Changes in obstetric management over the past decade
Reinold, E.; Pavelka, R.; Schmid, R.; Grünberger, W.; Husslein, P.
Wiener Klinische Wochenschrift 92(16): 564-569
1980
ISSN/ISBN: 0043-5325 PMID: 6933748 Document Number: 163064
Over a observation period of 10 years (1969-1979) developments in perinatal control techniques, mostly started in the 1st Department of Obstetrics and Gynaecology, University of Vienna, at the beginning of that period, and their effect on the obstetric management are presented. In contrast to a trend of decreasing birth rate for the whole of Austria the annual numbers of deliveries in this hospital remained -after a temporary increase-unchanged. Subpartial cardiotocographic monitoring is presently applied in about 95% of all cases. The frequency of Caesarean sections has risen from below 4% to approximately 8% over the past years. Simultaneously, a shift was observed from vital to preventive fetal indications in Caesarean sections, with a parallel tendency to relatively fewer vaginal-operative deliveries. The uncorrected perinatal mortality rate has been lowered to 1.35%. This decrease is partly due to our efforts to select high-risk pregnancies in order to control them intensively. Thus, ultrasound examinations have been liberally put into practice, e.g. leading to an early diagnosis of multiple pregnancy. Use of tocolytic drugs, as well as surgical closure of the cervix together with intensive prenatal care of pregnant women with a high risk of prematurity have proved their worth as compared with control groups. Due to early and special interest in research and in monitoring of placental insufficiency, hormone determinations and measurements of placental perfusion by isotopes took a fixed place in monitoring of high-risk pregnancies early on during the observation period. Evaluation of fetal lung maturity by amniocentesis now enables us to make well-grounded decisions to stop tocolytic measures or to induce labour. In the latter field the local application of prostaglandins to the cervix by an adaptor has recently opened up new aspects. Attention has also been paid to the emotional aspect by new techniques of psychprophylactic preparation for childbirth and by a policy of rooming-in of mother and child.