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PubMed2002

Clinical study on labor pain relief using the combined spinal-epidural analgesia and inhaling nitrous oxide.

OBJECTIVE: To study the pain relief effectiveness of the combined spinal-epidural analgesia (CSEA) and the inhalation of nitrous oxide, and the influences on the mothers and infants. METHODS: The 300 cases of pregnant women were randomly divided into 3 groups: CSEA group, nitrous oxide group and control group. The nitrous oxide group was that pregnant women inhaled nitrous oxide premixed with oxygen (50%:50%), the pregnant women of the CSEA group were injected fentanyl and bupivacaine in the subarachnoid and epidural space, analgesic was not used in the control group. The degree of labor pain, duration of the labor, way of delivery, bleeding volume, rate of anoxia of newborn, blood gas analysis to maternal radius artery and fetal umbilical blood among 3 groups were observed. RESULTS: The effect for analgesia labor of the CSEA group was much better than that of the nitrous oxide group (P < 0.01). In the first stage of labor and total stage of labor, the CSEA group was shorter than the others (P < 0.05), but there was no difference between the nitrous oxide group and the control group (P > 0.05). In the second stage of labor, the 3 groups were alike to each other. The bleeding volume of caesarean section (373 +/- 77) ml in the nitrous oxide group was much more than the other 2 groups, there was no difference between the CSEA group (259 +/- 78) ml and the control group (239 +/- 89) ml. The rate of obstetric forceps of CSEA group was higher than the control group (P < 0.01), and the rate of caesarean section of the nitrous oxide group was much higher than the CSEA group. The blood gas analysis to maternal radius artery and fetal umbilical blood and the rate of anoxia of newborn of 3 groups revealed no significant difference. CONCLUSIONS: The effectiveness of the combined spinal-epidural analgesia CSEA for analgesia labor is confirmed and has rarely side-effect, and it can be the first choice, and the inhalation of nitrous oxide can safely provide effective labor analgesia, too.

Analgesia, Epidural↗
PubMedDate not supplied

The effects of an external nasal dilator on labor.

BACKGROUND: The aim of this study was to assess the effect of an external nasal dilator on several variables characterizing labor in both mother and fetus. METHODS: One hundred and fifty primigravida women in active labor were randomized to wear, throughout labor, either a dilator spring-loaded nasal strip or a placebo device. Data were obtained during labor and compared between the groups. After delivery, the satisfaction rate was assessed. RESULTS: No differences were found between the study and the control group regarding rate of induction or augmentation of labor as well as Montevideo units reached, frequency of rupture of membranes, duration of the active phase and second stage of labor, usage of epidural analgesia, normal fetal heart pattern, meconium-stained amniotic fluid, and neonatal well being. Length of maternal and neonatal hospitalization also did not differ between the groups. Satisfaction rate was significantly higher in parturient women wearing nasal strips with a dilator spring than in parturient women wearing a placebo spring (P < 0.0001). CONCLUSION: Nasal strips do not change the course but ameliorate the quality of labor by improving the ease of breathing. Nasal dilators sustain the respiratory effort associated with the long process of labor and may control the switch from nasal to oronasal breathing during delivery.

Adult↗
PubMed2005

[Retrospective assessment of epidural analgesia during labor according to parturients].

AIM: The aim of the study was to find out parturients' evaluation of epidural analgesia (EA) during labor and factors influencing their opinion. MATERIALS AND METHODS: 100 women, aged 26-42, who gave birth at I Department of Obstetrics and Gynaecology in Warsaw, filled in a specially prepared inquiry. Primiparas contributed to 87% of the study group. The results were analyzed according to analgesia evaluation as: very good (group A-64%), good (group B-30%) and insufficient (group C-6%). RESULTS: Patients evaluated their pain according to Visual Analog Scale before and after EA was applied in the I and II stage of labor, respectively. Significant differences regarding the pain level in the II stage were observed--among patients from group C it was even higher than before EA was applied. That group more often notified perineum pain during the II stage of labor. Feeling uterine contractions, tenesmus and drugs' side effects had no influence on women's opinion. The way of grading EA depended on parity and education--patients from group C were all well-educated primiparas. The time of making a decision about willing to give birth with EA also depended on parity--multiparas decided earlier than primiparas. Women's main source of information about labor EA were press and books (56%), than labor school (26%), other women (24%) and only for 20% their gynaecologist. In spite of the differences in their answers, the majority of women would decide on labor EA again (95%) and recommend it to others (98%). CONCLUSIONS: The majority of patients gives labor EA very positive opinion. Insufficient pain control in the II stage of labor and perineum pain are the main factors lowering EA evaluation--it seems important to pay more attention to that fact in the future. Time of making a decision about EA and women's opinion depend on parity. As press is the main source of information for patients, the wider promotion of EA by medical staff seems necessary.

