased by severe spinal deformity. A 41-year-old female patient was 33 weeks into pregnancy. Her height and weight were 145 cm and 45 kg. The patient was planned for emergency cesarean section, due to cephalopelvic disproportion. Spinal anesthesia was planned since she was suffering from Duchenne's muscular dystrophy, and had risks of respiratory failure and prolonged mechanical ventilation after general anesthesia. However, the patient also had severe kyphoscoliosis, maybe due to Duchenne's muscular dystrophy. We are reporting a successful spinal anesthesia using real-time ultrasound guidance, for cesarean section in this obstetric patient with severe kyphoscoliosis.
Adult ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Spinal* ; Cephalopelvic Disproportion ; Cesarean Section* ; Congenital Abnormalities ; Emergencies ; Female ; Humans ; Mortality ; Muscular Dystrophies* ; Pregnancy ; Respiration, Artificial ; Respiratory Insufficiency ; Scoliosis ; Ultrasonography

The intrauterine fetal death(IUFD) is the death of the fetus prior to complete expulsion or extraction from its mother when the fetus is over 20 weeks gestation or weights more than 500 gm. This is a clinical study of 262 cases of IUFD and 262 control cases among 18542 deli-veries at Chung Goo Sung Sim Hospital during 10 years from 1987 to 1996. The results obtain-ed were as follows: 1. The incidence of IUFD was 1.41%. 2. The risk of IUFD was high in women older. 3. The risk of IUFD was high in women with parity of three or more, there was a previous history of IUFD in 11.2% of the IUFD cases and in 6.3% of the control cases, but there was no difference between the two groups of women in history of spontaneous abortion. 4. The sex ratio of male versus female was 1.24:1 in the IUFD cases, 1.11:1 in the control cases. 5. The low birth weight and preterm infants were much more frequent in the IUFD cases. 6. The mode of delivery IUFD was induced labor(77.5%), laparotomy(12.2%), spontaneo- us delivery(10.3%). The indications for laparotomy were placental abruption, placenta previa, transverse lie, previous cesarean section status, cephalopelvic disproportion and uterine rupture. 7. The most common cause of IUFD was unexplained causes(45.1%). 8. There were 67 cases(25.6%) of maternal complication, and the most common complica- tion was fever(35.8%). 9. In the incidence of abnormal coagulation test, the low platelet count(<100,000/mm3) was 8.0%, the prolonged prothrombin time(>14 seconds) was 7.2%, the prolonged partial thr- omboplastin time was 1.0%, the hypofibrinogenemia(<150mg/dl) was 7.2% and the elevated fibrinogen degradation products(>40 ug/ml) was 8.4%. 10. The risk of IUFD was lowered as the number of antenatal care was increased.
Abortion, Spontaneous ; Abruptio Placentae ; Blood Platelets ; Cephalopelvic Disproportion ; Cesarean Section ; Female ; Fetal Death* ; Fetus ; Fibrinogen ; Humans ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Laparotomy ; Male ; Mothers ; Parity ; Placenta Previa ; Pregnancy ; Prothrombin ; Sex Ratio ; Uterine Rupture ; Weights and Measures

OBJECTIVE: Under the definition of macrosomia where the birth weight of the fetus being 4,000 grams or more, we analyzed and studied the obstetrical problems, complications of both mother and the fetus and the predisposing factors of macrosomia in this report. METHODS: A study was done on 231 cases of macrosomia infants weighing 4,000 grams or more out of 5220 full-term delivered cases in Dongguk University, Kyung-ju hospital from January, 1998 to December, 2002. RESULTS: The frequency of macrosomia ranged from 4.18% in 4,000 g or more to 0.42% in 4,500 g or more. In macrosomia frequency correlations to parity showed 41.13% (95 cases) in primiparous women, 58.87% (134 cases) in multiparous women. According to the type of delivery, normal vaginal delivery has proven to be the most, consuming 52.38% (121 cases), where Cesarean section was 47.61% (110 cases). Indications for Cesarean section ranged from cephalopelvic disproportion (27.3%) to previous Cesarean section (25.4%), in the order of frequency. Maternal complications due to delivery showed highest incidence in postpartum hemorrhage (13.63%), followed by birth canal laceration (12.12%). As of fetal complications, 3 cases (2.72%) of cephalhematoma existed, and 1 brachial plexus palsy and clavicle fracture were reported and 1 case of fetal death was reported. CONCLUSION: It would be appropriate to have definite diagnostic schemes and adequate choice of delivery method for macrosomia. Therefore, the complications of macrosomia could be decreased by a well-trained delivery coming in forehand.
Birth Weight ; Brachial Plexus ; Causality ; Cephalopelvic Disproportion ; Cesarean Section ; Clavicle ; Female ; Fetal Death ; Fetal Macrosomia* ; Fetus ; Gyeongsangbuk-do ; Humans ; Incidence ; Infant ; Lacerations ; Mothers ; Paralysis ; Parity ; Parturition ; Postpartum Hemorrhage ; Pregnancy

