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PubMedDate not supplied

[Biochemical principles of cervix ripening and dilatation].

The central function of the cervix to maintain pregnancy is biochemically characterized by an increased synthesis of collagen, proteins, glycosaminoglycans (GAG) and fibronectin within the extracellular matrix, thus leading to an increase of cervical volume without significant changes of cervical consistency. During the time of cervical ripening we found a marked reduction of collagen concentration, a 2.5-fold increase in GAG content, a significant fall in dermatan sulfate concentrations from 41% to 15% of total GAG content, a 12-fold increase in hyaluronate concentrations, and a marked reduction in fibronectin, demonstrated by immunhistochemical methods. Thus, the loss of collagen and sulfated GAGs may facilitate distensibility in the ripened cervix, while the significant gain in hyaluronate associated with hydratation may explain the soft and swollen consistency. In this connection increased hyaluronate concentrations and degradation of fibronectin may play a trigger role for subsequent cervical dilatation. The dramatic changes of the cervix during parturition occurring within a few hours require the rapid activation and action of catabolic enzyme systems. Our studies showed a significant increase of sialidase-, collagenase- and elastase activities during cervical dilatation. These proteinases originate from polymorphonuclear leucocytes (pml), which accumulate in cervical capillaries at the onset of labor; this is followed by a massive leucocyte infiltration of the cervical stroma at the beginning of cervical dilatation and a degranulation of the pml at further dilatation, thus releasing collagenase and other proteinases. This process is limited by the immediate post partum insudation of the cervix by plasma containing highly potent proteinase inhibitors. The clinical aim of our basic biochemical studies is to develop new concepts in the causal treatment of cervical pathology during pregnancy.

Animals↗
PubMed1994

Evaluation of PGE2 gel for cervical ripening and induction of labour.

In a prospective study a single dose PGE2 gel 0.5 mg was given in 97 Low Bishop Score subjects, 12 hrs prior to indicated oxytocin or PGE2 tab induction for cervical ripening. Analysis of 97 subjects shows that it is very highly effective. 56 primi and 21 multi delivered spontaneously with gel administration only while 4 primi and 2 multi delivered vaginally following oxytocin and 3 more cases delivered vaginally following PGE2 tab administration and fewer caesarian section (11) were performed. The endo cervical administration of PGE2 was well tolerated and systemic PGE2 effects were minimal.

Administration, Oral↗
PubMed1977

Significance of amniotic fluid corticosteroid levels in human pregnancies.

Retrospective analysis of 103 samples of amniotic fluid was performed. Twenty-four samples were obtained prior to midtrimester abortion, 31 were from patients who delivered spontaneously, 14 were from patients in whom labor was induced, and the remaining samples were obtained from patients who were delivered by cesarean section. In all normal pregnancies, there was a rising trend in corticosteroid levels in amniotic fluid as the gestation advanced. This was less marked in abnormal pregnancies. There is a suggestive fetal role in initiation of normal spontaneous labor, as reflected by a significant increase in amniotic fluid corticosteroid levels, in patients immediately prior to vaginal delivery as opposed to abdominal delivery. There was a significant correlation between the birthweight of babies born vaginally with the amniotic fluid corticosteroid levels, as compared to the weight of babies born by cesarean section.

Adrenal Cortex Hormones↗
PubMed1977

Fetal movements in utero: nature, assessment, prognostic value, timing of delivery.

Fetal movements in utero are an expression of fetal well-being. However, a sudden increase of fetal movements is a sign of acute fetal distress, such as in cases of cord complications or abruptio placentae. Decreased fetal movements are seen in cases of chronic fetal distress such as preeclampsia, hypertension in pregnancy, etc. It was shown that in these cases a pronounced decrease up to cessation of fetal movements occurred before fetal death in utero while fetal heart beats were still audible for at least 12 hours. This situation was called "movements alarm signal" (MAS). This sign points to a severely disturbed fetus and indicates impending intrauterine fetal death. Such a development is an indication for immediate delivery of the fetus, provided it is viable. High-risk pregnant women are instructed to assess and record fetal movements daily as a monitor of fetal condition. A special device which records fetal movements is used to confirm the women's assessment of fetal movement. It was shown that fetal movement monitoring was found to be more reliable than the urinary estriol determination in predicting impending fetal death in utero. It was also shown that in cases of MAS, fetal heart rate (FHR) changes will appear 1 to 4 days after the MAS has appeared. Meconium was found in only 50% of these cases. Increased fetal movements are manifested as a response to various stimuli such as sound, light, touch, and ultrasound. Classification of high-risk pregnancies into 3 groups according to the hormone assays, enzyme assays, ultrasonic cephalometry, fetal movements, and FHR is suggested.

Acoustic Stimulation↗
PubMed1977

[Clinical experiences with prostaglandin E 2 and F 2 alpha in the termination of pregnancy and labor induction in intrauterine fetal death].

In 34 cases of therapeutic termination of pregnancy in the second trimester and in 26 cases of fetal death in utero up to the 43rd week of pregnancy, expulsion of the uterine contents was achieved by means of transabdominal-intraamniotic and intravenous administration of prostaglandin (PG) E2 and PGF2lalpha. The average expulsion time was 14 1/2-16h. The following respective doses were needed: for intraamniotic use, 5-25 mg PGE2 and 40-120 mg PGF2alpha, and for intravenous use 5.8-7.3 mg PGE2 and 43.3-52.3 mg PGF2alpha. Two patients required treatment for side effects. These results are compared with existing data from the literature and the clinical application of various prostaglandins is discussed.

Abortion, Therapeutic↗
PubMed1977

[Relationship between clinical parameters and labor (author's transl)].

