Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Labor Stage, First”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 757 records · Page 42Linked to original sources
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↗
PubMed1997

Determination of the minimum local analgesic concentration of epidural chloroprocaine hydrochloride in labor.

The aim was to determine the effective concentration in 50% of patients (EC(50)) of chloroprocaine in the first stage of labor. A constant dose modification of a model where EC(50) was previously defined as the minimum local analgesic concentration (MLAC) was used. Parturients (n = 36) requesting epidural analgesia in labor, at cervical dilatation not exceeding 7 cm, were enrolled into this prospective, double-blinded study. After placing a lumbar epidural catheter, chloroprocaine 150 mg diluted to the concentration being evaluated was given. The concentration was determined by up-down sequential allocation. The volume of the bolus ranged from 15 to 50 ml. Efficacy was assessed using 100 mm visual analogue pain scores with 10 mm or less within 30 min defined as effective. MLAC (95%CI) was 0.42%w/v (0.34 to 0.5) using the formula of Dixon & Massey and as a sensitivity test was 0.4%w/v (0.35 to 0.46) using probit regression analysis. In conclusion, MLAC of chloroprocaine was 0.42%w/v in these parturients, equivalent to 14 millimolar solution. This study confirmed that concentration rather than dose could be used as a measure of efficacy in this constant dose model.

Journal Article↗
PubMed1996

Latent labor with an unknown uterine scar.

OBJECTIVE: To determine if avoiding the augmentation of ineffective contractions in women with unknown uterine scars would decrease the risk of cesarean for protraction disorders, compared with awaiting the onset of spontaneous labor. METHODS: Term gravidas with one or two unknown uterine scars in early labor were randomized to nonintervention (N = 101) and intervention (N = 96) groups. Nonintervention subjects were discharged if cervical change did not occur within 4 hours. Intervention subjects were admitted. Contractions that persisted for 4 hours without cervical change were augmented with oxytocin. RESULTS: Intervention subjects received oxytocin significantly more often (82 versus 55%, P < .001) and had a statistically significantly higher rate of uterine scar separation (5 versus 0%, P = .03). There was no difference between the two groups in length of active labor (4.0 versus 4.25 hours) or incidence of cesarean delivery (16 versus 17%). CONCLUSION: The augmentation of ineffective contractions during latent labor in gravidas with an unknown uterine scar does not increase the rate of cesarean delivery, but it is significantly more likely to result in uterine scar separations.

Adult↗
PubMed2004

Prediction of labor in term and preterm pregnancies using non-invasive magnetomyographic recordings of uterine contractions.

OBJECTIVE: The purpose of this study was to characterize the noninvasive magnetic field recordings of the uterine electrophysiological activity in patients reporting onset of uterine contractions. STUDY DESIGN: Transabdominal magnetomyographic (MMG) recordings were performed with the use of the SARA system's 151 primary magnetic sensors (CTF Systems Inc, Coquitlam, British Columbia, Canada). Eleven term and 4 preterm patients participated in the study. On all patients, cervical dilation and outcomes were recorded. RESULTS: Of 8 patients having a peak MMG activity exceeding 8 pT (pico Tesla), all but 1 delivered within 48 hours of our recordings. Of the 7 patients with peak activity below 8 pT, 5 failed to deliver within 48 hours of the recordings. This observation reflects an increase in the electrophysiologic activity of the myometrium as labor progresses. CONCLUSION: MMG evaluation provides a new noninvasive method for the prediction of labor. Further studies are in progress to determine the temporal relationship of MMG changes with the onset of labor.

Adult↗
PubMed2001

[Maternal serum cytokines in labor, pregnancy and chorioamnionitis].

