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PubMed1989

[Changes in 13,14-dihydro-15-keto-prostaglandin F2 alpha and dehydroepiandrosterone-sulfate (DHA-S) levels in amniotic fluid and maternal peripheral venous blood in late pregnancy and during labor].

To study the role of prostaglandin (PG) and steroids on the mechanism of parturition, levels of 13,14-dihydro-15-keto-prostaglandin F2 alpha (dhk.PGF2 alpha) and dehydroepiandrosterone-sulfate (DHA-S) in amniotic fluid and plasma during late pregnancy, labor, and puerperium, were measured by radioimmunoassay and gas chromatography-mass spectrometry. Seven patients at term were selected for this study and labor was induced by amniotomy. Amniotic fluid and maternal peripheral blood were obtained simultaneously from each individual at A) the artificial rupture of the membranes before the onset of labor, B) the onset of labor, C) the second stage of labor, D) the delivery, and E) 2 hours postpartum. No increase in either amniotic fluid or plasma dhk-PGF2 alpha was noticed when compared before and at the onset labor. However, there was a steady increase during labor and the maximum was reached at delivery. The dhk-PGF2 alpha concentration in amniotic fluid correlated well with that in maternal plasma. A similar pattern was observed in the DHA-S levels both in amniotic fluid and plasma. No apparent change was observed before the onset of labor, but there was a tendency to increase during labor. A significant correlation between the levels of dhk.PGF2 alpha and DHA-S in amniotic fluid was noticed. From the results obtained above, it is suggested that PG and DHA-S may be involved not in the initiation of labor but in the promotion of parturition. The biological significance of DHA-S on PG levels remains to be clarified.

Amniotic Fluid↗

PubMed1986

Maternal position during parturition in normal labor.

While controversy exists as to the relationship between maternal position in labor and such measures as the labor duration, subjective discomfort, and fetal outcome, little appears to be known about the positions women assume in labor when they are permitted to do so without coercion or instruction. To learn more about maternal position in labor, we observed 80 consecutive patients with uncomplicated normal spontaneous vaginal delivery over the course of labor to ascertain the positions volitionally chosen by each. Data were collected on position preferences and phase of labor. All labors were analyzed; a codified lexicon was established to describe the position pattern in each phase and the principal positions the patient assumed over the course of labor. The frequencies and distributions were determined for nulliparas and multiparas separately and rates of position change were assessed. It was found that gravidas chose a number of different principal positions in the early phases of labor, but that they became more narrowly selective in the deceleration phase and second stage; at the same time, they tended to change position more often in late labor.

Adolescent↗

PubMed1982

[The changes of human plasma ACTH, immunoreactive-beta-endorphin and cortisol during pregnancy, labor and delivery (author's transl)].

Immunoreactive (IR)-beta-endorphin, ACTH and cortisol from the plasma of 88 pregnant women during gestation, and 28 women with spontaneous labor were measured. The concentrations of ACTH, IR-beta-endorphin and cortisol gradually increased during gestation. There were significant correlation between ACTH and IR-beta-endorphin (r = 0.79, p less than 0.0001), as well as between ACTH and cortisol (r = 0.54, p less than 0.0001) during gestation. Maternal ACTH and IR-beta-endorphin concentrations rapidly increased during the course of labor, peaked immediately after delivery at 671.3 +/- 136.1 and 513.9 +/- 85.5 pg/ml, respectively, and then decreased two hours later. There was a highly significant correlation (r = 0.89, p less than 0.0001) between ACTH and IR-beta-endorphin during labor. The levels of cortisol were elevated during labor and showed no difference during labor, or two hours later. However, there was no significant relationship between ACTH and cortisol (r = 0.24) during labor. Chromatographic analysis was performed on the pooled plasma extracts from pregnant women at the various stage of labor. In ACTH analysis, a single peak was seen at the position of native ACTH in each case. All detectable immunoreactivities eluted in two peaks at the position of beta-LPH and beta-endorphin. However, beta-LPH to beta-endorphin ratio was almost the same in each case. These results suggest that 1) ACTH and IR-beta-endorphin are secreted concomitantly, probably by the maternal pituitary gland during gestation as well as in response to the stress of labor; 2) the lack of correlation between ACTH and cortisol is due to the difference in metabolic clearance rate of these hormones during labor; 3) neither peripheral nor intrapituitary conversion of beta-LPH to beta-endorphin is seen during gestation and labor.

