Objective To determine whether hyoscine butylbromide shortens the first stage of labour, without an increase in maternal or neonatal complications.Design Randomised, double-blinded, controlled trial.Setting The Antenatal clinics and Labour and Delivery ward of the University Hospital of the West Indies, Kingston, Jamaica.Population Women in spontaneous labour at term.Methods Either drug or placebo was given intravenously once the women entered active labour.Main outcome measures The duration of the first stage of labour. Secondary outcomes included comparisons of the duration of the second and third stages of labour, blood loss at delivery, rate of caesarean section, and APGAR scores in the neonates between the two groups.Results A total of 129 women yielded data for analysis. Of these, 69 women received the placebo and 60 received hyoscine butylbromide. The mean time for the first stage in the control group was 228 minutes, compared with 156 minutes in the drug group, representing a decrease of 31.7% (P = 0.001). There was no significant change in the duration of the second and third stages of labour, and no difference in blood loss or in APGAR scores. There was a slight (but statistically insignificant) increase in the caesarean section rate.Conclusion Hyoscine butylbromide is effective in significantly reducing the duration of the first stage of labour, and it is not associated with any obvious adverse outcomes in mother or neonate.

Reported rates of postpartum urinary retention (PUR) following vaginal delivery range as high as 18%, but the risk of PUR associated with cesarean delivery is difficult to determine because of the effects of surgery and anesthesia on postpartum bladder function and also because there is no consensus on what constitutes PUR. In this study, PUR was diagnosed when ultrasonography demonstrated a postvoid residual bladder volume (PVRBV) of 150 mL or greater. Participating in this prospective study were 605 pregnant women having cesarean section. The PVRBV was estimated ultrasonically after first micturition.The overall incidence of PUR following cesarean delivery was 24.1%. The incidence of overt PUR, when no spontaneous micturition took place 6 hours after removal of the catheter and patients developed symptoms of obstructed voiding such as incomplete emptying, straining, and difficulty voiding, was 7.4%. Covert PR, with no associated urinary symptoms despite an elevated PVRBV, was more than twice as frequent (16.7%). Factors significantly associated with PUR included postoperative epidural morphine administration, multiple pregnancy, and a low body mass index at the time of delivery. After 3 months of follow-up, 5% of patients had obstructive voiding symptoms and 9.1% had irritative voiding symptoms. Differences in the frequency of voiding problems between the PUR and normal groups were not statistically significant.Nearly one-fourth of these patients developed PUR following cesarean delivery. The chief contributing factor was the use of morphine for postoperative analgesia. When transient and diagnosed at an early stage, PUR did not compromise urinary function and was not associated with subsequent voiding problems. ABSTRACTPerinatal complications are more frequent in cases of maternal diabetes, but little is known about the long-term intellectual outcome of offspring born to diabetic mothers. This study followed a cohort of Danish males born in the years 1976-1984 whose mothers were diabetic. These 282 subjects were followed up to the time of military conscription along with 870 population-based control subjects. The instrument used to gauge intelligence was the Boerge-Prien test, a 45-minute validated measure whose results correlate closely with those obtained using the Wechsler Adult Intelligence Scale.The rejection rate was 52.5% for diabetes-exposed subjects and 45.4% for control subjects. The risk difference was 7.3%, with a 95% confidence interval (CI) of 0.6 to 14.01. Analysis of the medical reasons for rejection failed to disclose diagnoses that could be related to cognitive performance. Among those who were not rejected, mean cognitive scores were 41.4 units (95% CI, 40.2-42.6) in diabetes-exposed individuals and 42.7 units (95% CI, 42.0-43.4) in control subjects. The findings were not altered when stratifying subjects by gestational age at birth or Apgar score. In a subgroup of 39 pregnancies with available data, a 1% point increase in maternal AIC (glycosylated hemoglobin) was associated with a 2.6% poi...

Acute post-coital sphincter injuries should be treated operatively on an emergent basis, without diversion because they are low energy injuries with minimal tissue loss and excellent blood supply. Although repair of each injury should be individualized, the majority of these injuries do not require concomitant protective colostomy creation.