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PubMed1980

Uterine contraction patterns in patients with severe abruptio placentae.

Uterine contractions were monitored in 54 patients in whom severe abruptio placentae had caused intra-uterine death of the fetus. The frequency at the beginning of monitoring ranged from 2 to 14 contractions in 10 minutes, with a mean of 8,4. Only 4 patients had 4 or fewer contractions in the first 10 minutes of monitoring. No change in contraction frequency was observed during the course of labour. A high frequency of contractions before or during labour is highly suggestive of severe abruptio placentae.

Abruptio Placentae↗
PubMed1977

Lumbar epidural analgesia in labour in twin pregnancy.

Fifty twin pregnancies in which the mother received epidural analgesia in labour were compared with 92 in which the mother received standard parenteral analgesia. The duration of the first and second stages of labour; the incidence of assisted deliveries when the head presented; the proportion of breech extractions when either the first or second twin presented by the breech; the incidence of low Apgar scores; and the perinatal mortality were not significantly different in the two groups. These findings suggest that lumbar epidural analgesia is safe for providing pain relief in labour for patients with a twin pregnancy. Moreover, an epidural block is preferable to conventional analgesia in these cases as it allows prompt intervention to effect delivery of the second twin.

Anesthesia, Epidural↗
PubMed1992

Maternal transport of patients with advanced cervical dilatation--to fly or not to fly?

Emergency maternal transport of women in advanced preterm labor often involves difficult decisions about whether to transport or not. A retrospective review of maternal transports performed in northern Arizona by Samaritan Air Evac covered a 21-month period. Of the 1080 patients transported for preterm labor, 54 calls for transport (5%) were received when the patient was 7 cm or more dilated. Five women were delivered at the referring hospital and 49 were transported, none of whom delivered en route. Only 21 (39%) of them delivered in the first hour after arrival at the tertiary center. The decision to transport patients in advanced preterm labor should be based on such factors as distance between hospitals, time required to cover that distance, personnel on the transport, facilities available at the transporting hospital, gestational age, and speed with which labor has progressed.

Aircraft↗
PubMed2005

Progress of first stage of labour for multiparous women: an observational study.

As there is no universal definition of 'normal' labour, diagnosing prolonged labour is inherently difficult. Simple charts (partograms) are used to aid this process; however, there are little empirical data on which to base such charts. Therefore, we monitored 403 multiparous women, in the first stage of labour with uncomplicated term pregnancies, in a midwife-led unit. They had vaginal examinations every 2 hours, and we modelled rates of cervical dilatation for all women, either to the end of the first stage of labour or to the point of transfer for intervention. Overall, the median rate of dilatation was 1.9 cm/hour and the 5th percentile was 0.5 cm/hour. There was a weak positive correlation between initial dilatation and rate of dilatation (r= 0.2). Individualised computer-based partograms incorporating some of the factors that affect progress might prove useful in the future.

Adult↗
PubMed1997

Perioperative management of intra-partum seizure.

A young nulliparous woman previously diagnosed with pregnancy-induced hypertension suffered a seizure during active first stage labour. Pre-seizure blood pressure was borderline high but she did not fulfill other criteria for preeclampsia. She underwent emergency caesarean section for presumed eclampsia. Postoperatively, she deteriorated neurologically. CT scan showed an intracranial haemorrhage requiring neurosurgical intervention. The similarities of presentation of a primary cerebrovascular event and eclampsia following an intra-partum seizure made the differential diagnosis difficult.

Adult↗
PubMed2005

Maternal and perinatal morbidity of caesarean delivery at full cervical dilatation compared with caesarean delivery in the first stage of labour.

To estimate maternal and perinatal morbidity associated with caesarean delivery at full cervical dilatation, a population-based cohort study from 1997 to 2002 was used, which included 1623 nullipara with singleton pregnancies at 37-42 weeks of gestation requiring caesarean delivery in labour. Compared to caesarean delivery at less than full dilatation, women undergoing caesarean delivery at full dilatation were more likely to have complications of intraoperative trauma (RR 2.6, P < 0.001) and infants with perinatal asphyxia (RR 1.5, P < 0.05). There was no difference in maternal or perinatal morbidity when duration of the second stage of labour or when failed assisted vaginal delivery was considered.