Adolescent↗

PubMed1981

[Initiation of labor and the fetal oxytocin contribution (author's transl)].

This study was designed to evaluate the fetal oxytocin (OT) contribution to the instigation and maintenance of human labor. Plasma samples together with placental tissues and myometria were collected in an effort to determine immunoreactive OT concentrations in plasma, oxytocinase activities in placenta and 3H-labeled OT uptake in myometria respectively and the following results were obtained. OT concentrations in the umbilical arterial plasma (UA) at 20 to 24 weeks were doubled at 37 to 42 weeks suggesting the increase of this hormone to occur in the latter half of pregnancy. The UA values at term were significantly higher than that of maternal peripheral and umbilical venous plasma (MPV and UV). OT concentrations in UA and UV showed a linear correlation but not with MPV. The study of labor (+) and labor (-) subjects were performed in cesarean sections as well as in vaginal deliveries. The OT concentrations in UA was higher in cesarean sections with labor pains than without labor pains. In vaginal deliveries, the OT concentrations were much higher. The uptake of biologically active OT estimated by 3H-labeled OT uptake of 20,000 xg precipitate fraction of nonpregnant, first trimester and term myometria were 10.5 plus or minus 3.1, 18.3 plus or minus 6.6 and 35.4 plus or minus 6.6% respectively. While no significant changes of placental oxytocinase activities were found between these specimens. The activities seemed to be lower in cases without labor pain than those with labor pains. These findings suggest that there is OT release from the fetus during labor to participate in the instigation and maintenance of labor with increase of the uterine sensitivity to OT, however it appears to be more active in maintaining labor than in initiating it.

Female↗

PubMed1993

[Induction of labor using endocervical administration of dinoprost in post-term pregnancy].

The authors analyzed results of 295 labors induced with endocervical application of dinoprostin (152 term- and 143 postterm labors) in relation to 242 (125 term- and 117 postterm-) spontaneous labors. Delayed labor increases the occurrence of meconial amniotic fluid (21.96%:9.03% p < 0.01), and pathological and prepathological CTG records (23.85%: 11.97% p < 0.005). In addition, children show lower Apgar score (p < 0.001), and among them there are more hypertrophic (6.54%:2.53% p < 0.05), postterm (6.92%:0.0% p < 0.005), and dysmature children (11.92%:3.12% p < 0.01) when compared to children born between the days 274 and 287 of the gestational age. Perinatal morbidity of children born after 287 gestational days in rather high-32.31%. Induction of labor with endocervical application of prostine shortens the duration of the labor (p < 0.001). Large numbers of labors are finished with vacuum extraction-3.73% (3.29% of term- and 4.19% of postterm labors) and cesarear section-12.88% (10.53% of term- and 15.38% of postterm labors) usually due to dystocia of the uterus and hypoxion of the neonate. Labor trauma is the most usual trauma among perinatal problems of new born infants delivered by the induction with prostaglandins and high perinatal morbidity rate is due not only to the induction method but also to the incorrect assessment of the gestational age.

Adolescent↗

PubMed1988

The convergence between in-labor report and postpartum recall of parturition pain.

This non-experimental study was designed to investigate the congruence between in-labor report and postpartum recall of labor pain as measured by the McGill Pain Questionnaire (MPQ). Fifty married parturients, ages 19 to 39 at term with a normal pregnancy, served as subjects. Analysis of variance showed that postpartum report of labor pain on the Present Pain Intensity scale of the MPQ was not consistently congruent with pain reported during labor. In contrast, the Pain Rating Index of the MPQ provided postpartum data that was congruent with the in-labor report. Significant interaction effects, however, suggested that postpartially the women tended to devaluate the pain of early labor and inflate the pain of transitional labor when compared to their in-labor report. Theoretical and practical implications of the results for the measurement of labor pain are discussed.

Adult↗

PubMed2002

Reassessing the labor curve in nulliparous women.

