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PubMedDate not supplied

Raspberry leaf in pregnancy: its safety and efficacy in labor.

OBJECTIVE: Many women consume the raspberry leaf herb during their pregnancies in the belief that it shortens labor and makes labor "easier." METHODOLOGY: Because of the paucity of research regarding this herb, particularly in relation to pregnancy and birth, the authors undertook a double-blind, randomized, placebo-controlled trial. The sample consisted of 192 low-risk, nulliparous women who birthed their babies between May 1999 and February 2000 at a large tertiary-level hospital in Sydney, Australia. The aim of the study was to identify the effect and safety of raspberry leaf tablets (2 x 1.2 g per day), consumed from 32 weeks' gestation until labor, on labor and birth outcomes. RESULTS: Raspberry leaf, consumed in tablet form, was found to cause no adverse effects for mother or baby, but contrary to popular belief, did not shorten the first stage of labor. The only clinically significant findings were a shortening of the second stage of labor (mean difference = 9.59 minutes) and a lower rate of forceps deliveries between the treatment group and the control group (19.3% vs. 30.4%). No significant relationship was found between tablet consumption and birth outcomes. CONCLUSION: The lack of significant differences between the groups on measures expected to demonstrate the effect of raspberry leaf ingestion during pregnancy on labor prompted consideration of the issue of effectiveness of dosage level. Suggestions for further research are offered.

Double-Blind Method↗
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↗
PubMed1977

Prostaglandin F2alpha and E1 in plasma and amniotic fluid during human pregnancy and labor.

In order to elucidate the significance of PGs in human labor, PGE1 and F2alpha in biological fluid during human pregnancy and labor were measured by RIA newly developed. Analytical studies demonstrated that the levels of PGF2alpha in maternal plasma were 3.7 +/- 2.5 ng/ml a few days before parturition, 2.0 +/- 0.9 ng/ml in the first stage of labor and 1.9 +/- 1.4 ng/ml at delivery. Thus the concentrations of PGF2alpha in maternal plasma showed no significant changes around parturition. On the otherhand, the level of PGF2alpha in amniotic fluid represented a significant increase up to 44.27 +/- 32.81 ng/ml at delivery from 1.45 +/- 0.76 ng/ml before labor at 38-40 weeks of pregnancy (p less than 0.05), although it was uncertain whether this elevation was the cause or effect of uterine contraction. The concentration of PGE1 ranged from 2 to 14 ng/ml around parturition. This indicates that there was little remarkable difference between the levels of PGE1 in plasma and amniotic fluid during the last month of pregnancy and labor. Possible involvement of prostaglandins (PGs) in human labor has been discussed.

Amniotic Fluid↗
PubMed1989

Analgesia and anesthesia during labor in Japan and developed countries.

Analgesia and anesthesia during labor were surveyed by the use of a questionnaire sent to university hospitals in USA, UK, France, FRG, GDR, Japan, and also other types of institutions in Japan. A rather negative attitude toward analgesia and anesthesia during labor was encountered less often in Japan than in USA, UK, and FRG, but the actual frequency of use was much less in Japan. Narcotics and/or tranquilizers were most frequently used in the first stage of labor. The only exception was France where lumbar epidural anesthesia was actually used as a method of choice at 70% of the institutions. Lumbar epidural anesthesia or some other regional block was the method of choice in the second stage except in UK where inhalation of nitrous oxide was the method of choice at 48% of the institutions. Augmentation of labor was much more frequent and the number of annual deliveries were much less in Japan. Higher C-section rate was seen in USA.

Analgesia↗
PubMed2002

[Paravertebral block for labor analgesia in a parturient with idiopathic thrombocytopenia].

