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At least 289 records · Page 16Linked to original sources
PubMed1994

Intrapartum fetal pulse oximetry: fetal oxygen saturation trends during labor and relation to delivery outcome.

OBJECTIVES: Our purpose was to study fetal arterial oxygen saturation trends by continuous pulse oximetry during labor in subjects with normal and abnormal delivery outcomes. STUDY DESIGN: Continuous fetal arterial oxygen saturation was measured during labor with a noninvasive reflectance pulse oximeter designed for fetal application. Averaged arterial oxygen saturation values were compared between stage 1 and stage 2 of labor, with stage 1 further subdivided into early (< or = 4 cm), middle (5 to 7 cm), and late (8 to 10 cm) phases. Delivery outcome was considered to be abnormal for any of the following conditions: gestational age < 37 weeks, maternal oxygen administration, delivery by cesarean section, 5-minute Apgar score < 7, umbilical artery pH < 7.10, birth weight < 2500 gm, or newborn intensive care unit admission. RESULTS: A total of 291 subjects were studied: 142 in Provo, 90 in Nijmegen and 59 in San Francisco. Subjects with delivery complications (n = 125) were evaluated separately from those with normal delivery outcomes (n = 160). Fetal arterial oxygen saturation was 58% +/- 10% (mean +/- SD) during the cumulative period of study for the normal-outcome group. A significant decrease (paired t test, p < 0.001) in fetal arterial oxygen saturation occurred from stage 1 (59% +/- 10%) to stage 2 (53% +/- 10%) labor. When stage 1 was subdivided into early (< or = 4 cm), middle (5 to 7 cm), and late (8 to 10 cm) phases, a gradual decreasing trend in fetal arterial oxygen saturation was observed: 62% +/- 9%, 60% +/- 11%, and 58% +/- 10%. CONCLUSIONS: With the use of reflectance pulse oximetry, a statistically significant decrease in fetal arterial oxygen saturation was observed during labor in women with normal and abnormal delivery outcomes.

Adult↗
PubMed1995

Impact of health education during pregnancy on behavior and utilization of health resources. Latin American Network for Perinatal and Reproductive Research.

OBJECTIVE: Our purpose was to assess whether an intervention in the education of the mother and the support person involves a change in health-related behavior and use of health facilities. STUDY DESIGN: A randomized, controlled trial was conducted in four cities of Latin America on pregnant women at risk. Half of them (n = 1115) received a home intervention of four to six visits dealing with psychosocial support and education about health-related habits, alarm signs, hospital facilities, antismoking and antialcohol programs, and a reinforcement of adequate health services utilization for the pregnant woman and a support person. The control group (n = 1120) received routine prenatal care. RESULTS: The distribution of risk factors and demographic, obstetric, and psychologic characteristics at baseline was similar in both groups. Women in the intervention group showed a statistically significant better knowledge of seven of the nine alarm signs considered and of two of the three labor-onset signs required. No differences between groups were observed in improvement on diet, cigarette and alcohol consumption, maternal physical strain, lactation at 40 days postpartum, and utilization of health facilities. CONCLUSIONS: An intervention of psychosocial support and health education during pregnancy failed to show any benefit on perinatal outcome, health-related behavior, or utilization of health facilities.

Alcohol Drinking↗
PubMed1992

Effects of arachidonic acid, prostaglandin F2 alpha, prostaglandin E2, and arginine vasotocin on induction of birth in vivo and in vitro in a viviparous lizard (Sceloporus jarrovi).

The ability of arachidonic acid (AA) and prostaglandins of the two series to induce parturition in vivo and oviducal contraction in vitro was studied in the viviparous lizard Sceloporus jarrovi. Injection of PGF2 alpha, PGE2, or AA during late pregnancy stimulated parturition within 2 hr in a threshold-dependent fashion. In contrast, during mid pregnancy, females did not respond. Surgically removed and cultured oviducts from females in late pregnancy gave "birth" in response to AA, PGF2 alpha, and PGE2. Oviducts from S. jarrovi in mid pregnancy responded to PGF2 alpha but not to AA. Addition of arginine vasotocin, a potent stimulator of PG synthesis, either alone or with AA to oviduct cultures stimulated rapid and complete birth in vitro from oviducts obtained from late, but not mid pregnant, females. Stage of pregnancy mediates the response of the lizard oviduct to prostaglandin stimulation.

Analysis of Variance↗
PubMed1991

Spurious labor: a high risk factor for dysfunctional labor and fetal distress.

This is a retrospective case controlled study comparing the outcome of labor and neonates in pregnancies complicated by spurious labor at term. The first stage of labor was significantly longer and the proportion of cases requiring oxytocin augmentation was higher in the study group when compared to the controls. More infants in the study group displayed intrapartum CTG abnormalities and five had a depressed Apgar score at 5 min, compared to none in the controls. Of these five neonates, three were admitted to the neonatal intensive care unit and one died from meconium aspiration syndrome and asphyxia. The findings in this study support the view that spurious labor at term constitutes a high risk factor for the ensuing labor.