Adult↗
PubMed1990

Simple management of poor cervical progression during labor by continuous epidural analgesia.

A series of 112 primiparous parturients in labor with poor cervical progression were managed according to the double-lined labor nomogram. These patients all had labor progression beyond the alert line which were defined as poor cervical progression. Continuous low concentrated marcaine (0.125%) epidural analgesia were then offered to these indicated patients. These 112 poor labors were compared with 143 poor cervical progression labors without epidural analgesia in terms of mode of delivery and maternal morbidities. The results showed a decrease in cesarean section rate in cases with epidural analgesia (20.5% vs 34.3%, p less than 0.05) but no increase use of instrumentation was noted, also, maternal morbidities were much less in epidural cases compared to poor labors without epidural analgesia (6 in 112 vs 19 in 143, p less than 0.05). Continuous epidural analgesia performed on labors with poor progression improved the labor outcome and decrease maternal morbidities satisfactorily.

Analgesia, Epidural↗
PubMed1984

[Changes in steroids in amniotic fluid in relation to the initiation of labor].

To study the changes in steroid concentrations in amniotic fluid (AF) in relation to the initiation of parturition, eleven steroids in AF which included cortisol(F), progesterone (P4), 20 alpha-dihydroprogesterone, free(f-) and conjugated(c-) pregnenolone, DHA, estradiol(E2) and estriol(E3) were measured by RIA. Experiment 1: Samples were obtained at I) elective cesarean section (not in labor, n = 9), II) vaginal delivery after the spontaneous onset of labor (in labor, n = 13). Experiment 2: AF were collected serially from each individual at A) the artificial rupture of the membrane before the onset of labor, B) the initiation of labor and C) second stage of delivery. Samples of B and C were obtained with a catheter which was placed in the uterine cavity at the rupture of the membrane. The mean concentrations of F,c-E2,f- and c-E3,DHA in I were significantly higher than those in II. In experiment 2, except for P4, all steroid concentrations tended to increase during the course of labor. The levels of F increased significantly from A to C but not from A to B. Free DHA increased from B to C. The percentage increase in steroid levels was also caliculated and it was found that the steroid increase from A to B was f-E2 while P4 decreased. E2/P4 ratio increased significantly from A to B. These results suggested that the increase in F and DHA may be due to the fetal response to the stress of labor. A possible role of increased E2 and decreased P4, and subsequently increased E2/P4 ratio, in AF on the onset of labor is suggested.

20-alpha-Dihydroprogesterone↗
PubMedDate not supplied

[13, 14-Dihydro-15-keto-PGF2 alpha (PGFM) and progesterone serum levels in labor].

Progesterone and PGFM serum levels were estimated by RIA in patients with spontaneous and induced labor. Induction of labor was performed by amniotomy or by local application of prostaglandins. Mean progesterone serum levels were at 130 ng/ml at the time of admission into the labor-room, and declined to mean levels of some 50 ng/ml in all 3 groups of patients 30 minutes after placenta expulsion. Mean PGFM serum levels were 2,5 to 3,5 times higher in patients with spontaneous labor than in those in whom labor was induced. Parallel decline of progesterone and PGFM serum levels was noted in patients with spontaneous labor, whereas declining progesterone levels but increasing PGFM serum levels were observed in patients with induced labor. These data combine to suggest that an increase in PGFM serum levels may be the cause for the onset of labor. But, the question whether progesterone triggers these processes cannot be answered by the present observations.

Dinoprost↗
PubMed1982

[The physiological importance of prostaglandins in the mechanism of human labor].