A parturient with idiopathic thrombocytopenia received labor analgesia with bilateral paravertebral blocks, because epidural analgesia was contraindicated due to her low platelet count (69,000.microliter-1) even after intravenous administration of freeze-dried sulfonated human normal globulin (400 mg.kg-1.day-1) and transfusion of platelet (20 units.day-1). In spite of predonisolone (1 mg.kg-1.day-1) p.o., her platelet counts could not increase at early gestation period. Prior to the induction of the labor, two catheters were inserted into T 11 bilateral paravertebral spaces, then 0.2% ropivacaine 10 ml was administered in each side, followed by the infusion at 5 ml.hr-1 each for the management of first stage of labor pain. Labor was induced with oxytocin infusion at 2.5-5.0 mU.min-1. As she requested additional analgesia in the second stage of labor, fentanyl 50 micrograms was administered twice intravenously. The labor course was uneventful with adequate analgesia, and the neonate (2,826 g) was vigorous with Apgar scores 9/10. Complications associated with this block such as hypotension, vascular or pleural punctures and pneumothorax were not seen. Bilateral paravertebral blocks may provide adequate analgesia as an alternative method for labor analgesia in a parturient with thrombocytopenia when conventional epidural analgesia is contraindicated.

Adult↗
PubMed1984

Submucous paracervical blockade compared with intramuscular meperidine as analgesia during labor: a double-blind study.

A double-blind study was carried out to compare the effect of submucous paracervical blockade using 12 mL 0.25% bupivacaine (55 women) to the effect of intramuscular injection of 75 mg meperidine (62 women) during the first stage of labor. All 117 were normal primiparous pregnancies. Seventy-eight percent of the women in the paracervical blockade group achieved full or acceptable pain relief against 31% in the meperidine group (P less than .01). Transient fetal bradycardia occurred in two cases in the paracervical blockade group and one in the meperidine group; all infants were born in good condition. Fetal distress, defined as an umbilical artery pH of 7.15 or less and/or a one-minute Apgar score of 7 or less was more frequent in the meperidine group (16 infants) than in the paracervical blockade group (six infants) (P less than .05). Submucous paracervical blockade is superior to intramuscular meperidine as pain relief during labor. Furthermore, meperidine results in more infants with asphyxia as compared with paracervical blockade.

Anesthesia, Obstetrical↗
PubMed1989

Plasma prolactin concentrations in mares and their neonates after oxytocin induction of parturition.

Studies were undertaken to investigate the effects of oxytocin induction on prolactin release in term (Group II) and preterm (Group III) mares and to compare these effects to spontaneously foaling mares (Group I). Since physiological concentrations of prolactin in blood have not been measured in the neonatal foal, experiments were designed to monitor prolactin in the cord artery and jugular blood of the foals from all groups of mares. Although prolactin levels varied in term mares (Group I and II) during the last 11 days of pregnancy, an increase was observed between Day -6 and Day 0 (2.7 and 11.9 ng/ml respectively; P less than 0.1). The average concentration of prolactin over the last 4 days (Days -3 to 0) had increased by 40% when compared to the average concentration on Days -6, -5, and -4. These findings indicate a rising trend which appears to occur concomitantly with changes in concentrations of 2 mammary components tested, sodium and potassium. Prolactin concentrations did not significantly increase in term mares after oxytocin treatment or in spontaneously foaling mares. However, the preterm induced mares had higher prolactin concentrations during the first stage of labor (19.3 +/- 7.2 ng/ml) than prior to treatment with oxytocin (4.7 +/- 2.0 ng/ml; P less than 0.01). Levels of prolactin in all groups significantly declined by 20-min post-placental expulsion. For the first 30 min after birth, prolactin concentrations in foals from oxytocin-induced mares appeared to be 2-fold higher than those from spontaneously foaling mares. Thereafter, prolactin values declined to baseline values by 48 hrs. When comparing cord arterial plasma with cord venous plasma in each group, prolactin concentrations were similar. However, the average prolactin levels in both the cord artery and vein appeared higher (ave: 1.1 ng/ml) in Group II and III than in Group I (less than 0.5 ng/ml). From these results, the authors suggest that 1) prolactin may have a role in regulating mammary secretory products in mares just prior to parturition; 2) oxytocin may increase prolactin secretion in preterm induced mares; 3) oxytocin induction may have a short term effect to increase circulatory prolactin concentrations in neonates in utero regardless whether their dams were treated preterm or term.

