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PubMed1995

Migration and the quasi-labor market in Russia.

"This paper explores the twin concepts of labor demand and labor mobility during the Soviet and post-Soviet periods. The study uses a detailed data set on labor stock, industrial labor demand, and labor flows for the 1980s in the Yaroslavl' Oblast, and data on migration and regional labor markets for all Russian regions in the 1990s. Contextual features, such as the social contract, full employment, methods of labor allocation, and a generally low rate of geographic mobility, distinguish the centrally planned quasi-labor market from the labor market in capitalist democracies. The findings suggest that net in-migration induces employment change in the current period rather than in a future period. The job creation effects appear concurrent with migration during the Soviet period. In the post-Soviet period, migration and employment relationships are not predictable based on the same relationships during the Soviet period."

Demography↗
PubMedDate not supplied

Changes in oxytocin receptor messenger RNA in the endometrium, myometrium, mesometrium, and cervix of sheep in late gestation and during spontaneous and cortisol-induced labor.

OBJECTIVE: Changes in oxytocin binding in intrauterine tissues have been demonstrated in relation to labor and delivery in several species using ligand-binding techniques. Little information is available in any species on changes in mRNA for the oxytocin receptor in intrauterine tissues in relation to the changes in myometrial activity at term. The objective of this study was to quantify oxytocin receptor mRNA in critical intrauterine tissues in the pregnant sheep in relation to the myometrial electromyographic activity patterns that accompany labor. METHODS: Uterine tissues were removed under halothane general anesthesia from control ewes not in labor at two stages of gestation, 131 and 140-145 days, and from ewes in spontaneous term labor at 140-145 days' gestation. Tissues were also obtained from ewes in labor following the infusion of cortisol to the fetus beginning at 127 days' gestation. RESULTS: In both the myometrium and endometrium, oxytocin receptor mRNA was significantly increased in both spontaneous term labor and cortisol-induced labor as compared with appropriate gestational age-matched controls. In contrast, oxytocin receptor message was unchanged at the time of labor in the mesometrium and cervix in all groups studied. CONCLUSIONS: In the pregnant sheep, myometrial and endometrial oxytocin receptor mRNA increase significantly in both spontaneous and cortisol-induced labor as compared with appropriate controls. In contrast, there was no increase in oxytocin receptor mRNA in either the cervix or the mesometrium.

Animals↗
PubMed2006

Corticotropin-releasing hormone, its binding protein and receptors in human cervical tissue at preterm and term labor in comparison to non-pregnant state.

BACKGROUND: Preterm birth is still the leading cause of neonatal morbidity and mortality. The level of corticotropin-releasing hormone (CRH) is known to be significantly elevated in the maternal plasma at preterm birth. Although, CRH, CRH-binding protein (CRH-BP), CRH-receptor 1 (CRH-R1) and CRH-R2 have been identified both at mRNA and protein level in human placenta, deciduas, fetal membranes, endometrium and myometrium, no corresponding information is yet available on cervix. Thus, the aim of this study was to compare the levels of the mRNA species coding for CRH, CRH-BP, CRH-R1 and CRH-R2 in human cervical tissue and myometrium at preterm and term labor and not in labor as well as in the non-pregnant state, and to localize the corresponding proteins employing immunohistochemical analysis. METHODS: Cervical, isthmic and fundal (from non-pregnant subjects only) biopsies were taken from 67 women. Subjects were divided in 5 groups: preterm labor (14), preterm not in labor (7), term labor (18), term not in labor (21) and non-pregnant (7). Real-time RT-PCR was employed for quantification of mRNA levels and the corresponding proteins were localized by immunohistochemical analysis. RESULTS: The levels of CRH-BP, CRH-R1 and CRH-R2 mRNA in the pregnant tissues were lower than those in non-pregnant subjects. No significant differences were observed between preterm and term groups. CRH-BP and CRH-R2 mRNA and the corresponding proteins were present at lower levels in the laboring cervix than in the non-laboring cervix, irrespective of gestational age. In most of the samples, with the exception of four myometrial biopsies the level of CRH mRNA was below the limit of detection. All of these proteins could be detected and localized in the cervix and the myometrium by immunohistochemical analysis. CONCLUSION: Expression of CRH-BP, CRH-R1 and CRH-R2 in uterine tissues is down-regulated during pregnancy. The most pronounced down-regulation of CRH-BP and CRH-R2 occurred in laboring cervix, irrespective the length of gestation. The detection of substantial expression of the CRH and its receptor proteins, as well as receptor mRNA in the cervix suggests that the cervix may be a target for CRH action. Further studies are required to elucidate the role of CRH in cervical ripening.