Adult↗
PubMed1979

[Inhibition of premature uterine contractions].

Various drugs used to stop premature uterine contractions are discussed in the paper. Particular attention is paid to beta-mimetic drugs. The results of ming Partusisten, one of beta-mimetic drugs, is presented on the material of 104 patients with threatening immature and premature labour. Partusisten was administered in the form of intravenous drip infusion or tablets. During treatment monitoring of the uterine contractility and of foetal heart rate took place. Inhibition of the uterine contraction activity was successful in 100 per cent of cases. In 60,9 per cent in the group of threatening immature labour and in 38,1 per cent in the group threatening premature labour, the delay of delivery was more then 28 days. The delay of delivery by 48 hours was 87 per cent and 84 per cent in both groups respectively. Tachycardia was one of the first side effects observed in 15,2 per cent of cases. There is also presented an example of pregnancy when delivery was delayed by 21 days in spite of premature outflow of amniotic fluid (at a high rupture of membrane). The authors are of the opinion that Partusisten is very effective and gives little side effects, preventing premature uterine contractions. Dosage should be individualized according to the case and labour advancement, and should be based on topographic evaluation of uterine contraction. Negative influence of the drug on foetuses was not observed.

Abortion, Spontaneous↗
PubMed2004

[The therapeutic role of tocolysis].

In twin pregnancies, the use of beta-adrenergics is associated with a significantly higher incidence of cardiovascular complications, and calcium channel blockers as well as oxytocin antagonists currently appear as first line agents. After extreme preterm delivery of the first twin and in selected patients, the birth of second twin may be delayed with a mean gain of 10-50 days. In cases of symptomatic placenta previa with mild-to-moderate bleeding, tocolytic agents may be associated with a prolongation of pregnancy and increased birth weight without significant impact on frequency or severity of bleeding. Calcium channel blockers are the drugs of choice in the event of diabetes. Indomethacin is a potent tocolytic, in particular in patients with polyhydramnios. However, it may cause oligohydramnios, premature closure of the ductus arteriosus and intrauterine fetal death when high doses are administered for a duration exceeding 48 to 72 hours, particularly beyond 32 weeks' gestation. The neonatal complications of indomethacin occur frequently. Tocolysis appears to reduce the failure rate of external cephalic version at term.

Female↗
PubMed2004

[In utero transfer for preterm labor: experience of a regional perinatal hotline providing a 24-hour on call service].

OBJECTIVE: Preterm labor is one of the major causes of concern for level I and II obstetricians. The purpose of this study was to determine the incidence of in utero transfer performed for preterm labor. We also aimed to evaluate the algorithm we used in case of call for preterm labor. This algorithm allowed us to study the rate of endovaginal sonography use prior to in utero transfer, to calculate its predictive value and to evaluate the risk of delivery during transfer. PATIENTS AND METHOD: We conducted an 8-months prospective study of all calls for preterm labor received at a regional call center in France (EU). All obstetrical data were entered in a computerized anonymous database. Three months after the first call midwives collected data from the receiving hospital. RESULTS: Calls for preterm labor account for 40% of calls for in utero transfer. Two hundred and sixty-five calls have been received for preterm labor; among them 50 cases were associated with a preterm rupture of membrane, a maternal or fetal pathology and 14 cases were lost for follow-up. Those 64 cases were excluded leaving 201 cases for analysis. Twenty-eight had a cervix dilated 4 cm, or more, while 173 had a cervix dilated less than 4 cm. Fifty percent of woman that had a cervical dilatation of 4 cm or more delivered more than 4 h after the call. Among the 173 patients that had a cervix dilated less than 4 cm, 71% had not delivered 7 days after the hotline call and 26% had an endovaginal ultrasonography performed before the transfer. None of the women that had a cervical length longer than 27 mm delivered in the 7 following days. None of the 176 women that were transferred delivered during the transfer. DISCUSSION AND CONCLUSION: In utero transfer for preterm labor is the leading cause of in utero transfer. Endovaginal ultrasonography prior to transfer should be performed in order to avoid unnecessary transfer. Women who have a preterm labor with a cervical dilatation of 4 cm or more are not an absolute contra-indication to in utero transfer. In those cases the transfer indication should be discussed on a case-to-case basis including the actual term and the distance between hospitals.

