The rate of transplacental passage of diazepam (DZ) has been studied in 33 cases of cephalic presentation where operative forceps delivery was indicated by intrauterine hypoxia or by prolonged second stage of labor. The drug (30 mg) was injected intravenously immediately before delivery either during uterine contractions (Group I) or in the relaxation period (Group II) according to a randomized protocol. As judged by the concentration in the newborn and the child/mother concentration ratio at 2 hr after delivery, and the concentration on the second day, the fetal exposure to the drug was probably less when the injection was timed to coincide with uterine contractions. In the group of patients given the drug in the relaxation period, the injection-delivery (I-D) interval was up to 305 sec and the 2-hr child/mother concentration ratio was close to unity in some cases. It therefore appears that the transplacental passage of DZ is rapid when the high initial concentrations in the maternal circulation coincide with favorable conditions for transfer in the relaxation period. Although sleep was induced by the injection of DZ in all of the mothers, the amounts of drug transferred during the short I-D intervals in the present study did not exert delterious effects on the newborn infants.
The two largest Norwegian obstetrical departments, in the cities of Bergen and Stavanger, differ markedly with regard to the frequency of Cesarean section. During the 1970's the proportions rose in both departments, but the Stavanger rate remained about half of that in Bergen, the latter following the national average. These differences were not reflected in the perinatal mortality, which had the same rates and fell equally in both hospitals. To search for explanations, all records of Cesarean section cases from the years 1974 and 1979 were studied in both hospitals. We found that mechanical indications, meaning disproportion and prolonged labor, accounted for most of the difference, whereas there was no significant rise in the frequencies for the indication fetal asphyxia in either of the hospitals, these being numerically the most important indications. In fact, there was no significant rise for mechanical indications in Stavanger between 1974 and 1979, whereas in Bergen the increased frequency for this indication gave the highest significance level for any of the seven subgroups of indications. It is suggested that the chain of command may be an important cause of the observed differences between the two departments, although this is not reflected in any stated or conscious policy in either place.
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