Adolescent↗
PubMed1998

Corticotropin-releasing hormone receptor subtype 1 is significantly up-regulated at the time of labor in the human myometrium.

Circulating concentrations of CRH rise late in human pregnancy, reaching a peak at labor. The presence of functional CRH receptors, CRH-R1 and CRH-R2, in the human myometrium suggests that CRH may modulate uterine activity. We hypothesized that the number of CRH receptors would be higher in myometrium than fetal membranes (FM) and would change during labor. Myometrial samples were collected from the lower segment (LS) in nonpregnant, preterm (32 +/- 2 weeks), and term (39 +/- 1.6 weeks) pregnant patients before and at labor. Fundus and LS samples were also collected from nonpregnant, pregnant, laboring, and postpartum women. FM were collected at term and at labor. We identified CRH receptors in myometrium and FM by semiquantitative RT-PCR and immunohistochemistry. CRH-R1 messenger ribonucleic acid (mRNA) in the LS was decreased in pregnancy and increased significantly in both preterm and term labor (P < 0.05), but remained unchanged in the fundus. CRH-R2 mRNA was present in 28% of LS myometrium with no change at labor. CRH-R1 and CRH-R2 protein was localized to myometrial smooth muscle in nonpregnant and laboring patients, with lower levels at term. CRH-R1 mRNA was present in chorion and decidua, but CRH-R2 was undetectable in these tissues. We conclude that CRH-R1 is expressed preferentially in myometrium and FM. Changes in CRH receptors during labor are consistent with CRH mediating effects on myometrial activity.

Adult↗
PubMed1997

Parathyroid hormone levels in preterm and term labor.

This prospective study was undertaken to test the hypothesis that parathyroid hormone (PTH) might be involved in preterm or term labor. Four groups of patients were formed, 15 patients in each group. The preterm labor group were patients who were admitted to our perinatal care unit with preterm labor and unruptured membranes (< 35 weeks' gestation). The preterm or term nonlabor control groups were patients matched for gestational age, maternal age, and parity, who were not in labor. The term labor group were patients matched for maternal age and parity who were in active labor. Mean (+/-SD) level of biologically intact PTH was 18.9 +/- 10.6 pgr/mL, 7.6 +/- 4.7 pgr/mL, 20.8 +/- 10.1 pgr/mL, 13.7 +/- 5.3 pgr/mL in preterm labor group, preterm nonlabor group, term labor group, and term nonlabor group, respectively (p < 0.05). No statistically significant differences were observed in the levels of calcium, phosphorus, magnesium, or albumin. We therefore suggest that PTH may have a role in preterm or term labor. The nature of its role should be investigated in further studies.

Calcium↗
PubMed1980

Fetal breathing in labor.

Fetal breathing during labor was investigated in a 3-part study of 42 normal singleton pregnancies. In the first part fetal breathing movements (FBM) were compared antenatally and during labor in 22 patients to determine whether FBM persisted during labor in fetuses in whom these movements had been demonstrated antenatally. In the second part a double-blind trial was conducted on the responsiveness of fetal breathing in labor to maternal glucose infusion in 12 patients. In the third part the influence of artificial rupture of the membranes (ARM) to induce labor was examined in 8 patients. Fetuses spent 36% of their time making breathing movements antenatally but this decreased to less than 1% during labor. Fetal trunk movements also decreased during labor but not significantly. Fetal breathing and trunk movements were not stimulated by maternal glucose infusion. Fetal breathing but not trunk movements were significantly inhibited by ARM prior to the onset of labor. Cessation of fetal breathing in labor is normal, but the cause of this change in behavior has not been positively identified.