Female↗
PubMed2003

Vacuum application through a nonfully dilated cervix: a viable option.

The aim of this cross-sectional study was to assess the feasibility of vacuum delivery through a nonfully dilated cervix. The study group consisted of 39 women with vacuum deliveries through a nonfully dilated cervix larger than 9 cm and station of the head at S or more +2 cm. These were compared to a control group of 215 vacuum deliveries at a fully dilated cervix and 46 women who underwent cesarean section at a nonfully dilated cervix larger than 9 cm. The main indication for vacuum extraction in the study group was fetal distress and in the control groups prolonged 2nd stage, dysfunctional labor and fetal distress. Maternal and neonatal morbidity was low and not different between the groups. Neonatal well being, evaluated by cord pH and 5-min Apgar score, was not different. Based on predefined criteria, vacuum extraction through a nonfully dilated cervix is a viable alternative to emergency cesarean section and is apparently not associated with higher maternal or infant morbidity.

Apgar Score↗
PubMed1990

Prophylactic intrapartum amnioinfusion: a randomized clinical trial.

Amnioinfusion was performed in a prospective, randomized trial of 60 women in the latent phase of labor with oligohydramnios, as defined by an amniotic fluid index less than or equal to 5.0 cm. All fetuses were at least 37 weeks' gestational age, had normal baseline fetal heart rate variability, and no clinically significant fetal heart rate decelerations at the outset. Subjects in the amnioinfusion group (n = 30) were titrated to and maintained at an amniotic fluid index level greater than or equal to 8.0 cm throughout labor. In the group receiving amnioinfusion, significantly lower rates of meconium passage (p = 0.04), severe variable decelerations (p = 0.04), end-stage bradycardia (p = 0.05), and operative delivery for fetal distress (p = 0.002) occurred. Significantly higher umbilical arterial blood pH values were also noted in the infusion group (p = 0.02). We conclude that prophylactic intrapartum amnioinfusion is an important technique for the reduction of intrapartum morbidity.

Adolescent↗
PubMed1995

A metaanalysis of home uterine activity monitoring.

OBJECTIVE: Our purpose was to assess by metaanalysis the evidence from randomized clinical trials regarding home uterine activity monitoring. STUDY DESIGN: Six randomized controlled trials of home uterine activity monitoring, the same six trials reviewed by the U.S. Preventive Services Task Force on home uterine activity monitoring, were studied. Data were extracted from published reports of the six trials. In addition, unpublished data were obtained by personal communication from the trials' principal investigators. Insofar as possible, the principle of intention-to-treat was maintained. Data regarding twins were handled by use of numbers of pregnancies rather than numbers of infants as sample sizes. Stratified metaanalyses were conducted according to whether the trial did or did not control in study design for the nursing contact factor that accompanies home uterine activity monitoring. In addition, stratified metaanalyses were conducted for singleton and twin pregnancies. The four outcomes investigated were incidence of preterm birth, incidence of preterm labor combined with cervical dilatation > 2 cm, infant referral to the intensive care unit, and mean birth weight. RESULTS: Overall, for all pregnancies home uterine activity monitoring was associated with a statistically significant reduction of 52% in risk of preterm labor combined with cervical dilatation > 2 cm (relative risk = 0.48, p = 0.001) and a statistically significant increase of 86 gm in mean birth weight (p = 0.038). When stratified by singleton or twin pregnancy, the pooled results generally differed by strata. Among singleton pregnancies, home uterine activity monitoring was associated with a statistically significant reduction of 24% in risk of preterm birth (relative risk 0.76, p = 0.037) and a statistically significant increase of 126 gm in mean birth weight (p = 0.009). Among twin pregnancies, there was a statistically significant effect of home uterine activity monitoring with a reduction of 56% in risk of preterm labor combined with cervical dilatation > 2 cm (relative risk 0.44, p = 0.005). There were no statistically significant effects found overall and in any stratum with regard to infant referral to the intensive care unit. Metaanalyses of studies that controlled in design for the nursing contact factor that accompanies home uterine activity monitoring showed either no difference or stronger pooled effects compared with metaanalyses of those studies that did not control for nursing contact. This suggests that the potential bias attributed to the nursing contact feature that accompanies home uterine activity monitoring is not as appreciable as home uterine activity monitoring critics have suggested. CONCLUSIONS: Metaanalysis of existing clinical trial evidence regarding home uterine activity monitoring reveals statistically significant benefits of home uterine activity monitoring. Of the outcomes investigated, home uterine activity monitoring is associated with reductions in risks of preterm birth (in singleton pregnancies only) and preterm labor combined with cervical dilatation > 2 cm, as well as with increased mean birth weight (in singleton pregnancies only).

