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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↗
PubMed2001

Minimum analgesic dose of epidural sufentanil for first-stage labor analgesia: a comparison between spontaneous and prostaglandin-induced labors in nulliparous women.

BACKGROUND: The aim of this prospective, double-blind, sequential allocation study was to compare the effects of spontaneous and prostaglandin-induced labor on the minimum analgesic dose of epidural sufentanil in the first stage of labor. METHODS: Seventy healthy, nulliparous women, at more than 37 weeks' gestation with cervical dilatation from 2 to 4 cm, requesting epidural pain relief in labor were enrolled. The subjects were assigned to two different groups according to whether labor was spontaneous or induced with dinoprostone 0.5 mg. Parturients received 10 ml of the study solution through a lumbar epidural catheter. The initial dose was sufentanil 25 microg, and subsequent doses were determined by the response of the previous patient in the same group using up-down sequential allocation. The analgesic effectiveness was assessed using 100-mm visual analog pain scores. The up-down sequences were analyzed using the method of independent paired reversals and probit regression. RESULTS: The minimum analgesic dose of sufentanil in spontaneous labor was 22.2 microg (95% CI: 19.6, 22.8) and 27.3 microg (95% CI: 23.8, 30.9) in induced labor. The minimum analgesic dose of sufentanil in induced labor was significantly greater (P = 0.0014) than that in spontaneous labor (95% CI difference: 2.9, 9.3) by a factor of 1.3 (95% CI: 1.1, 1.5). CONCLUSION: Prostaglandin induction of labor produces a significantly greater analgesic requirement than does spontaneous labor.

Adult↗
PubMed2004

To induce or not to induce labor: a macrosomic dilemma.

We assessed the effect of labor induction among parturients carrying macrosomic fetuses on the risk of a cesarean section (CS). The study population consisted of consecutive women with singleton fetuses weighing >/=4,000 g, delivered between 1988 and 1999. A comparison was made between parturients who delivered after labor induction and those who delivered without labor induction. The Mantel-Haenszel procedure was used to obtain the weighted odds ratios while controlling for confounding variables. During the study period, 4,755 women delivered macrosomic newborns in our institution. In 20% of the women (n = 951) labor was induced, while 80% of them (n = 3,804) delivered without labor induction. The women who delivered after labor induction were more likely to be nulliparous (18.0 vs. 10.0%; p < 0.001). In addition, these women had significantly higher rates of gestational diabetes (23.3 vs. 10.7%; p < 0.001), hypertensive disorders (10.1 vs. 5.3%; p < 0.001), hydramnios (17.4 vs. 9.9%; p < 0.001), and oligohydramnios (2.1 vs. 0.2%; p < 0.001). The CS rate was significantly higher among the patients who delivered after labor induction as compared with those in whom labor was not induced (17.8 vs. 11.9%; odds ratio 1.6, 95% confidence interval 1.3-1.9, p < 0.001). Stratified analysis using the Mantel-Haenszel technique was performed to control for confounders such as gestational diabetes, hypertensive disorders, previous CS, hydramnios, oligohydramnios, and nulliparity. None of these variables changed the significant association between induction of labor and CS. The induction of labor among women carrying macrosomic fetuses was found to be an independent risk factor for a CS.

Adult↗
PubMed1979

A comparison of three methods for inducing labor: oral prostaglandin E2, buccal desaminooxytocin, intravenous oxytocin.

A study of labor induction in 325 patients is reported. Group I (77 patients with Bioshop's scores 0-6) and 2 (69 patients with Bishop's scores 7-12) were given 0.5 mg prostaglandin E2 every half hour (maximum 5 mg per day). Group 3 (87 patients with Bishop's scores 0-6) was givne 50 International units of buccal desaminooxytocin every half hour (maximum 500 International units per day). In Group 4 (92 patients with Bishop's scores 7-12), labor was induced by primary amniotomy and automatic oxytocin infusion by the Cardiff method. In groups 1, 2 and 3, 45 per cent, 74 per cent and 41 per cent delivered within 48 hours, while 100 per cent in group 4 delivered within 24 hours. No differences were found in either the frequency of cesarean section or the incidence of low Apgar scores. A higher, but not statistically significant frequency of vacuum extraction was found in the Cardiff group (25 per cent) than in the tablet-induced groups (15 per cent). There was, however, a significantly higheroccurrence of alterations in fetal heart rate which led to instrumental intervention to hasten delivery in the Cardiff group compared to the tablet-induced patients.

