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PubMed2004

Regulation of 15-hydroxyprostaglandin dehydrogenase (PGDH) gene activity, messenger ribonucleic acid processing, and protein abundance in the human chorion in late gestation and labor.

The prostaglandin (PG)-inactivating enzyme 15-hydroxyprostaglandin dehydrogenase (PGDH) is highly expressed in the chorion leave. To assess the involvement of PGDH in the regulation of intrauterine PG levels, we have determined the mechanisms that control chorionic PGDH expression in women at term and preterm labor. PGDH gene activity decreased at term and during normal labor. PGDH mRNA abundance also decreased at term due to changing splice variant distribution. Gene activity predicted PGDH mRNA abundance preterm and after normal labor, but not at term before labor. PGDH mRNA decayed rapidly in cultured tissues and was stabilized by transcriptional arrest. PGDH protein levels varied without being significantly different between the patient groups. PGDH mRNA levels predicted PGDH protein levels at term, but not preterm and after labor. PGDH gene activity, mRNA variant, and immunoreactive protein levels were not different between the preterm labor and preterm not in labor groups. Thus, PGDH mRNA is transiently down-regulated before term labor by a posttranscriptional mechanism(s). Protein turnover controls PGDH protein abundance at preterm and after normal labor. At term, PGDH protein levels become dependent on the rapidly turning over PGDH mRNA. This may allow rapid changes in PGDH protein abundance and uterotonic PG concentrations promoting labor.

Chorion↗
PubMed1993

Endothelin levels in human amniotic fluid at mid-trimester and at term before and during spontaneous labor.

Endothelin (ET)-1 is synthesized in human amnion and immunoreactive (ir) ET is present in amniotic fluid in concentrations 10- to 100-times those found in plasma. ET-1 is a potent uterotonin; therefore, the possibility must be considered that ET-1, derived from amnion/amniotic fluid, serves to promote the uterine contractions of human labor. In term pregnancies, after labor begins, the amniotic fluid normally becomes divided into the upper and forebag compartments as the fetal presenting part is engaged in the maternal pelvis. The forebag tissues are exposed in the vagina because of cervical dilatation. Vaginal fluid contains microorganisms, bacterial toxins, and cytokines, e.g., interleukin-1 beta, that oblige an inflammatory reaction. Increased ET-1 formation in these tissues of the forebag would be indicative that the greater rate of ET-1 formation and entry into amniotic fluid was an aftereffect of labor, not a cause of parturition. The levels of irET in amniotic fluid during the midtrimester of human pregnancy, 93.3 +/- 7.4 pmol/L (mean +/- SEM, n = 38), were significantly greater than those in amniotic fluid at term before the onset of labor, 39.8 +/- 4.1 (n = 33, p < 0.01). The levels of irET in the upper compartment during labor, 45.5 +/- 3.5 pmol/L (n = 40), were not significantly different from those in amniotic fluid before labor, but were significantly less (p < 0.01) than those in amniotic fluid of the forebag, 82.1 +/- 5.2 pmol/L (n = 125). These findings are suggestive that increases in the concentration of ET in amniotic fluid at parturition are confined to the forebag and are the result of ET formation after labor begins. Inflammation of the tissues lining the forebag compartment of the amniotic fluid is a normal consequence of labor. Therefore, the entry of inflammatory response mediators, some of which are uterotonins, viz., ET and prostaglandins, into forebag amniotic fluid is an aftereffect of labor and not indicative of a role for these agents (in amniotic fluid) in the initiation of parturition. In a subset of the amniotic fluids from normal pregnancies at term, prostaglandin (PG) levels also were determined. There was a highly significant correlation between the levels of irET and PGE2 in the forebag compartment (p < 0.0001); there was no correlation between irET and PGE2 levels in the upper compartment or in amniotic fluid collected at term prior to labor onset.(ABSTRACT TRUNCATED AT 400 WORDS)

Amniotic Fluid↗
PubMed1997

Epidermal growth factor receptors in uteroplacental tissues in term pregnancy before and after the onset of labor.

