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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↗
PubMed1982

The monitoring of labor by telemetry.

Telemetry and conventional cardiotocography were compared by monitoring the labor of 60 patients with an uneventful pregnancy and delivery in the 38th-42nd week of pregnancy. 31 patients were monitored by telemetry and 29 by cardiotocography. The patients were matched for age (+/- 5 years), duration of pregnancy (+/- 7 days) and parity (I or II). The husband attended labor and delivery in 42% of the cases in the telemetry group and in 59% of the cases in the control group. Induction of labor by amniotomy was performed in 32% of the cases in the telemetry group and in 24% of the cases in the cardiotocography group. The patients monitored subjective pain every half hour during the opening phase. The telemetric patients were encouraged to sit or walk during the first stage. No maternal or fetal complications occurred. All infants were born in good condition with APGAR scores greater than or equal to 7 recorded at one and five minutes. There were 4 operative deliveries in the telemetry group and 5 in the control group. Indications for these were maternal or uterine exhaustion with the exception of two control patients where fetal asphyxia was suspected. The duration of the first stage of labor did not differ significantly between the telemetry and the cardiotocography groups. The telemetric patients received less analgesics than the controls but this difference was not significant. In spite of less analgesia in the telemetry group, the secondparas of the telemetry group experienced significantly less (p less than 0.01) labor pain than the controls. In addition, the secondparas of the telemetry group considered the present labor less painful than the previous one significantly more often than the controls. Among the primiparous patients there was no difference in the amount of pain experienced by the patients.

Adult↗
PubMed2000

Association of stress during delivery with increased numbers of nucleated cells and hematopoietic progenitor cells in umbilical cord blood.

OBJECTIVE: Umbilical cord blood can be used as a source of bone marrow repopulating cells for allogeneic stem cell transplantation. Large variations in the frequencies of white blood cells and hematopoietic progenitor cells have been found for umbilical cord blood. These variations may be due in part to specific circumstances during labor and delivery. STUDY DESIGN: In this study we analyzed the relationship between stress factors occurring during parturition and the frequencies of nucleated cells, leukocyte subsets, CD34(+) cells, and hematopoietic progenitor cells, as determined in semisolid medium cultures of umbilical cord blood. RESULTS: We observed that a prolonged first stage of labor resulted in increases in the numbers of nucleated cells, granulocytes, CD34(+) cells, and hematopoietic progenitor cells in umbilical cord blood. Evaluation of parameters that indicate stress of the infant during delivery demonstrated higher numbers of nucleated cells, granulocytes, CD34(+) cells, and hematopoietic progenitor cells in umbilical cord blood from children with lower venous pH. CONCLUSION: Longer duration stress during delivery increased the numbers of nucleated cells, granulocytes, CD34(+) cells, and hematopoietic progenitor cells, possibly by causing mobilization of various cell populations by endogenous cytokines. As long as umbilical cord blood harvesting does not interfere with the delivery, umbilical cord blood collected after stressful deliveries may provide optimal units for hematopoietic stem cell transplantation.

Antigens, CD34↗
PubMed1996

Extradural analgesia with clonidine and fentanyl compared with 0.25% bupivacaine in the first stage of labour.

Conventional extradural analgesia during labour with 0.25-0.375% bupivacaine may induce motor weakness and subjective sensory deficit, reducing maternal satisfaction. Even in a regimen for ambulatory extradural analgesia (0.1% bupivacaine-fentanyl 2 micrograms ml-1), a potential for proprioreception impairment exists, which may impair safe ambulation. We have combined fentanyl with clonidine for extradural analgesia in labour, and compared its effects with 0.25% bupivacaine, in a randomized, double-blind study. We studied 28 women requesting extradural analgesia for labour; they were allocated randomly to either group 1, who received clonidine 120 micrograms with fentanyl 50 micrograms, or group 2, who received bupivacaine 25 mg. Detailed clinical neurological examination was undertaken 30 min later. Pain was assessed subjectively using a 10-cm visual analogue scale (VAS). There were no significant differences in VAS between the groups at any time. Median onset of analgesia was longer in group 1 (24.3 (interquartile range 20-35) compared with 17.5 (15-25) min) (P < 0.05) and 79% of group 1 vs 86% of group 2 patients reported a high degree of satisfaction with extradural analgesia. Patients in group 2 had a much higher incidence of motor weakness (P < 0.01), impaired perception of pinprick (P < 0.01) and impaired distal joint proprioception (P < 0.05) than group 1. We conclude that clonidine 120 micrograms-fentanyl 50 micrograms provided comparable extradural analgesic efficacy as 0.25% bupivacaine for the first stage of labour. Furthermore, unwanted neurological effects were significantly less.