UNLABELLED: The purpose of our study was to compare maternal serum levels of interleukin-6, interleukin-8, tumor necrosis factor-alpha and interferon-gamma in gravidities, during spontaneous term and preterm labor and their relation to histologic chorioamnionitis. METHODS: We investigated 61 women: 10 in preterm labor, 36 in term labor and 15 healthy pregnant nonlabouring controls. Venous bloods for cytokines determinations were obtained during the first stage of labor and during routine screening tests. Titers of cytokines were measured by means of ELISA technique. All births after preterm deliveries were examined to establish histologic chorioamnionitis. RESULTS: Serum levels of IL-6 and IL-8 were significantly elevated both in term (mean: IL-6: 17.5 +/- 58 pg/ml; IL-8: 148 +/- 215 pg/ml) and preterm labor (IL-6: 23 +/- 44 pg/ml; IL-8: 332 +/- 389 pg/ml) when compared to nonlabouring gravidities (IL-6: 5 +/- 7 pg/ml; IL-8: 14 +/- 11 pg/ml). IL-6 and IL-8 titers were statistically similar in term and preterm labors and in patients with and without histologic chorioamnionitis. TNF-alpha and IFN-gamma were not statistically analyzed because only a few patients had detectable serum levels of these cytokines. CONCLUSION: Serum levels of IL-6 and IL-8 in both: term and preterm labor are elevated in comparison to nonlabouring gravidities. The elevated levels of these cytokines are not connected with coexisting chorioamnionitis.

Adult↗
PubMed2002

[Evaluation of fetal oxygen saturation (FSpO2) during the course of underwater labor].

During controlled, randomized prospective trials, fetal arterial hemoglobin saturation (FSpO2) was estimated during 25 underwater labors and compared to results obtained from 34 classical deliveries. Mean fetal hemoglobin saturation during the first stage of labor was similar in both groups while a gradual decreasing trend in fetal FSpO2 was noticed throughout the progress of labor. In the second stage of labor higher mean FSpO2 values were observed in the group of fetuses born underwater. The author emphasized in discussion that underwater labor constitutes delicate and mild procedure particularly for the fetus.

Delivery, Obstetric↗
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↗
PubMed1994

Intrathecal sufentanil compared to epidural bupivacaine for labor analgesia.

BACKGROUND: Although intrathecal sufentanil has been reported to provide rapid-onset, complete analgesia lasting 1-3 h for the first stage of labor, no well-controlled double-blind study has compared this technique to the use of epidurally administered local anesthetics. METHODS: Fifty healthy parturient women requesting labor analgesia were studied. In a combined spinal-epidural technique, a spinal needle was inserted through the epidural needle before insertion of the epidural catheter. Patients were randomly assigned to receive either intrathecal sufentanil (10 micrograms) and epidural saline, or intrathecal saline and epidural bupivacaine (30 mg). Visual analog scores for pain, blood pressure, heart rate, sensory levels, and the incidence of nausea, pruritus, and motor blockade were recorded. RESULTS: Patients receiving intrathecal sufentanil had significantly lower visual analog pain scores at 5, 15, and 30 min after injection and a greater duration of analgesia before requesting additional medication (mean 123 vs. 68 min for those receiving bupivacaine; P < 0.05). These patients also experienced pruritus more frequently but motor blockade less frequently than patients receiving epidural bupivacaine. The groups exhibited dermatomal sensory deficits to pin prick as well as bradycardia and hypotension with equal frequency. The length of labor and type of delivery were similar between the groups. No patient experienced a post-dural puncture headache. CONCLUSIONS: The rapid onset of analgesia and lack of motor blockade from intrathecal sufentanil injection may be advantageous in certain clinical situations. With this technique, however, pruritus is common; hypotension may occur; and extensive dermatomal spread suggests that early-onset respiratory depression could occur. Therefore, blood pressure and respiratory adequacy should be monitored if intrathecal sufentanil is used.

Adult↗
PubMed1998

What's new with intrathecal narcotics for labor analgesia.

The profound analgesic properties of intrathecal narcotics without motor blockade make them an excellent choice for pain relief during the first stage of labor. Recent studies have attempted to define more clearly the pharmacology of commonly used agents. In this review we shall outline some of these advances and discuss their impact on labor.

Journal Article↗
PubMed2002

Plasma oxytocin levels in women during labor with or without epidural analgesia: a prospective study.

