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PubMed1986

[Prognostic significance of heart rate accelerations of the fetus in the first stage of labor].

The clinical data and the cardiotocograms of 232 low-risk-deliveries and that of 344 cases of high risk deliveries (98 premature deliveries, 102 cases with meconium stained amniotic fluid, 86 cases with EPH gestosis and 58 cases of fetal distress necessitating emergency cesarean section) have been studied. It is concluded that the fetal heart rate accelerations even in cases of high risk pregnancies and deliveries indicate a good fetal state and a good neonatal outcome. In the presence of both of decelerations and accelerations the fetal state is still good. In the presence of accelerations the low- and high risk deliveries (except the premature deliveries) have a similarly good prognosis. In the lack of accelerations the neonatal mortality, the frequency of resuscitations is higher, and the low Apgar-scores are commoner.

Asphyxia Neonatorum↗
PubMed1989

[Correlation between the levels of catecholamines (noradrenaline, adrenaline) and adrenal steroids (DHA-S, cortisol) in maternal and fetal blood during pregnancy and labor].

It is known that both catecholamines (CA) and cortisol (F) levels elevate during labor. To determine the correlation between adrenal steroids and medullary function, maternal blood was collected during pregnancy, first stage of labor (MVI) and at delivery (MVII). Umbilical arterial and venous blood (UA, UV) was also obtained at delivery. Further, ACTH or dexamethasone (Dx) was given during the first stage of labor, and maternal blood was collected before and 30 minutes after the administration. Plasma levels of CA[noradrenaline (NA), adrenaline (Ad)] were extracted by trihydroxyindole method and were measured by HPLC. DHA-S and F levels were determined by specific RIA. Results are as follows: 1. No apparent change was observed in maternal NA and Ad levels throughout pregnancy. DHA-S levels were high in first trimester and decreased as pregnancy advanced, while F levels showed an increase trend as pregnancy progressed. 2. All hormone levels in maternal blood increased remarkably during labor. A significant negative correlation between F and Ad levels at delivery was noted. When F levels were elevated by ACTH administration, Ad levels decreased. Ad levels elevated when F levels were suppressed by Dx administration. 3. NA, Ad and DHA-S levels in cord blood were higher than those in MVII. Levels of F in maternal blood were higher than those in cord blood. A significant correlation of F in MVII and UA was observed. These results indicate that the suppressive effect of F may be involved in the mechanism of Ad secretion, though the secretion of Ad increased with F in the course of labor. The response of fetal adrenal to the stress of labor may be different from that of maternal adrenal since a significant correlation was not noticed between the levels of Ad and cortisol in cord blood as was found in maternal blood.

Adrenocorticotropic Hormone↗
PubMedDate not supplied

Reevaluation of Friedman's Labor Curve: a pilot study.

OBJECTIVE: To reevaluate the average length of each phase/stage of labor for multiparous and primiparous women in North America who received no regional anesthesia or oxytocin augmentation or induction, to describe a range of labor lengths associated with good childbirth outcomes, and to determine if there is a consensus among labor and delivery nurse managers responding to the survey regarding the need to revise Friedman's Labor Curve. DESIGN: This pilot study used a descriptive and anonymous cross-sectional survey design. Surveys were mailed to 500 maternity care agencies in the United States, Canada, and Mexico with a return rate of 17.8% (n = 89). Each participating agency was asked to submit five patient cases to be included in the analysis. SAMPLE AND SETTING: The sample of patient cases (n = 419) was drawn from randomly selected maternity care agencies throughout North America representing all sizes of agencies and geographic locations. The cases submitted for analysis represented women 14 to 44 years of age with varying ethnicities who received no regional anesthesia or oxytocin augmentation or induction. Twenty-three percent of the women in the sample (n = 97) were primigravidas. RESULTS: The average length of labor for primiparous and multiparous women today is similar to the average length of labor described by Friedman in 1954. However, a wider range of "normal" was found in cases included in the current study. Primiparous women remained in the first stage of labor for up to 26 hours and the second stage of labor up to 8 hours with no adverse effects to mother or infant. Multiparous women remained in the first stage of labor for up to 23 hours and the second stage of labor for up to 4.5 hours with good birth outcomes. In addition, 87.6% of nurse managers responding to the survey believed that Friedman's Labor Curve should be revised to meet the needs of current patient populations, technological advances, and nursing responsibilities. CONCLUSIONS: This study suggests that the parameters to determine if a labor is progressing satisfactorily may need to be expanded. With the availability of technology to assess maternal and fetal well-being, labor should be allowed to progress past the rigid 2-hour time limit for the second stage of labor artificially imposed on women in some childbirth settings. More emphasis should be placed on the nursing assessment techniques used to reassure the family and health care practitioners that labor is progressing safely and the nursing interventions that may have an impact on the length of each stage of labor.