Blood Glucose↗
PubMed1993

Elective induction versus spontaneous labor after sonographic diagnosis of fetal macrosomia.

OBJECTIVE: To test the hypothesis that elective induction of labor, compared to spontaneous labor, reduces the cesarean rate in women with a sonographic diagnosis of fetal macrosomia. METHODS: Sonography results over a period of 27 months were used to select 262 consecutive patients who met the following inclusion criteria: singleton pregnancy at term, estimated fetal weight (EFW) at the 90th percentile or greater, and delivery at our institution. The subjects were divided into four groups based on obstetric management: spontaneous labor (N = 115), elective induction of labor with macrosomia as the sole indication (N = 44), induction of labor for other maternal or fetal indications (N = 48), and elective cesarean delivery (N = 55). The analysis focused on the first two groups. These were compared regarding cesarean rate, indications for cesarean, and shoulder dystocia rate. Multiple logistic regression was used to control for potential confounders. RESULTS: With elective induction, the cesarean rate was 57%, significantly higher than the 31% rate with spontaneous labor (P < .01). The induced group also had a significantly higher EFW and birth weight. When logistic regression was used to control for birth weight, parity, and care provider, elective induction was still associated with a higher risk of cesarean delivery than was spontaneous labor (adjusted odds ratio 2.7, 95% confidence interval 1.2-5.9; P < .02). Shoulder dystocia occurred in one of 19 vaginal deliveries with elective induction (5.3%) and in two of 79 with spontaneous labor (2.5%). CONCLUSION: Because elective induction of labor increased the cesarean rate and did not prevent shoulder dystocia, we conclude that mothers with macrosomic fetuses can safely be managed expectantly unless there is a medical indication for induction.

Adult↗
PubMed2001

[The influence of water immersion on the course of labor].

OBJECTIVE: The aim of this study was to examine the influence of water immersion on the course of labor. MATERIAL AND METHODS: The study group consisted of 109 women, who have delivered in water in Obstetrical Ward in Puck from 1998 to 2000. 110 women composed control group. Mean patients' age in study and control group was respectively 26.40 +/- 4.33 and 26.72 +/- 5.82 years (ns). Gestational age was 40.69 +/- 5.91 and 39.71 +/- 2.03 weeks (ns). The duration of labor stages, time from membranes rupture to delivery, birthweight and newborns condition, frequency of episiotomy and perineum injuries as well as necessity of labor stimulants use were analyzed. Particular parameters were also assessed regarding to parity. The differences were determined using T-test. RESULTS: Mean duration of 1st labor stage was 319 min in study group and 375 min in control group (p < 0.02). The 2nd and 3rd labor stages did not differ significantly. II labor stage in nulliparous and I stage in multiparous were shorter in study group (respectively 34.41 vs. 45.5 min; p < 0.02 and 258.23 vs. 329.83 min; p < 0.02). The episiotomy was less frequent in study group (p < 0.01), whereas perineum injuries in control one (p < 0.05). Use of oxytocin was comparable between both groups. 97% of newborns from study group and 93% from control group, they were in good condition (ns). CONCLUSIONS: The profitable influence of water immersion to short 1st labor stage was noted. There were no differences in newborns' condition. The water birth is a safe method of labor in patients with physiological pregnancy.

Adult↗
PubMed2003

Clinical significance of the floating fetal head in nulliparous women in labor.

OBJECTIVE: To examine the course of labor in nulliparous women in active labor with a floating fetal head. STUDY DESIGN: A prospective, cohort study of nulliparous women presenting in active labor at term with a floating fetal head (station > or = -3, n = 108) or engaged fetal head (n = 241). All patients were examined by a senior physician. Assignment to the study or control group was noted in the investigator's records. However, management of labor was at the discretion of the labor ward team on duty. RESULTS: Cesarean section rates for failure to progress were significantly higher in the study group (17.1% versus 4.2%, P < .0001), and the second stage of labor was prolonged (65.3 +/- 27.1 versus 54.9 +/- 30.2 minutes, P < .03). None of the women who had a persistently floating fetal head at 7 cm of cervical dilation delivered vaginally. Birth weights were larger (P < .03) and Apgar scores lower (P < .0001) in the study group. The lengths of the active phase and instrumental delivery rates were similar in the two groups. CONCLUSION: Nulliparous women presenting in active labor at term with a floating head are at substantially increased risk of cesarean section for abnormal progress of labor. However, the majority of patients will still deliver vaginally. A persistently floating head with advanced cervical dilation (7 cm) should prompt consideration of cesarean section since little is to be gained by waiting.

