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PubMedDate not supplied

Second stage labor: what is normal?

Traditional management of second stage labor has come under scrutiny because of improved understanding of what normally occurs when second stage labor is allowed to proceed of its own accord without direction from birth attendants. When women bear down spontaneously as they feel the urge to push, either holding their breath briefly or with short exhalation of air, normal maternal and fetal physiological status is maintained and second stage labor does not appear to be lengthened. Using a variety of maternal positions during second stage labor can optimize physiologic functioning and increase maternal comfort.

Female↗
PubMed2004

IFN-gamma-mediated inhibition of COX-2 expression in the placenta from term and preterm labor pregnancies.

PROBLEM: The inflammatory-anti-inflammatory cytokine network is thought to play a critical role in regulated progression and termination of pregnancy. The aim of this study was to evaluate the effects of interferon (IFN)-gamma on the expression of Cyclooxygenase (COX)-2 and production of prostaglandin E(2) (PGE(2)) in the human placenta from term and preterm labor deliveries. METHOD OF STUDY: Placental explant culture system was used. COX-2 expression was determined by complementary techniques of immunohistochemistry and Western blotting. Released IFN-gamma and PGE(2) by placental explants were measured by enzyme-linked immunosorbent assay. Signal transducer and activator of transcription 1 (STAT1) phosphorylation was evaluated by Western blotting using a specific antibody. RESULTS: IFN-gamma was poorly detected in the placenta but was significantly expressed in decidual tissues from both term and preterm pregnancies as detected by immunohistochemistry. IFN-gamma significantly inhibited COX-2 expression and PGE(2) release in cultured placental explants from term and preterm labor deliveries. This effect most likely occurred in a STAT1-dependent manner as this regulatory protein was phosphorylated in response to IFN-gamma. IFN-gamma receptor (IFN-gammaR) was expressed in normal early pregnancy placental samples. However, its expression was significantly reduced in placental samples from term and preterm deliveries. Of interest, IFN-gammaR was expressed in placentas from term and preterm labor deliveries after 24 hr in culture. CONCLUSIONS: Our data suggest that the human placenta is an important site for IFN-gamma-mediated repression of COX-2 expression and PGE2 production, implying that functional withdrawal of IFN-gamma may be involved in the onset of term or preterm labor.

Adolescent↗
PubMed1985

The influence of labor and delivery on preterm fetal adrenal function.

The influence of labor and route of delivery upon umbilical cord serum levels of cortisol and dehydroepiandrosterone sulfate in one hundred sixty-nine preterm infants not exposed prenatally to corticosteroids was studied. Vaginally born infants (group A, n = 89) presented a higher mean cord cortisol and dehydroepiandrosterone sulfate concentrations than those delivered by cesarean section (group B, n = 80). Although there were no differences in cortisol and dehydroepiandrosterone sulfate levels between infants delivered by cesarean section after spontaneous onset of labor (group B-I, n = 42) and those without labor (group B-II, n = 38), the mean cortisol and dehydroepiandrosterone sulfate concentrations were higher in group A than in group B-I. There was a correlation between umbilical cord cortisol and dehydroepiandrosterone sulfate levels. It is concluded that there is no association between the presence of labor and high cord serum levels of cortisol and dehydroepiandrosterone sulfate and there is an association between vaginal delivery and high cord cortisol and dehydroepiandrosterone sulfate levels in preterm infants. It is suggested that the stress of vaginal delivery stimulates the secretion of fetal cortisol and dehydroepiandrosterone sulfate in preterm infants.

Adrenal Glands↗
PubMed1996

Vaginal birth following unmonitored labor in patients with prior cesarean section.

Following a previous cesarean section, trial labour followed by spontaneous birth is currently popular but is still debatable. In an effort to assess the risks of unmonitored labor, the outcomes of 165 patients with previous cesarean section who delayed coming to hospital were reviewed. Seventy-one patients were allowed to continue labor and 62 achieved successful vaginal delivery, a success rate of 87.3%. Sixty-one of 71 patients had an unknown uterine scar type prior to birth and, of these, 57 were delivered vaginally. The scar separation rate of this group was found to be 3.5% and the overall scar separation rate in our patients was 3.6%. Other than scar separation and febrile morbidity, no maternal morbidity or mortality was observed. The vast majority (98.4%) of infants delivered vaginally had 5-min Apgar scores of 7 or greater. We suggest that increasing the use of trial labor in patients with prior cesarean section, even in the presence of an unknown scar, may reduce the number of patients laboring in an unmonitored environment who wish to give birth vaginally.