Using saturation binding assays and Scatchard analyses, we determined the concentrations and binding affinities of epidermal growth factor (EGF) receptors in human myometrium (n = 13) and decidua (n = 10) before and during labor and in placenta (n = 15), chorion (n = 17), and amnion (n = 17) before labor, during labor, and after vaginal delivery. Each tissue was individually assayed. In myometrium and chorion, EGF receptors increased significantly from 5.6 +/- 0.8 and 13.5 +/- 1.7 fmol/mg protein (mean +/- SEM) before labor to 11.1 +/- 2.8 and 26.7 +/- 3.0 fmol/mg protein, respectively, after the onset of labor (P < 0.05). In amnion, EGF receptors increased from 12.8 +/- 2.7 fmol/mg protein before labor to 33.0 +/- 2.3 fmol/mg protein during labor, but decreased significantly (5.9 +/- 1.2 fmol/mg protein) with vaginal delivery (P < 0.05). Decidual and placental concentrations of EGF receptors did not change significantly with labor. The binding affinity of EGF receptors in all tissues studied did not change significantly with labor, as reflected by their respective association and dissociation constants. Up-regulation of EGF receptors in myometrium, chorion, and amnion with spontaneous labor may enhance stimulation of prostanoid production and stimulate uterine activity.

Amnion↗
PubMed1997

Changes in amniotic fluid immunoreactive corticotropin-releasing factor (CRF) and CRF-binding protein levels in pregnant women at term and during labor.

Corticotropin-releasing factor (CRF)-binding protein (CRF-BP) modulates the activity of the hypothalamus-pituitary-adrenal axis during pregnancy, counteracting the actions of circulating or locally produced CRF. The aim of the present study was to evaluate CRF and CRF-BP levels in amniotic fluid of healthy pregnant women during the last 4 weeks of gestation and during spontaneous labor at term. A cross-sectional study was conducted on amniotic fluid collected from pregnant women (n = 68), subdivided into two groups: 1) not in labor (n = 31), and 2) in labor (n = 37). CRF-BP was measurable in all specimens of amniotic fluid, but at 37 weeks of pregnancy the concentration in amniotic fluid was lower (10-fold) than that in maternal plasma (P < 0.01). Pregnant women at 39 and 40 weeks gestation had amniotic fluid CRF-BP levels significantly lower than those at 37 weeks (P < 0.01), and pregnant in women in labor had significantly lower levels than women at term but not in labor (P < 0.01). CRF levels in amniotic fluid and plasma collected in women at 40 weeks gestation not in labor or in labor were significantly higher than those at 37 weeks (P < 0.01). During the last 4 weeks of gestation, amniotic fluid CRF levels in women not in labor did not significantly differ from those obtained at term labor. During the last weeks of pregnancy, amniotic fluid CRF-BP levels decrease and are inversely correlated to CRF levels. The decrease in amniotic fluid CRF-BP at term, augmenting the amount of free CRF, supports the hypothesis that labor is associated with significant changes in local autocrine and paracrine factors that may affect PG release and myometrial contractility, contributing to the mechanism of parturition.

Adult↗
PubMed1986

[Evaluation of the dopaminergic neuroendocrine control of prolactin release during labor in humans].

Eight women with normal term pregnancy were i.v. administered 10 mg Metoclopramide (M), dopamine antagonist, before and during labor. Serum prolactin (PRL), TSH, GH and cortisol levels were measured at -30, 0, 30 and 60 minutes after M administration by specific radioimmunoassay. Basal serum PRL levels before labor, 287.5 +/- 28.6 ng/ml (mean +/- S.E.), significantly declined during labor to 237.0 +/- 22.4 and 216.4 +/- 22.9 ng/ml (p less than 0.05 at both) at 0 and 30 minutes before M administration, respectively. The increments in serum PRL at 30 and 60 minutes after M administration during labor (209.5 +/- 33.9 and 120.0 +/- 27.1 ng/ml, respectively) were not significantly different from those before labor (202.1 +/- 48.7 and 89.9 +/- 30.1 ng/ml, respectively), suggesting that the decline in serum PRL levels during labor is not due to the dopaminergic control. Basal serum TSH and GH levels were not significantly changed by labor and M administration either before or during labor. Serum cortisol levels tended to increase during labor, but these changes were not significant. The data suggest that the PRL releases from the pituitary during labor are not controlled by the dopaminergic mechanism.

Adult↗
PubMed1992

Onset of spontaneous labor and changes in E2 and progesterone levels--possible interrelation.

