[Measurement of the relative changes of the blood flow through the uterus during and without contractions in the first stage of labor by means of I-131 HSA].
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Female↗
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Supportive role of nurse in first stage of labor "cannot be emphasized enough", according to patient.
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Female↗
[Management of the first stage of labor. (Use of combined fluphenazine and meperidine)].
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Anesthesia, Obstetrical↗
The first stage of labor.
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Anesthesia, Obstetrical↗
Enemas during labor.
BACKGROUND: The use of enemas during labor usually depends on the preference of the attending physician and available resources. However enemas cause discomfort in women and increase the costs of delivery. OBJECTIVES: The objective of this review was to assess the effects of enemas during the first stage of labor on infection rates in mothers and newborns, duration of labor, perineal wound dehiscence in the mother, perineal pain, faecal soiling and costs. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register, Database of Abstracts of Reviews of Effectiveness, Medline and reference lists of articles. SELECTION CRITERIA: Randomised trials in which an enema was administered during the first stage of labor and which included assessment of possible neonatal or puerperal morbidity or mortality. DATA COLLECTION AND ANALYSIS: Selected studies were assessed by three reviewers independently. MAIN RESULTS: Two trials involving 665 women were included. These showed no clear difference in infection rates for puerperal mothers (odds ratio 0.61, 95% confidence interval 0.36 to 1.04) or newborn children. REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate the use of routine enemas during the first stage of labor.
Enema↗
Enema prior to labor: a controversial routine in Taiwan.
While taking an enema to induce labor is a controversial issue worldwide, in Taiwan it remains a routine procedure in many hospitals in preparation for birth. Episiotomy is also a prevalent procedure performed during the birthing process. Some physicians believe that enemas help reduce the risk of feces contamination of the episiotomy incision and, therefore, are justified as a routine procedure. This study compared the neonatal infection rates, times to appearance of fetal head, times to first post-labor bowel movement, and rates of episiotomy dehiscence of women receiving a pre-labor enema against those who did not. A total of 534 women classified with low-risk pregnancies were recruited from a medical center in central Taiwan and assigned randomly into one of two groups for a six-month period. The first group (264 subjects) received routine enema procedures prior to delivery in the first 6 months. The second group (270 subjects) did not receive enemas. Study results revealed no significant difference between enema and non-enema groups in terms of infection rates in mothers or infants or in terms of average time to fetal head appearance. While labor duration was the same for the two groups in the first and third stages of labor, the enema group experienced a relatively shorter second stage. No significant difference was observed in times to first post-labor bowel movement or episiotomy dehiscence rates. The results of this study indicate that the administration of enemas as a routine practice prior to labor is not substantiated by medical necessity. However, limitations of the research design suggest that a randomized clinical trial be adopted in the future to explore further the scientific validity of study results.
Adult↗
Drotaverine hydrochloride for augmentation of labor.
OBJECTIVES: To study the use of drotaverine hydrochloride for acceleration of labor and relief of labor pains. METHODS: In this double-blind placebo-controlled randomized study, 100 primigravidas in uncomplicated spontaneous labor at term were given drotaverine hydrochloride or placebo (distilled water) intramuscularly. Labor events, including pain (assessed by a visual analog scale and a verbal rating scale), neonatal outcome, and side effects of the drug were recorded. Student's t-test was used for analysis. RESULTS: Forty-four patients in the drug group and 40 in the placebo group had complete data for analysis after decoding. In drotaverine group, there was a mean 15% reduction in the duration of the first stage of labor and a mean 19% reduction in the second stage. The maximum shortening of the first stage (28%) was observed when drotaverine was administered when cervical dilatation was 4 cm (P=0.044). There were no adverse fetal effects, but atonic postpartum hemorrhage was more common in the drotaverine group. There was no relief of pain with the drug except in the fourth stage of labor. CONCLUSIONS: Drotaverine hydrochloride is safe and effective in accelerating labor, but not effective in lessening labor pain.
Adult↗
More than support: nursing interventions provided to women in labor.
