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PubMed1988

Quantitation of uterine activity preceding preterm, term, and postterm labor.

To assess uterine activity before labor in patients delivering preterm, at term, and postterm, the maximum spontaneous contraction frequency per 10-minute window during the initial portion of antepartum fetal heart rate monitoring was analyzed. Patients with multiple gestation, third trimester bleeding, polyhydramnios, or premature rupture of membranes and those already diagnosed with preterm labor were eliminated from the study. Of the 2446 remaining patients (7247 antepartum fetal heart rate tests) who went into spontaneous labor, 237 did so before 37 completed weeks of gestation, 1077 entered labor at term (38 to 42 completed weeks), and 1132 did so after 42 weeks. There was a significant increase in maximum uterine activity per 10-minute window from 30 to 44 weeks of gestation (average 4.7% per week; r = 0.97, p less than 0.0001). When compared with patients delivering spontaneously at term, average maximum uterine activity per 10-minute window was greatest in the preterm labor group (p less than 0.05) and least in the postterm labor group (p less than 0.05). These differences were present for several weeks preceding the onset of spontaneous labor. All three groups showed a surge of uterine activity during the 3 days before the onset of spontaneous labor.

Female↗
PubMed1992

Tumor necrosis factor in preterm and term labor.

OBJECTIVE: Our objective was to determine if labor (term and preterm) and microbial invasion of the amniotic cavity were associated with changes in amniotic fluid concentrations of tumor necrosis factor. STUDY DESIGN: Amniotic fluid was retrieved by transabdominal amniocentesis from 269 women in the following groups: midtrimester (n = 38), preterm labor with intact membranes (n = 52), preterm premature rupture of membranes (n = 74), term in active labor (n = 84), and term not in labor (n = 21). Fluid was cultured for aerobic and anaerobic bacteria and for Mycoplasma species. Tumor necrosis factor was measured with a commercially available enzyme-linked immunosorbent assay validated for amniotic fluid (sensitivity 60 pg/ml). RESULTS: Amniotic fluid from pregnant women in the second and third trimesters who were not in labor did not contain tumor necrosis factor. Among women in preterm labor, 92.3% (12/13) of patients with a positive amniotic fluid culture had detectable tumor necrosis factor in the amniotic fluid (median 820 pg/ml, range less than 60 to 2340 pg/ml). In contrast, only 10.2% (4/39) of women with a negative amniotic fluid culture had detectable tumor necrosis factor. Histopathologic chorioamnionitis was found in all patients who had a positive amniotic fluid culture, and tumor necrosis factor was detectable in the amniotic fluid of all but one of these patients. Among women in active labor at term, 25% (21/84) had detectable tumor necrosis factor in the amniotic fluid. Tumor necrosis factor was detected more frequently in the amniotic fluid of patients with a positive amniotic fluid culture than in patients with a negative culture (46.6% [7/15] vs 20.2% [14/69], p = 0.047). Amniotic fluid concentrations of tumor necrosis factor were significantly higher in patients with preterm premature rupture of membranes, labor, and a positive amniotic fluid culture than in the other subgroups of patients with preterm premature rupture of membranes. CONCLUSION: Parturition in the setting of microbial invasion of the amniotic cavity is associated with activation of the cytokine network as demonstrated by the detection of tumor necrosis factor in human amniotic fluid.

Adult↗
PubMed2005

Decreased serum level of macrophage inflammatory chemokine-3beta/CCL19 in preterm labor and delivery.

OBJECTIVE: Chemokines are small soluble molecules which mediate leukocyte migration and may be involved in the pathophysiology of preterm labor. We aimed to determine if serum concentrations of selected chemokines are changed in preterm labor and delivery. STUDY DESIGN: A novel array-based enzyme-linked immunosorbent assay was used to quantitate serum levels of nine chemokines from a single sample: MDC/CCL22, TARC/CCL17, ITAC/CXCL11, I-309/CCL1, IP-10/CXCL10, MIP-1alpha/CCL3, -1beta/CCL4, -3alpha/CCL20 and -3beta/CCL19. Women in preterm labor who delivered (n = 17), women at preterm pregnancy not in labor (n = 13) and women in labor at term (n = 8) participated. RESULTS: In the preterm delivery group of patients, the MIP-3beta/CCL19 concentration was in mean (+/-S.D.) 70.4+/-31.7 pg/mL, which was significantly lower than that in preterm gravidas not in labor of 123+/-34 pg/mL (p < 0.001) and those in labor at term of 118+/-25.6 pg/mL (p < 0.01). The other measured chemokines did not differ significantly. CONCLUSIONS: Of a small number of examined chemokines, we were able to show that one of them, MIP-3beta/CCL19 was significantly lower in women with preterm labor and delivery. Whether or not this chemokine has a potential as biochemical marker of preterm delivery remains to be determined.