Adult↗
PubMed1985

Lack of beta-endorphin plasma level rise in oxytocin-induced labor.

beta-Endorphin (beta-EP), beta-lipotropin (beta-LPH) and cortisol plasma levels were measured during labor in 18 pregnant women. In 7 cases labor progressed spontaneously and in 11 cases oxytocin (5 mIU/min) was administered to stimulate uterine contractions. In control and oxytocin-treated subjects hourly blood samples were taken until delivery. In spontaneous labor all three hormones showed a progressive and significant increase until parturition. In oxytocin-treated patients, however, both beta-EP and beta-LPH remained constant until parturition. Cortisol levels in oxytocin-treated patients presented a significant increase but reached values significantly lower than in control patients. These results indicate that women with uterine hypocontractility during labor requiring oxytocin showed no rise in their plasma beta-EP and beta-LPH and a blunted cortisol rise during oxytocin administration.

Adult↗
PubMed2005

High fetal urocortin levels at term and preterm labor.

CONTEXT: Placental urocortin has a role in the cascade of events leading to parturition by stimulating myometrial contractility and placental uterotonins secretion. OBJECTIVE: The objective of this study was to evaluate urocortin levels in maternal and fetal [umbilical cord artery (UCA) and vein (UCV)] plasma at term and preterm labor. DESIGN: The study design was a controlled cross-sectional study performed from November 2003 to June 2004. SETTING: This study was performed at the Division of Obstetrics and Gynecology, University of Siena (Siena, Italy). PATIENTS: Plasma samples were collected at term in the absence of labor (TNL; n = 27; 39.3 +/- 0.1 gestational weeks), at term spontaneous vaginal delivery (TL; n = 24; 40.1 +/- 0.2 gestational weeks), and at preterm labor (PTL; n = 19; 32.4 +/- 0.4 gestational weeks). Changes in urocortin mRNA expression were also evaluated in placentas collected from TNL (n = 11), TL (n = 11), and PTL (n = 10). INTERVENTION: Urocortin levels were measured by specific RIA. Changes in placental mRNA expression were determined by real-time quantitative RT-PCR analysis. RESULTS: Maternal and UCA plasma urocortin levels were significantly (P < 0.0001 for all) higher in TL and PTL than in TNL. Furthermore, UCA concentrations were significantly (P < 0.0001 for all) higher than and correlated with maternal concentrations (TNL: r = 0.45; P < 0.05; TL: r = 0.959; P < 0.0001; PTL: r = 0.7719; P < 0.0001). UCV levels were significantly (P < 0.001) higher in TL and PTL than in TNL and were significantly (P < 0.0001 for all) higher than and significantly (P < 0.0001 for all) correlated with maternal values, but were significantly (P < 0.0001 for all) lower than and correlated with UCA values (TNL: r = 0.9548; P < 0.0001; TL: r = 0.927; P < 0.0001; PTL: r = 0.838; P < 0.0001). Placental urocortin mRNA expression did not differ among TNL, TL, and PTL samples. CONCLUSIONS: Fetal urocortin secretion is increased in term and preterm labor. Whether these changes are a consequence rather than a cause of human parturition remains to be addressed.

Corticotropin-Releasing Hormone↗
PubMed1980

Emotional stress in childbirth and its modification by variations in obstetric management. Epidural analgesia and stress in labor.

Emotional stress before, during and after labor was measured in 20 primigravidae by serial estimation of plasma 11-hydroxycorticosteroids and by stress assessment interviews. The anticipation of epidural analgesia and internal fetal monitoring was a significant source of emotional stress to women awaiting induction of labor, despite explanation and attempted reassurance. During labor epidural analgesia reduced stress by abolishing pain, so eliminating the progressive rise in 11-hydroxycorticosteroids normally seen throughout labor. Epidural analgesia does not, however, block the potential for the adrenocortical response to stress and the physical work, emotional stress and surgical trauma of delivery stimulate a considerable output of 11-hydroxycorticosteroids.