OBJECTIVES: To evaluate the clinical manifestations and perinatal outcomes of pregnancies complicated with gestational impaired glucose tolerance (GIGT) and gestational diabetes mellitus (GDM). METHODS: We performed 50gm oral glucose tolerance test (OGTT) for GIGT and GDM screening in 4,367 pregnant women at 24-28 weeks of gestation. In 1,010 women with plasma glucose level over 130mg/dl, 753 women underwent 100gm OGTTs at 28-32 weeks of gestation. According to the NDDG criteria, 113 cases with GIGT (single positive level of OGTT ; group 2), 125 cases with GDM (group 3), and 515 cases with control (group 1) were identified among the 753 cases. Retrospective review of outcome of these patients was performed. ANOVA and chi-square test were used to determine the statistical significance. RESULTS: The incidence of GIGT and GDM was 2.7%, 3.0%. The prepregnant body mass index (21.4+/- 3.0kg/m2, 21.3+/-2.8kg/m2, 23.2+/-4.1kg/m2), overweight of BMI over 26 (7.4%, 4.4%, 14.4%) and obesity of BMI over 30 (1.2%, 0.0%, 8.0%) was significantly higher in group 3 than group 1 (p<0.05). We defined poor maternal outcome as those suffering from any one of birth canal injury, hydramnios or oligohydramnios, preeclampsia, cesarean delivery due to cephalopelvic disproportion, dystocia, fetal distress. Group 3 showed most highest poor maternal outcome (22.3%, 28.3%, 39.2%, p<0.05). And we defined poor neonatal outcome as those suffering from any one of hyperbilirubinemia, hypoglycemia, congenital anomaly, admission to neonatal intensive care unit due to respiratory distress syndrome. Group 2 and group 3 showed poor neonatal outcome than group 1 (6.2%, 13.3%, 21.6%, p<0.05). CONCLUSION: Pregnancies complicated with GDM showed poor maternal and neonatal outcome, and GIGT experienced no adverse maternal outcomes but showed poor neonatal outcomes compared to normal pregnancy, and showed less correlation with obesity than GDM. Further study of pathophysiology and proper management of GIGT will be mandatory.
Blood Glucose ; Body Mass Index ; Cephalopelvic Disproportion ; Diabetes, Gestational* ; Dystocia ; Female ; Fetal Distress ; Glucose Tolerance Test ; Glucose* ; Humans ; Hyperbilirubinemia ; Hypoglycemia ; Incidence ; Infant, Newborn ; Intensive Care, Neonatal ; Mass Screening ; Obesity ; Oligohydramnios ; Overweight ; Parturition ; Polyhydramnios ; Pre-Eclampsia ; Pregnancy* ; Pregnant Women ; Retrospective Studies

OBJECTIVE: To determine whether hydramnios occurring in pregnant women complicated with gestational diabetes mellitus (GDM) affects maternal and neonatal outcomes. METHODS: We evaluated 277 pregnant women with singleton pregnancies and GDM diagnosed by the National Diabetes Data Group (NDDG) criteria. The study group was consisted of 23 pregnant women diagnosed as hydramnios (Amniotic fluid index; AFI>24 cm) by ultrasonography, and the control group was consisted of 254 pregnant women with normal AFI (10-24 cm). Retrospective review of maternal and neonatal outcomes in these women was performed. Student t-test, chi-square test, Fisher's exact test, and logistic regression analysis were used for statistics. RESULTS: There were no significant differences in the maternal age and parity between the two groups. The frequency of preterm labor was higher in the study group compared to the control group (4.3% vs. 34.8%, p<0.001). The frequencies of cesarean delivery due to cephalopelvic disproportion or failure to progress, preeclampsia, and placental abruption were not significantly different between the two groups. The study group showed significantly shorter gestational age (38.2+/-1.4 weeks vs. 36.7+/-2.5 weeks, p<0.05) and heavier neonatal birth weight at delivery (3,405.0+/-595.2 gm vs. 3,701.3+/-757.9 gm, p=0.026). The frequencies of preterm birth (5.1% vs. 39.1%, p<0.001), macrosomia (13.0% vs. 34.8%, p<0.001), admission to neonatal intensive care unit (7.1% vs. 34.8%, p=0.050), neonatal respiratory complications (3.9% vs. 21.7%, p<0.001), and hyperbilirubinemia (11.0% vs. 47.8%, p<0.001) were higher in the study group even after logistic regression analysis for controlling gestational age. CONCLUSION: Hydramnios occurring in pregnant women with GDM may be associated with increased risk of preterm birth and neonatal respiratory complications, but not associated with adverse maternal outcomes, except preterm labor.
Abruptio Placentae ; Birth Weight ; Cephalopelvic Disproportion ; Diabetes, Gestational* ; Female ; Gestational Age ; Humans ; Hyperbilirubinemia ; Infant, Newborn ; Intensive Care, Neonatal ; Logistic Models ; Maternal Age ; Obstetric Labor, Premature ; Parity ; Polyhydramnios* ; Pre-Eclampsia ; Pregnancy Outcome ; Pregnancy* ; Pregnant Women ; Premature Birth ; Retrospective Studies ; Ultrasonography