Animals↗
PubMed2005

Labor progression and risk of cesarean delivery in electively induced nulliparas.

OBJECTIVE: To describe the pattern of labor progression and risk of cesarean delivery in women whose labor was electively induced. METHODS: We analyzed data on all low-risk, nulliparous women with an elective induction or spontaneous onset of labor between 37 + 0 and 40 + 6 weeks from January 2002 to March 2004 at a single institution. The median duration of labor by each centimeter of cervical dilation and the risk of cesarean delivery were computed for 143 women with preinduction cervical ripening and oxytocin induction, 286 women with oxytocin induction, and 1,771 women with a spontaneous onset of labor. An intracervical Foley catheter was used to ripen the cervix. RESULTS: Electively induced labor with cervical ripening had substantially slower latent and early active phases. After controlling for potential confounders, women who had an elective induction with cervical ripening had 3.5 times the risk of cesarean delivery during the first stage of labor (95% confidence interval 2.7-4.5), compared with those admitted in spontaneous labor. Elective induction without cervical ripening, on the other hand, was associated with a faster labor progression from 4 to 10 cm (266 compared with 358 minutes, P < .01) and did not increase the risk of cesarean delivery, compared with those in spontaneous labor. CONCLUSION: The pattern of labor progression differs substantially for women with an electively induced labor compared with those with spontaneous onset of labor. Furthermore, elective induction in nulliparous women with an unfavorable cervix has a high rate of labor arrest and a substantially increased risk of cesarean delivery. LEVEL OF EVIDENCE: II-2.

Adult↗
PubMed2005

Lesotho midwives' utilization of non-pharmacological pain management methods during the first of stage labour.

The purpose of this study was to determine the use of non-pharmacologic methods of pain management used by midwives in Lesotho. The research design was non-experimental and of a descriptive nature. The data was obtained by means of a structured questionnaire which was compiled after a thorough literature analysis was done. Midwives, working in the Maternity wards of the Christian Hospital Association of Lesotho as well as the government Hospitals completed the questionnaires. All data was analysed on a nominal descriptive level. According to the results, the midwives indicated that they were taught non-pharmacologic methods of pain management, however they expressed that they inadequately use these methods during the first stage of labour due to shortage of staff, lack of privacy and space, a high midwife-mother ratio, culture and hospital policies. In the light of these findings, recommendations were made of maximizing the use of non-pharmacologic methods during the first stage of labour.

Adaptation, Psychological↗
PubMed1983

Fetomaternal opioid levels and parturition.

The present study evaluates the plasma level changes in beta-lipotropin and beta-endorphin in nine women at term throughout spontaneous labor, in ten pregnant women undergoing elective cesarean section in the absence of uterine contractions, and in ten women submitted to emergency cesarean section because of fetal distress occurring during labor. A basal plasma sample was taken before labor in the 39th week of pregnancy. Two subsequent samples were then obtained before and after parturition, together with umbilical cord samples at birth. beta-lipotropin and beta-endorphin were measured by radioimmunoassay after silicic acid plasma extraction and gel filtration. In cases of spontaneous labor, there was a progressive increase in opioid concentrations as labor progressed, the maximal values being observed after delivery. Cord values were similar to those observed in the mother, without showing any relationship to them. Pregnant women undergoing cesarean section in the absence of labor show constant beta-lipotropin and beta-endorphin concentrations both before and after fetal extraction, both values being significantly lower than those found at delivery after spontaneous labor. beta-Endorphin neonatal levels were significantly higher than in the respective mothers and were in the same range as those of infants born through vaginal delivery. In the third group (cesarean section performed at the first stage of labor), presurgical opioid levels were higher than in women at the same stage of spontaneous labor, whereas postextraction values showed a wide range, with mean values similar to those observed after spontaneous delivery.(ABSTRACT TRUNCATED AT 250 WORDS)

Apgar Score↗
PubMed1978

Hypotension after lumbar epidural analgesia.

