A new contraceptive (LNG rod implants, Jadelle, Leiras Oy's registered trademark for rod implants) was prospectively evaluated in randomized 5 year comparison with Norplant (Population Council's registered trademark for contraceptive implants releasing levonorgestrel) capsule implants. The study involved 1198 women at seven centres. No pregnancies occurred in the first 4 years. At 5 years, the cumulative pregnancy rate was 1 per 100 users or less for each regimen. Annual discontinuation rates averaged 11-12 per 100 users (P > 0.05), corresponding to 5 year continuation rates of 55.1 for rods and 53.0 per 100 for capsules. Mean annual discontinuation rates for menstrual disturbances were 3.5 and 4.2 per 100 for rod and capsule implants respectively (P > 0.05), and mean annual removal rates for medical problems were 3.5 and 3.0 per 100 (P > 0.05) respectively. Apart from menstrual problems, headache, weight gain and acne were the principal medical reasons for removal. In proportional hazard analyses, family formation variables, age, parity and desire/non desire for another child, recorded at admission, significantly affected discontinuation rates for major decrement categories and for all reasons combined. Mean rod removal time was half that of Norplant (P < 0.01); complications of rod removal were at a lower rate. With these contraceptives indistinguishable in performance except for ease and speed of removal, LNG rod implants appear to be preferable to Norplant for use through 5 years by virtue of relative ease of removal.
At Sorrento Maternity Hospital Asian mothers whose babies had grown poorly in utero had anthropometric and biochemical evidence suggesting an inadequate nutritional state. To test this hypothesis further the effect of unselective dietary protein energy supplementation was studied. A total of 153 Asian mothers received one of three supplements from the 18th to 38th weeks of pregnancy: (a) vitamins only-vitamin C 30 mg daily, iron 3 mg daily; (b) energy-42-80 MJ; (10 000-19 000 kcal)/ trimester, all from carbohydrate, plus vitamins; (c) protein energy-energy and vitamins as before, but with 5-11% of energy from milk protein. By the 28th week mothers receiving the protein energy supplement had put on more-weight and more fat than the vitamin-only group. Neither protein energy nor energy supplementation alone enhanced intrauterine growth.It is concluded that dietary supplementation of all pregnant mothers does not enhance intrauterine growth.
Summary
Perinatal outcome and infant development in 73 preterm breech deliveries is described in relation to mode of deliver‐.
32 such cases were delivered b‐ caesarean section and 41 b‐ the vaginal route between April 1982 and December 1983 at the 5 major government deliver‐ units in Singapore ‐ all with comparable neonatal services.
Vaginal deliver‐ was associated with a higher intrapartum and neonatal mortalit‐ and morbidit‐ when compared with infants delivered b‐ caesarean section (mortalit‐ rate in vaginal deliver‐ group = 17.1% compared with 6.3% in caesarean section group). Furthermore, amongst the 25 children assessed at 12 months of age, there was a tendenc‐ to better performance in gross motor function and language abilit‐ in those delivered abdominall‐. The present results suggest that the preterm breech might benefit from caesarean section even if variables other than the mode of deliver‐ influence the outcome. These findings are consistent with previous reports which have also been briefl‐ reviewed.
However, the higher maternal morbidit‐ associated with caesarean deliver‐ and the risk for unnecessar‐ surgical intervention (eg in cases of malformed fetuses) make a careful preoperative assessment imperative.
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