Administration, Oral↗
PubMed1983

Comparison of plasma oxytocin levels during spontaneous labor and labor induced by amniotomy, prostaglandin F2 alpha, and prostaglandin E2.

Plasma concentrations of oxytocin in nine spontaneous labors (group 1), nine amniotomy-induced labors (group 2), six prostaglandin F2 alpha-induced labors (group 3), and five prostaglandin E2-induced labors (group 4) were determined at the stages of 1 to 7 days preceding the onset of labor, onset of labor, and established labor, by means of unextracted radioimmunoassay. The levels of oxytocin in the stage preceding the onset of labor in group 1 were not significantly different from the levels of oxytocin in the corresponding stages in groups 2, 3, and 4. However, the levels of oxytocin in the stages of onset of labor and established labor in group 1 were significantly higher than those in the corresponding stages in groups 2, 3, and 4. These results suggest that oxytocin plays a leading role in the onset and progress of spontaneous labor, whereas something other than oxytocin might be involved in the labor induced by amniotomy alone or by prostaglandins.

Adult↗
PubMed1994

Transvaginal ultrasonographic evaluation of the cervix before labor: presence of cervical wedging is associated with shorter duration of induced labor.

OBJECTIVE: Our purpose was to test the hypothesis that transvaginal ultrasonographically determined characteristics of the cervix are associated with duration of induced labor. STUDY DESIGN: Fifty-three patients scheduled for induction of labor underwent transvaginal ultrasonography and digital cervical examinations before labor induction. Cox proportional-hazards multiple regression analysis was performed to determine the variables that made a significant contribution to the prediction of latent-phase and total labor duration. In the analysis the possible confounding effects of exogenous prostaglandin, previous vaginal delivery, and previous termination of pregnancy were controlled. RESULTS: Latent-phase and total labor duration were significantly associated with the presence of cervical wedging noted on transvaginal ultrasonography and administration of prostaglandin but not with the result of digital examination of cervical effacement or dilatation. Latent-phase duration was also associated with cervical length measured by transvaginal ultrasonography. The presence of wedging was significantly associated with shorter latent (15.9 +/- 1.7 vs 34.1 +/- 3.8 hours, p = 0.0001) and total (22.0 +/- 1.8 vs 38.3 +/- 3.6 hours, p = 0.0001) labor length. CONCLUSION: The presence of wedging and decreased cervical length observed by transvaginal ultrasonography is associated with a shorter duration of induced labor and may be useful in the evaluation of induction candidates.

Adult↗
PubMed1984

Prediction of time to delivery from start of contractions in induced labor: a life table analysis approach.

Labor was induced in a total of 200 patients. Outcome of treatment was compared with respect to time to delivery from start of contractions. Prognostic variables compared here were, e.g. dilatation, parity and Bishop score. All comparisons were performed with a life table technique, both bivariate and multivariate. Parity showed a strong relation to prognosis and so did cervical dilatation. The degree of cervical dilatation as in spontaneous labor is the factor in the Bishop index that correlated best to the outcome of treatment. With the two predictors parity and dilatation, a scoring system was constructed.

Actuarial Analysis↗
PubMed1981

Spontaneous or systematically induced labor for the termination of twin pregnancies.

The best time for twin delivery is at 38 or 39 weeks gestation. Systematic Caesarean section or induction is decided upon during these weeks. Thanks to this policy, the good results formerly obtained have been maintained and an important decrease in emergency. Caesarean sections has been noted thus reducing the risks inherent in this method. However, a randomized trial is necessary to confirm these results.

Cesarean Section↗