OBJECTIVE: To describe the type and quantity of interventions provided to women in the first stage of labor. DESIGN: Descriptive, observational. SETTING: An intrapartum nursing unit in a Pacific Northwest medical center. PARTICIPANTS: Participants were 24 registered nurses employed on the intrapartum nursing unit and 75 women in labor with singleton pregnancies at 36 weeks or more gestation. Seventy-five 2-hour episodes of care that included one registered nurse assigned to a woman in labor were the units of analysis. MAIN OUTCOME MEASURES: Observed surveillance, indirect care, and supportive care interventions recorded during the episode of care during the first stage of labor. RESULTS: Nurses spent an average of 58.9% of the observed time in direct or indirect care of the study patient and provided an average of 169.9 interventions. Nurses spent 31.5% of the observed time providing at least one supportive care intervention with or without a simultaneous surveillance and/or indirect care intervention. CONCLUSION: Nurses provided supportive care more frequently than previous work sampling studies have suggested. This supportive care was frequently done in conjunction with other, more technical nursing care interventions. Integration of supportive care with other direct and indirect care interventions may offer the best model for providing high-quality intrapartum nursing care.
Female↗
Outcome of normal and dysfunctional labor in different racial groups.
Spontaneous labor in patients of different racial groups has been studied relating progress and outcome to whether labor was dysfunctional as defined by the partogram and action line. Forty-three percent of primigravidas and 17.6 to 25.8% of multigravidas passed the action line and had a lower admission cervical dilatation and a longer observed first stage than those patients whose labor progress remained to the left of the action line. White and black primigravidas whose labor progressed to the right of the action line had lower 1 and 5 minute Apgar scores and delivered heavier babies than those to the left. The cesarean section rates were 1.6% and 1.4% (left) and 7.6% and 18.2% (right) in white and black primigravidas, respectively. The cesarean section rate was significantly higher in black primigravidas irrespective of the relationship to the action line due to the high incidence of the complications of hypertension such as fetal distress and abruptio placentae in those in normal labor as well as those in dysfunctional labor due to cephalopelvic disproportion in those patients whose cervimetric progress went to the right of the action line.
Age Factors↗
Analgesic efficacy and side effects of subarachnoid sufentanil-bupivacaine administered to women in advanced labor.
BACKGROUND AND OBJECTIVES: Previous studies of labor analgesia using subarachnoid sufentanil (alone or with adjuvants) have focused on women in the early first stage of labor. This study prospectively evaluated analgesia and side effects of subarachnoid sufentanil (10 micrograms) plus bupivacaine (2.5 mg) in parturients with cervical dilation of 7 cm or more. METHODS: In an open-label, nonrandomized trial, 32 parturients in the late first stage of labor, who had requested regional anesthesia, consented to subarachnoid injection of sufentanil (10 micrograms) and bupivacaine (2.5 mg). Patients rated their pain by a verbal pain score (0-10 scale) prior to regional anesthesia, 5 minutes after subarachnoid injection, and every 20 minutes thereafter until delivery or request for additional analgesia. Blood pressure, pruritus, Bromage motor block score (0-3), mode of delivery, and need for supplemental analgesics were recorded. RESULTS: Lumbar puncture was successful in 30 women. Pain scores (mean +/- SD) were 8.7 +/- 1.0 prespinal and 0.7 +/- 1.5 5 minutes postinjection, and remained less than 5 for 130 minutes after the spinal injection. Of these 30 patients, 24 had unassisted vaginal delivery, 4 had instrumental vaginal delivery (3 vacuum, 1 low forceps), and 2 had cesarean delivery. Of the 28 patients who delivered vaginally, 19 did not require supplemental analgesics and had a delivery pain score of 5 or lower. Blood pressure decreased after spinal analgesia (P < .05), and necessitated treatment in three patients. The Bromage motor block score was 0 in 26 patients and 1 in 4 patients. Pruritus was noted by 22 patients. CONCLUSION: In parturients with cervical dilation of 7 cm or more, subarachnoid sufentanil-bupivacaine produces rapid analgesia with an effective duration of approximately 130 minutes.
Adult↗
Epidural analgesia for labor pain is not associated with a decreased frequency of uterine activity.