Adolescent↗
PubMed2000

Effects of epidural fentanyl on labor pain during the early period of the first stage of induced labor in nulliparous women.

BACKGROUND AND PURPOSE: It is generally accepted that epidural injection with local anesthetics and narcotics administered when the cervix has dilated to a diameter exceeding 4 cm can adequately control labor pain. However, many nulliparous women still suffer from labor pain for a few hours prior to the administration of epidural analgesia. This study examined the effectiveness of relief of labor pain obtained by injection of narcotics epidurally once the labor pain begins and the subject requests analgesia. METHODS: Subjects scheduled for induced labour were divided into three groups: Group A (n = 60) received 5 x 10(-4)% fentanyl (10-20 mL) administered epidurally to relieve early first-stage labor pain. Group B (n = 60) received no analgesic in the early first stage of labor. For groups A and B, when cervical dilatation exceeded 4 cm, 10 to 15 mL of 5 x 10(-2)% bupivacaine and 2 x 10(-4)% fentanyl were injected epidurally and a continuous low dosage was maintained until full dilatation of the cervix resulted. Group C (n = 198) received no analgesic during the entire labor course. RESULTS: There were no significant differences in the duration of the early period of the first stage of labor, the duration of the late period of the first stage, the duration of the second stage, the Apgar score, or the arterial blood gas of neonates among the three groups. However, group C had a significantly higher cesarean section rate (28.8%) than group A (16.7%) or group B (15%). Pain scores assessed with the Visual Analog Scale (VAS) throughout the entire labor course, were lower in group A than in group B; particularly during the early period of the first stage. The VAS scores in both groups A and B were significantly lower than those in group C during the late period of the first stage of labor. CONCLUSIONS: The results indicate that once labor pain begins and the subject requests analgesia, epidural injection with fentanyl alone can relieve labor pain during the early period of the first stage. The analgesia does not cause adverse effects to the mothers or neonates. In addition, the labor course and the method of delivery are not affected.

Adult↗
PubMed2001

Changes in molecular weight of hyaluronan and hyaluronidase activity in uterine cervical mucus in cervical ripening.

BACKGROUND: This study was undertaken to investigate changes in the forms of hyaluronan and hyaluronidase activity in cervical mucus during cervical ripening. METHODS: Uterine cervical mucus was obtained from 57 pregnant women (25 at preterm gestation, ten at term gestation, 11 within 1 week before labor, and 11 during the first stage of labor). We determined 1) concentration of hyaluronan, 2) hyaluronidase activity, and 3) molecular weight of hyaluronan in cervical mucus. Data are presented as mean and range. RESULTS: The hyaluronan concentration in mucus in the 1st stage of labor (1.58 microg/ml, 0.46-23.96) was significantly (p<0.05) higher than that in all other groups (preterm: 0.29, 0.10-0.88; term: 0.24, 0.11-0.80; within 1 week before labor: 0.30, 0.18-0.62). Hyaluronidase activity both within 1 week before labor group (3.03 min., 1.12-3.95) and in 1st stage of labor group (3.52, 0.43-5.15) was significantly (p<0.05) higher than that in preterm group (1.70, 0.00-5.47). The molecular weight of hyaluronan in cervical mucus in the 1st stage of labor (0.97x106, 0.86-1.41) was significantly (p<0.05) lower than in the preterm and term groups (preterm: 1.60, 1.21-2.20, term: 1.41, 1.21-2.20). There was a significant correlation between hyaluronidase activity and molecular weight of hyaluronan (p<0.05, r=-0.41, n=23). CONCLUSION: These findings suggest that either hyaluronidase or low-molecular weight hyaluronan could be one of the most important regulators in the process of cervical ripening.

