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PubMed1994

Nitrous oxide in early labor. Safety and analgesic efficacy assessed by a double-blind, placebo-controlled study.

BACKGROUND: Intermittent self-administered nitrous oxide has long had widespread use as an analgesic in labor, but its efficacy has not been adequately established. Questions about its effect on maternal oxygenation between labor contractions also have been raised. METHODS: Twenty-six women were recruited to participate in a randomized, double-blind, cross-over, placebo-controlled study to assess the effect of intermittent nitrous oxide inhalation on labor pain and maternal hemoglobin oxygen saturation (SPO2) during the first stage of labor. Visual analog scale pain scores for each of five consecutive labor contractions were measured after administration of either nitrous oxide or compressed air. RESULTS: Mean visual analog scale pain scores for five contractions were 5.1, 5.2, 5.7, 5.2, and 5.6 (nitrous oxide) and 4.9, 5.2, 6.1, 5.6, and 5.7 (compressed air). There were no statistically significant differences in pain when nitrous oxide as compared with compressed air was administered. Pain scores did not differ significantly over time as a function of inhaled substance (F = 0.41, P = 0.53). The mean lowest SPO2 observed between these contractions after self-administration of nitrous oxide and air were 97, 97, 97, 97, and 97% (nitrous oxide) and 97, 96, 96, 96, and 96% (compressed air). SPO2 was significantly higher after nitrous oxide administration (F = 8.8, P = 0.007). CONCLUSION: While intermittent self-administered 50% nitrous oxide in oxygen does not appear to predispose parturient women to hemoglobin oxygen desaturation, its analgesic effect has yet to be clearly demonstrated.

Adult↗
PubMed1985

Segmental epidural analgesia in labor: a matched control study.

The effects of epidural analgesia, given during the first stage of labor, on the course of labor, mode of delivery, and fetal outcome were evaluated in 43 matched controlled patients. Both stages of labor were prolonged, more forceps were applied, and more patients needed oxytocin augmentation for a longer period in the epidural group. Cesarean section was associated also with the use of epidural analgesia, owing to failure to progress. Fetal outcome was similar in both groups as judged by Apgar scores. Patients who elect this mode of pain relief in labor should be made aware that these side effects can be expected.

Adult↗
PubMed2001

The analgesic effect of sufentanil combined with ropivacaine 0.2% for labor analgesia: a comparison of three sufentanil doses.

UNLABELLED: The combination of opioids with local anesthetics is commonly used for epidural labor analgesia. We examined whether increasing sufentanil in doses of 5, 10, and 15 microg prolonged the duration of labor analgesia produced by ropivacaine. One hundred healthy parturients in the first stage of labor who requested epidural analgesia were enrolled. Parturients were randomized to receive 12 mL ropivacaine 0.2% alone or with sufentanil 5 microg, sufentanil 10 microg, or sufentanil 15 microg. The duration of analgesia, pain score, degree of motor blockade (using a four-point Bromage scale), heart rate, blood pressure, respiratory rate, oxygen saturation, and incidence of nausea and pruritus were recorded. The mean duration of epidural analgesia was 96 +/- 32 min for patients without sufentanil, 134 +/- 27 min for Group 5 (p < 0.01 versus control), 135 +/- 33 min for Group 10 (p < 0.01 versus control), 130 +/- 33 min for Group 15 (p < 0.01 versus control) without differences among sufentanil groups. Between 30 and 90 min, the sufentanil groups (5 microg, 10 microg, and 15 microg) had lower pain scores than the control group (p < 0.01 versus control) but there were no differences among the sufentanil groups. No patient in any group had a Bromage score more than 1. No significant difference was found for opioid-related side effects. We conclude that 5-10 or 15 microg sufentanil induced a similar prolongation of analgesia when combined with ropivacaine 0.2% for initiation of labor analgesia. IMPLICATIONS: We studied the effect of adding one of three possible sufentanil doses to epidural ropivacaine 0.2% for labor analgesia. Adding sufentanil increased the duration of analgesia but there was no advantage in adding more than 5 microg of sufentanil.