Adult↗
PubMed1986

Transition from latent to active labor.

The transition from the latent to the active phase of labor, as defined by Friedman, was studied in all noncomplicated patients over a four-year period. Mothers studied were in spontaneous labor with a singleton fetus in the vertex position with intact membranes at admission. The independent variables were the parity and vaginal examination data, and the dependent variable was the rate of cervical dilation. The transition from latent to active labor was recorded and stratified by the cervical dilation where it occurred in a sample population consisting of 1060 nulliparous and 639 primiparous or multiparous women. There were no differences between nulliparous and multiparous patients. Less than 50% of labors became active by the time the cervixes had reached 4-cm dilation. By 5 cm, 74% of labors were active. However, when protracted and arrested labors were eliminated, 60% of the patients had reached the latent-active transition by 4 cm and 89% by 5 cm. We concluded that once a normal patient has reached 5 cm, she should be in the active phase of labor. If not, there is a high probability of labor dystocia.

Cervix Uteri↗
PubMedDate not supplied

Risk of perinatal death associated with labor after previous cesarean delivery in uncomplicated term pregnancies.

CONTEXT: Trial of labor after previous cesarean delivery is associated with increased risk of uterine rupture. However, no reliable data exist on the effect of a trial of labor on the risk of perinatal death in otherwise uncomplicated term pregnancies. OBJECTIVE: To determine the risk of intrapartum stillbirth or neonatal death not related to congenital abnormality among women with uncomplicated term pregnancies who had a trial of labor after previous cesarean delivery, compared with women having a planned repeat cesarean delivery, and multiparous and nulliparous women at term not delivered by planned cesarean method. DESIGN AND SETTING: Population-based, retrospective cohort study of data from the linked Scottish Morbidity Record and Stillbirth and Neonatal Death Enquiry encompassing births in Scotland between January 1, 1992, and December 31, 1997. POPULATION: A total of 313 238 singleton births between 37 and 43 weeks' gestational age in which the fetus was in a cephalic presentation. MAIN OUTCOME MEASURE: Delivery-related perinatal death, defined as intrapartum stillbirth or neonatal death unrelated to congenital anomaly, compared among the 4 groups. RESULTS: Among women who had a trial of labor following previous cesarean delivery (n = 15 515), the overall rate of delivery-related perinatal death was 12.9 (95% confidence interval [CI], 7.9-19.9) per 10 000 women. This was approximately 11 times greater (odds ratio [OR], 11.6; 95% CI, 1.6-86.7) than the risk associated with planned repeat cesarean delivery (n = 9014), more than twice (OR, 2.2; 95% CI, 1.3-3.5) the risk associated with other multiparous women in labor (n = 151 549), and similar to the risk among nulliparous women in labor (n = 137 160; OR, 1.3; 95% CI, 0.8-2.1). The associations were not explained by differences in maternal height, smoking status, socioeconomic status, age, fetal growth, or week of gestation at delivery. Among women having a trial of labor, the rate of death due to mechanical causes, including uterine rupture, was 4.5 (95% CI, 1.8-9.3) per 10 000 women. This was more than 8 times greater than other multiparous women (OR, 8.5; 95% CI, 3.2-22.3) and nulliparous women (OR, 8.8; 95% CI, 3.2-24.2). CONCLUSIONS: The absolute risk of perinatal death associated with trial of labor following previous cesarean delivery is low. However, in our study, the risk was significantly higher than that associated with planned repeat cesarean delivery, and there was a marked excess of deaths due to uterine rupture compared with other women in labor.