Recent results indicate that prostaglandins play a major role in the mechanism of human labor. There are, however, no systematic studies on the role of prostaglandins in various forms of induction of labor. In the present study the concentration of 13,14-dihydro,15-ketoprostaglandin F2 (PGFM) in the maternal peripheral plasma was determined in labor of spontaneous onset, in labor after induction with oxytocin and in labor after induction by artificial rupture of membranes (ARM). In an additional group of women PGFM was determined before and immediately after delivery to get an insight into the mechanism of placental separation. In labor of spontaneous onset PGFM concentration increased significantly. In labour induced by oxytocin PGFM levels rose only in those women in whom induction of labor was successful. In induction of labor by ARM, PGFM level also increased in all women in whom induction was successful. At the time of placental separation PGFM concentration in the maternal blood increased dramatically. From the result of this study it is concluded that the increase of prostaglandin F synthesis is a necessary prerequisite for vaginal delivery and that prostaglandins are of major importance in the mechanism of placental separation and expulsion.

Dinoprost↗
PubMed1989

Infection and labor. III. Interleukin-1: a signal for the onset of parturition.

The regulatory signals responsible for the increased biosynthesis of prostaglandins during parturition have not been established. Because interleukin-1 is capable of stimulating prostaglandin production by intrauterine tissues and is an inflammatory mediator, we propose that interleukin-1 may act as a signal for the onset of human labor in the setting of intrauterine infection. The purpose of these studies was to determine interleukin-1 activity in amniotic fluid and to establish its relationship with the onset of term and preterm labor. Amniotic fluid from 182 patients was assayed for interleukin-1 activity. Cell-associated interleukin-1 activity was detected in fluid obtained in the third trimester but not in fluid obtained in the second trimester of pregnancy, suggesting a maturational event in interleukin-1 production. The factor responsible for interleukin-1 activity had biochemical characteristics of interleukin-1 alpha (estimated molecular weight of 14 kilodaltons, isoelectric point = 4.9), and its activity was blocked with an anti-interleukin-1 alpha antisera. Women in spontaneous labor at term were likely to have fluid phase interleukin-1 activity in amniotic fluid than women who were not in labor at term. Preterm labor in the setting of intraamniotic infections was associated with significant interleukin-1 activity in amniotic fluid. This bioactivity was predominantly attributable to interleukin-1 beta. A strong correlation between interleukin-1 and amniotic fluid concentrations of prostaglandin E2 and prostaglandin F2 alpha was found in women in preterm labor. These findings support the hypothesis that interleukin-1 may play a role in the initiation of preterm labor associated with intraamniotic infection.

Amniotic Fluid↗
PubMed2005

Normal labor: mechanism and duration.

Labor is refers to the chain of physiologic events that allows a fetus to undertake its journey from the uterus to the outside world. The mean duration of a singleton preganancy is 40.0 weeks (280 days), which is dated from the first day of the last normal menstrual period. The period from 37.0 weeks (259 days) to 42.0 weeks (294 days) of gestation is regarded as "term". This article focuses on the onset progress, and mechanics of normal labor term. Topics such as preterm labor (labor before 37 weeks), postterm labor (labor after 42 weeks), and abnormal labor and delivery have not been addressed and are discussed in detail elsewhere in this issue.

Female↗
PubMed2006

The impact of parity on course of labor in a contemporary population.

BACKGROUND: Few studies have examined in depth the labor progression of multiparas to determine if there is any additional impact of being parous beyond the first birth. The objective of this study was to determine the effect of parity on labor progression in contemporary obstetric practice. METHODS: Our sample consisted of all low-risk women who delivered a term, live-born infant from January 2002 to March 2004 at a single institution in Delaware, United States (n = 5,589). The median duration of labor by each centimeter of cervical dilation was computed for parity = 0 (n = 2,645); parity = 1 (n = 1,839); parity = 2 (n = 750); and parity = 3 + (n = 355). RESULTS: Multiparas had a significantly faster labor progression from 4 to 10 cm (293, 300, and 313 min, respectively, for parity = 1, parity = 2, and parity = 3 +), compared with nulliparas (383 min for parity = 0), as well as a shorter second stage of labor. However, no significant differences were found in duration of the active phase or the second stage of labor among multiparas. CONCLUSIONS: Additional childbearing appears to have no effect of on the progression of labor among multiparous subgroups. The difference in duration of the active phase between nulliparas and multiparas is substantially smaller in a contemporary population.

Adult↗
PubMed1976

A reappraisal of the duration of labor.