OBJECTIVES: Our purpose was to examine the pattern of labor progression in nulliparous parturients in contemporary obstetric practice. STUDY DESIGN: We extracted detailed labor data from 1329 nulliparous parturients with a term, singleton, vertex fetus of normal birth weight after spontaneous onset of labor. Cesarean deliveries were excluded. We used a repeated-measures regression with a 10th-order polynomial function to discover the average labor curve under contemporary practice. With use of an interval-censored regression with a log normal distribution, we also computed the expected time interval of the cervix to reach the next centimeter, the expected rate of cervical dilation at each phase of labor, and the duration of labor for fetal descent at various stations. RESULTS: Our average labor curve differs markedly from the Friedman curve. The cervix dilated substantially slower in the active phase. It took approximately 5.5 hours from 4 cm to 10 cm, compared with 2.5 hours under the Friedman curve. We observed no deceleration phase. Before 7 cm, no perceivable change in cervical dilation for more than 2 hour was not uncommon. The 5th percentiles of rate of cervical dilation were all below 1 cm per hour. The 95th percentile of time interval for fetal descent from station +1/3 to +2/3 was 3 hours at the second stage. CONCLUSION: Our results suggest that the pattern of labor progression in contemporary practice differs significantly from the Friedman curve. The diagnostic criteria for protraction and arrest disorders of labor may be too stringent in nulliparous women.

Adult↗

PubMed2000

Interleukin 8 expression in human myometrium: changes in relation to labor onset and with gestational age.

PROBLEM: Preterm labor remains the major cause of perinatal mortality and morbidity in normally formed babies. The mechanisms involved in the onset of preterm labor are poorly understood, mainly because the mechanisms initiating term labor remain ill-defined. METHOD OF STUDY: Human myometrial samples were collected at cesarean delivery from preterm (26-36 weeks gestation) and term (37-41 weeks) women. Women at term were either non-laboring or laboring. The expressions of interleukin-8 (IL-8) mRNA and protein were measured by reverse transcriptase-polymerase chain reaction and enzyme-linked immunosorbent assay, respectively. RESULTS: The expression of both IL-8 mRNA and protein significantly increased in the term laboring group, compared with either the term non-laboring or preterm groups. Levels of IL-8 expression did not alter with advancing gestational age. CONCLUSIONS: The increased expression of IL-8 in laboring myometria at term supports the hypothesis that up-regulation of IL-8 has a role in the initiation of labor in association with an influx of neutrophils and the release of their collagenolytic enzymes into uterine tissues.

Enzyme-Linked Immunosorbent Assay↗

PubMed1990

Labor patterns in women with previous cesareans.

Little information exists to help determine the presence or significance of labor abnormalities in women attempting vaginal birth after previous cesarean. A case-control study was performed to obtain information on patterns of labor progress and the incidence of dysfunctional labor in patients having a trial of labor after previous cesarean delivery. Sixty-eight such women were matched to nulliparous and multiparous controls. Labor-curve characteristics for the group of women with previous cesarean differed significantly from those of both the nulliparas and multiparas. When stratified by history of previous vaginal birth, however, those with no previous vaginal birth were indistinguishable from nulliparous controls and those with a previous vaginal birth were indistinguishable from multiparous controls. Parity-specific criteria for the diagnosis of dysfunctional labor were thus indicated. Labor disorders were present most frequently in the previous-cesarean group with no previous vaginal birth (41.9%). This incidence did not differ significantly from that in the control nulliparas (27.1%) (P = .15), but did differ from that in the multiparas (15.8%) (P less than .01). Previous-cesarean patients with a previous vaginal birth had a frequency of labor disorders (14.3%) not significantly different from that of multiparous controls. We conclude that trial of labor in women with a previous cesarean should be evaluated by standard criteria for nulliparas if there has been no previous vaginal birth, and by criteria for multiparous women if there has been any previous infant born vaginally.

Adult↗

PubMed1984

[The importance of oxytocin and prostaglandins to the mechanism of labor in humans].