Analysis of Variance↗
PubMedDate not supplied

Effects of diluent volume of a single dose of epidural bupivacaine in parturients during the first stage of labor.

BACKGROUND AND OBJECTIVES: 0.1% bupivacaine for obstetric epidural analgesia is given by infusion, using a loading dose of a higher concentration alone or in combination with opioid analgesics. A single dose of 0.1% without any additive for relief of first-stage labor pain has not yet been documented. METHODS: Fifty-eight primiparae in active labor and with less than 5 cm cervical dilatation received 20 mg epidural bupivacaine diluted in 4 mL [group 1: 0.5% (I)], 10 mL [group 2: 0.2% (II)], or 20 mL [group 3: 0.1% (III)]. Pain relief, dermatomal spread, and motor block were assessed. RESULTS: Visual analog pain scale (VAS) was significantly lower in group 2 (0.88 +/- 1.34) and group 3 (0.25 +/- 0.61) than in group 1 (4.37 +/- 2.57). Onset and time to maximum analgesia was significantly shorter in group 2 than in group 3. Mean duration of analgesia was 120 +/- 21 minutes in group 3, 100 +/- 26 in group 2, and 43 +/- 21 in group 1. The mean numbers and upper limits of dermatomes blocked did not differ between groups 2 and 3, but were higher than in group 1. Motor blocks in groups 2 and 3 were more extensive than in group 1 with no difference between groups 2 and 3. Ten mL 0.2% or 20 mL 0.1% epidural bupivacaine results in a similar degree of pain relief, superior to that following 4 mL 0.5%, while duration was longest after 20 mL 0.1%. CONCLUSIONS: Analgesia lasts significantly longer following 20 mL 0.1% bupivacaine than following 10 mL 0.2% bupivacaine when given for first-stage labor pain. Four milliliters 0.5% bupivacaine results in inadequate pain relief.

Adult↗
PubMed2001

Evaluation of fetal heart monitoring in the first stage of labor.

OBJECTIVE: To evaluate the usefulness of continuous electronic fetal heart rate (FHR) monitoring in the first stage of labor. METHODS: A total of 814 pregnant women in labor without identifiable risk factors was divided into two groups. In group A (468 cases), continuous FHR monitoring began in the earliest phase of the first stage of labor (cervical dilatation < or = 4 cm), while in group B (346 cases) it began when the cervical dilatation was > 4 cm. Initial FHR tracings were normal in all 814 cases. The fetal monitoring findings were analyzed at 10-min intervals, and comparisons were made between the two groups concerning FHR findings and their correlation with the state of the newborns. RESULTS: No significant difference was found between the two groups in the incidence of repetitive variable decelerations (1.9% and 1.7%, respectively); sporadic variable decelerations (9.2% and 8.7%, respectively); persistent repetitive late decelerations that resulted in Cesarean section (1.1% and 1.4%, respectively); or sporadic late decelerations (8.3% and 8.1%, respectively). One newborn from each group required intensive neonatal care. CONCLUSIONS: The same tracing sufficiency of fetal stress was observed in the two groups. However, the manner of labor supervision in group B seemed to be more beneficial, because of greater maternal comfort, a lower necessity for personnel, lower consumption of cardiotocographic materials and the possibility of labor induction for more women. Since fetal monitoring is widely used, it is preferable to start continuous FHR monitoring when the dilatation of the cervix approximates 4-5 cm (second phase of the first stage of labor) without risk of fetal loss.