The mean, median, and modal durations of labor have been established following a prospective study of 602 consecutive labors. The mean duration of labor for primiparae was 14.92 hours, while the median and modal durations were 13.20 and 9.66 hours, respectively. The corresponding figures for multiparae were 10.02, 9.28, and 7.80 hours, respectively. There was a statistically significant difference in the mean duration of labor in the 2 groups of patients (P less than 0.001). A significant positive correlation has been observed between the duration of the first stage of labor and the second stage of labor (P less than 0.001), and this might be of clinical importance. It has been suggested that the median and modal durations of labor may be more representative and informative than the mean or average.

Adult↗
PubMedDate not supplied

Prediction of difficult vaginal birth and of cesarean section for cephalopelvic disproportion in early labor.

OBJECTIVE: A total of 1,692 patients were evaluated in early labor, and predictions were made for easy labor-vaginal birth, difficult labor-vaginal birth, or improbable vaginal birth-cesarean section. METHODS: The prediction was based on clinical evaluation of pelvic dimensions, and fetal measurements by sonography at term. RESULTS: The combined prediction that a patient would have either a difficult labor-vaginal birth or cesarean section was very accurate (362 out of 370, or 97.8%). However, the separate prediction of difficult labor-vaginal birth and a cesarean section was less accurate, although still significant (73.4% and 90.2%, respectively). A similar study on 141 vaginal birth after cesarean (VBAC) candidates showed that by sectioning electively patients in whom cesarean sections were predicted, the cesarean section rate barely increased. CONCLUSION: Careful evaluation of a patient in early labor could help to recognize the dystocic labor-delivery and early indication for cesarean sections. This would avoid unnecessary and prolonged labor without necessarily increasing the cesarean section rate.

Body Constitution↗
PubMed1976

Induction of labor with oral prostaglandin E2.

Prostaglandin E (PGE2) was administered orally for induction of labor to 100 patients. Active labor and progression occurred in 92 per cent of these cases. The dosage regimen used was 0.5 to 1.5 mg. hourly. Amniotomy was performed in most cases once active labor and progression were noted. There were 83 vaginal deliveries and 12 cesarean sections. There were eight failure of induction, one patient left the study, and one was not delivered at that admission. Fetal distress occurred in 10 patients but this was related to cord and placental problems and not to PGE2 per se. Side effects were minimal, the most prominent being nausea and vomiting. Total labor in hours compares to normal labor. Over-all, labor in primigravidas averaged 10.15 hours and 6.5 hours in multiparas. There was a direct relationship of the Bishop score to the start of active labor and progression. PGE2 appears safe and efficacious for inductions of labor at terms.

Administration, Oral↗
PubMed1984

Hazards and benefits of elective induction of labor.

Labor, delivery, and newborn course were studied in 621 pregnancies in which labor was electively induced at or after 39 weeks, and in 3,851 control pregnancies in which the onset of labor was spontaneous. Induced labors were not prolonged, nor was the duration of ruptured membranes. Fetal distress and birth asphyxia were not more frequent after induction, and release of meconium occurred much less frequently (9.3% for induced labor versus 16.7% for spontaneous). There was greater use of epidural analgesia and of forceps delivery in induced labor. Among primiparous patients, cesarean delivery for "failure to progress" was performed in 14% of electively induced labors and 7% of spontaneous control labors, a difference not noted among multiparous patients who had a primary cesarean birth rate of less than 2%. Iatrogenic prematurity was not a problem; none of the 621 infants who was born after elective induction developed respiratory distress syndrome, and only one weighed less than 2,500 gm.

Anesthesia, Obstetrical↗
PubMed1987

Prostaglandin E2 release on the fetal and maternal sides of the amnion and chorion-decidua before and after term labor.