Adult↗
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↗
PubMedDate not supplied

Expectations, perceptions, and management of labor in nulliparas prior to hospitalization.

This ethnographic qualitative study was designed to explore the phenomenon of prehospitalization labor from the perspective of nulliparous women. Twenty-three women were interviewed in the early postpartum period using a semistructured interview guide. The participants recounted their experiences with labor onset recognition and management before being admitted to the hospital for birthing. Qualitative analyses included verbatim transcription of audiotaped interviews, line-by-line coding, and categorization of data into codes and categories. Interpretive analyses were validated with a collaborative research team and the participants themselves. The central theme that emerged from this study was confronting the relative incongruence between expectations and actual experiences. Supporting categories included: expectations about the labor experience, identifying labor onset, managing the physical and emotional responses to labor, supportive resources, and decision making about hospital admission. Early labor experiences in nulliparas offer insight into the contributions of both expectations and environment to adaptation in labor. Midwives and perinatal nurses are in a unique position to design interventions that support and reinforce laboring women's activities outside of the hospital setting.

Attitude to Health↗
PubMed1998

Uterine activity during pregnancy and labor assessed by simultaneous recordings from the myometrium and abdominal surface in the rat.

OBJECTIVES: The aim of this study was to analyze records of uterine electrical activity made from the abdominal surface of pregnant and laboring rats to examine whether similar quantitative information can be extracted as from direct recording from the uterine muscle. STUDY DESIGN: Electrical activity during pregnancy (nonlabor, days 18 to 22), term labor (day 22), and preterm labor (onapristone injected on day 18, delivery on day 19) was measured with use of electrodes attached to the uterine wall and to the abdominal surface. The fast Fourier transform and wavelet transforms were obtained for representative electromyographic bursts. Power spectra were generated. Intrauterine pressure was also measured. RESULTS: (1) Several parameters have been identified for use in following up the progressive increase in uterine activity that occurs in preparation for and during labor. Analyses of amplitude, frequency, and percent time active represent a convenient method for objectively determining the efficiency of uterine contraction. (2) Most of the changes in these parameters appear in the last 24 hours before delivery. (3) Although the uterine electromyographic signals on the abdominal surface are attenuated, the abdominal surface signals are generally similar to the signals obtained from the uterine muscle during pregnancy and during preterm and term labor. (4) The characteristics of onapristone-induced preterm labor are generally similar to those of spontaneous term labor. CONCLUSIONS: Recording of uterine electromyographic activity from the abdominal surface may be useful in following the progression of pregnancy and in predicting and diagnosing labor.

Abdomen↗
PubMed2004

Drotaverine hydrochloride for augmentation of labor.

OBJECTIVES: To study the use of drotaverine hydrochloride for acceleration of labor and relief of labor pains. METHODS: In this double-blind placebo-controlled randomized study, 100 primigravidas in uncomplicated spontaneous labor at term were given drotaverine hydrochloride or placebo (distilled water) intramuscularly. Labor events, including pain (assessed by a visual analog scale and a verbal rating scale), neonatal outcome, and side effects of the drug were recorded. Student's t-test was used for analysis. RESULTS: Forty-four patients in the drug group and 40 in the placebo group had complete data for analysis after decoding. In drotaverine group, there was a mean 15% reduction in the duration of the first stage of labor and a mean 19% reduction in the second stage. The maximum shortening of the first stage (28%) was observed when drotaverine was administered when cervical dilatation was 4 cm (P=0.044). There were no adverse fetal effects, but atonic postpartum hemorrhage was more common in the drotaverine group. There was no relief of pain with the drug except in the fourth stage of labor. CONCLUSIONS: Drotaverine hydrochloride is safe and effective in accelerating labor, but not effective in lessening labor pain.