Female↗
PubMed2006

Risk factors for previable premature rupture of membranes or advanced cervical dilation: a case control study.

OBJECTIVE: The purpose of this study was to identify risk factors for second trimester premature preterm rupture of membranes or advanced cervical dilation in a high-risk population. STUDY DESIGN: A retrospective case control study was performed that compared women with premature preterm rupture of membranes or advanced cervical dilation to term control subjects. The cases included all singleton pregnancies between 14 and 24 weeks of gestation with premature preterm rupture of membranes or advanced cervical dilation between 1996 and 2000. The next 2 term deliveries were chosen as control subjects. The variables compared between cases and control subjects included pregnancy history, infectious and medical histories, cervical/uterine procedures, and habits. This study had institutional review board approval. RESULTS: There were 102 women with premature preterm rupture of membranes, 56 women with advanced cervical dilation, and 316 control subjects. The mean gestational ages for premature preterm rupture of membranes or advanced cervical dilation were 20 +/- 2.6 and 19.9 +/- 2.6 weeks. Tobacco use, history of or current cervical incompetence, previous second trimester delivery, previous termination at <20 weeks of gestation, and previous premature preterm rupture of membranes were associated significantly with premature preterm rupture of membranes or advanced cervical dilation compared with term control subjects. When controlled for parity, age, marital status, and race, these variables remained significant. Bacterial vaginosis in current pregnancy was associated significantly with only advanced cervical dilation but not premature preterm rupture of membranes compared with control subjects. A history of Chlamydia was most common in the term control subjects (19.6%). CONCLUSION: In a high-risk population of inner city women, only pregnancy history and tobacco use distinguished women with second trimester premature preterm rupture of membranes or advanced cervical dilation from term control subjects. No infectious risk factors distinguished control women from women with premature preterm rupture of membranes. The only modifiable risk identified was tobacco use.

Case-Control Studies↗
PubMed2000

The effect of fetal fibronectin testing on admissions to a tertiary maternal-fetal medicine unit and cost savings.

OBJECTIVE: Fetal fibronectin bedside testing has been proposed as a diagnostic tool for the accurate diagnosis of preterm labor. The study objective was to determine whether the introduction of routine fetal fibronectin bedside testing affected costs and transfer rates from referral district hospitals to a tertiary obstetric hospital, as well as direct admissions to a tertiary referral hospital. STUDY DESIGN: We performed an 18-month prospective audit of fetal fibronectin use in 9 referral hospitals and one university maternal-fetal medicine unit. Data collected were delivery details and cervical dilatation at admission. Cost savings in terms of transport costs for patients with a negative fetal fibronectin result who were not transferred or admitted to the tertiary center were calculated for interhospital transfer (road ambulance or fixed-wing retrieval). RESULTS: One hundred fifty-one patients had a presumptive diagnosis of threatened preterm labor. Forty-five patients had a positive fetal fibronectin result and 106 had a negative fetal fibronectin result (3 with cervical dilatation >/=3 cm). Eleven (24%) patients with a positive fetal fibronectin result were delivered within 7 days, and 5 (5%) with a negative fetal fibronectin result were delivered within 7 days. One patient was delivered at 34 weeks, and the remaining patients were delivered at or after 36 weeks' gestation. All 3 patients with negative fetal fibronectin results with cervical dilatation of >/=3 cm were delivered within 5 days, leaving 2 (1.9%) patients (with closed cervices and negative fetal fibronectin results) being delivered 5 days after the fetal fibronectin testing. Ninety percent of the patients admitted to a referral hospital with threatened preterm labor who had a negative fetal fibronectin result were not transferred; thus an unnecessary transfer was avoided, with cost savings ranging from $30,297 for road and fixed-wing transport. CONCLUSION: A negative fetal fibronectin result is not helpful if cervical dilatation is present, and these patients should be treated as having a high risk of preterm delivery. The use of a fetal fibronectin test was associated with a 90% reduction in maternal transfer and can substantially reduce the costs and inconvenience associated with unnecessary transfer.