Adolescent↗
PubMed2005

Cesarean delivery during second-stage labor: characteristics and diagnostic accuracy.

OBJECTIVE: To characterize dysfunctional labors that lead to cesarean delivery in the second stage and to assess the accuracy of diagnoses of abnormal fetal descent. METHODS: Thirty-one patients delivered by cesarean during the second stage because of abnormal labor or presumed cephalopelvic disproportion were studied and compared to 62 control cesarean cases delivered for the same indications in the first stage. The clinical diagnosis of dysfunctional labor that led to the cesarean was compared to the diagnosis made by retrospective analysis of the labor curves. RESULTS: Cases did not differ from controls delivered in the first stage in maternal age, race, parity, gestational age, weight gain, or the frequency of associated medical complications. The newborns were not significantly different in birth weight,ponderal index, sex, or the incidence of low Apgar scores. Among study patients, 94% had a second stage labor dysfunction determined by graphic labor analysis, predominantly arrest of descent (69%) and failure of descent (28%). In 79% of cases a dysfunctional first stage preceded the abnormal second stage. Among these first stage labor abnormalities, 68% were not recognized during the labor. CONCLUSION: Characteristics of patients delivered by cesarean during the second stage were similar to those delivered before full cervical dilatation. Second stage labor abnormalities were usually preceded by an abnormal first stage. There was considerable inaccuracy in the diagnosis of second stage labor dysfunction.

Adult↗
PubMed1980

[Clinical analysis of the pain pathways of labor (author's transl)].

Segmental epidural blocks by double catheters which were inserted in the thoracolumbar (Th12-L1) and lower lumbar region (L4-L5) were performed in eleven primiparas to investigate the correct pain pathways of labor and the sensory innervation of uterus. It is generally believed in Japan that the sensory nerves of the cervix of uterus enter the cord through the sacral segments (s2,3,4) and the uterine body through the thoracic segments (Th11, Th12). 5 ml dose of 0.5% bupivacaine (Marcaine) was used to the upper catheter (Th12-L1) during the first stage of labor. Segmental spread of analgesia was on average Th9.4-L1,6 and the duration was 1 hr 57 min +/- 34 min. Seven cases (64%) had no pain up to the full dilatation of cervix and four cases (36%) complained of the pain in the pudendal nerve region (S2,3,4) at the 8 cm dilatation of cervix due to the lower engagement of the fetal head. These findings suggest that not only the pain impulses during the first stage of labor which are resulted from the uterine contraction and the dilatation of the cervix enter the cord through Th10.Th11.Th12.L1 segments and no relation to sacral nerves.

Adult↗
PubMed2001

Abnormal fetal heart rate tracing patterns during the first stage of labor: effect on perinatal outcome.

