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[VedranaV]

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20060516-61# Is planned vaginal delivery for breech presentation at term still an option? Results of an observational prospective survey in France and Belgium - American Journal of Obstetrics and Gynecology , vol 194, no 4, April 2006, pp 1002-1011 Goffinet F; Carayol M; Foidart JM; et al - (2006) OBJECTIVE: A large trial published in 2000 concluded that planned vaginal delivery of term breech births is associated with high neonatal risks. Because the obstetric practices in that study differed from those in countries where planned vaginal delivery is still common, we conducted an observational prospective study to describe neonatal outcome according to the planned mode of delivery for term breech births in 2 such countries. STUDY DESIGN: Observational prospective study with an intent-to-treat analysis to compare the groups for which cesarean and vaginal deliveries were planned. Associations between the outcome and planned mode of delivery were controlled for confounding by multivariate analysis. The main outcome measure was a variable that combined fetal and neonatal mortality and severe neonatal morbidity. The study population consisted of 8105 pregnant women delivering singleton fetuses in breech presentation at term in 138 French and 36 Belgian maternity units. RESULTS: Cesarean delivery was planned for 5579 women (68.8%) and vaginal delivery for 2526 (31.2%). Of the women with planned vaginal deliveries, 1796 delivered vaginally (71.0%). The rate of the combined neonatal outcome measure was low in the overall population (1.59%; 95% CI [1.33-1.89]) and in the planned vaginal delivery group (1.60%; 95% CI [1.14-2.17]). It did not differ significantly between the planned vaginal and cesarean delivery groups (unadjusted odds ratio = 1.10, 95% CI [0.75-1.61]), even after controlling for confounding variables (adjusted odds ratio = 1.40, 95% CI [0.89-2.23]). CONCLUSION: In places where planned vaginal delivery is a common practice and when strict criteria are met before and during labor, planned vaginal delivery of singleton fetuses in breech presentation at term remains a safe option that can be offered to women. (25 references) (Author)

20060516-37# Just take a deep breath... A review to compare the effects of spontaneous versus directed Valsalva pushing in the second stage of labour on maternal and fetal wellbeing - MidIRS Midwifery Digest , vol 16, no 2, June 2006, pp 157-165 Bosomworth A, Bettany-Saltikov J - (2006) Background: This work was undertaken as part of a MastersBachelors degree in Midwifery. The main focus of this article is around the methods used to review and synthesise the literature in order for it to be useful in practice. Management of the second stage of labour for women without epidural analgesia varies considerably. The Valsalva manoeuvre was introduced into obstetrics as a way of reducing the duration of the second stage in order to limit the exposure of the fetus to the perceived risks of this stage of labour. Taking a more holistic view it is necessary to evaluate the effects of directed Valsalva pushing on other maternal and fetal labour outcomes in order to test its effectiveness and efficacy as a method of pushing. Aims: Objectives: This review aimeds to compare the effects of directed Valsalva pushing with spontaneous pushing on: duration of the second stage, mode of delivery, perineal outcome, Apgar scores, cord blood pH and fetal heart rate. Search Strategy: Extensive searching was carried out using Eelectronic resources and hand searching were undertaken for quantitative research carried out on women without epidural analgesia. No restrictions were made based on parity or gestation, however all included studies involved women at 37–42 weeks gestation. Studies were not excluded on the basis of their age. A thorough analysis of quality was carried out on each paper prior to extraction and comparison of data. Main results: Ten10 studies were included in the review - three3 randomised controlled trials (including one1 pilot study), five5 non-randomised controlled trials (including one1 pilot study), one1 retrospective analysis and one1 controlled trial using intra-subject replication. Very few statistically significant results were reported and . it would appear that directed Valsalva pushing has no effect on the mode of delivery. Although dDirected Valsalva pushing may shorten the second stage of labour, but the results were inconclusive and contradictory It would appear that directed Valsalva pushing has no effect on the mode of delivery. The outcome most affected by directed Valsalva pushing was perineal integrity, with significantly poorer outcomes being reported in terms of severity and frequency of perineal tears. In considering fetal wellbeing, no differences were found between directed Valsalva pushing and spontaneous pushing for Apgar scores or umbilical cord blood pH values. The effect of directed Valsalva pushing on the fetal heart rate is inconclusive but there is some evidence to suggest that it may increase risk of late decelerations. (50 references) (Author)

I još nešto zgodno što sam pročitala u Reader's Digestu - kad si žedan, više te boli. Dva podražaja djeluju jedan na drugi tako da se pojačava onaj koji je bitniji za preživljavanje. Bol je bitnija od žeđi i onda je mozak naglasi. Korisno za znati za vrijeme poroda.

[mamazika]

Što je Valsalva, skakanje na trbuh?
Ja pod tim pojmom znam puhanje u začepljeni nos da se otčepe eustahijeve tube, ali vjerujem da se ne radi o tome

[VedranaV]

To ti je ono kad udahneš, zadržiš zrak i tiskaš. Nije skakanje na trbuh ni puhanje u nos .

[mamazika]

Ma krivo sam se izrazila, nije puhanje u nos... no to s eustahijevima je isto, samo začepiš nos.