Antibodies, Monoclonal↗
PubMed1999

Cervical dimensions and risk of preterm birth: a prospective cohort study.

OBJECTIVE: To examine the relation between cervical dilatation and length and the risk of spontaneous preterm birth, including its subtypes preterm labor and preterm premature rupture of membranes (PROM). METHODS: Cervical dimensions assessed by clinical examination were recorded prospectively at 24-29 weeks' gestation in 871 subjects with singleton pregnancies who were followed to delivery. Relative risks (RRs) of preterm birth, preterm labor, and preterm PROM were calculated for clinically distinguishable categories of cervical dilatation and length and for cervical score (length minus dilatation). Regression analysis was used to adjust for confounding. Time to delivery from baseline examination was summarized using survival analysis. RESULTS: There were 73 spontaneous preterm births (8.3%), 46 preterm labors and 27 cases of preterm PROM. All cervical measurements were associated with increased risks of preterm birth, with increasing abnormality more strongly predictive of risk. The adjusted RR for preterm birth with dilatation of at least 0.5 cm was 2.9 (95% confidence interval [CI] 1.2, 7.3); for length of 1.5 cm or less, the RR was 2.1 (95% CI 1.0, 4.5), and for cervical score less than 2.0, the RR was 2.8 (95% CI 1.4, 5.6). The association with cervical measurements was stronger for preterm PROM than for preterm labor, although precision was limited. These measurements had high specificity (93-99%) and low sensitivity (8-20%) for predicting preterm birth. CONCLUSION: In asymptomatic women at 24-29 weeks' gestation, greater cervical dilatation and shorter length were associated with increased risk of spontaneous preterm delivery, particularly preterm PROM.

Adult↗
PubMed2001

Labor admission test: an assessment of the test's value as screening for fetal distress in labor.

BACKGROUND: To determine if the labor admission test (LAT) can predict fetal distress in a population of laboring women, and in subgroups of low- or high-risk women, who delivered within six hours or between six and 24 hours after LAT. METHODS: The data charts of all women who delivered at Hammerfest Hospital in 1996, 1997 and 1998 were retrospectively read. If the woman was admitted to the hospital because of onset of labor, was in the first stage of labor and delivered within 24 hours after admission, she was included. In the study period, 1639 gave birth and 932 were included in the study. A descriptive analysis of the population and assessment of LAT's sensitivity, positive predictive value, specificity and negative predictive value at different cut-off values was done. RESULTS: In the study population 5.8% had fetal distress, and 5.3% had an operative delivery because of fetal distress. LAT's sensitivity in the whole population was 0.15 and positive predictive value was 0.16. Specificity was 0.95 and positive predictive value was 0.95. In the subgroups of low- and high-risk women, who delivered within six hours or between six and 24 hours after LAT, sensitivity varied between 0 and 0.36, and positive predictive value varied between 0 and 0.27. Specificity varied between 0.92 and 0.96, and negative predictive value varied between 0.89 and 0.97. CONCLUSIONS: According to these results, LAT cannot be recommended as a screening test for fetal distress in labor in low-risk women. Sensitivity is too low, and there are too many false-positive tests. It is unclear if LAT has benefits among high-risk women.

Adult↗
PubMed1975

Vacuum extraction.

In the past twenty years, the vacuum extractor has gained wide use in Europe with an associated decrease in perinatal mortality. There, its use is considered by many to be much safet than a forceps delivery. Certain complications are associated with its use, but in general these are minor and transitory. On analysis, most of the serious complications reported in the literature are considered to be due to other associated factors, or to misuse of the vacuum extractor. Experience with the vacuum extractor in the United States has been minimal, and most authors feel that there are few indications for its use. Perhaps it is time that obstetricians in the United States take a more careful look at the European experience, and give the vacuum extractor a fair trial.

Birth Injuries↗