Adolescent↗
PubMed1998

A comparative study using two dose regimens (200 microg or 400 microg) of vaginal misoprostol for pre-operative cervical dilatation in first trimester nulliparae.

OBJECTIVE: To determine the optimal dosage and dosing interval for the use of misoprostol administered vaginally for pre-operative cervical dilatation. DESIGN: Prospective double-blind randomised study. SETTING: Fertility Control Centre, National University Hospital, Singapore. METHODS: Women were randomly allocated to either the 200 microg or the 400 microg misoprostol group. Vacuum aspiration was performed at either three or four hours after the insertion of misoprostol tablets. Using Hegar's dilatator, degree of cervical dilatation before operation was measured. Other parameters assessed included the amount of additional dilatation required (if it was < Hegar 8), pre-operative and intra-operative blood loss, and associated side effects. RESULTS: For the 200 microg misoprostol group, only seven (23.3%) achieved a dilatation of > or = 8 mm compared with 29 women (96.7%) in the 400 microg misoprostol group. The odds ratio was 95.3 (95% CI 10.9-830.9) for 400 microg misoprostol for successful pre-operative cervical dilatation of > or = 8 mm. The mean cervical dilatation for 400 microg and 200 microg misoprostol was 8.2 mm and 6.4 mm, respectively (P < 0.001). The use of 400 microg misoprostol with an evacuation interval of three hours appears to be the optimal dosage and evacuation time interval. Increasing the time interval beyond three hours did not confer any additional advantage on the rate of successful cervical dilatation but was instead associated with an increase in side effects such as vaginal bleeding, lower abdominal pain and the appearance of products of conception at the cervical os. However, besides vaginal bleeding, no significant differences in the frequency of these side effects were demonstrated. CONCLUSION: This first report on the comparison of differing dosages and time intervals to determine the optimal dosage treatment schedule shows that the vaginal application of 400 microg misoprostol for at least three hours is optimal for pre-operative cervical dilatation before vacuum aspiration in first trimester nulliparae.

Abdominal Pain↗
PubMedDate not supplied

Intrapartum ultrasonographic depiction of fetal malpositioning and mild parietal bone compression in association with large lower segment uterine leiomyoma.

With normal flexion of the fetal head prior to and during early normal labor, the fetal biparietal diameter becomes engaged in (and subsequently traverses) the anterior posterior aspect of the pelvic inlet. Thus, the biparietal diameter (characterized sonographically by depiction of the falx cerebri, thalami, and cavum septum pellucidum) will be obtainable upon transverse suprapubic placement of the ultrasound transducer during the first stage of labor. Deflexion, or extension, of the fetal head may be demonstrated sonographically at the level of the cervical spine. Recently, during intrapartum ultrasonographic assessment of a nulliparous patient with a known, large, lower-segment, uterine fibroid, exhibiting poor progress of labor, the fetal biparietal diameter was documented upon midsagittal suprapubic placement of the transducer. In addition, mild compression of the distal parietal fetal bone was demonstrated and considered consistent with compression by the leiomyoma. Following abdominal delivery, due to fetal distress and arrest of descent, significant deflexion of the fetal head (not suspected by intrapartum cervical examinations) and mild parietal bone depression, consistent with the ultrasonographic examination, were noted.

Adult↗
PubMed2001

The distribution of major lymphocyte subsets in cord blood is associated with its pH.

OBJECTIVES: To assess in venous cord blood the distribution of major lymphocyte subsets according to pH and medications used during labor. DESIGN AND METHODS: Venous cord blood was sampled immediately after labor from 70 newborns (35 males and 35 females) delivered vaginally. Lymphocytes were immunophenotyped by flow cytometry and pH was measured using the AVL 900 automated blood gas analysis system. Data on birth weight, gestational age at delivery, length of labor, presence of stained amniotic fluid, medications used during labor, maternal risk factors, age and parity were collected. RESULTS: The percentage of T lymphocytes decreased while the percentage of NK lymphocytes increased with decreasing pH over the whole range of pH values. The proportions of T and NK lymphocytes were associated with the administration of neuroplegics, spasmolytics or dihydroergotoxin in the first stage of labor. CONCLUSIONS: Cord blood pH and labor-associated variables should be taken into account to adequately interpret the profile of major lymphocyte subsets as a marker of the effect of different prenatal factors on the immune system of neonates.