STUDY OBJECTIVE: To evaluate the effect of epidural and pethidine analgesia on the frequency of uterine contractions during the first stage of labor. DESIGN: Retrospective study. SETTING: Delivery ward of a public hospital. PATIENTS: Forty consecutive parturients. MEASUREMENTS AND MAIN RESULTS: The mean number of contractions in the 30 min before administration of pethidine analgesia was 8.2+/-1.7 as compared to 8.7+/-1.3 after administration of the analgesia. The mean number of contractions in the 30 min before administration of epidural analgesia was 8.0+/-1.4 as compared to 8.8+/-1.9 after administration of the analgesia. The differences between the two groups and between the number of contractions before and after the administration of both types of analgesia were not statistically significant. CONCLUSION: Properly and timely administered epidural analgesia during the first stage of labor has no effect on frequency of uterine activity.
Adult↗
[Reference values range of the fetal oxygen saturation and its dispersal during labor without cardiotocographic evidence for fetal distress].
UNLABELLED: The objective of this study is to establish the reference values range of the fetal oxygen saturation during the first and the second period of labor and their dispersal according to the extent of cervical dillatation in cases with normal FHR--absence of fetal hypoxia and asphyxia of the newborn. MATERIAL AND METHODS: This is a prospective study which involves 94 women with normal FHR. All of the newborns are with umbilical artery pH values greater than 7.15 and 5 min Apgar score greater than 7; there was no necessity for any reanimation procedures, assisted ventilation or intensive care treatment. The fetal oxygen saturation (SpO2) is monitored by fetal pulseoxymeter Nellcor N 400, fetal sensors FS - 14. Cardiotocographic monitoring is carried out simultaneously. Blood is obtained from the fetal scalp during labor for blood gas and pH analysis, and umbilical artery pH as well as the Apgar score of the newborn are determined. RESULTS: The average monitoring time during the first period of labor is 107.19+/-29.49 min. with reliability of the recordings 86.54+/-6.10%. The average monitoring time for the second period of labor is 36.72+/-8.31 min. with reliability of the recordings 75.42 +/-9.61%. The mean SpO2 values are 48.71+/-5.52% during the first period and 47.30+/-4.62% during the second period of labor. The reference SpO2 values ranging between the 25-th and 75-th percentile in fetuses with normal FHR are 46-52 % for the first and 44-50 % for the second period. The results for fetal SpO2 during the different stages of cervical dillatation are as follows: for 4-5 cm - 49.49+/-5.12%, for 6-7 cm - 48.76+/-5.42%, for 8-9 cm - 48.39+/-5.49%. CONCLUSIONS: The fetal SpO2 dispersal during cervical dillatation of 4-5, 6-7 and 8-9cm accordingly demonstrates a nonsignificant decrease of SpO2 for the different groups (p>0.05). The fetal SpO2 dispersal between the first and the second period of labor also demonstrates decrease of SpO2 values and shows a minor statistically significant difference (p < 0.05 - Repeated measures ANOVA), which is considered to be within the normal range and does not reflect on the newborn's well-being.
Apgar Score↗
Progression of labor in twin versus singleton gestations.
OBJECTIVE: The aim of this study was to investigate whether labor curves of twin gestations differ from those of singleton gestations. STUDY DESIGN: Among 1821 twin deliveries at our institution (1984-1996), we found 69 nulliparous and 94 multiparous women who were delivered at term (>/=37 weeks) of a vertex twin A with a birth weight of >/=2500 g. We excluded women who had any of the following: induction of labor, oxytocin augmentation, cervical dilatation >6 cm on admission, tocolysis during the previous 14 days, height <150 cm, hypertension, and diabetes. Women with singleton gestations (n = 163) who met the same exclusion criteria were matched for parity and maternal age (+/-3 years). Stage 1 of labor was defined as the interval between 4 and 10 cm cervical dilatation. Kaplan-Meier survival analysis was used for comparison between the groups. RESULTS: The study and control groups were similar in mean maternal height; however, women with twins were significantly heavier than were those with singletons (79.3 +/- 11.2 kg vs 73.2 +/- 10.8 kg, P <.001), had a higher frequency of epidural anesthesia (82% vs 62%), and had a significantly lower birth weight of the presenting fetus (2779.1 +/- 242.5 g vs 3301.4 +/- 429.2 g, P <.001). The cervical effacements and vertex stations on admission were similar in the 2 groups. On admission the cervical dilatation of women delivered of twins was smaller than that of the control group. Twin gestations had a significantly shorter first stage of labor than did their matched singleton control gestations (3.0 +/- 1.5 hours vs 4.0 +/- 2. 6 hours, P <.0001). This difference was apparent only in nulliparous women. No statistical difference was noted in the mean length of the second stage of labor (0.8 +/- 0.5 hour for twins and 0.7 +/- 0.6 hour for singletons). CONCLUSION: Twin gestations have a significantly shorter first stage of labor than do singleton gestations. This difference may be the result of the birth weight of the presenting twin being lower than that of its singleton counterpart or to differences in uterine contractility in twin and singleton gestations. Different labor curves should be considered for managing twin deliveries.