In the present work an attempt is made to get a deeper insight into the mechanism of labor and the events leading to the onset of labor by means of radioimmunological measurements of OT, PGE, PGF, PGEM and PGFM and by determining the oxytocin sensitivity and the concentration of oxytocin receptors. Prostaglandins play a major role for the mechanism of labor in labor of spontaneous onset as well as in several forms of induced labor (intravenous infusion of OT, amniotomy, local application of PGE2). The reason for this seems to be the 3 fold action of prostaglandins: stimulation of myometrial contractions, cervical softening, induction of gap junctions. Moreover prostaglandins produced in the placenta play a major role in the mechanism of placental separation and expulsion. Oxytocin seems to be of importance for the initiation of labor and the final expulsion of the fetus. Immediately before the onset of regular contractions a marked increase of oxytocin sensitivity can be demonstrated which correlates very well with an increase of oxytocin receptor concentration in the myometrium and decidua. Due to this increase in oxytocin sensitivity no rise in oxytocin plasma levels is necessary to induce labor. Apart from the induction of myometrial contractions oxytocin leads via receptors in the decidua to a stimulation of prostaglandin synthesis which can also be demonstrated in vitro. In cases of premature contractions the same mechanisms seem to be operational as at term, oxytocin and prostaglandins again playing a major role. Inhibition of contractions with ethanol is based on the capacity of alcohol to inhibit oxytocin secretion. The contractions inhibiting effect of ritodrine is mediated through the cAMP induced relaxation of the myometrium although possibly a direct reduction of prostaglandin synthesis by ritodrine is possible. Increasing estrogen and decreasing progesterone activities at term lead to multiple subtile changes leading to an increased prostaglandin synthesis and mainly to a rise in oxytocin receptor concentration in the myometrium and the decidua. Oxytocin from the fetal and maternal side stimulates contractions in the myometrium and prostaglandin synthesis in the decidua leading to the onset of labor. With progressing cervical dilatation prostaglandin synthesis is further stimulated; these prostaglandins together with the increased oxytocin plasma levels in the second stage of labor lead to expulsion of the fetus. After delivery prostaglandin synthesis in the placenta leads to placental separation and expulsion.(ABSTRACT TRUNCATED AT 400 WORDS)

Administration, Topical↗

PubMed1981

Maternal positions in labor: analysis in relation to comfort and efficiency.

The influence of maternal position during labor on comfort and uterine efficiency was studied by contrasting the influence of sitting in a chair with lying on the side during the first stage of labor. Nineteen primigravidas alternated between these two positions at 30 minute intervals for as long as this was possible during their labors. There was a significant difference in their preference to sit up during early labor (less than 6 cm dilation) and lie on their side during late labor (greater than 6 cm dilation). Uterine efficiency, however, was significantly less (p less than 0.05) in early labor in the sitting position than on the side. After labor was well established, ie after 6 cm dilation, the efficiency of uterine contractions to dilate the cervix was not significantly different between the 2 positions although it was less in the sitting position. The lateral recumbent position was accompanied by more efficient labor and was preferred by most women in late labor. Localization of pain and fetal position also seem to be associated with maternal position preference, and both factors require further investigation.

Adolescent↗

PubMed1999

Gender, household labor, and psychological distress: the impact of the amount and division of housework.

Using a national longitudinal survey of a representative sample of 1,256 adults, I assess the impact of the amount of household labor performed and its division within the household on men's and women's depression levels, adjusting for prior mental health status. I test two alternative explanations of the contributions of household labor and the division of household labor to gender differences in depression: differential exposure and differential vulnerability. The results indicate that men's lower contributions to household labor explain part of the gender difference in depression. Inequity in the division of household labor has a greater impact on distress than does the amount of household labor. Employment status moderates the effect of the division of labor on depression. Among those who describe themselves as keeping house, depression was lowest for those who performed 79.8 percent of housework. In contrast, for those employed full-time the minimum level of depression occurs at 45.8 percent of the household labor. Men report performing 42.3 percent of the housework in their homes compared to 68.1 percent reported by women. Thus, on average women are performing household labor beyond the point of maximum psychological benefit, whereas men are not. Social support mediates the effects of the division of household labor. The only gender difference in effects occurred among those who are married, for whom social support was associated with lower levels of depression for women than men.

Adult↗

PubMed2004

The role of ultrasound and fetal fibronectin in predicting the length of induced labor when the cervix is unfavorable.