Adolescent↗
PubMed1990

The addition of fentanyl to epidural bupivacaine in first stage labour.

Epidural analgesia was studied in 100 healthy Chinese women with uncomplicated pregnancies in first stage labour. Patients were randomly allocated to receive 8 ml of one of the following five solutions: bupivacaine 0.125% with fentanyl 50 micrograms or fentanyl 100 micrograms, bupivacaine 0.25% plain, bupivacaine 0.25% with fentanyl 50 micrograms or fentanyl 100 micrograms. There was no difference in quality of analgesia among groups as measured by the reduction of visual analogue pain scores 20 minutes after the epidural dose. The duration of analgesia was similar among groups with the overall median duration being 105 minutes. There was no difference in method of delivery or neonatal Apgar scores. The least concentrated mixture providing good quality analgesia for the first stage of labour was the combination of bupivacaine 0.125% with fentanyl 50 micrograms.

Adult↗
PubMed2000

[Changes in fibrinogen, fibrin-fibrinogen degradation products and fibrinolytic activity during pregnancy, labor and the puerperium in pregnant women with chronic hypertension].

In this study 79 pregnant women were analyzed, during the pregnancy, delivery and postnatal period. The control group consisted of 41 healthy women, while in the studied group there were 38 patients with severe chronic hypertension. Analyzed parameters: fibrinogen, fibrinolysis and FDP. Parameters were performed in all cases of pregnancies during third trimester (I), during the first stage of labor (II), immediately after delivery of placenta (III), two hours after placenta was delivered (IV), eight hours (V), 24 hours (VI), 48 hours (VII) and 72 hours (VIII) after placenta was delivered. Comparing certain measures in fibrinogen's value, high statistical significance was obtained for control group (healthy women), ANOVA (F = 5.17; p < 0.001) and for studied group (women for chronic hypertension), (F = 3.17; p < 0.001. Analyses of FDP values showed high statistically significant difference for control group, F = 15.03; p < 0.00001, and for studied group, F = 10.56; p < 0.00001. Statistically significant difference in fibrinolytic activity was obtained for control group, F = 60.72; p < 0.0001 and studied group, F = 5.70; p < 0.0001.

Adult↗
PubMed1978

Prostaglandin F2alpha human blood during labor.

Plasma prostaglandin F2alpha (PGF2alpha) concentrations were determined by radioimmunoassay in serial samples during labor and the early postpartum period. PGF2alpha was also measured during and between contractions every 20 to 30 seconds. The highest levels of PGF2alpha were found during expulsion of the fetus and placenta with an additional rise half an hour after delivery and a decrease 2 hours after delivery to the levels of first stage of labor. PGF2alpha values from cord blood were higher than in maternal peripheral blood in labor. The maximum PGF2alpha concentration occurred between 100 to 120 seconds after the peak uterine contraction and between 40 and 60 seconds prior to peak of the next contraction. The possible explanation is that PGF2alpha initiates uterine contractions and plays a role in the maintenance of labor, in the expulsion of the fetus and the placenta, and in the involution after delivery.

Female↗
PubMed2003

The nature and management of labor pain: part II. Pharmacologic pain relief.

A group of family physicians, obstetricians, midwives, obstetric anesthesiologists, and childbirth educators attended an evidence-based symposium in 2001 on the nature and management of labor pain and discussed a series of systematic reviews that focused on methods of labor pain management. Parenteral opioids provide modest pain relief in labor, and little evidence supports the use of one agent over another. Epidural analgesia is used during labor in most large U.S. hospitals, and its use is rapidly increasing in small hospitals. Although epidural analgesia is the most effective form of pain relief, its use is associated with a longer labor, an increased incidence of maternal fever, and increased rates of operative vaginal delivery. The effect of epidural analgesia on rates of cesarean delivery is controversial. Nitrous oxide provides a modest analgesic effect, but it is used less often in the United States than in other developed nations. Paracervical block provides effective analgesia in the first stage of labor, but its use is limited by postblock bradycardia. Research is needed regarding which pain-relief options women would choose if they were offered a range of choices beyond epidural analgesia or parenteral opioids.