Unlike the findings in animal studies, in which a decline in progesterone levels is clearly associated with the onset of labor, investigation of progesterone levels among human parturients has resulted in controversy. This study was designed to address the issue and evaluate labor-onset related changes of estradiol-progesterone (E2-P) concentration in fetal scalp serum, umbilical vein serum and in the peripheral maternal serum. Seven women in spontaneous labor, were compared to 7 women in whom labor was induced. Our results reveal a significant decrease in the maternal serum P concentration when spontaneous labor is taking place (120.6 +/- 24.5 mg/ml verus 177.3 +/- 61.4 mg/ml, p < 0.05). Significant change in the ratio of the fetal scalp to the maternal serum E2/P ratio in women at spontaneous labor versus induced labor is also shown. We could not demonstrate any changes in the E2 levels in relation to labor. We conclude that the onset of labor in human pregnancy is most probably preceded by local changes in the levels of P and ratio of P to E2. These changes may play an important regulatory role in onset of labor.

Adult↗
PubMed2003

Characterization of two labor-induced genes, DSCR1 and TCTE1L, in the pregnant ovine myometrium.

In the present study we characterized two labor-induced genes, DSCR1 (Down syndrome candidate region 1) and TCTE1L (murine t-complex like), which were identified by suppression subtractive hybridization in the pregnant ovine myometrium. DSCR1 and TCTE1L cDNA sequences were retrieved from a custom-made labor-myometrial cDNA library by hybridization screening. The characterized cDNA sequences include 5'-untranslated region (UTR), coding region and 3'-UTR, which are 12 bp, 351 bp and 1716 bp for TCTE1L, and 64 bp, 594 bp and 1539 bp for DSCR1 respectively. The two cDNA sequences encode proteins of 116 and 197 amino acids for TCTE1L and DSCR1 respectively. Northern analysis further confirmed the significant increases of myometrial DSCR1 and TCTE1L mRNA associated with spontaneous term labor (n=6) compared with gestation-matched controls not in labor (n=6). The abundance of DSCR1 and TCTE1L mRNA was attenuated when myometrial contraction was inhibited by Nimesulide (n=6), a specific prostaglandin H synthase 2 inhibitor. Fetal occupancy greatly upregulated DSCR1 and TCTE1L mRNA in the gravid horn during betamethasone-induced premature labor (n=6) compared with the non-gravid horn not in labor (n=3). Estradiol upregulated TCTE1L mRNA, but had no effect on DSCR1 mRNA expression in the non-pregnant sheep myometrium. Progesterone alone had no effect on both DSCR1 and TCTE1L mRNA expression, however progesterone antagonized estradiol's stimulating effect on myometrial TCTE1L mRNA expression in ovariectomized non-pregnant sheep. Upregulation of DSCR1 and TCTE1L in both betamethasone-induced premature labor and spontaneous term labor and inhibition of their expression by Nimesulide suggest a functional role of these two genes in myometrial activation associated with onset of labor. Mechanical stretch, labor and steroids differentially regulated DSCR1 and TCTE1L mRNA in the pregnant and non-pregnant sheep myometrium.

Amino Acid Sequence↗
PubMed2006

Drug therapy during labor and delivery, part 1.

PURPOSE: The drug therapy of common conditions and complications during labor and delivery and the fetal and neonatal effects of this therapy are examined. SUMMARY: The pharmacologic therapy of common conditions that occur in labor and delivery primarily involves oxytocin and prostaglandins for cervical ripening and labor induction and systemic and regional narcotic analgesics for pain. Because most medications used in women during labor and delivery do not have Food and Drug Administration-approved labeling, pharmacists should understand the benefits and limitations of medications used in the mother. Although induction and augmentation of labor and the control of pain often require drug therapy, other, less frequent, complications may occur in labor. Drug therapies for these complications include anti-infective agents to treat maternal infection and prevent neonatal diseases; antiretrovirals to reduce perinatal HIV-1 transmission from the mother to the fetus; corticosteroids to prevent fetal lung immaturity; antihypertensives to treat preeclampsia; anticonvulsants to treat eclampsia; antibiotics to prolong pregnancy and improve neonatal outcomes after premature rupture of the membranes; tocolytics for premature labor; and oxytocin, ergot alkaloids, and prostaglandin analogues for postpartum hemorrhage. The fetal and neonatal effects of therapy for the conditions that occur during labor and delivery are usually benign, but significant morbidity and mortality involving the mother, the fetus, and the newborn are ever-present risks. CONCLUSION: Awareness of the conditions and complications requiring drug therapy during labor and delivery will allow hospital pharmacists to make knowledgeable decisions about the rapid accessibility of critical medications in the labor and delivery unit.

Adrenal Cortex Hormones↗
PubMed1994

'To bathe or not to bathe' during the first stage of labor.