Adult↗
PubMed2005

Serum and placental interleukin-18 are elevated in preeclampsia.

OBJECTIVES: Interleukin-18 (IL-18) is a proinflammatory cytokine with pleiotrophic qualities and its roles in pregnancy, labor onset and pregnant complications have been proposed. However, the alterations of serum and placental IL-18 have been less investigated. The objective of the current investigation was to detect IL-18 concentrations in serum and placentas from patients with preeclampsia and women with normal pregnancy. METHODS: 27 patients with preeclampsia and 28 women with normal pregnancy were recruited. Blood and placental samples were taken and IL-18 concentrations in serum and placental homogenate were analyzed by enzyme-linked immunosorbent assay (ELISA). The levels of IL-18 in serum and placenta were compared between preeclampsia and control. RESULTS: Both serum and placental levels of IL-18 were significantly increased in preeclampsia as compared with control (P=0.014 and 0.003, respectively). Serum and placental levels of IL-18 were not significantly different in preeclamptic women who received dexomethasone and those who did not (P=0.223 and 0.330, respectively). Serum and placental IL-18 levels were not significantly different between preeclamptic women who delivered before 36 complete gestational weeks and those who delivered after 36 complete weeks (P=0.616 and 0.869, respectively). There were no significant differences in serum and placental IL-18 between women with mild preeclampsia and those with severe preeclampsia (P=0.056 and 0.357, respectively). CONCLUSIONS: Increased serum and placental levels of IL-18 were observed in preeclampsia. Those associations may offer insight into the pathogenesis of the disease.

Adult↗
PubMed1992

Serum collagenase levels in relation to the state of the human cervix during pregnancy and labor.

OBJECTIVE: The purpose of our study was to investigate the role of collagenase in the cervical ripening and dilatation process in term pregnancy. STUDY DESIGN: Serum samples were obtained from nonpregnant women (n = 5) and term-pregnant women. The term-pregnant women were either admitted for elective cesarean section or labor induction (unfavorable cervix, n = 19; favorable cervix, n = 12) or in spontaneous, active labor (stiff and inelastic cervix, n = 7; soft compliant cervix, n = 8). Statistical analysis was performed with the Student t test. RESULTS: The nonpregnant women had low serum collagenase levels (5.2 +/- 0.7 micrograms collagen digested per minute per 100 ml serum, mean +/- SEM). At term but before labor, women with unripe cervices had higher collagenase levels (10.3 +/- 0.9). The women with ripe cervices had even higher serum collagenase levels (22.9 +/- 4.2; p < 0.001). During labor, women with stiff and inelastic cervices had lower serum collagenase levels compared with women with soft and compliant cervices (12.9 +/- 1.7 vs 28.0 +/- 4.2; p < 0.01). CONCLUSION: Serum collagenase during ripening at term and in active labor increases, supporting its active role in the ripening process.

Adult↗
PubMed1975

Computer diagnosis of labor progression.

Abnormal labor has been suspected of being inherently delectorious to the fetus. In order to explore this problem, clinical factors, labor progress, and fetal monitoring parameters were compared in matched groups of high-risk patients whose fetuses were in theoccipitoposterior (0P) and occipitoanterior postions. The OP group showed significant excesses of dysfunctional labor aptterns, uterine contraction pattern abnormalities, and late and variabl fetal heart rate decelerations not accounted for by theuse of oxytocin or the presence of cord problems. In OP labor, lower Apgar scores were associated withasignificant excess of preceding fetal heart rate decelerations independant of operative delivery. This study suggests that neonatal depression in OP laboris related to intrapartum factors preceding delivery and provides direct support for theconcept that abnormal labor may adversely affect the fetus. The OP position is an indication for close fetomaternal supervision during labor.

Adolescent↗
PubMed1999

The tumor necrosis factor alpha and its soluble receptor profile in term and preterm parturition.