11-Hydroxycorticosteroids↗
PubMed1983

The role of estradiol and progesterone in the regulation of myometrial activity for the onset of labor.

The concentrations of estradiol (E2) and progesterone (P) were measured in peripheral plasma and myometrium from women in the 35th to 42nd week of pregnancy. On the basis of the subjective symptoms and objective signs of labor, judged by tocography and cervical status, the women were divided into two groups, one in labor and the other not. There were no significant inter-group differences in the concentrations of E2 or P in either plasma or the myometrium. The plasma P/E2 ratio, however, differed significantly, being lower in the women in labor. A similar tendency was found in the P/E2 ratio in the myometrium but due to a wide variation, the inter-group difference did not attain statistical significance. The results suggest that a lower P/E2 ratio at term would facilitate the action of an, as yet unknown, physiological stimulus to the onset of labor.

Adult↗
PubMed1985

Auditory evoked responses in the human fetus. II. Modifications observed during labor.

The author presents his observations made on the behavior of an auditory evoked response of the human fetus during labor, elicited by a standardized sound stimulus at 1500 cycles/second. The method was applied to 233 women during labor and the pattern of responses evoked by sound stimulation was studied in all clinical conditions present in this high-risk population. A fair number of observations was made on vigorous/depressed newborns by Apgar rating, in the presence of definite cardiotocographic signals of fetal distress, in cases of intact or ruptured membranes, in cephalo-pelvic disproportion, in the presence of maternal risk factors, in cases of cord entaglement, in cases of meconium present in amniotic fluid, in intra-uterine growth retardation, hypertensive disease of pregnancy, and in familial and class A diabetes. A significant decrease in the response to sound stimulation was observed in cases of fetuses born in a depressed condition, after more than 2 hours following membrane rupture, in the presence of maternal obstetric risk factors, and in cases of hypertension in pregnancy. Women with intra-uterine growth retardation and cephalo-pelvic disproportion presented smaller changes and in cases of umbilical cord entaglement, presence of meconium in amniotic fluid and with history of familial or class A diabetes, no differences in the patterns of responses to sound stimulation as compared with normal could be observed. The author observed a good correlation between the auditory evoked response and fetal conditions during the course of labor and suggests that this method should be further developed as a simple method of evaluating the cerebral function of the unborn human fetus. In the first published part of this study (19) we described the modifications in the auditory evoked response of the human fetus caused by the progress of labor. A closer scrutiny of our data revealed the influence of several other factors acting upon the pattern of fetal response to sound stimulation. The present paper describes studies on those factors influencing the behavior of the human fetus following sound stimulation.

Cerebral Cortex↗
PubMed1997

High progesterone is related to effective human labor. Study of serum progesterone and 5alpha-pregnane-3,20-dione in normal and abnormal deliveries.

BACKGROUND: The role of progesterone levels during human labor is unclear. OBJECTIVE: To investigate serum concentrations of progesterone and 5alpha-pregnane-3,20-dione in normal and abnormal deliveries. METHODS: Venous and umbilical cord serum samples were collected from 108 parturient women. In a further 49 deliveries, arterial and venous umbilical cord sera were collected separately. The concentrations of progesterone and 5alpha-pregnane-3,20-dione were determined by radioimmunoassay. The delivery modes studied were: elective cesarean section; oxytocin-resistant dystocia; normal but induced delivery, and normal spontaneous delivery. RESULTS: Progesterone concentrations in maternal and umbilical serum were higher following normal labor than after dystocia (p<0.005) and elective cesarean section (p<0.005). The maternal and umbilical progesterone concentrations in dystocia and elective cesarean section were between 77-43% of those in normal labor. The concentrations did not vary between gestational weeks 37 and 42, within the different modes of delivery. The 5alpha-pregnane-3,20-dione serum concentration in the fetal compartment was twice that in the maternal compartment (p<0.001); its concentration in venous umbilical serum was higher than in corresponding arterial samples (p<0.001). No distinct differences in the 5alpha-pregnane-3,20-dione serum concentration were found with regard to parity or mode of delivery. CONCLUSION: High progesterone concentrations during parturition appear to be related to effective labor. The findings support results from in vitro experiments on human term myometrium.