BACKGROUND: Epidural analgesia (EDA) has been reported to prolong labor. Whether this is by interference with endogenous oxytocin release or other mechanisms is unclear. With increasing numbers of women receiving an EDA, it is important to study its effects on labor. The aim was to study the concentration of plasma oxytocin and the progress of labor in women with and without EDA. METHODS: Thirty-four full-term women in spontaneous labor were included, 17 with epidural and 17 controls, matched for cervical dilatation and parity. Oxytocin was measured by radioimmunoassay before analgesia, 60 min later and after placental discharge. No oxytocin augmentation was given during the first hour. RESULTS: EDA during labor was associated with a fall in plasma oxytocin. There was no difference in plasma oxytocin levels between the groups at inclusion. One hour later, oxytocin concentrations had decreased in the epidural and increased in the control group (Student's t-test, p = 0049). The change in oxytocin levels between the first and second sample differed significantly between the groups (ancova, p = 0.028). No difference in cervix dilatation between the groups 1 h after inclusion was noted, but women with EDA had a longer labor compared with those without, especially those with epidural and oxytocin augmentation during the later phase of the first stage of labor. CONCLUSION: EDA during labor may interfere with the release of plasma oxytocin, which may be one mechanism behind prolongation of labor. Larger studies are needed to clarify the effects of epidural analgesia and the role of oxytocin during labor.

Adult↗
PubMed1992

Warm tub bath after spontaneous rupture of the membranes.

Increasing numbers of pregnant women take a warm bath during labor. Yet few evaluations have addressed benefits claimed and possible risks of this practice. Using retrospective data from a continuing trial at a birth center in Stockholm, we compared 89 women who took a warm bath after spontaneous rupture of the membranes at term with 89 women who had the same interval from spontaneous membrane rupture to delivery and who did not bathe. No statistical difference was observed between the groups with respect to infections, asphyxia or respiratory problems in the newborn infant, or maternal signs of amnionitis. However, a tendency toward more complications was observed in the bathing group. Babies born more than 24 hours after rupture of membranes had significantly lower Apgar scores at 5 minutes in the bathing group than in the control group. As a result of our review of the sparse literature on this practice and the data from this study, we have modified the bathing policy at the birth center from a rather enthusiastic to a more cautious approach. Recommendations about the use of a warm bath in labor will require further investigation, such as randomized trials with large numbers of subjects.

Apgar Score↗
PubMedDate not supplied

Phasic maternal prolactin secretion during spontaneous labor is associated with cervical dilatation and second-stage uterine activity.

OBJECTIVE: In this study, we attempted to determine the physiologic roles of prolactin (PRL) and hCG during labor. METHODS: Serial blood samples were collected from 19 women (15 multiparous and four nulliparous) before, during, and after labor; assayed for PRL and hCG; and compared with cervical dilatation and uterine contraction frequency. RESULTS: Prolactin levels decreased in association with progressive cervical dilatation during the first stage of labor and reached a nadir at full dilatation. Thereafter, PRL increased rapidly during the second stage of labor and peaked within 1 hour postpartum. Uterine contraction frequency also increased during the second stage and correlated significantly (r2 = 0.60; P = .0006) with levels of PRL. Levels of hCG increased during labor and peaked at about the time of delivery. CONCLUSION: These data suggest that phasic PRL secretion is associated with cervical dilatation and that after transition to the second stage of labor, uterine contraction frequency may be associated with the increase in PRL levels.

Cervix Uteri↗
PubMed1983

Epicutaneous application of A2358 compresses containing ketocaine for pain relief in labor. A multicenter double-blind trial.

In the present multicenter trial 147 primigravidae were treated for low-back pain during the first stage of labor. 72 parturients were treated with A2358 compresses containing ketocaine, which were applied to the sacral lower-back region for one hour, 75 parturients were treated identically with compresses without the anesthetic drug. The pain relieving effect was almost the same in both treatment groups. The low-back pain was alleviated in about half of the mothers at 0.5, 10 and 1.5 hours after the application of both A2358 or control compresses. Supplementary analgesics had to be administered in about 60% of the parturients in both groups. The results show that factors other than ketocaine are involved in pain relief after application of A2358 compresses.

Adult↗
PubMed2002

Risk factors at caesarean section and failure of subsequent trial of labour.