Adult↗
PubMed1995

Trial of labor after cesarean delivery with a lower-segment, vertical uterine incision: is it safe?

OBJECTIVE: Our purpose was to assess maternal and perinatal outcomes associated with a trial of labor and attempted vaginal birth after prior low-segment vertical cesarean delivery. STUDY DESIGN: During a 10-year period in a single tertiary hospital, all patients with a prior low-segment uterine incision (whether vertical or transverse) were considered candidates for a trial of labor in the absence of other contraindications or patient refusal. Among the 1137 women who underwent low-segment vertical cesarean delivery, 262 were subsequently delivered of 322 live-born infants, and 174 (54%) of them were identified retrospectively as having attempted vaginal birth. The maternal and perinatal outcomes of patients who did or did not undergo a trial of labor were analyzed and compared. RESULTS: No significant differences between the two patient groups were observed regarding demographic characteristics, antepartum complications, gestational age at delivery (mean 37.4 weeks), birth weight, and cord pH at delivery. Vaginal delivery was accomplished successfully in 144 of 174 (83%) patients who underwent a trial of labor. Abdominal delivery was necessary for 17 mothers with labor disorders and 13 with suspected fetal distress. Postpartum hemorrhage occurred more often in the trial of labor group (7/174 [4.0%] vs 2/148 [1.4%], p not significant), but endometritis developed significantly more often in patients with elective repeat cesarean delivery (16.9% vs 6.3%, p = 0.006). Rupture of the low-segment vertical cesarean scar occurred in 2 patients during a trial of labor (1.1%) versus none in the elective repeat cesarean group. Neither mother experienced fetal extrusion or adverse maternal or fetal sequelae. Frequency of serious neonatal complications (8.1% vs 10%) and neonatal mortality (1.7% vs 2.0%) were similar between groups. All neonatal deaths were a result of extreme prematurity or congenital anomalies. CONCLUSIONS: Our experience indicates that a mother with a prior low-segment vertical cesarean delivery can undertake a trial of labor with relative maternal-perinatal safety. The likelihood of successful outcome and the incidence of complications are comparable to those of published experience with a trial of labor after a previous low-segment transverse incision.

Cesarean Section↗
PubMed1996

Cervical priming with oral misoprostol in pre-labor rupture of membranes at term.

OBJECTIVE: To investigate the effectiveness of oral misoprostol as a cervical priming agent for patients presenting with pre-labor rupture of membranes at term. METHODS: Eighty patients presenting with pre-labor rupture of membranes at term were randomized to receive either 200 micrograms of misoprostol or 50 mg of vitamin B6 orally 1 hour after admission. Labor was induced with intravenous oxytocin infusion 12 hours after oral medication if the patient did not go into labor. We compared the induction rate, duration of labor, mode of delivery, and leaking-to-delivery interval in the two groups. RESULTS: The cervical score was significantly improved and the induction rate was also reduced in the misoprostol group when compared with the control group. The interval from recruitment to onset of labor, duration of labor, and the interval from recruitment to delivery were significantly shorter in the misoprostol group. The mode of delivery and the perinatal outcome were similar for the two groups. CONCLUSION: Oral misoprostol is an effective agent for cervical priming and labor induction in patients with pre-labor rupture of membranes at term.

Administration, Oral↗
PubMed2005

The impact of labor at term on measures of neonatal outcome.