Adult↗
Epidural sufentanil and bupivacaine for labor analgesia and Doppler velocimetry of the umbilical and uterine arteries.
BACKGROUND: The pain of parturition is associated with major physiologic alterations mediated by neurohumoral factors and increased activation of the sympathetic nervous system. Epidural local anesthetics abolish or alleviate many of the pain-mediated responses by reducing maternal catecholamine levels, inducing sympathectomy and consequent vasodilatation. The hormone response to surgical stress is not attenuated after epidural opioids as efficiently as after local anesthetics. Opioid receptors may modulate sympathetic outflow at a spinal level. This study was performed to compare the effects of epidural sufentanil and bupivacaine on the uterine and placental circulation. METHODS: Utilizing a prospective randomized, double-blind study design, 30 healthy women at term were examined employing a color Doppler technique to assess and compare the effects of analgesia using sufentanil or bupivacaine epidurally during the first stage of labor on blood flow velocity waveforms in the uterine and umbilical arteries. RESULTS: Effective analgesia was provided by both drugs, bupivacaine and sufentanil. Uterine and umbilical blood velocity waveform indices did not change significantly. There was, however, a significantly greater incidence of fetuses with changes in heart rate tracings in the sufentanil group, decreased variability being the most frequent. Maternal side effects attributable to sufentanil were common but mild. No patient became hypotensive in either group. CONCLUSIONS: Epidural sufentanil and bupivacaine provide effective analgesia with acceptable side effects during the first stage of labor in healthy parturients. Neither drug had any detrimental effects on blood flow indexes reflecting peripheral vascular resistance in the umbilical and uterine arteries in healthy parturients.
Adult↗
Warm tub bathing during labor: maternal and neonatal effects.
AIM: To study possible detrimental maternal and neonatal effects of immersion in warm water during labor. DESIGN: Prospective randomized controlled bathing during first stage of labor vs no bathing. SETTING: Obstetrical departments at a university hospital and two central hospitals. PRIMARY END-POINT: Referral of newborns to NICU. MATERIAL AND METHODS: Randomization took place by means of sealed opaque envelopes at each delivery unit. Preconditions for participation in the study were: singleton parturient wishing to bathe, a gestational duration of at least 35 weeks+0 days, a planned vaginal delivery, normal admission test, regular contractions and cervix dilated to at least 3-4 cm. Parturients randomized to the 'no bath' control group were allowed to use a shower. Rupture of the membranes was not a contra-indication to participation. Those excluded from randomization were women with intra-uterine growth retardation, meconium-stained amniotic fluid, or in the event that the tub was occupied by another randomized parturient. MAIN RESULTS: On average, parturients stayed in the tub for 50-60 min. No significant difference was seen regarding the referral rate to NICU among 612 cases vs 625 controls, OR 0.8; 95% CL 0.2, 3.1. The OR for epidural analgesia was 1.0; 95% CL 0.8, 1.3. Nor was any significant difference seen in the rate of perineal tear grade III-IV (OR 1.3), instrumental delivery (OR 1.1), cesarean section (OR 1.8), or maternal post partum stay on the ward. During the neonatal period, no significant difference was seen in the number of newborns with Apgar <7 at 5 min (4 vs 5), neonatal distress (OR 2.2) or tachypnéa (OR 1.0). CONCLUSION: In the present study no negative effects of bathing during labor could be discerned. The results indicate that expectant mothers wishing to bathe during labor may do so without jeopardizing their own, or their newborns' wellbeing after birth.