Adult↗
PubMed1986

Fetal acid-base balance in low-risk patients in labor.

The fetal acid-base balance from scalp blood in the early and late first stage of labor and from cord arterial blood was assessed in 120 low-risk patients only monitored electronically for 15 minutes at admission. The mean scalp blood pH values were 7.332 at a cervical dilatation of 5 cm and 7.335 at 10 cm cervical dilatation. A low pH value (less than 7.25) was found in 14 patients; five (4.2%) of them had fetal distress. Stethoscopic auscultation failed to identify these cases. Another nine patients had transient abnormal acid-base balance (a check value within 30 minutes was normal), and the fetal heart rate trace (obtained immediately after the sampling) showed no ominous changes in these cases. It is concluded that an abnormal fetal acid-base balance is not uncommon in a low-risk population in labor. However, a critical evaluation of the acid-base balance is necessary, since in most cases the abnormal acid-base balance is transient and of a respiratory, innocuous type without concomitant fetal distress.

Acid-Base Equilibrium↗
PubMed2004

Maternal admission characteristics as risk factors for preterm birth.

OBJECTIVE: The aim of this study is to identify a subset of women presenting with preterm labor not responding upon tocolytic therapy, eventually resulting in preterm birth. STUDY DESIGN: The maternal admission characteristics of 185 women with preterm labor receiving tocolysis were analysed for risk factors that could predict which women will deliver within 48 h after the start of tocolysis, or before 34 weeks gestation. Univariate analysis and multivariate logistic regression analysis was performed. RESULTS: Logistic regression analysis identified the following risk factors for delivery within 48 h after the start of tocolysis: cervical dilatation at admission (odds ratio (OR, cm(-1)) 1.47; 95% confidence interval (CI), 1.44-1.49), elevated leukocyte count at admission (per 10(3) leukocytes/mm(3)) (OR 1.27; 95% CI, 1.26-1.28), use of nifedipine (OR 0.49; 95% CI, 0.26-0.49), and developing signs suggestive of chorioamnionitis following admission (OR 2.12; 95% CI, 1.04-4.33). For delivery before 34 weeks of gestation the following risk factors were identified: use of steroids (OR 5.87; 95% CI, 2.34-14.7), use of nifedipine (OR 0.46; 95% CI, 0.27-0.85), developing signs suggestive of chorioamnionitis following admission (OR 10.6; 95% CI, 3.1-35.9), and preterm premature rupture of the membranes (OR 12; 95% CI, 4.1-35.2). CONCLUSIONS: Risk factors associated for delivery within 48 h after starting tocolysis are: cervical dilatation at admission, elevated leukocyte count at admission, and developing signs suggestive of chorioamnionitis following admission. Use of nifedipine was associated with a delay of delivery >48 h. Risk factors associated for delivery within 34 weeks gestation are: use of steroids, developing signs suggestive of chorioamnionitis following admission, and ruptured membranes. Use of nifedipine was associated with a delay >34 weeks.

Adult↗
PubMed1990

Intrapartum, intranasal cocaine use and acute fetal distress. A case report.

Intrapartum, intranasal cocaine was used for relief of labor pains by a healthy woman with an uncomplicated pregnancy. Fetal hypoxemia and distress followed the event. A causal relationship between the intrapartum use of cocaine and the fetal distress was postulated. Cocaine abusers could benefit from hospitalization early in labor for close surveillance and monitoring, thus avoiding exposure to cocaine and its unpredictable systemic effects.

Adult↗
PubMed1981

[Pressures on the human fetus during labor - intrauterine and on the fetal head (author's transl)].

During labor, the body surface of the fetus is subjected to strong pressure exerted by uterine contractions. In 40 cases, intrauterine pressure (IUP) which acts on the fetal body in the uterine cavity and pressure between the presenting part of the fetus and birth canal (PFB) which acts on the part of the fetus engaged in the birth canal were measured to determine the difference in pressure depending on the parts of the fetal body and their changes during the progress of labor. 1) Both peak IUP and PFB values increased gradually in the first stage of labor, and they became double in the period of labor with bearing-down efforts. 2) Since the peak value of PFB was 2.2 to 3.5 times higher than that of IUP, the part of the fetus engaged in the birth canal should always be subjected to 2.2 to 3.5 times more pressure than the intrauterine part of the fetal body. 3) Manual procedures such a vacuum extraction and Krysteller's compression on the uterine fundus increased the peak value of PFB markedly. The objective measurement of the pressure which acts on the fetal head during labor can be considered to contribute to the prevention of cerebral damage and fetal hypoxia.