OBJECTIVE: The purpose of this study was to determine risk assessments for a spectrum of neonatal outcomes with elective cesarean delivery versus a trial of labor for previous cesarean section and otherwise healthy patients who deliver at term. STUDY DESIGN: The perinatal/neonatal database of St. Joseph's Health Care, London, Ontario, Canada, was used to obtain the umbilical cord pH and base excess values, incidence of adverse neonatal outcomes, and patient demographics for all term (> or =37 weeks of gestation), singleton, liveborn, or intrapartum demise infants with no major anomalies who were delivered between January 1992 and March 2002 (n = 33,709 infants). Patient groupings (all patient, patient with previous cesarean delivery, and low-risk patient) with no labor versus labor were studied by a comparison of mean values/incidences for those neonatal outcomes that were available from the database with the use of linear and logistic regression analysis and controlling for potentially confounding variables. RESULTS: Labor was associated with a small drop in umbilical artery pH from approximately 7.27 to 7.25 and base excess from approximately -3.1 to -5.4 mmol/L, but this was generally well tolerated, with no difference in the incidence of 5-minute Apgar scores of <7 for any of the patient population groupings. Neonatal respiratory morbidity was increased generally in the group of elective cesarean delivery patients, which resulted in increased neonatal intensive care unit triage/admission even out to 7 days; some of this risk was likely to persist even with a policy of elective cesarean delivery after 39 weeks of gestation. Although we found no significant difference in the incidence of pathologic acidemia at birth with an umbilical artery pH <7.00, there was a risk for intrapartum/neonatal death that could be attributed to labor events per se that ranged from 1 of 882 for the patients with previous cesarean delivery to 1 of 3406 for the low-risk patients. CONCLUSION: For otherwise healthy patients at term, the risk of adverse neonatal outcomes is low, with the choice between elective cesarean delivery and trial of labor in general balancing the low risk of increased respiratory morbidity and thereby neonatal intensive care unit triage/admission against the extremely low risk of labor-related infant death and severe morbidity. However, this balance for the patients with previous cesarean delivery appears shifted, with less benefit from a trial of labor in terms of reduced respiratory morbidity and neonatal intensive care unit triage/admission and with increased labor-related severe morbidity/death, albeit with all of these still at a low level.

Adult↗
PubMed2005

The epidemiology of threatened preterm labor: a prospective cohort study.

OBJECTIVE: The purpose of this study was to describe the occurrence, timing, and outcomes of hospital-based diagnoses of preterm labor. STUDY DESIGN: Administrative records identified hospital admissions for preterm labor among 2534 women in an ongoing cohort study. Factors that were considered risks for prematurity were examined by logistic regression for an association with any preterm labor diagnosis, a preterm labor diagnosis <33 weeks of gestation, or > or =33 weeks of gestation. RESULTS: Of 234 women (9%) who experienced hospitalization for preterm labor, 90 women (38%) were delivered in the first episode. Previous preterm birth consistently was associated with a diagnosis of preterm labor. Reporting a sexually transmitted infection (odds ratio, 1.8; 95% CI, 1.1-3.0) or bacterial vaginosis (odds ratio, 2.6; 95% CI, 1.7-4.1) early in pregnancy was associated with hospitalization for preterm labor between 24 and 32 weeks of gestation. CONCLUSION: The incidence of first-time hospitalization for preterm labor was 9%, with most episodes not resulting in preterm birth. Previous preterm birth was associated therefore with a preterm labor diagnosis.

Adolescent↗
PubMed2004

Prelabor rupture of the membranes at term: when to induce labor?

OBJECTIVES: To determine the significant predictors of clinical chorioamionitis and neonatal infection in patients with prelabor rupture of the membranes at term, and to apply this information to determination of optimal timing of labor induction. STUDY DESIGN: A retrospective case control series of women at > or =37 weeks' with prelabor rupture of the membranes. The study group consisted of women with evidence of maternal or neonatal infection. Controls had no evidence of infection. Three types of management were compared. (1) Immediate induction of labor, (2) expectant management up to 24 h followed by induction of labor if still necessary, or (3) expectant management for over 24 h. Univariate and multivariate analyses were performed by stepwise logistic regression (SPSS software package). The size of the study and the control groups was calculated for a 90% power with two sided P value of 0.05 in order to demonstrate an odds ratio of 2 for expectant management (two groups: early and late) versus immediate induction of labor (132 and 279 women in the study and the control groups, respectively). RESULTS: The rate of expectant management for over 24 h versus expectant management until 24 h followed by induction of labor when still necessary, was higher among cases than among controls ( OR = 1.84; P < 0.017; 95% CI, 1.127-3.003). Conversely, the rate of immediate induction of labor versus expectant management until 24 h followed by induction of labor when still necessary, was also higher among cases ( OR = 2.66; P < 0.001; 95% CI, 0.222-0.644). CONCLUSION: In women with prelabor rupture of the membranes at term, the best approach is to induce labor if spontaneous labor has not begun after 24 h.