Adult↗
PubMedDate not supplied

Parathyroid hormone-related protein mRNA in sheep endometrium and myometrium during late gestation and labor.

OBJECTIVE: To determine quantitative changes of parathyroid hormone-related protein (PTHrP) mRNA in sheep myometrium and endometrium during late gestation and labor. METHODS: Tissues were obtained from 22 pregnant ewes under halothane anesthesia: early controls at 131 days' gestational age (dGA) not in labor (ECNL; n = 6); during cortisol-induced premature labor (CPL at 131 dGA; n = 6); in term spontaneous labor (STL at 140-145 dGA; n = 5); or term control animals not in labor (TCNL at 140-145 dGA; n = 5). Total RNA was extracted and subjected to Northern blot analysis. Blots were probed with a human PTHrP cDNA probe, stripped, and rehybridized with an 18s rRNA nucleotide probe to normalize PTHrP mRNA levels. RESULTS: Endometrial PTHrP mRNA:18s was unaffected by gestational age or labor in tissues from the four groups. In contrast, myometrial PTHrP mRNA:18s ratio was decreased when TCNL and STL were compared with both ECNL and CPL groups (P < .05). CONCLUSIONS: Significant changes occur at the end of gestation in pregnant ovine myometrium PTHrP mRNA but not in the endometrium. In myometrium PTHrP mRNA levels were down-regulated at term regardless of whether labor was present. It seems that PTHrP mRNA levels in myometrium are related to gestational age rather than to labor per se in sheep. We hypothesize that PTHrP may play a role in maintaining uterine quiescence until term, at which time levels fall allowing myometrial contractile activity to increase unopposed by PTHrP.

Animals↗
PubMed1996

Comparison of a trial of labor with an elective second cesarean section.

BACKGROUND: In an attempt to reduce the rate of cesarean section, obstetricians now offer a trial of labor to pregnant women who have had a previous cesarean section. Although a trial of labor is usually successful and is relatively safe, few studies have directly addressed the maternal and perinatal morbidity and mortality associated with this method of delivery. METHODS: We performed a population-based, longitudinal study of 6138 women in Nova Scotia who had previously undergone cesarean section and had delivered a singleton live infant in the period from 1986 through 1992. RESULTS: A total of 3249 women elected a trial of labor, and 2889 women chose to undergo a second cesarean section. There were no maternal deaths. The overall rate of maternal morbidity was 8.1 percent; 1.3 percent had major complications (a need for hysterectomy, uterine rupture, or operative injury) and 6.9 percent had minor complications (puerperal fever, a need for blood transfusion, or abdominal-wound infection). Although the overall rate of maternal complications did not differ significantly between women who chose a trial of labor and the women who elected cesarean section (odds ratio for the trial-of-labor group, 0.9; 95 percent confidence interval, 0.8 to 1.1), major complications were nearly twice as likely among women undergoing a trial of labor (odds ratio, 1.8; 95 percent confidence interval, 1.1 to 3.0). Apgar scores, admission to the neonatal intensive care unit, and perinatal mortality were similar among the infants whose mothers had a trial of labor and those whose mothers underwent elective cesarean section. CONCLUSION: Among pregnant women who have had a cesarean section, major maternal complications are almost twice as likely among those whose deliveries are managed with a trial of labor as among those who undergo an elective second cesarean section.

Adolescent↗
PubMed2001

Predicting outcomes of trials of labor in women attempting vaginal birth after cesarean delivery: a comparison of multivariate methods with neural networks.