OBJECTIVE: The common terminal pathway of parturition describes the anatomic, biochemical, endocrine, and clinical events present in the fetus and mother in both term and preterm labor. Labor at term is thought to result from physiologic activation of this pathway, whereas preterm labor is the result of pathologic activating events. The purpose of this study was to determine whether physiologic and pathologic activation could be discerned by the analysis of a cytokine-receptor signaling system. Tumor necrosis factor alpha and its soluble receptors were used as probes because of their pivotal role in the regulation of several processes activated during parturition. Soluble receptors are thought to buffer the biologic and potentially deleterious effects of tumor necrosis factor alpha in pathologic conditions. STUDY DESIGN: The in vivo concentrations of tumor necrosis factor alpha and its soluble receptors were studied in patients in term labor and preterm labor. Amniotic fluid was retrieved from 175 women and tumor necrosis factor alpha, tumor necrosis factor receptor 1, and tumor necrosis factor receptor 2 concentrations were measured by highly sensitive immunoassays. Patients were classified in the following groups: (1) term labor (n = 29), (2) term not in labor (n = 29), (3) preterm labor leading to term delivery (n = 34), (4) preterm labor without infection resulting in preterm delivery (n = 34), (5) preterm labor with intra-amniotic infection (n = 23), and (6) second trimester (n = 26). RESULTS: Tumor necrosis factor alpha and tumor necrosis factor receptor 1 concentrations decreased with advanced gestational age (r = -0.51 and r = -0.7; P <.01 for each). (1) Patients in spontaneous term labor had a higher median concentration of tumor necrosis factor alpha than those at term not in labor (median, 6.4 pg/mL; range, 2.4->500 pg/mL vs median, 4.1 pg/mL; range, 1.1-22.7 pg/mL; P <.01) but had lower concentrations of tumor necrosis factor receptor 1 (median, 3.2 ng/mL; range, 1.3-9.1 ng/mL vs median, 4.2 ng/mL; range, 1.6-8.3; P <.001) and tumor necrosis factor receptor 2 (median, 5.5 ng/mL; range, 0.73-12.8 ng/mL vs median, 6.8 ng/mL; range, 2.9-12.9 ng/mL; P <.01). (2) In contrast, patients with preterm labor leading to preterm delivery had higher concentrations of tumor necrosis factor alpha (median, 12.3 pg /mL; range, 1.5->500 pg/mL vs median, 4.8 pg/mL; range, 1-60.9 pg/mL; P <.01), tumor necrosis factor receptor 1 (median, 8.8 ng/mL; range, 2.5-38 ng/mL vs median, 6.2 ng/mL; range, 1.4-28 ng/mL; P <.05), and tumor necrosis factor receptor 2 (median, 8.5 ng/mL; range, 3.5-45.4 ng/mL vs median, 6.1 ng/mL; range, 1.99-14.1 ng/mL; P <.01) than patients with preterm labor who delivered at term. (3) Microbial invasion of the amniotic cavity was associated with dramatic increases in the concentrations of tumor necrosis factor alpha (median, 93.5 pg/mL; range, 1.2->500 pg/mL) and its soluble receptors tumor necrosis factor receptor 1 (median, 8.8 ng/mL; range, 2.1-36.7 ng/mL) and tumor necrosis factor receptor 2 (median, 11.8 ng/mL; range, 3.4-46. 3 ng/mL), concentrations that were significantly higher than in those with preterm labor who delivered at term and those who delivered preterm but were not infected. CONCLUSION: The tumor necrosis factor alpha and tumor necrosis factor alpha soluble receptor profiles are different in term and preterm parturition. Our observations provide support for the thesis that preterm parturition is a pathologic condition. Increased tumor necrosis factor alpha soluble receptor concentrations may attenuate the deleterious effects of the excess of tumor necrosis factor alpha found in pathologic labor.

Amniotic Fluid↗
PubMed2000

Criteria for failed labor induction: prospective evaluation of a standardized protocol.

OBJECTIVE: To assess the safety and efficacy of a protocol that mandated at least 12 hours of oxytocin administration after membrane rupture before cesarean delivery for failed labor induction in the latent phase. METHODS: Gravidas at or beyond 36 weeks' gestation undergoing indicated induction with cervical dilatation up to 2 cm were studied prospectively. Prior cesarean was an exclusion criterion. If the fetal heart rate pattern was reassuring, cesarean was not permitted before the active phase of labor (4-cm dilatation and at least 90% effacement or 5-cm dilatation regardless of effacement) unless the membranes had been ruptured and oxytocin administered for at least 12 hours. RESULTS: Five hundred nine women were treated according to protocol; 360 (71%) were nulliparas and 149 (29%) were parous. Twenty-five percent of nulliparas and 9% of parous women were delivered by cesarean. After 6 hours of ruptured membranes and oxytocin, 14% of nulliparas were still in the latent phase; 39% of whom delivered vaginally, compared with 7% still in the latent phase after 9 hours (vaginal delivery rate 28%), and 4% after 12 hours (vaginal delivery rate 13%). In contrast, after 6 hours of ruptured membranes and oxytocin, only five (3%) parous women were still in the latent phase. Among those, none remained in the latent phase for 12 hours and all were delivered vaginally. No women had serious complications. Severe neonatal morbidities were infrequent and not related to duration of the latent phase. CONCLUSION: By requiring a minimum of 12 hours of oxytocin after membrane rupture before failed labor induction could be diagnosed, many nulliparas who remained in the latent phase at 6 and 9 hours had safe vaginal deliveries, and failed labor induction was eliminated as an indication for cesarean in parous women.

Adult↗