OBJECTIVE: To identify risk factors at caesarean section (CS), related to failure of a trial of labour (TOL) in subsequent pregnancy. STUDY DESIGN: Hospital records (1988-1999) of the index pregnancy were reviewed at caesarean delivery for oxytocine use, indication for caesarean, dilatation of cervix, speed of dilatation, duration of contractions and birth weight. The records of the subsequent pregnancy were reviewed for successful vaginal birth after caesarean (VBAC), maternal and neonatal outcome. Data were tested for statistical significance with a Mantel-Haenszel equation for odds ratios (OR, with 95% confidence interval (CI)), a Fisher exact test or a Student's 't'-test. RESULTS: From 214 women with a previous caesarean section, 68.7% underwent a TOL, which was successful in 71.4%. A labour pattern during the index pregnancy characterised by oxytocine use (OR=3.1; 95% CI=1.4-7.1), contractions for more than 12h (OR=3.0; 95% CI=1.3-7.0) and cervical dilatation less than 1cm/h (OR=5.6; 95% CI=1.1-39.4) increased the risk of a failed TOL at subsequent labour significantly. CONCLUSION: Women who attempt VBAC may be informed that a labour pattern of their index pregnancy characterised by oxytocine use, contractions for more than 12h and slow dilatation is associated with a reduced chance of success. A partograph obtained during first labour can be a managerial tool for subsequent labour.

Adult↗
PubMed1995

Obstructed labor and shoulder dystocia.

Dystocia of labor has become one of the leading indications for operative delivery during the past few years. Dystocia of the first stage of labor complicates 8-11% of all vertex delivery, and in the second stage of delivery it is at least as common. Dystocia may result in part from three factors: uterine activity, the fetus, and the pelvis. In each case of abnormal labor, assessment should be made according to those criteria. Shoulder dystocia is an infrequent, unanticipated, and unpredictable nightmare for the obstetrician. Although it is difficult to predict shoulder dystocia, effort should be made to prevent it. Tight glucose control in the management of diabetic patients will reduce the incidence of macrosomic fetuses. Cesarean section should be considered for diabetic women carrying fetuses with estimated fetal weight of greater than 4250g and for non-diabetic women carrying fetuses with estimated fetal weight of greater than 4500g. In all cases good clinical judgement can reduce the rate of shoulder dystocia. However, in some cases it remains a problem for the obstetrician and because it occurs so rarely, the care provider may have limited skills to manage this condition.

Dystocia↗
PubMed2002

Stress during labor and delivery is associated with delayed onset of lactation among urban Guatemalan women.

A delayed onset of lactation (OL) is likely to have a negative influence on breast-feeding outcomes. Thus, it is important to identify risk factors for delayed OL. We examined prospectively the association between stress during labor and delivery and OL in a cohort of urban Guatemalan women. Healthy women (n = 136) were recruited during the first stage of labor in the labor unit of a social security hospital in Guatemala City. Women provided salivary samples for cortisol determinations 3.2 +/- 3.2 h before birth and 1.7 +/- 1.9 h and 17.1 +/- 4.7 h after delivery. At the same time points women were asked to respond to a 17-item psychosocial stress and anxiety questionnaire. Women were called daily until OL occurred. Primiparous women had higher antepartum and early postpartum cortisol levels that were twice as high as those among multiparous women (P < 0.05). The parity differential in salivary cortisol concentrations vanished with time. General linear model multivariate analysis indicate that multiparous women (n = 77), irrespective of mode of delivery, had an earlier OL (P < 0.05) than primiparae who underwent emergency cesarean section deliveries (n = 11) (adjusted mean +/- SEM, 2.5 +/- 0.1 vs. 3.4 +/- 0.3 d postpartum, respectively). OL took longer to occur among multiparous women with prenatal salivary cortisol levels above (vs. below) the 40th percentile [3 +/- 0.2 (n = 28) vs. 2.4 +/- 0.2 d postpartum (n = 38), respectively; P = 0.02]. Thus, stress during labor and/or delivery is likely to be a significant risk factor for delayed OL in urban Guatemala.

Adult↗