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[Movement and heart acceleration behavior of eutrophic fetuses in the early and late dilatation period].

The degree of fetal respiratory and body movements as well as of fetal heart rate reactivity was checked by synchronous ultrasonic and cardiographic monitoring of 18 normotrophic fetuses in the early and late dilation period. Apart from the fetal respiratory movements, which could no longer be observed in the late dilatation period, the degree of fetal body movements remained unaffected during the birth process. In the late dilatation period, the mean amplitude of heart rate accelerations occurring in association with fetal body movements was significantly lower than in the early dilatation period. In the unimpaired normotrophic fetus, however, the reactivity of the fetal cardiovascular system increased during the birth process in relation to the ratio of the amplitude of heart rate accelerations and the duration of associated fetal body movements. Hence, a decrease in fetal heart rate reactivity signals intranatal disturbance of the materno-utero-placento-fetal entity.

Cardiotocography↗

[Cervical maturation. Physiologic aspects and pharmacologic implications].

The latest theories on cervical maturation and the techniques of pharmacological induction of labour are summarised. The role of the prostaglandins is particularly stressed both from the physiological viewpoint and as drugs of choice for effective pharmacological induction of uterine cervix. Finally, the personal clinical protocol for the induction and management of labour is reviewed.

Adult↗

The clinical significance of pain and cognitive activity in latent labor.

We examined the relationship between pain and cognitive activity during the latent (less than or equal to 3 cm), mid-active (5-7 cm), and transition (greater than or equal to 8 cm) phases of labor and the concomitant efficiency of the latent, active, and descent phases in 115 nulliparous women. Patients provided subjective pain ratings and described their thoughts during each of the three phases. Higher levels of pain during the latent phase of labor were predictive of longer latent (r = 0.58) and active (r = 0.50) phases of labor. Distress-related thoughts during latent labor were predictive of longer latent (r = 0.31, P less than .01), active (r = 0.67), and second-stage (r = 0.61) labor. We found no relationships between pain and cognitive activity measured during active labor and efficiency of active labor or second stage of labor. Pain and cognitive activity assessed during the latent phase were also prognostic of obstetric outcome. Thirteen of 19 women (68.4%) who reported "horrible" or "excruciating" pain required instrumental delivery, compared with eight of 27 women (29.6%) in the "discomforting" pain group. Subjects in the "distress-related" cognitive group had 2.6 times the incidence of instrumental delivery, five times the incidence of abnormal fetal heart rate patterns, and four times the requirement for pediatric assistance for the neonate than subjects in the "coping" group. We conclude that latent labor is a critical phase in the psychobiology of labor and that pain and cognitive activity during this phase are important contributors to labor efficiency and obstetric outcome.

Adolescent↗

Endorphins and parturition.

Endorphins and beta-lipotropin have been implicated as the modulators of pain during the labor process. To investigate their possible role during parturition, the present study was undertaken to determine the levels of beta-endorphin, beta-endorphinlike immunoactivity, and beta-lipotropin during labor and delivery. Fourteen patients were evaluated at 4 cm dilatation, complete dilatation, at the time of delivery, and immediately postpartum. In addition, samples were obtained from nine nonpregnant control subjects. The venous levels of beta-endorphinlike immunoactivity and beta-lipotropin were determined, and the beta-endorphin level was calculated. The maternal cerebrospinal fluid (CSF) levels and the newborn umbilical venous level also were determined in the delivery room. A gradual rise was noted in the beta-endorphin, beta-lipotropin, and beta-endorphinlike immunoactivity values up to the time of delivery. There was noted to be a modest decrease in their levels in the immediate postpartum period. These levels were significantly elevated over control samples for both beta-endorphinlike immunoactivity and beta-lipotropin (P less than .05). Values for beta-endorphin were not significantly different from control levels. In addition, maternal CSF levels were found to show modest elevations above the simultaneously drawn venous specimens. The umbilical cord venous samples drawn at delivery were also higher than the simultaneous maternal venous levels. These values, although elevated over control values, were not statistically different from simultaneously drawn maternal venous levels.

Endorphins↗

[Ripening of the cervix uteri at term by a single intracervical application of prostaglandin E2 gel].

The efficacy and the side effects of an intracervical PGE2 gel application, as compared to placebo, for priming of the cervix have been studied in 208 patients at term (104 PGE2 and 104 placebo) with an unripe cervix (Bishop score less than 5) and with a medical indication for induction of labour. The cervical ripening success rate (as defined in methodology) is significantly higher in the treated group (58.6%) than in the control group (27.8%; p = 0.0001): 38.5% out of the PGE2 treated patients delivered within 12 hours after the gel application; 12 hours after PGE2 or placebo gel application labour was induced in the remaining patients with intravenous oxytocin infusion. Under these conditions there were 13.5% failures in the PGE2 treated group and 16.3% in the placebo group. We observed a statistically significant decrease in the length of labour of the PGE2 treated patients as compared to the control group. Since signs of myometrial hypercontractility were observed in the PGE2 treated group as compared to the control group (p = 0.01), the authors advocate careful cardiotocographic monitoring for at least three hours after the gel application. It is concluded that intracervical application of Prostaglandin E2 followed by intravenous infusion of oxytocin in an effective and safe method for induction of labour with an unfavorable cervix at term.

Adult↗

Effect of amniotic fluid bacteria on the course of labor in nulliparous women at term.

Patients with intraamniotic infection have an increased rate of cesarean delivery. To determine whether bacterial colonization of amniotic fluid affects uterine activity or delivery outcome, serial amniotic fluid samples were collected from 41 nulliparous patients in active labor with ruptured membranes for longer than 12 hours. To define positive changes, these samples were divided arbitrarily by colony count change using an increase of less than 10(2) colony-forming units per milliliter; greater than or equal to 10(2) but less than 10(4) colony forming units per milliliter; or greater than or equal to 10(4) colony forming units per milliliter. Nineteen, seven, and 15 sample sets fulfilled these criteria, respectively. Comparing serial samples with these changes in colony count revealed no significant difference in ten labor and delivery variables. Based on virulence of the isolates identified, samples were then divided into high (N = 19) or low (N = 16) virulence in both samples. Compared with sample sets with persistently low-virulence organisms, sample sets with persistently high-virulence isolates had a lower cervical dilatation rate (0.49 +/- 0.39 versus 0.98 +/- 0.58 cm/hour, P = .04), despite an increased maximum oxytocin dose (10.0 +/- 8.0 versus 5.4 +/- 5.2 mU/minute, P = .03). Controlling for birth weight, labor length, and epidural, magnesium sulfate, and oxytocin use, it was found that patients with high-virulence bacteria also had a higher cesarean section rate (57.9 versus 25.0%, P = .05). These results support a causal relationship between high-virulence bacteria in the amniotic fluid and poor cervical dilatation response to oxytocin in patients at risk for the development of intrapartum infection.

Amniotic Fluid↗

False labor.

The nature of false labor and its influence on the subsequent course of true labor was examined by a retrospective case-controlled matched study of 83 patients admitted in false labor. Patients with a history of false labor had a significantly greater incidence of dysfunctional labor when true labor did commence. The frequency of cesarean section was also higher, though not statistically significantly so. The dilatation of the cervix and the station of the presenting part at admission were both significantly different in patients with false labor from those in true labor; however, the overlap of these two groups makes this of limited clinical use. Time of day and day of the week did not correlate with the likelihood of being admitted in false labor.

Cesarean Section↗