OBJECTIVE: Our aim was to assess the utility and effectiveness of a neural network for predicting the likelihood of success of a trial of labor, relative to standard multivariate predictive models. STUDY DESIGN: We identified 100 failed trials of labor and 300 successful trials of labor in women with a prior cesarean delivery performed at our institution. Information was collected on >70 potential predictors of labor outcomes from the medical records, including demographic, historical, and past obstetric information, as well as information from the index pregnancy. Bivariate analyses comparing women in whom a trial of labor failed with those whose trial succeeded were performed. These initial analyses were used to select variables for inclusion into our muitivariate predictive model. From the same data we trained and tested a neural network, using a back-propagation algorithm. The test characteristics of the multivariate predictive model and the neural network were compared. RESULTS: From the bivariate analysis a history of substance abuse (adjusted odds ratio, 0.27; 95% confidence interval, 0.09-0.80), a successful prior vaginal birth after cesarean delivery (adjusted odds ratio, 0.13; 95% confidence interval, 0.05-0.31), cervical dilatation at admission (adjusted odds ratio, 0.53; 95% confidence interval, 0.31-0.88), and the need for labor augmentation (adjusted odds ratio, 2.15; 95% confidence interval, 1.14-4.06) were ultimately discovered to be important in predicting the likelihood of the success or failure of a trial of labor. With these variables in the predictive model the sensitivity of the derived rule for predicting failure was 77%, the specificity was 65%, and the overall accuracy was 69%. We also built a network using the 4 variables that were included in the final multivariate model. We were unable to achieve the same degree of sensitivity and specificity that we observed with the regression-based predictive model (sensitivity and specificity, 59% and 44%). CONCLUSION: In this study a standard multivariate model was better able to predict outcome in women ttempting a trial of labor.

Adult↗
PubMed2002

Connexin 43 expression in normal versus dysfunctional labor.

OBJECTIVE: We sought to determine whether connexin 43 (Cx43), the major myometrial gap junction protein, is differentially expressed in normal versus dysfunctional labor. STUDY DESIGN: Myometrial biopsies were obtained from 28 patients undergoing cesarean section and grouped into the following categories: (1) no labor, (2) dysfunctional labor, and (3) normal labor. Northern and Western analyses were performed to determine Cx43 messenger RNA (mRNA) and protein expression, respectively. Localization of Cx43 protein was determined by immunohistochemistry. RESULTS: Labor was associated with increased Cx43 mRNA expression (P <.05). This association was not true for protein. There was no difference in mRNA or protein expression between patients with normal labor versus those with dysfunctional labor. The extent of Cx43 immunohistochemical staining was not significantly different among the groups (P >.05). CONCLUSION: Dysfunctional labor is not associated with aberrant Cx43 mRNA or protein expression or with a reduction in immunodetectable Cx43 gap junctions.

Adult↗
PubMed2003

Changes in platelet function, volume and count during labor and 24 hours postpartum.

Increased platelet activation has been reported during labor. We evaluated changes in platelet count, volume and function during labor and 24 hours postpartum. Platelet function during labor was not previously evaluated. Twenty-five healthy women in labor, subsequently having singleton spontaneous vaginal delivery following uncomplicated pregnancy at term were recruited for this prospective study. Blood was withdrawn during latent phase, active phase, second stage of labor, and 24 hours postpartum. Platelet function was assessed by hemoSTATUS2 test (Hepcon, Medtronic, USA). Twenty-five healthy non-pregnant volunteers served as controls. Platelet count and volume did not change significantly throughout labor and 24 hours postpartum. Platelet function was 120.8 +/- 26.9 %, 106.8 +/- 24.6 % (p = 0.06), 105.2 +/- 30.9 % (p < 0.05), and 117.6 +/- 21.5 % during latent phase, active phase, second stage of labor, and 24 hours postpartum, respectively. Platelet function was altered during labor while platelet count and volume did not change significantly. Platelet function remained increased when compared to non-pregnant controls.

Blood Platelets↗
PubMed2004

Ambulatory labor analgesia: what does an obstetrician need to know?

A simple statement that describes the degree of the patient's satisfaction with the pain relief from her labor epidural analgesia has often assessed the quality of labor analgesia as perceived by the patient. Many laboring parturients, midwives, obstetricians and anesthesiologists are increasingly concerned by the limitations of traditional epidural labor analgesia. In general, women dislike the inability to void, the often-dense motor block, the feeling of numbness of the lower body, the total lack of the urge to bear down, and the complete perineal anesthesia. Continuous search for balanced labor analgesia that provides relief from pain, while preserving motor function, has led to the development of an ambulatory labor analgesia technique. This article assesses the validity of various strongly advocated opinions as to whether parturients benefit from ambulation in labor and also reviews the current trends in ambulatory labor analgesia.