Adult↗
Quality of intrapartum cardiotocography in twin deliveries.
OBJECTIVE: Intrapartum fetal heart rate (FHR) recordings in twins were compared for fetal signal loss during both stages of labor to assess the quality of these recordings by the method that had been used: external ultrasound or directly via a scalp electrode. STUDY DESIGN: Analysis of recordings collected between January 1, 1994, and January 1, 2002, from consecutive twin deliveries at the Vrije Universiteit Medical Center in Amsterdam. One hundred seventy-two twins that delivered via the vaginal route were included in the study. FHR recordings had a duration of at least 1 hour before the birth of the second twin. Subdivision took place on the basis of the recording technique, ie, ultrasound or scalp electrode. FHR data was obtained with HP-M1350 cardiotocographs. The status (pen on, pen off, maternal signal) and the mode of the signals were acquired. The duration of pen lifts and maternal signals was divided by the total duration of the recording. Statistical analyses were performed with the Mann-Whitney U test and the Wilcoxon signed ranks test. RESULTS: Recordings obtained via ultrasound demonstrated significantly more fetal signal loss than those obtained via the direct mode, particularly in the second stage. Approximately 26% to 33% of first stage and 41% to 63% of second stage ultrasound intrapartum FHR recordings in twins exceeded the International Federation of Gynecology and Obstetrics (FIGO) criteria for fetal signal loss. CONCLUSION: Intrapartum FHR monitoring via ultrasound provides far poorer quality FHR signals than the direct mode. The direct mode deserves a more prominent position in fetal surveillance than it currently has.
Adult↗
Saline amnioinfusion for relief of repetitive variable decelerations: a prospective randomized study.
A prospective randomized study was undertaken in order to further investigate the effect of intrauterine saline amnioinfusion for the relief of repetitive variable decelerations in the first stage of labor. Intrauterine saline amnioinfusion corrects the oligohydramnios that makes the cord more vulnerable to compression during uterine contractions. Included in this study were 96 patients who had repetitive variable decelerations not relieved either by changes in position or by oxygen. Randomization resulted in 49 patients in the infusion group and 47 patients in the noninfusion group. Relief of variable decelerations was 51% in the infusion group, as compared to 4.2% in the noninfusion group. Relief of variable decelerations was more dramatic in the nulliparous infusion group (66.7%) than in the noninfusion group (0%). In the nulliparous patients there was a significant decrease in the rate of cesarean sections for fetal distress, being 14.8% in the infusion group as compared to 47.6% in the noninfusion group. This study clearly showed that saline amnioinfusion is a logical, simple, safe, and effective therapy for the relief of repetitive variable decelerations in the first stage of labor and can lower the incidence of cesarean sections for fetal distress in nulliparous patients. Furthermore, amnioinfusion was much superior to changes in position in treating repetitive variable decelerations.
Amnion↗
[Fatty acid composition of the cervical mucus obtained during ovulation and at the term of pregnancy].
BACKGROUND: Aim of this work is to evaluate the different fatty acid composition of cervical mucus obtained during ovulation and at the term of pregnancy. METHODS: The fatty acid composition in cervical mucus was determined in 14 non pregnant women during expected ovulation (cervical score > 10) and in 12 at term pregnant women. Following extraction, (acidification and transesterification), the identification and quantification of fatty acids was performed by gas-chromatographic analysis, with the aid of a specific software. RESULTS: In both groups of samples, palmitic acid, stearic acid and oleic acid were the prevalent acids comprising more than half of the total amounts. Compared to non pregnant samples, in pregnant cervical mucus, elevated levels of oleic acid were pointed out, while mean levels of miristic acid and stearic acid were lower. In the samples of cervical mucus drew at the term of pregnancy, arachidonic acid levels mean values were higher when the first period of labour was started. CONCLUSIONS: The pregnancy-induced biochemical changes in fatty acid pattern could likely be correlate to the variations of the physiochemical properties and to the physical appearance that cervical mucus undergoes during pregnancy. The elevated levels of arachidonic acid, during the first period of labour, may be correlated with prostaglandin production by intrauterine tissues (amniotic fluid, amnion, chorion, decidua, myometrium) and probably by cervical mucus.
Adult↗