OBJECTIVE: Does a warm tub bath relieve labor pain? How is it experienced by the parturient? METHODS DESIGN: prospective randomised trial. SETTING: labor ward of a teaching hospital with a uniform active labor management. PARTICIPANTS: one hundred and ten nulliparous low risk women, at term, in true spontaneous labor. Fifty-four women had a bath, 56 women served as controls. MEAN OUTCOME MEASURES: labor pain (assessed by means of a visual analogue scale) and post partum patients' bathing experience (by means of a self-made questionnaire). RESULTS: The study group and the control group were comparable with respect to maternal age, weight, length, duration of gestation, cervical status and labor pain sensation before randomisation. Absolute values of labor pain were not statistically different between the two groups, yet this latter progressed differently: in the bathing group the initial pain sensation (V.A.S.) was 6.8, and this remained stable during the first 25 minutes (V.A.S. = 6.7) and then rose to 8.2 after a mean of 53 minutes. In the control group, labor pain rose progressively from 6.3 to 7.3 after 25 min and to 8.7 after a mean of 52 min (p < 0.01, Student t-test). There was no difference in the use of epidural analgesia. There were no differences in labor duration nor in the frequencies of either operative deliveries or neonatal complications. Eighty percent of the bathers experienced soothing of the pain and all but one reported body relaxation. Ninety percent wanted to bathe again during a next labor. CONCLUSION: Bathing provided no objective pain relief. It had, however, a temporal pain stabilizing effect possibly mediated through the improved ability to relax in between contractions. No side effects were found. It gives great satisfaction to users. Bathing, in conjunction with other forms of analgesia, is recommended.

Adult↗
PubMed1991

[The meaning of pain in labor].

From of old, labor has been accompanied by pain and much effort has been made to eliminate or diminish the amounts of pain during labor. Little concern has yet been given to the subjective meaning of pain in labor. Recently, rates of cesarean section in Korea and in some other nations have increased rapidly and some investigators are reporting negative reactions such as anger, disappointment and feeling of loss due to lack of control over labor and its pain. These findings are thought to suggest that control of labor and its pain gives some meaning to the laboring woman. Thus the investigators sought to discover the meaning of pain during labor for Korean women. Specific objectives of this study were to explore the meaning of pain in labor to the mothers, their reactions to the experience of labor and their preference for delivery method. The subjects of this study were 95 mothers who delivered their babies in hospital from September 1989 to May 1990: 45 gave birth by vaginal delivery, and 50 by cesarean section. Data were gathered through direct interviews by the investigators, and questions were focused on five areas i.e. mothers' feelings about delivery and their babies, their feelings about of having more children, the most difficult aspect about this labor and delivery, and what they thought the differences were between vaginal delivery and cesarean section. After interview, mothers' answers were summarized, and classified according to the degree of positive or negative attitude.(ABSTRACT TRUNCATED AT 250 WORDS)

Cesarean Section↗
PubMed2004

Transvaginal ultrasonography for cervical assessment before induction of labor.

OBJECTIVE: To evaluate the value of ultrasonographic cervical assessment in predicting the outcome of labor induction and to compare its performance against the Bishop score. METHODS: The Bishop score was determined by digital examination, and transvaginal ultrasonography was performed in 105 women at 37 to 42 weeks' gestation scheduled for labor induction. Ultrasonographic parameters evaluated were cervical length, the presence of funneling, funnel width, and funnel length and were blinded to managing physicians. The primary outcome was the occurrence of active labor within 2 days (successful labor induction). The interval from the onset of induction to active labor (duration of induction) was the secondary outcome. Statistical analysis was performed by the chi2 test, Wilcoxon rank sum test, Pearson correlation, receiver operating characteristic curves, logistic regression, Cox proportional hazards model, and generalized Wilcoxon test for survival data. RESULTS: Induction of labor was successful in 93 women (89%). The area under the receiver operating characteristic curve for cervical length was greater than that of the Bishop score in predicting a successful labor induction (z = 2.18; P < .05). A cervical length of 3.0 cm or less had sensitivity of 75% (70 of 93) and specificity of 83% (10 of 12). Multiple logistic regression analysis showed a significant relationship between successful labor induction and cervical length but not the Bishop score (odds ratio = 0.24; 95% confidence interval, 0.096-0.59; P = .002). Only parity and cervical length had a significantly independent relationship with the duration of induction. CONCLUSIONS: Cervical length measured by transvaginal ultrasonography is a useful and independent predictor of successful labor induction and the duration of induction and provides better predictability of successful labor induction than the Bishop score does.

Adult↗
PubMed1999

[Twin delivery after cesarean section: is a trial of labor warranted?].