Analgesia, Epidural↗
PubMed1978

Plasma concentrations of prostaglandins during late human pregnancy: influence of normal and preterm labor.

Highly sensitive and specific RIA procedures have been used to measure prostaglandin concentrations in the peripheral circulation of late pregnant and parturient women. The concentrations of prostaglandin E (PGE) and prostaglandin F (PGF) in plasma samples assayed within 4 weeks of collection were not significantly different among the groups studied, the levels (mean +/- SEM, picograms per ml) were: late pregnancy (n = 13): PGE, 4.8 +/- 1.0; PGF, 6.2 +/- 0.5; early term labor (n = 5): PGE, 6.8 +/- 1.5; PGF, 7.9 +/- 0.7; late term labor (n = 5): PGE, 5.4 +/- 2.2; PGF, 12.4 +/- 3.5; and preterm labor (n = 7): PGE, 4.4 +/- 0.4; PGF, 6.9 +/- 1.4. The concentration of 13,14-dihydro-15-keto-prostaglandin F (PGFM) in late pregnancy was 59.0 +/- 7.8 pg/ml. During spontaneous term labor, the concentration of PGFM was significantly elevated (P less than 0.01) to 142.8 +/- 32.3 pg/ml in early labor and 282.7 +/- 55.3 pg/ml in late labor. The concentration of PGFM in plasma from patients in preterm labor (62.7 +/- 17.4 pg/ml) was not significantly different from that found during late pregnancy, but was significantly lower than levels found at term during early labor (P less than 0.05). The concentration of PGE increased significantly in frozen plasma samples stored for more than 4 weeks in all groups studied; the concentration of PGF was significantly elevated after storage only in the late pregnancy group (P less than 0.01). The plasma concentration of PGFM in all groups studied was unaffected by storage. It is concluded that measurement of PGFM concentrations is the most reliable method available of monitoring prostaglandins in the peripheral circulation and that great care must be exercised in the assay and interpretation of prostaglandin levels in human plasma.

Female↗
PubMed1988

[Steroids' action on dependence of outset, maintenance of gravidity and onset of labor].

Dependence of outset, maintenance of gravidity and onset of labor on different kinds of steroid hormones has long been the focus of debate with the underlying control mechanism of these hormones in question remaining left unestablished still in these days. Of author's particular concern in this paper was the two-sided aspect of steroid functions. In fact, the steroid may stimulate mother's organ, fetus and placenta to produce much amount of steroid hormone throughout gravidic interval, while at the same time it may control the two contradictory processes, namely the maintenance of gravity and onset of labor through one and the same route. With a view to solve the complexity referred to above an effort has been made through a series of experiments particularity in the term of: 1. Dependent of a system capable to simultaneously determine concentrations of a variety of steroid hormones using the high performance liquid chromatography (HPLC); 2. Profile-analysis to be made on behavior of different kinds of steroids observable over gravidic interval under a support of HPLC system; 3. Behavior of different kinds of hemogenic hormones subsequent to an active DHAS loading in both group with- and without labor pains; 4. Influence of DHAS and gestation on activity of 11 beta hydroxy steroid dehydrogenase in placenta; Some of the results brought by these experiments, which are of some value to speculate on the mechanism of labor-onset and growth of fetus, may be summarized below in line with the preceding items: 1. The measuring system incorporating HPLC made it possible to determine 8 kinds of steroid hormones under systems of C19 and C21 readily in approx. 45 min., even when pretreatment is made involved in the procedure. It was also demonstrably verified that the system shows an acceptable sensitivity combined with a higher correlation with the RIA-method. 2. Profile was successfully delineated of those steroids which would participate in controlling the labor pains inducing mechanism through a series of analytical works made on the behavior of steroid associated with the process of gravidism. With the approach of expected labor, it was seen that 5 kinds of steroid hormones comprising DHA, testosterone, pregnenolone, 20 alpha OH-progesterone, and cortisol showed a marked increase. In contrast, androstenedione and progesterone begin to fall abruptly ever since several days preceding the date of labor. 3. Gain of DHA, 17 alpha OH-progesterone, due to DHAS-loading was clearly identified in the group with onset of labor pains.(ABSTRACT TRUNCATED AT 400 WORDS)

Chromatography, High Pressure Liquid↗
PubMed1985

Elective induction of labor: a prospective clinical study, I: Obstetric and neonatal effects.