OBJECTIVE: To compare cervical clinical data, ultrasound parameters and fetal fibronectin assessment in the prediction of the duration of induced labor when the cervix is unfavorable. METHODS: This was a prospective study of 90 pregnant women with a Bishop score </= 5 undergoing labor induction. The Bishop score and its components, parity, cervical ultrasound parameters and fetal fibronectin level were analyzed using Cox's model in order to determine the most predictive factors for the duration of the latent and active phases of labor as well as its total duration. RESULTS: There was a significant correlation between duration of the latent phase and the whole of labor, and digitally assessed cervical dilatation (P = 0.003 and P < 0.001, respectively), parity (P = 0.006 and P < 0.001), the Bishop score (P = 0.019 and P = 0.003) and ultrasound-determined cervical length (P = 0.035 and P = 0.003). The length of the active phase of labor did not correlate with the cervical status. Funneling did not appear to be predictive of the duration of labor and it had a poor correlation with digital cervical dilatation. The length of the latent phase and that of the whole of labor was significantly longer when cervical dilatation was </= 2 cm (P < 0.001 in each case), when women were nulliparous (P = 0.002 and P < 0.001) and when ultrasound cervical length was >/= 27 mm (P = 0.002 and P = 0.005). CONCLUSION: Cervical dilatation as assessed by digital examination is the best predictor of the duration of the latent phase and of that of the whole of labor. Ultrasound measurement of cervical length is not more accurate at predicting the duration of labor than are clinical data.

Biomarkers↗

PubMed1977

Serum progesterone and estradiol-17beta levels in premature and term labor.

A total of 30 to 50 per cent of premature labors occur without identifiable predisposing conditions. To evaluate the hormonal status of these pregnancies, serum progesterone (P) and estradiol (E2) were measured by radioimmunoassay singly in 60 premature labor patients and serially in 19 normal pregnancies. Premature labor patients as a group have significantly lower P and E2 levels than controls. Pregnancies complcated by idiopathic premature labor (IPL) (p less than 0.01), premature labor secondary to abruptio-marginal separation (A-MS) (p less than 0.05), and premature rupture of membranes (PROM) (p less than 0.05) have significantly lower P levels than controls. Patients with IPL and A-MS have significantly lower P levels (p less than 0.01) than PROM patients. No significant change in P or E2 occurs immediately prior to normal term labor. Conclusions are that (1) premature labor patients have significantly lower Pand E2 levels than controls, (2) the degree of P depression varies according to the type of premature labor and (3) IPL is characterized by premature labor with no identifiable predisposing factors.

Estradiol↗

PubMed1994

Ultrasound assessment of cervical dynamics during the first stage of labor.

OBJECTIVE: Assessment of cervical dynamics during the first stage of labor by a combination of ultrasound cervimetry and intrauterine tocography. METHODS: Sixty-two parturients were divided into four groups: nulliparous women in spontaneous (n = 9) or oxytocin-induced labor (n = 26), parous women in spontaneous (n = 11) or oxytocin-induced labor (n = 16). Intrauterine pressure and cervical dilatation were continuously recorded and assessed by off-line computer analysis. RESULTS: All women with spontaneous labor showed cervical responses to uterine contractions at the beginning of the recording. The first cervical response to a uterine contraction occurred at a significantly smaller dilatation in parous than in nulliparous women with induced labor (2.9 and 3.6 cm, respectively). Also, acceleration of cervical dilatation occurred at less dilatation in parous than in nulliparous women (3.4 cm and 4.8 cm, respectively), and myometrial work per cm of cervical dilatation was less in parous than in nulliparous parturients. CONCLUSIONS: The results indicate significant differences between cervical dilatation patterns in nulliparous and parous women, which may be due to structural cervical changes caused by labor and parturition. The labor patterns found were different from those originally described by Friedman (Friedman EA. Graphic analysis of labor. Am J Obstet Gynecol 1954; 68: 1568-1575), as no deceleration phases were detected. Ultrasound cervimetry is a valuable technique for the study of cervical dynamics during labor.

Adolescent↗

PubMed1998

The course of labor with and without epidural analgesia.

OBJECTIVE: Our purpose was to measure effects of epidural analgesia on labor compared with boluses of meperidine in a cohort of women with similar clinical circumstances. STUDY DESIGN: One hundred ninety-nine nulliparous women who were delivered spontaneously at term and who received oxytocin for labor augmentation before the initiation of analgesia were identified for analysis. All these women were managed in a low-risk labor unit according to a standardized protocol. This management protocol encouraged early amniotomy and the use of oxytocin when ineffective labor was diagnosed. RESULTS: The demographic characteristics of the two study groups were similar with respect to age, height, weight, and maternal age. The two groups had the same cervical dilatation on admission (3.3 cm) and at the time of analgesia administration (4.1 vs 4.2 cm), indicating similar progress of labor before oxytocin administration. The length of the active phase of labor was longer in the epidural group (7.9 vs 6.3 hours, p = 0.005), as was the second stage (60 vs 48 minutes, p = 0.03). The mean and maximal rates of oxytocin infusion were similar between the two study groups; however, the amount of oxytocin required for each centimeter of cervical change was more in the epidural group (22 vs 16 mU per cm of cervical change, p = 0.009). Neonatal outcomes were unaffected by the type of labor analgesia. CONCLUSION: Epidural analgesia decreases uterine performance during oxytocin-stimulated labor, resulting in an increase in the length of the first and second stages of labor.