OBJECTIVE: To determine whether a trial of labor in twin pregnancy is a valuable alternative to routine repeat cesarean section. MATERIAL AND METHODS: Based on retrospective analysis of 31 cases of twin gestation with previous cesarean section, we tried to assess the outcomes of 25 cases of trial of labor. The outcomes of trial of labor in twin pregnancy were compared to those of trial of labor in singleton pregnancy. RESULTS: The trial of labor was successful in 21 cases (84%). There was one case of scar dehiscence among the women who underwent a trial of labor, that occurred in the parturient with two previous cesarean sections after complete breech extraction. There were no significant differences in perinatal outcomes in any comparison of trial of labor versus no trial of labor. The outcomes of trial of labor in the twin pregnancy were similar to singleton pregnancy. CONCLUSIONS: Routine repeat cesarean section in the twin pregnancy is not necessarily warranted; a controlled trial of labor in selected cases would be a valuable alternative.

Adult↗
PubMed2002

Factors related to perceived labor pain in primiparas.

The purpose of this study was to investigate the association between demographic-obstetric factors and perceived labor pain in primiparas. The participants in this study were 90 primiparas having normal childbirths at the Department of Obstetrics, Chi-Mei Medical Center in southern Taiwan between September 1999 and June 2000. The perceived intensity of labor pain was measured using the visual analogue scale for pain and the present behavioral intensity score in the latent phase (cervix dilated 3-4 cm), active phase (cervix dilated 5-7 cm), and transitional phase (cervix dilated 8-10 cm). The subjects' mean age was 27.82 +/- 3.64 years (range, 20-39 yr), and the mean newborn birth weight was 3,162 +/- 387 g (range, 2,340-4,120 g). The primiparas' perceived labor pain at each of the three phases of labor was positively related to expected labor pain, but had no significant association with newborn birth weight, maternal age, body mass index, confidence in labor, or duration of labor. The expected labor pain of the primiparas had a negative correlation with body mass index. The birth weight of the newborn was positively related to the duration of labor. These findings suggest that primiparas' perceived labor pain is correlated with psychogenic rather than physical factors.

Adult↗
PubMedDate not supplied

Premature labor, Part I: Risk assessment, etiologic factors, and diagnosis.

BACKGROUND: This paper, the first of a two-part series on premature labor, reviews the recent literature on the causes of and risk factors for preterm labor and methods of diagnosis. METHODS: A review of the literature on risk determination and diagnosis of preterm labor was conducted by searching MEDLINE files from 1983 to the present, using the key terms "preterm labor," "premature labor," "preterm labor and infection," and "uterine monitoring." Additional references were accessed by cross-referencing the bibliographies of the articles obtained through this search. RESULTS AND CONCLUSIONS: Risk factors for preterm labor, which include items related to the pregnant woman's demographic characteristics, history, daily habits, and current pregnancy, have been combined into scoring systems commonly used by clinicians and researchers to single out women at risk for preterm delivery. When such systems are tested in obstetric populations, results show variable success in predicting preterm labor or birth. These inconsistent results could be due, in part, to important factors that have often been omitted from scoring systems, such as chemical abuse, poor nutrition, little social support, demanding work, multiple sexual partners, past or current sexually transmitted diseases, and other gynecologic infections. Women who are considered high risk for preterm labor can benefit from participating in preterm birth prevention programs that incorporate home monitoring, patient education regarding the signs and symptoms of preterm labor, frequent contacts with health professionals, and cervical examinations.

Biomarkers↗
PubMed1992

Maternal and neonatal outcomes after oxytocin augmentation in patients undergoing a trial of labor after prior cesarean delivery.

OBJECTIVE: To study the safety of oxytocin augmentation in patients having abnormal labors after a prior cesarean delivery. METHODS: We retrospectively analyzed a case series of women undergoing a trial of labor after a previous cesarean delivery from the University of California San Francisco perinatal data base. Women whose labors were augmented with oxytocin were compared to women with labor abnormalities managed without the use of oxytocin. A wide range of maternal and neonatal outcomes was compared. Only vertex singleton term deliveries were studied. RESULTS: From 1975-1990 there were 504 trials of labor, of which 185 (37%) had labor abnormalities; 62 of these 185 (34%) were augmented with oxytocin. Fifty-eight percent of the trials of labor ended in vaginal delivery. In patients since 1982, 73% delivered vaginally. Forty-six (74%) of augmented patients delivered vaginally. There were no maternal deaths, uterine ruptures, or hysterectomies. Estimated blood loss was slightly greater among augmented patients after controlling for mode of delivery (P < .05), but only by 50-100 mL on average. There was no difference in the need for maternal transfusion. Fetal trauma and fetal scalp blood sampling occurred more frequently (P < .05) in the augmented labors, but only in the subgroup delivered by cesarean. No increased risk was demonstrated by a comparison between patients receiving oxytocin and epidural anesthesia and patients with labor abnormalities receiving neither. CONCLUSION: Retrospective analysis supports the use of oxytocin and epidural anesthesia to augment abnormal trials of labor after prior cesarean.