In 200 cases of childbirth supervised by intra-amniotic tocometry the relations between various clinical parameters such as age, parity, gestosis, rise of temperature, birth weight, small circumference of the head, duration of the cervical dilatation and the expulsion period, and the exactly defined motility of the uterus were investigated during different phases. The results confirmed the very limited influence of selected clinical phenomena upon the multifactiorially regulated total complex of labour.

Adult↗
PubMed1995

[The effect of dehydroepiandrosterone sulfate on cervical maturation during pregnancy].

Steroid hormones would have an effect on the duration of pregnancy. Venous blood was drawn in 90 patients who were scheduled for provoked delivery for assay of serum dehydroepiandrosterone sulphate (S-DHEA), oestrogen, progesterone and cortisol. Serum concentration of S-DHEA was significantly higher (p<0.005) in women with a favourable Bishop score (>6) compared with those with an unfavourable score. These findings suggest that a rise in S-DHEA level occurs before modifications in the cervix.

Adolescent↗
PubMed1996

[Programmed labor--beneficial for the mother and fetus or an obstetrical hazard?].

During the period between Jan. 1, 1992 and Dec. 31, 1995 at the Second Department of Gynaecology and Obstetrics 482 full-term pregnancies were terminated by elective induction of labour. Labour was induced by extraamnial administration of PGE2 (Prostin UPJOHN 3.0 mg tablets vag). Depending on the maturity of the portio uteri a maximum of two doses after two hours were administered: 0.5 mg PGE2 when the cervical score was > 8 and 1.0 mg PGE2 when the score was 5-8 points. The results were compared with 278 non-risk pregnant women who were delivered of babies between Jan. 1 and June 30, 1995. The first stage of labour was longer in patients with spontaneous labour. The second stage of labour was longer in patients with induced labour. From the results ensues that an elective induction of labour does not increase the perinatal risk for mother and foetus, and conversely if all conditions are respected it is better for the mother, her family and the staff of the labour ward.

Dinoprostone↗
PubMed1996

[The active management of labor. The advantages and disadvantages].

The doctrine for active conduct of labour is undoubtedly leading in the modern obstetrics. The authors apply a new, modified method for the conduct of labour, which is applied electively. The most important labour's components are reflected on simplified partogram in order to graphic visual aids.

Adolescent↗
PubMed1997

[Correction of occipito-posterior position by maternal posture during the process of labor].

OBJECTIVE: To investigate the effect on correction of occipito-posterior (OP) presentation by changing maternal posture during labor. METHOD: A prospective study was conducted in 120 pregnant women from March 1994 to December 1995. Women in labor were instructed to take the lateral posture so that the resultant force of the gravity of the fetus, the buoyancy of amniotic fluid, and the intermittent uterine contraction may change the fetal position from occipito-posterior into occipito-anterior (OA) presentation. Another 120 women were selected as controls. RESULTS: (1) In the study group, 106 women (88.3%) delivered vaginally with fetal presentation changed from OP into OA, and 14 (11.7%) received cesarean section. In the control group, only 20 women (16.7%) delivered vaginally, and 100 (83.3%) had cesarean sections (P < 0.001). (2) The average time interval in the study group was 302.6 min for the first stage and 59.8 min for the second stage, whereas 483.7 min and 156.1 min respectively in the controls. A significant difference was noted (P < 0.01). CONCLUSION: It is an effective method for the mother to take the lateral posture on the same side of the fetal spine for correcting the OP position. The incidence of dystocia may be reduced as well as the cesarean section rate. The method in simple and effective, and can be used in most of hospitals.

Adult↗
PubMed1997

[The characteristics of labour course and perinatal prognosis in cases of fetal persistent occiput-transverse position and persistent occiput-posterior position].

OBJECTIVES: To study the characteristics of the labour course and perinatal prognosis in cases of fetal persistent occiput-transverse position (POTP) and persistent occiput-posterior position (POPP). METHODS: All the cases, delivered with POTP and POPP in or hospital from Nov, 1995 to July 1996 were analyzed retrospectively. RESULTS: In abnormal fetal occipital position group, the following indices were significantly higher than those of normal group: fetal macrosomia, uterine inertia, and duration of each labour course. The speed of descending of presentation was obviously slower. The incidence of abnormal labour course was markedly increased. The rate of operative delivery was significantly higher. The total rate of operative delivery was 82.81% in the POTP group, and 92.31% in the POPP group. The incidence fetal hypoxia and neonatal asphyxia was markedly high in the abnormal occiput group. CONCLUSIONS: The POTP and POPP are major cases of dystocia. If management is unsuitable, perinatal prognosis will be poor.

Adult↗
PubMed1976

[Automatic tocography using the Cardiff infusion system under cardiotocographic control with the fetal monitor BMT 504].

Clinical results of the induction of labour by means of the Cardiff-equipment. The fetal monitor BMT-504 (VEB Kombinat Mebgerätewerk Zwönitz) has been used as cardiotocographic control unit. Labour has been induced with oxytocin (n = 38) or methyloxytocin (n = 30). 50 deliveries, which where induced by means of intravenous oxytocin infusion enables to be comparate the results. Using the automatic infusion the average induction-delivery interval was 4 hours 14 minutes, the average dosage of tocergic drugs was 2 IW oxytocin or 20 mug methyloxytocin. Using oxytocin for labour induction we found an increase in obstetric operative frequency caused by fetal distress. There where an increase in basal tone of uterine activity in this patients. Therefore we recommend methyloxytocin for the labour induction of high risk pregnancies. The safety factors, which are incorporated in the Cardiff-equipment have many advantages in obstetrical routine work, to determine fetal distress at an earlier stage. The results presented show that with this automatic infusion system labour can induced with even greater efficiency and safety. The equipment is very useful in accordance to the continuous increasing number of planned deliveries.

Female↗