Despite preloading with fluid, a fall in the mean arterial pressure was recorded in 66% of patients after standard epidural analgesia. In 83% of patients in whom blood pressure fell, hypotension was classified as moderate or severe. In cases of severe hypotension the dermatome level of the block always surpassed T9. The maximal fall in blood pressure always occurred within the first 25 minutes after administration of the local anaesthetic agent.

Anesthesia, Epidural↗
PubMedDate not supplied

Tissue polypeptide specific antigen and soluble Fas during normal pregnancy and early life.

BACKGROUND: Intrauterine fetal development is characterized by increased rates of proliferation and apoptosis, while both these processes may be attenuated post-natally. AIM: Tissue polypeptide specific antigen and sFas serum concentrations were determined during pregnancy and post-natally, in order to evaluate their alterations during these crucial periods. MATERIALS AND METHODS: Forty-seven healthy pregnant women, their full-term newborns and 35 healthy adults (controls) were included in the study. Markers were measured: (a) in maternal serum (MS), during the 1st, 2nd, 3rd trimester and at the 1st stage of labor; (b) in the umbilical cord (UC), during the 2nd stage of labor; (c) in neonatal serum in the 1st (IN) and 5th (5N) day after birth; and (d) in controls. RESULTS: The serum TPS concentrations in MS increased significantly with gestational age, being higher in the 3rd trimester and labor, than those in controls (p < 0.001). TPS values were significantly lower in the UC, compared to those in MS (p < 0.001), while they were markedly elevated in IN, compared to MS and UC (p < 0.001), and subsequently decreased in 5N (p < 0.001), remaining higher, than those in the controls (p < 0.001). Serum sFas concentrations in the MS depended significantly on gestational age (p < 0.001), being significantly lower in the first trimester, than those in the second (p < 0.003), the third (p < 0.03), in labor and controls (p < 0.005). sFas concentrations in the UC were significantly lower than in MS and controls (p < 0.001), while they increased significantly in 5N samples (p < 0.01). CONCLUSION: Our results demonstrate: (a) a higher apoptosis rate in the first trimester of pregnancy, possibly affecting maternal immuno-tolerance, followed by a down-regulation during the post-natal period; (b) a progressively increased proliferation from the first trimester to parturition, reflecting the fetal and placental growth and development, that seems to be thereafter moderated.

Adult↗
PubMed1985

Effect of Lamaze childbirth preparation on maternal plasma beta-endorphin immunoreactivity in active labor.

Previous studies have documented a reduction in plasma beta-endorphin levels with the use of various analgesic techniques in labor, such as segmental epidural anesthesia or intrathecal morphine. The Lamaze method of childbirth preparation, which has been found to reduce the need for medication during childbirth and to decrease the subjective perception of pain during labor and delivery, has not been studied in this regard. In this study plasma beta-endorphin immunoreactivity levels were measured during the active phase of labor in 26 patients who had Lamaze classes and in 28 patients who did not have Lamaze classes. The Lamaze group had significantly lower plasma beta-endorphin immunoreactivity (37.2 vs. 68.5 pg/ml; P less than 0.001) and significantly shorter first stages of labor (8.28 hrs. vs. 9.86 hrs; P less than 0.02). It can be theorized that both lower beta-endorphin immunoreactivity and shorter labor in patients in the Lamaze group were related to the reduction of fear, tension, and the emotional stress of labor.

Adult↗
PubMed1995

Oral misoprostol versus placebo for cervical dilatation before vacuum aspiration in first trimester pregnancy.

Intravaginal misoprostol has been shown to be effective for cervical priming before a surgically induced abortion. The objective was to investigate the effectiveness of oral misoprostol in cervical dilatation prior to vacuum aspiration between the 6th and 12th weeks of pregnancy. The results showed that in nulliparous patients, the median cervical dilatation in the treatment group (7.8 mm) was significantly greater than that in the placebo group (3.7 mm). In multiparous patients, the difference was also statistically significant (9.8 versus 6.0 mm). The ease of dilatation, assessed subjectively by the operating surgeons, was significantly improved in the treatment group. There was also a significant reduction in the duration of the operation and in the mean blood loss in the treatment group. The side-effects encountered in the treatment group were mild and well accepted by the women. Oral misoprostol is an effective and safe method for cervical dilatation prior to vacuum aspiration in first trimester pregnancy.