Anesthesia, Epidural↗
PubMedDate not supplied

Premature labor, Part II: Management.

BACKGROUND: As the second paper in a two-part series on preterm labor, this article discusses the management of preterm labor as it relates to risk reduction, tocolytic therapy, corticosteroids, and antibiotics. METHODS: Published literature on the management of preterm labor was reviewed by searching MEDLINE files from 1983 to the present, using the terms "preterm labor," "premature labor," "preterm labor and antibiotics," "tocolytic agents," "tocolysis," "betamethasone," and "premature rupture of membranes." Additional references were obtained by cross-referencing bibliographies from available articles. RESULTS AND CONCLUSIONS: Effective management of preterm labor and birth begins with an assessment and reduction of risks for all pregnant women. In addition, pregnant women should be screened and appropriately treated for urologic and gynecologic infections (e.g., syphilis, gonorrhea, Chlamydia, and bacterial vaginosis). Women who are at high risk for preterm birth should be enrolled in a preterm birth prevention program that includes frequent contact with health professionals, patient education about the signs and symptoms of preterm labor, home monitoring, and regular cervical examinations. For women who develop preterm labor that does not require immediate delivery, recommended management strategies include reduced activity, early tocolytic therapy, corticosteroids for up to 34 weeks' gestation (both for women with intact and ruptured membranes), and antibiotics for known infections. Early studies also suggest that prophylactic antibiotics can be beneficial for women with idiopathic preterm labor or preterm premature rupture of membranes.

Adrenal Cortex Hormones↗
PubMed2005

[Effects of ambulatory labor analgesia on fetal oxygen saturation].

OBJECTIVE: To observe the effect of ambulatory labor analgesia on fetal oxygen saturation during labor. METHODS: Sixty parturients with uncomplicated term pregnancies were equally divided, according to their personal preference, into ambulatory analgesia group receiving combined spinal-epidural labor analgesia and control group without analgesia administration. All the parturients with ambulatory labor analgesia received sufentanil and ropivacaine administration. Fetal oxygen saturation was monitored continuously during the labor by recording the values every 5 minutes and the mean value was calculated. Umbilical blood was analyzed after fetal delivery and the pH, base excess (BE) value were recorded. RESULTS: In the analgesia group and the control group, the mean values of fetal oxygen saturation was (51.92+/-5.90)% and (50.77+/-6.47)%, respectively, during the first labor stage (P=0.48), and was (44.85+/-6.27)% and (43.12+/-7.34)% during the second labor stage (P=0.32), and the lowest values during the labor was (41.63+/-7.51)% and (40.96+/-7.48)%, respectively (P=0.73), showing no significant differences in the three values between the two groups. CONCLUSION: Ambulatory labor analgesia does not significantly affect fetal oxygen saturation during the entire course of labor.

Adult↗
PubMed1990

The duration of labor in primiparas undergoing vaginal birth after cesarean delivery.

The purpose of this retrospective investigation was to evaluate the duration of labor in women having a trial of labor after a previous low transverse cervical cesarean delivery for dystocia. We specifically sought to determine whether these patients experienced a labor similar to that of the nulliparous or multiparous woman. During the study period, 73 women who had previously undergone a cesarean for dystocia had a successful trial of labor. We matched each study patient to two controls. One control was nulliparous and the second was a woman who had undergone a previous uncomplicated vaginal delivery. Thirty-six study patients had had a cesarean in the latent phase of labor (group I), 29 in the active phase of labor (group II), and eight in the second stage of labor (group III). With the exception of group I patients, the first and second stages of labor were similar to those of nulliparous control patients. Patients in group I had a significantly longer first stage of labor than did the nulliparous controls. There was no significant difference in oxytocin requirements among the three groups. We conclude that primiparous women who have had a previous cesarean delivery for dystocia have a duration of labor similar in length or longer than that of nulliparous women.

Cesarean Section↗