Adult↗
PubMed2004

Procalcitonin in cervicovaginal secretion in pregnancies complicated by preterm labor--a preliminary report.

OBJECTIVES: Although the usefulness of procalcitonin (PCT) in clinical practice is increasing, no data are available on procalcitonin during pregnancy. The purpose of this study was to investigate whether procalcitonin was present in the cervicovaginal secretion of pregnant women and, if so, to evaluate the practical value of determining the concentration. STUDY DESIGN: A total of 53 patients in whom preterm labor (PTL) was expected and 31 healthy pregnant women were enrolled in this study. In the preterm labor group procalcitonin concentrations were analyzed with reference to laboratory indices suggestive of infection. The outcome of pregnancy was recorded in each case, with mention of the gestational age at delivery and of the time between admission to hospital and delivery. RESULTS: Concentrations of procalcitonin in the preterm labor group were comparable to those in the healthy pregnant women. In the preterm labor group no significant correlations were observed between procalcitonin concentration and laboratory indices of infection. Nor were any correlations observed between procalcitonin concentration at the onset of preterm labor and gestational age either at the onset of labor or at delivery. However, procalcitonin concentrations at the onset of preterm labor were higher in patients who delivered prematurely than in those who delivered near term after treatment to delay labor. Procalcitonin concentrations in women whose babies were delivered within 3, 7 and 14 days of admission and in those whose babies were born at later times were comparable. CONCLUSIONS: In this study, procalcitonin was determined in the cervicovaginal secretion of pregnant women for the first time. However, no association was observed either between procalcitonin concentration at the onset of preterm labor and laboratory signs of infection or between procalcitonin concentration and time between admission to hospital and delivery. Procalcitonin determination would be unsatisfactory as a prognostic indicator of the length of time between admission to hospital and delivery.

Adult↗
PubMed2006

Systemic activation and vascular infiltration of neutrophils with term labor.

OBJECTIVE: The purpose of the current study was to determine if neutrophils infiltrate maternal systemic vascular tissue at the time of term labor. METHODS: Subcutaneous fat biopsies were obtained at cesarean delivery or abdominal surgery from laboring women (n = 5), non-laboring women (n = 5), and normal non-pregnant women (n = 5). Immunohistochemical staining was performed for CD66b, a neutrophil antigen, and intercellular adhesion molecule-1 (ICAM-1; CD54), an endothelial cell adhesion molecule for neutrophils. Vessels (10 to 200 microm) were analyzed for intensity of staining and percentage of vessels with staining. RESULTS: CD66b staining intensity was significantly greater for laboring women at term than for non-laboring women at term or for normal non-pregnant women (1.3 +/- 0.3 versus 0.2 +/- 0.1 versus 0.2 +/- 0.1, respectively, P < .01). Laboring women had significantly more vessels with staining for CD66b (79 +/- 4 versus 24 +/- 8 versus 19 +/- 6%, P < .001), more vessels with neutrophils adhered and flattened to endothelium (67 +/- 3 versus 16 +/- 7 versus 12 +/- 4%, P < .001), more vessels with neutrophils in the intima (30 +/- 6 versus 5 +/- 2 versus 2 +/- 1%, P < .05), and a greater number of neutrophils per vessel (5.4 +/- 1.1 versus 1.7 +/- 0.5 versus 1.2 +/- 0.3, P < .01) as compared to non-laboring or normal non-pregnant women. ICAM-1 staining was present in the endothelium of all groups, with no difference in staining intensity or percent of vessels stained. Between 86% to 96% of vessels stained for ICAM-1. Laboring patients had numerous leukocytes stained for ICAM-1 in their vessels. CONCLUSION: This study demonstrates that neutrophils infiltrate maternal systemic vascular tissue at the time of term labor. Neutrophils were flattened and adhered to endothelium and infiltrated into the intimal space.

Adult↗