OBJECTIVE: The purpose of this study was to evaluate perinatal outcomes of infants who had pathologic fetal heart rate tracings during the first stage of labor, in comparison with pregnancies with normal tracings. STUDY DESIGN: The perinatal outcomes of 301 infants born at 37 to 42 weeks of gestation with pathologic fetal heart rate patterns during the first stage of labor were compared with 300 infants with normal fetal heart rate tracing patterns. The data were collected prospectively. Tracings were interpreted with the use of the National Institute of Child Health and Human Development fetal heart rate monitor guidelines. RESULTS: Hydramnios (odds ratio, 7.68; 95% CI, 1.75%-33.63%), oligohydramnios (odds ratio, 2.74; 95% CI, 1.01%-7.39%), and the presence of meconium-stained amniotic fluid (odds ratio, 1.91; 95% CI, 1.03%-3.3%) were independent factors that were associated with pathologic fetal heart rate monitoring during the first stage of labor in a multivariable analysis. The occurrences of umbilical arterial pH of <7.20, a 1-minute Apgar score of <7, a base deficit of 12 mmol/L or higher, and operative deliveries were significantly higher in the study group as compared with subjects with normal fetal heart rate monitoring. Late decelerations and severe variable decelerations (<70 bpm) during the first stage of labor were independent risk factors (odds ratio, 17.5; 95% CI, 1.61%-185.7% and odds ratio, 3.9; 95% CI, 1.36%-11.7%, respectively) that were associated with fetal acidosis (determined by both pH of <7.2 and a base deficit of 12 mmol/L or higher) in a multiple logistic model, controlled for hydramnios, oligohydramnios, meconium-stained amniotic fluid, augmentation by oxytocin, nulliparity, duration of first stage of labor, and birth weight. CONCLUSION: The operative delivery rate was higher among patients with abnormal first-stage fetal heart rate patterns. Late decelerations and severe variable decelerations were significant factors associated with fetal acidosis.

Apgar Score↗
PubMedDate not supplied

Length of normal labor in women of Hispanic origin.

Emanuel Friedman in the 1950s established means and statistical guidelines for normal lengths of labor. The childbearing population in the United States has changed considerably since Friedman's research was conducted. This study documented the duration of labor in a cohort of 240 Hispanic women who had normal vaginal births of singleton term infants from January 1995 through December 1998 and compared these results with the mean duration of the first and second stages of labor as established by Friedman. The mean duration of the active phase first stage labor duration for nulliparous Hispanic women was 6.2 hours, and for multiparous Hispanic women was 4.4 hours, both significantly longer than Friedman's group (P <.01). The mean duration of the second stage of labor in nulliparous Hispanic women was 54.2 minutes and for multiparous Hispanic women was 22.2 minutes, not significantly different from Friedman's group (P =.5 and P =.09, respectively).

Adolescent↗
PubMed1987

Nuchal cords and neonatal outcome.

To assess the significance of nuchal cords, 110 affected woman-infant pairs at term gestation were compared with 110 control pairs. Newborns with a nuchal cord had an increased prevalence of umbilical artery acidemia (22 of 110 versus 13 of 110; P less than .05) and more variable fetal heart rate (FHR) decelerations in the first stage of labor (mild = 41 versus 20; P less than .0001; moderate-severe = 21 versus 5; P less than .0001) and the second stage of labor (moderate-severe = 46 versus 21; P less than .0001). In newborns with a nuchal cord, the umbilical artery acidemia was usually mixed (68%) or respiratory (23%) in origin, and pure metabolic acidemia was infrequent (9%). We conclude that nuchal cords are associated with an increased prevalence of variable FHR decelerations in the first and second stages of labor and with an increased incidence of umbilical artery acidemia.

Acidosis, Respiratory↗
PubMed1989

Characteristics of normal labor.

The length of the first and second stages of labor was evaluated in 6991 women with singleton gestations at 37-42 weeks with vertex presentation. All patients delivered spontaneously without the use of oxytocin. Four study groups were created based on parity and whether conduction anesthesia was used. The mean lengths and limits (95th percentile) for the first stage of labor, respectively, were as follows: nulliparas: no anesthesia--8.1 and 16.6 hours, conduction anesthesia--10.2 and 19.0 hours; multiparas: no anesthesia--5.7 and 12.5 hours, conduction anesthesia--7.4 and 14.9 hours. Similar data for the second stage were as follows: nulliparas: no anesthesia--54 and 132 minutes, conduction anesthesia--79 and 185 minutes; multiparas: no anesthesia--19 and 61 minutes, conduction anesthesia--45 and 131 minutes. These statistical parameters are useful for defining when a labor becomes abnormal and intervention should be considered.

Anesthesia, Conduction↗