Release of prostaglandin E2 on each of the fetal and maternal sides of the fetal membranes (8 cm2) from term cesarean (no labor) and spontaneous vaginal (labor) deliveries was studied with the use of dual-compartment perfusion chambers. Postlabor amnion released significantly (p less than 0.05) more total prostaglandin E2 (5.66 +/- 1.02 ng, mean +/- SEM) than prelabor tissue (3.34 +/- 1.76 ng) with equivalent prostaglandin E2 levels being released on both sides. A net decrease (p less than 0.001) in prostaglandin E2 release by chorion-decidua was identified after labor (fetal = 0.12 +/- 0.05 ng; maternal = 0.17 +/- 0.09 ng) when compared with that before labor (fetal = 1.28 +/- 0.69 ng; maternal = 2.31 +/- 0.56 ng). Amnion-chorion-decidua released more prostaglandin E2 on the fetal side after labor (2.37 +/- 1.43 ng) than prior to labor (1.49 +/- 0.60 ng); however, prostaglandin E2 on the maternal side was significantly less (p less than 0.05) after labor (0.24 +/- 0.12 ng) when compared with that of the prelabor membrane (2.03 +/- 1.08 ng). Elution of prostaglandin E2 from preincubated membranes and endogenous membrane prostaglandin E2 content showed similar results. Thus concentrations of prostaglandin E2 on the maternal side of the fetal membranes appear diminished after spontaneous labor despite an increased release from the fetal surface.

Amnion↗
PubMed1992

The Green Bay cesarean section study. II. The physician factor as a determinant of cesarean birth rates for failed labor.

OBJECTIVE: Our study was designed to develop a profile of specific labor management characteristics generally used by physicians with low versus those with high rates of cesarean sections in the care of nonprogressive labor in nulliparous patients. STUDY DESIGN: A 4-year retrospective data set was used to analyze all patients with nonprogressive labor cared for by 11 board-certified obstetricians and gynecologists practicing full-time at two Green Bay hospitals. Variations in labor management are analyzed and tested for their effect on the rate of cesarean section for failure of labor to progress. RESULTS: Cesarean section in nulliparous women for nonprogressive labor varied from 4.3% of all deliveries in the low group to 12.3% in the high group. Through multivariate analysis we developed a profile of specific labor management characteristics used by physicians with low versus those with high rates of cesarean section. CONCLUSION: These techniques can be used to definitively identify management strategies that result in a decrease in cesarean rates for nonprogressive labor.

Anthropometry↗
PubMed1993

Amniotic fluid interleukin-6 levels correlate with histologic chorioamnionitis and amniotic fluid cultures in patients in premature labor with intact membranes.

OBJECTIVES: Our purpose was (1) to determine the frequency of intraamniotic and extraamniotic intrauterine infection in patients with premature labor and intact membranes and (2) to determine if intrauterine infection is associated with elevated amniotic fluid interleukin-6 levels. STUDY DESIGN: Amniocentesis was performed on 57 patients in preterm labor and 201 controls at various gestational ages without labor and at term with labor. The amniotic fluid was evaluated with gram stain, cultures, and an enzyme-linked immunosorbent assay specific for interleukin-6. Placentas from study patients (n = 52) and term controls (n = 120) were analyzed. RESULTS: The frequency of positive amniotic fluid cultures (intraamniotic intrauterine infection) was 10 of 57 (18%) in the preterm labor group and zero of 201 for controls. Histologic chorioamnionitis (extraamniotic intrauterine infection) was present in 21 of 24 (88%) of patients in preterm labor that failed tocolysis and 28 of 120 (23%) of term laboring controls. An amniotic fluid interleukin-6 level of > or = 600 pg/ml was 100% sensitive and 89% specific (positive predictive value 85%, negative predictive value 100%) for the identification of intrauterine infection. CONCLUSION: Interleukin-6 is a sensitive and specific marker for the identification of both intraamniotic and extraamniotic intrauterine infection in patients in preterm labor with intact membranes.

Adult↗
PubMed1987

Remembrance of labor pain: how valid are retrospective pain measurements?

Recently, several authors have questioned the reliability and validity of relying on retrospective assessment of labor pain. Many studies designed to determine the relationships between psychosocial and demographic factors and pain intensity during labor have relied on such measurements. The purpose of this prospective study was to determine if primiparas and multiparas can accurately remember the pain of labor. Fifty primiparas and 88 multiparas participated in the study. Prospective assessment of in-labor pain was performed using a Visual Analogue Scale (VAS) in 3 phases of labor. Retrospective assessment of labor pain was performed 2 days post partum using the VAS. Results showed that there were significant differences between the amount of actual pain reported and the amount of pain and discomfort remembered by both primiparas and multiparas. The mean rating for remembered discomfort was higher than for remembered pain. The subjects tended to deflate the intensity of their labor pain. The results suggest that previous studies that have relied on retrospective assessments of labor pain may be invalid.

Adolescent↗