Abortion, Induced↗
PubMed1992

The effect of morphine and naloxone administration on plasma oxytocin concentrations in the first stage of labour.

OBJECTIVE: We investigated the effect of an opiate (morphine) and an opiate antagonist (naloxone) on the maternal secretion of oxytocin in the first stage of labour. DESIGN: Patients were randomized to receive either morphine 5 mg (n = 9), naloxone 1.2 mg (n = 10) or sterile water (n = 9) which was injected intravenously. PATIENTS: Healthy women in the first stage of labour between 3 and 6 cm dilated with no prior analgesia or oxytocin administration were recruited for the study. MEASUREMENTS: Peripheral maternal oxytocin levels were measured by radioimmunoassay for 15 minutes before and 15 minutes after administration of the assigned substance. Sampling was at 2.5 minute intervals. RESULTS: Significant reduction in the mean oxytocin concentration was found in the patients who received morphine (-2.62 pmol/l/sample) but no change was found in the naloxone group (+0.57 pmol/l/sample) when compared with controls (+0.64 pmol/l/sample). CONCLUSION: Maternal oxytocin secretion is inhibited by exogenous opiates in the first stage of labour while an effect of opiate antagonism was not demonstrated.

Adult↗
PubMed1996

Transcutaneous nerve stimulation (TENS) during the first stage of labour: a randomized clinical trial.

Our objective was to study the efficacy of transcutaneous electrical nerve stimulation (TENS) in reducing pain during the first stage of labour. Using a prospective randomized placebo-controlled, double blind clinical trial, a patient-controlled analgesia system was used to measure differences in outcome. Trials took place in a labour unit at the St. Antonius Hospital, Nieuwegein, The Netherlands, during a period of 18 months. Forty-six patients, during the first stage of labour, were treated with TENS, and 48 with a placebo apparatus. Main outcome measures were pain relief, amount of administered analgesics, obstetrical and neonatal outcome, and side effects. No significant differences occurred between groups in the number of requests for pethidine/promethazine. The foetal outcome in both groups was the same. TENS and placebo were considered equally effective by both patients and staff. In conclusion, TENS was not more effective than a placebo apparatus in relieving pain during the first stage of labour. No adverse side-effects occurred.

Adult↗
PubMed1999

Comparison of vaginal misoprostol and gemeprost as pre-treatment in first trimester pregnancy interruption.

OBJECTIVE: To compare the effectiveness of vaginal misoprostol pre-treatment with standard gemeprost pre-treatment in first trimester pregnancy termination. DESIGN: A prospective randomised study. POPULATION: One hundred and ninety-nine women scheduled for day case termination of pregnancy during the first trimester. METHODS: Cervical priming with a vaginally applied 200 microg tablet of misoprostol for at least four hours, compared with a 1.0 mg vaginal suppository of gemeprost for at least three hours before vacuum aspiration. MAIN OUTCOME MEASURES: The prostaglandin effect on baseline cervical dilatation was the main outcome. Others were occurrence of pre-operative pain and need for analgesia, pre-operative side effects such as nausea, vomiting and diarrhoea, presence of blood in the vagina and blood loss during the operation. RESULTS: There was no significant difference in the dilatation ability of misoprostol or gemeprost, nor in the pre-operative use of analgesics. The frequency of nausea and diarrhoea was significantly less common in the misoprostol treated women. CONCLUSIONS: Vaginally applied misoprostol is as effective as gemeprost in cervical priming prior to first trimester vacuum aspiration. Misoprostol was associated with fewer side effects than gemeprost.

Abortifacient Agents, Nonsteroidal↗