Female↗
PubMed1977

[Management of labor in fetal cardiac sound changes after paracervical block].

A pain free period during the first stage of labor is made possible by paracervical block anaesthesia. The extent of risks for the fetus using this method of anaesthesia is measured by different means. Changes of the fetal heart rate after paracervical block must be regarded as a complication. During the period of ten years paracervical block anaesthesia was performed in 10.041 cases in our hospital (Landesfraunklinik Wuppertal). The analysis of all cardiotocograms taken shows changes of the fetal heart rate after paracervical block in 11,3%. Carbostesin with adrenalin (0.5%) was used, 5 ml were injected on each side. Motility disturbances of the uterus and the vena cava-syndrome are clinically evident because of the various reasons for bradycardy. ECG analysis detects a suppression of the sinus-atrial node as a stimulator. During the period of bradycardy after paracervical block Caesarian section is not indicated. A conservative attitude is justified with the patient in a lateral position. Disturbances of uterine motility and long periods of bradycardy call for intrauterine resuscitation with the application of Partusisten (Th 1165) under constant control of maternal circulation. If there are other reasons for a Caesarian section an improvement of the fetal heart rate--as shown in the cardiotocogram--should be achieved in any case.

Anesthesia, Obstetrical↗
PubMedDate not supplied

Comparison of active phase labor between triplet, twin, and singleton gestations.

OBJECTIVE: To characterize the active phase of labor in triplet pregnancies and compare it with gestational age-matched twins and singletons. METHODS: Active phase rates were calculated beginning at 5 cm of dilation for women with triplet gestations longer than 24 weeks who labored and reached the second stage. Twin and singleton cohorts that also completed the first stage of labor were matched for gestational age at delivery (+/-1 week), parity, and epidural use. Intrapartum variables included oxytocin use (induction or augmentation, duration of infusion, and maximum dosage), cervical dilation at membrane rupture, and active phase dilation rate. RESULTS: Thirty-two triplet pregnancies met inclusion criteria between January 1994 and September 1998 and were each compared with twin and singleton cases in a 1:2 ratio. Triplet and twin active phase rates, while similar (1.8 versus 1.7 cm/hour, respectively), were significantly lower than the mean singleton dilation rate (2.3 cm/hour, P =.02). No other intrapartum variables differed between the three groups. Despite controlling for gestational age at delivery, mean birth weights were significantly higher in singletons and correspondingly lower in twins and triplets (2,493 versus 2,112 and 1,968 g, respectively; P =.001). An analysis of active phase dilation rates as a function of the cumulative birth weight per pregnancy demonstrated an inverse correlation, with slower progress in active labor associated with increasing total fetal weight (R = -.24; P =.002). CONCLUSIONS: Triplet and twin active phase dilation proceeds at a slower rate than that observed in singleton pregnancies. The rate of active phase dilation is inversely correlated to total fetal weight.

Birth Weight↗
PubMed1985

Vasopressin levels during pregnancy and labor.

