not associated with longer second stage labor. Women who delivered within 0 to 1 hour had a spontaneous vaginal delivery (SVD) 90% of the time; those delivered in 2 to 3 hours had a 62.4% SVD rate, with 30.1% having operative vaginal delivery and 7.5%, CS; at Z3 hour, SVD rates dropped to 35.8%, with 37.4% having operative vaginal delivery, and 26.8%, CS.Epidural anesthesia was associated with an increased risk for operative vaginal deliveries, but not with higher CS rates in second stages exceeding 3 hours. Rates of thirddegree or fourth-degree perineal laceration, postpartum hemorrhage, chorioamnionitis, and endomyometritis increased with lengthening duration of second stage. Neonates delivered after a second stage of Z2 hours had higher undesirable neonatal outcomes, including 5-minute Apgar scores <7, umbilical artery pH <7, base excess < À 12, meconium-stained amniotic fluid, intensive care nursery admission, and prolonged hospital stays.A small subgroup of multiparous women do experience a second stage of labor >2 hours in duration. Whether to intervene depends on a thorough evaluation of the ongoing risks of the intervention versus further expectant management, along with patient preference. The authors believe their findings can help facilitate such a discussion and counseling of multiparous women in this situation. They recommended larger, randomized, controlled studies regarding intervention when the second stage of labor progresses beyond 2 hours in multiparous women.I n the late 1990s, the McRoberts maneuver was widely used in the United Kingdom to manage shoulder dystocia during vaginal delivery and protocols to overcome this complication had become established at most centers. This study investigated trends in shoulder dystocia prevalence, methods used to overcome the obstruction, and associated maternal, fetal, and neonatal morbidity at one medical center in the United Kingdom.Cases of shoulder dystocia from 1991 to 2005 were identified from maternal delivery records. Cases of brachial plexus injury and other neonatal diagnoses made during the same period were identified separately. The demographic and delivery statistics for all vaginal deliveries during each year were obtained. Information on shoulder dystocia management, once the condition was diagnosed, was also recorded. Neonate conditions at birth were assessed by recording APGAR scores, umbilical cord blood gases, evidence of orthopedic injury, and neurologic outcome. The level of obstetrician training was recorded. Maternal injury was documented as was management of subsequent deliveries, including recurrent shoulder dystocia and neonatal birth weight.Among 95,321 deliveries, 79,781 were vaginal and among these were 514 cases of shoulder dystocia, 44 cases of neonatal brachial plexus injury, and 36 asphyxiated neonates. The mean annual rate of vaginal deliveries was 82.4%, which decreased by 0.64% each year. Use of epidural analgesia averaged 28.3% annually. The overall rate of shoulder dystocia during the 15 year was 0.64% of vaginal deliv...

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The effects of morphine and verapamil have been assessed on the gastrointestinal propulsion of charcoal meal and egg yolk-induced gall bladder emptying in mice. Each drug significantly inhibited these functions. In combination, an additive effect was seen on the inhibition of gastrointestinal transit, whilst verapamil potentiated the morphine-induced inhibition of gall bladder emptying. It is concluded that calcium ion channel antagonists may potentiate the activity of opiate drugs.

Cloacal malformation is a rare abnormality, characterized by direct communication between the gastrointestinal, urinary, and genital structures, resulting in a single perineal opening. Prenatal diagnosis is difficult because of nonvisualization of the communication. We report a case of prenatal diagnosis of this condition, in which the recognition of calcified meconium in the colon and urinary tract provided an important clue.

Pregnancy complicated with Eisenmenger syndrome is associated with high risk to the fetus as well as the mother. There is approximately 50% risk of sudden maternal death, frequently occuring a few days postpartum and the overall fetal wastage is reported to be up to 75%. Patients with Eisenmenger syndrome are advised to refrain from pregnancy or to terminate pregnancy by the end of rst trimester itself. Management of these patients requires a co- ordinated multi-specialist care when such pregnancies reach a stage where safe termination is not advisable. However, in spite of all the risks, a few patients deliver successfully with a good maternal and neonatal outcome. We present 2 cases reported till third trimester and delivered a healthy baby and were subsequently discharged on the 10th postpartum day without any serious complications.