5-alpha-Dihydroprogesterone↗
PubMed1976

Patterns of labor in native and immigrant population in Israel.

The application of cervical dilatation rates as a predictive index of the outcome of labor was tested among various subgroups of the Israel population. Cervical dilatation rates, gestational ages, birth weights, initial fetal head station, cervical dilatation at head engagement, and incidence of delivery problems were similar among Jewish patients, both native born and foreign; and among Arab patients. Generally, primiparas entered labor with lower fetal head station and reached head engagement with less cervical dilatation than did multiparous or grand multiparous patients. The results suggest that the rate of cervical dilatation, as measured early in the active phase of labor, can be used with equal confidence among all our population groups to forecast type of delivery. Early in the active phase of labor, women in whom the probability of a spontaneous delivery is approximately 95% can be separated from those cases in which intervention will be necessary.

Adolescent↗
PubMed1999

The influence of prepregnancy body mass index on labor complications.

BACKGROUND: To investigate the influence of Body Mass Index on the incidence of labor complications in a population of women with a normal pregnancy. MATERIAL AND METHODS: From a local database, information on maternal weight and height was extracted concerning 4258 women who had an uncomplicated pregnancy. After calculation and stratification with respect to Body Mass Index, this was retrospectively related to labor interventions and complications. RESULTS: High Body Mass Index was related to more oxytocin infusion and early amniotomy, but not to vacuum extraction or cesarean section. Primary inertia and, to a minor degree, cephalopelvic disproportion and secondary inertia were seen more often in women with high Body Mass Index. CONCLUSIONS: Overweight (25.0<=BMI<30.0) and obesity (BMI>=30.0) are only weak predictors of labor complications, given a normal pregnancy. However, the heavy use of labor augmentation indicates that obese women should not be recommended to give birth in an ABC-clinic or at home.

Body Mass Index↗
PubMed2000

Predicting the success of a trial of labor with a simple scoring system.

OBJECTIVE: To determine the applicability of a simple scoring system, by Troyer and Parisi, in predicting the success of a trial of labor among parturients with prior cesarean delivery. STUDY DESIGN: Retrospectively, all patients who underwent a trial of labor over six consecutive years were reviewed. chi 2, Fisher's exact test and analysis of variance followed by the Turkey or Dunn test were used when appropriate. P < .05 was considered significant. RESULTS: There were 263 trials of labor, of which 63% (167) ended in vaginal delivery. While 21% had a score of 0, 40%, 28% and 11% had a score of 1, 2 and at least 3, respectively. The frequency of vaginal birth was significantly different between the four groups (P < .001): 98% for a score of 0, 69% for 1, 40% for 2 and 33% for 3-4. Occurrence of cesarean delivery for cephalopelvic disproportion (2%, 24%, 39%, 56%; P < .001) or for a nonreassuring fetal heart rate tracing (0%, 7%, 21%, 11%; P < .001) was significantly different between the four groups. CONCLUSION: In our population, we confirmed the inverse relationship between the Troyer-Parisi scoring system and a successful trial of labor.

Adult↗
PubMed1975

Comparison of uterine contractions in spontaneous and oxytocin- or PGF2alpha - induced labors.

Labor contractions in 20 patients in spontaneous labor and 40 others who reveived either PGF2alpha or oxytocin for stimulation of the active phase of labor were statistically analyzed during 1 hour of labor. Measurement criteria were the frequency, intensity, and duration of contractions. Statistical analysis failed to reveal any significant difference in contractions in the three groups, suggesting that oxytocin and PGF2alpha-induced contractions and spontaneous contractions appear to be indistinguishable.

Adolescent↗
PubMed1995

[Immigration and labor: Australia and Canada compared].

"Australia and Canada share...a common colonial history and many similarities in geography, economy, demography, etc., as well as a substantial anti-non anglo-celtic immigrant tradition, in spite of their being immigration countries. Those similarities and differences are analyzed here, as far as labor migration and relationships between immigrant and local labor are concerned. The arrival of European labor first, Asian later, was perceived similarly by both Australia and Canada, combining racial prejudice and unions' hostility towards contract labor migration as well as towards assisted migration. The evolution of those difficult relations through the 19th and 20th centuries is analyzed here." (SUMMARY IN ENG)

Americas↗
PubMed2002

[Management of abnormal fetal heart rate in the second stage of labor].