Baseline plasma vasopressin concentrations were measured in 10 healthy women during a normal menstrual cycle, 97 normal women during pregnancy and 43 pregnant women hospitalized during the third trimester because of pregnancy-induced hypertension (PIH). Plasma vasopressin levels were also measured in 44 normal pregnant women in early labor and in 30 parturients at delivery. The random plasma vasopressin concentrations did not vary significantly between the nonpregnant women during the follicular phase (2.3 +/- 0.2 microU/ml) and luteal phase (2.2 +/- 0.3 microU/ml) or during the third trimester in normal pregnant women (2.0 +/- 0.2 microU/ml) or those with PIH (2.0 +/- 0.1 microU/ml). There was a significant reduction (p less than 0.01) in plasma vasopressin levels in the pregnant women during the first trimester (1.5 +/- 0.1 microU/ml) and second trimester (1.5 +/- 0.1 microU/ml) as compared to levels in nonpregnant and pregnant women in the third trimester. The mean plasma vasopressin levels in the pregnant women complaining of nausea were similar to those in the pregnant women without nausea. Plasma vasopressin levels in women during labor did not increase significantly over third-trimester-pregnancy concentrations during the first stage of labor (1.9 +/- 0.1 microU/ml) or at delivery (1.8 +/- 0.1 microU/ml). These cross-sectional measurements of maternal plasma vasopressin levels do not support a role for vasopressin in the development of PIH or in the initiation or maintenance of labor.

Arginine Vasopressin↗
PubMed1987

Oxytocin during labor after previous cesarean section: results of a multicenter study.

The use of oxytocin for labor induction or augmentation in patients with previous cesarean delivery is controversial. This paper presents a series of 1776 patients allowed to labor after a previous cesarean section, of whom 485 (27%) were treated with oxytocin. When the patients who received oxytocin were compared with those who did not, no significant differences were found with respect to uterine rupture, maternal morbidity, fetal morbidity, or fetal mortality. We conclude that the judicious use of oxytocin is safe in the patient with a previous low transverse cesarean section.

Cesarean Section↗
PubMed1991

Intrathecal morphine 0.2 mg versus epidural bupivacaine 0.125% or their combination: effects on parturients.

To compare the efficacy and side effects of 0.2 mg intrathecal (IT) morphine with 0.125% epidural bupivacaine, 62 women in labor were studied. They were randomly divided into three groups: group 1 (n = 20) received IT morphine; group 2 (n = 22) received epidural bupivacaine; and group 3 (n = 20) received a combination of both using a combined spinal-epidural (CSE) technique. According to a visual analogue scale for assessing analgesia, neither IT 0.2 mg morphine nor 10 ml 0.125% epidural bupivacaine was effective in producing adequate pain relief in labor, whereas the combination produced excellent analgesia. The use of IT morphine significantly reduced the dosage requirement of epidural bupivacaine. The incidence of nausea, vomiting, and pruritus was significantly higher when IT morphine had been administered, whereas that of urinary retention did not differ. No serious respiratory depression occurred in any of the patients. When the course of labor was studied, the prior use of IT morphine significantly prolonged the duration of the first stage of labor and the total duration of labor. We conclude that the administration of 0.2 mg IT morphine in combination with epidural administration of 0.125% bupivacaine provides better analgesia than the administration of either drug alone.

Adult↗
PubMed2002

Labor in the grand multipara.

OBJECTIVE: To assess delivery time and the frequency of dystocia in grand multiparous (GMP) and grand grand multiparous (GGMP) women. METHOD: Labor records from 272 women with parity 4-8 (GMP) and 56 women with parity 9 or higher (GGMP) were retrospectively reviewed regarding duration of labor and the occurrence of dystocia. As a comparison, data from 263 women with parity 1-3 (LMP) and 87 nulliparas (NP) was used. RESULTS: Duration of labor, defined as time from admission of the laboring woman to delivery of the infant, lasted in median 2.0, 2.3 and 3.1 h in LMP, GMP and GGMP, respectively. There was no difference in mean cervical dilatation on admission in multiparous women. In GGMP, the presenting part was more frequently positioned above the pelvic inlet at time of admission. In multiparous women admitted during the latent phase, the active phase of labor lasted in median 3.7 h in GMP and 4.7 h in GGMP, significantly longer than 2.9 h in LMP. During the active phase of labor, GGMP experienced arrest of cervical dilatation more frequently than the LMP. In parous women, there was a positive relationship between parity and duration of the active phase of labor as well as the duration of labor. Infant's birth weight increased by parity. CONCLUSION: Duration of the active phase of labor increased after the fourth child. Failure of descent of the presenting part during the first stage of labor in addition to arrest of cervical dilatation was associated with a high cesarean section rate in the GMP woman.

Dystocia↗