Adolescent↗

PubMedDate not supplied

Inhibitory effect of iloprost on the contractility of lower uterine segment myometrium from rhesus monkeys in normal-term and androstenedione-induced preterm labor.

OBJECTIVE: Iloprost, a combined EP(1) stimulatory and IP inhibitory receptor agonist, was tested in vitro on myometrium from the lower uterine segment of pregnant rhesus monkeys to compare its effects in spontaneous labor and in labor induced by the administration of androstenedione to the mother. METHODS: Pregnant rhesus monkeys carrying fetuses of known gestational age were instrumented under halothane general anesthesia with femoral artery and vein catheters and uterine electromyogram leads. Experimental animals were infused with androstenedione from 139 days' gestation. Control animals were infused with intralipid vehicle from 139 days' gestation. Lower uterine segment myometrium was removed from control animals either before labor began (n = 6) or in spontaneous labor (n = 4) and from animals undergoing premature labor induced by androstenedione (n = 4). Myometrial contractility in response to iloprost was evaluated using a superfusion system in vitro. RESULTS: Iloprost was inhibitory on myometrium obtained from the lower uterine segment from androstenedione-treated animals as well as vehicle-infused animals in spontaneous term labor. In contrast, iloprost had no effect on myometrial strips from control animals not in labor. CONCLUSION: These findings indicate up-regulation of IP receptors which inhibit myometrial contractility and/or down-regulation of EP(1) receptors which stimulate myometrial contractility in the lower uterine segment during labor. A relative increase in inhibitory responses in the lower uterine segment during labor may enable this region to dilate to allow passage of the fetus.

Androstenedione↗

PubMed1999

Lumbar sympathetic blocks speed early and second stage induced labor in nulliparous women.

BACKGROUND: Rapid cervical dilation reportedly accompanies lumbar sympathetic blockade, whereas epidural analgesia is associated with slow labor. The authors compared the effects of initial lumbar sympathetic block with those of epidural analgesia on labor speed and delivery mode in this pilot study. METHODS: At a hospital not practicing active labor management, full-term nulliparous patients whose labors were induced randomly received initial lumbar sympathetic block or epidural analgesia. The latter patients received 10 ml bupivacaine, 0.125%; 50 microg fentanyl; and 100 microg epinephrine epidurally and sham lumbar sympathetic blocks. Patients to have lumbar sympathetic blocks received 10 ml bupivacaine, 0.5%; 25 microg fentanyl; and 50 microg epinephrine bilaterally and epidural catheters. Subsequently, all patients received epidural analgesia. RESULTS: Cervical dilation occurred more quickly (57 vs. 120 min/cm cervical dilation; P = 0.05) during the first 2 h of analgesia in patients having lumbar sympathetic blocks (n = 17) than in patients having epidurals (n = 19). The second stage of labor was briefer in patients having lumbar sympathetic blocks than in those having epidurals (105 vs. 270 min; P < 0.05). Nine patients having lumbar sympathetic block and seven having epidurals delivered spontaneously, whereas seven patients having lumbar sympathetic block and seven having epidurals had instrument-assisted vaginal deliveries. Cesarean delivery for fetal bradycardia occurred in one patient having lumbar sympathetic block. Cesarean delivery for dystocia occurred in five patients having epidurals compared with no patient having lumbar sympathetic block (P = not significant). Visual analog pain scores differed only at 60 min after block. CONCLUSIONS: Nulliparous parturients having induced labor and receiving initial lumbar sympathetic blocks had faster cervical dilation during the first 2 h of analgesia, shorter second-stage labors, and a trend toward a lower dystocia cesarean delivery rate than did patients having epidural analgesia. The effects of lumbar sympathetic block on labor need to be determined in other patient groups. These results may help define the tocodynamic effects of regional labor analgesia.

Analgesia, Epidural↗