OBJECTIVE: We investigated the correlations between abnormal fetal heart rate (FHR) during the second stage of labor and delivery types and intrapartum maternal complications and fetal outcome. METHODS: The data of 232 nulliparas with single vertex in the second stage of labor (111 cases with normal FHR, 121 cases with abnormal FHR) were analyzed retrospectively. RESULTS: The incidence of abnormal FHR in the second stage of labor was 52.2% (121/232). The patterns of abnormal FHR included: 81 (66.9%) cases with moderate and/or severe variable deceleration (VD), 27 (22.3%) cases with scattered late deceleration (LD), only one with continuous LD, 4 (3.3%) cases prolonged deceleration (PD), 2 (1.7%) cases with VD and LD, 3 (2.5%) cases with VD and PD, 4 (3.3%) cases with diminished baseline variability. There were 13 (11.7%) among the cases with normal FHR and 35 (28.9%) among the cases with abnormal FHR underwent assistant delivery operations (forceps or/and vaccum), respectively (P < 0.05). Furthermore 29 of 35 (82.9%) cases underwent assistant operations for vagina delivery due to abnormal FHR, the others underwent assistant operations for vagina delivery due to weak expulsive force or malpositioning of fetal head. There was one case of complicated vaginal laceration in the group with abnormal FHR. There was no difference of newborns with low Apgar score between two groups. CONCLUSIONS: There was a very high incidence of abnormal FHR during the second stage of labor, however, the most cases were response to parasympathetic stimulation due to umbilical cord or fetal head compression by mothers over push and descent of fetal head, or temporal diminishing of uterine placenta blood flow. It suggests that it is unnecessary to interfere immediately, unless truly fetal distress.

Adult↗
PubMed1992

Delivery through the maternal bladder during trial of labor.

BACKGROUND: The safety of trial of labor after cesarean has been documented by numerous studies. Large series have demonstrated that in a properly chosen setting, 75% of women can achieve vaginal delivery without undue risk to the mother or fetus. In a small percentage of cases, trial of labor deviates from the expected outcome. CASES: Two infants were delivered through the maternal bladder, one after uterine dehiscence and the other after vaginal rupture at trial of labor. CONCLUSION: Standard and unique complications are reported with trial of labor. Because these complications occur infrequently, they should not discourage an attempt at vaginal delivery after cesarean.

Adult↗
PubMed2006

[Effects of routine early amniotomy on labor and health status of foetus and neonate: a meta-analysis].

OBJECTIVE: To analyze the effects of routine early amniotomy on labor and health status of foetus and neonate. METHODS: The results of Early amniotomy increases the frequency of fetal heart rate abnormalities, A randomized controlled trial of early amniotomy, Effect of early amniotomy on the risk of dystocia in nulliparous women, The influence of elective amniotomy on fetal heart rate patterns and the course of labor in term patients: A randomized study, Randomised trial comparing a policy of early with selective amniotomy in uncomplicated labour at term and A randomized controlled trial and meta-analysis of active management of labour were analyzed using Mantel-Haenszel method (fixed effect model) in meta-analysis. RESULTS: (1) The routine early amniotomy can shorten 94.90 min of the first stage of labor, 95% CI (-119.17, -70.52). (2) The OR for cesarean section was 1.25, 95% CI (0.99-1.57), for instrumental vaginal delivery was 1.05, 95% CI (0.90-1.24). (3) There was no difference in abnormal fetal heart rate at first stage (OR = 0.95, 95% CI: 0.75-1.21), but there was increased abnormal fetal heart rate at second stage (OR = 1.28, 95% CI: 1.02-1.61). (4) The frequency of stained amniotic fluid and abnormal Apgar scores at 1 minute was not different significantly [OR = 1.17, 95% CI (0.78-1.73); OR = 0.71, 95% CI: (0.49-1.03)]. CONCLUSIONS: Routine early amniotomy appears to be associated with both benefits and risks. Beneficial effects include reductions in labor duration and possible decrease in frequency of abnormal Apgar score at one minute. Risks include increase in abnormal fetal heart rate at second stage and possible rise in cesarean section rate.

Amnion↗

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