Elective induction of labor is still a controversial obstetric procedure. The safety of the procedure and the possibility to program labor during daytime is an often heard argument in favor of it. Also the possibility to prevent term intrauterine fetal death of unknown cause and the possibility to apply fetal monitoring from the beginning of labor are put forward as arguments in favor of elective induction of labor. Feelings of unnaturalness and the dangers of prematurely induced delivery are the most often heard arguments against it. We performed a prospective study to determine the differences between elective induction of labor and spontaneous labor. During 17 consecutive months a group of 184 elective inductions was studied in the Department of Obstetrics, University Hospital - Dijkzigt, Rotterdam. Only healthy women with an uncomplicated pregnancy were included in the study group and all women were allowed a free choice of elective induction or spontaneous labor. The reference group was composed by a system of "matched controls". For induction of labor a standard technique including artificial rupture of the membranes and constant intrauterine fetal monitoring was used. Oxytocin was administered intravenously in an incremental dose. After delivery the acid-base status of the newborns was determined, and part of the newborns were subjected to a neurological screening according to Prechtl. The developments of the infants was followed during one year using a "psychomotor development scheme 0-15 months".(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2002

Labor induction after fetal death. A retrospective analysis.

OBJECTIVE: To describe the delivery outcomes in patients with stillborn infants after labor induction versus spontaneous onset of labor. STUDY DESIGN: A retrospective chart review was performed of singleton pregnancies complicated by fetal death over a three-year period when awaiting spontaneous onset of labor was a common practice. Exclusion criteria were prior multiple cesarean deliveries, placenta previa, preeclampsia or suspected abruptio placentae. Outcome measures included time spent in the labor and delivery unit and rates of maternal hemorrhagic morbidity and endomyometritis. RESULTS: Two hundred eight patients, 100 patients undergoing labor induction and 108 with spontaneous onset of labor, met the study criteria. Patients delivering after induction spent a longer time in the labor and delivery unit (13.7 versus 4.4 hours). The endomyometritis rate was higher in the spontaneous labor group (6% versus 1%). There were no differences in the frequency of postpartum hemorrhage, retained placenta or need for blood transfusion. CONCLUSION: Induction following diagnosis of fetal death is safe and may reduce maternal infectious morbidity.

Adult↗
PubMedDate not supplied

Levels of maternal plasma corticotropin-releasing factor and urocortin during labor.

OBJECTIVE: Corticotropin-releasing factor (CRF) is produced by the placenta and intrauterine tissues and secreted in increasing amounts from early to term pregnancy. In the presence of labor, a more incisive increase in CRF levels has been described, and women with preterm labor or those destined to have premature delivery have higher midpregnancy CRF levels than those who deliver at term. Urocortin is a 40-amino acid peptide belonging to the CRF family, expressed by human trophoblast and fetal membranes, which has the same biologic effects as CRF. Acting on the same CRF receptors, urocortin stimulates myometrial contractility and ACTH and prostaglandin release from cultured human placental cells. Because no data exist about urocortin levels in the maternal circulation at parturition, we investigated whether maternal plasma urocortin and CRF levels change according to cervical dilatation in healthy pregnant women at term labor. METHODS: In a cross-sectional study of labor, a single maternal blood sample was collected from healthy pregnant women at term (n = 40); in a second longitudinal study, plasma samples were collected longitudinally in a subset of patients (n = 8) throughout labor, according to a Bishop score evaluation. RESULTS: Both maternal plasma CRF and urocortin levels were higher in labor than those previously reported during pregnancy, but they did not change significantly during the different stages of labor when evaluated longitudinally. Some patients showed a trend toward increasing levels, whereas others had variable concentrations. CONCLUSION: Neither CRF nor urocortin levels changed during the progression of spontaneous labor.

Adult↗