Analgesia, Epidural↗
PubMedDate not supplied

[Uterine activity in induction of labor by vaginal administration of prostaglandin E2 tablets].

Induction of labor with intravaginal application of PGE2-tablets has become more popular recently. Delivery intervals have been reported to be reduced. Therefore we investigated intrauterine pressure profiles in a group of 25 women in which labor was induced electively by means of vaginal applications of 3 mg PGE2-tablets and compared them to a control group of 27 women with spontaneous onset of labor. In the first hours after amniotomy the frequency of contractions was higher in nulliparous whereas baseline and amplitude were increased in multiparous women. Overall uterine activity (hourly contraction area) however, was not statistical different in both groups. We concluded that shortened delivery intervals in the PGE2 induction group is based on an increased uterine activity in the first stage of labor. At the usual dosage no pathological pressure increases could be observed which lead to fetal compromise.

Administration, Intravaginal↗
PubMed2005

Oral versus vaginal misoprostol administered one hour before surgical termination of pregnancy: a randomised controlled trial.

OBJECTIVE: To assess the efficacy of oral and vaginal misoprostol as cervical priming agents administered 1 hour before first trimester surgical termination of pregnancy. DESIGN: A randomised controlled trial. SETTING: Chelsea and Westminster Hospital, London. POPULATION: Pregnant women of 10 weeks or less gestation attending the termination of pregnancy clinic. METHODS: Ninety eligible women were recruited to the study during September 2001 and September 2002. Women were randomised to one of the three groups: misoprostol administered orally (400 microg), misoprostol administered vaginally (800 microg) and standard care (no cervical priming agent) administered prior to surgical termination of pregnancy. Under general anaesthesia, and prior to the operation, a cervical tonometer was used to determine the main outcome measures. MAIN OUTCOME MEASURES: Baseline cervical dilatation and the cumulative force required to dilate the cervix from 3 to 9 mm. RESULTS: There was no significant difference in the mean baseline cervical dilation (P= 0.16) or the cumulative force required to dilate the cervix (P= 0.12) between the three randomised groups. CONCLUSION: No cervical priming effects were detectable with oral or vaginal misoprostol administered 1 hour before first trimester surgical termination of pregnancy.

Abortifacient Agents, Nonsteroidal↗
PubMed1997

Early or late bath during the first stage of labour: a randomised study of 200 women.

OBJECTIVE: To compare obstetric outcome after a bath offered to women on two different occasions during the first stage of labour. The aim of the study was to determine whether an early bath affected the progress of labour and the use of analgesia when compared with a late bath during the first stage of labour. DESIGN: A randomised prospective pilot-study. SETTING: The delivery ward at Ostra Hospital in Göteborg. PARTICIPANTS: Two hundred women, at low obstetric risk. INTERVENTIONS: The women were randomised to either the 'early bath group' or the 'late bath group'. The women in the 'early bath group' had a bath before a cervical dilatation of 5 cm, while the women in the 'late bath group' had a bath after the cervix was 5 cm dilated. MEASUREMENTS AND FINDINGS: The women in the 'early bath group' had a longer time period from established labour to delivery (9.8 hours) compared to the 'late bath group' (8.5 hours) (p < 0.004). A higher proportion of women in the 'early bath group' needed oxytocin administration (57%) compared to the 'late bath group' (30%) (p < 0.01). Epidural analgesia was used by 27% of the women in the 'early bath group' and by 9% in the 'late bath group' (p < 0.001). One baby in the 'early bath group' had clinical signs of infection and required antibiotic treatment. No cases of amnionitis or endometritis were present in the women. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The findings suggest that a bath during the first stage of labour should preferably be used after a cervical dilatation of 5 cm to avoid prolonged labour, and an increased use of oxytocin and epidural analgesia.

Adult↗
PubMed2004

Impact of first-stage ambulation on mode of delivery among women with epidural analgesia.

BACKGROUND: New techniques for administering epidural analgesia allow increased mobility for labouring women with epidurals. AIM: To determine the effect of ambulation or upright positions in the first stage of labour among women with epidural analgesia on mode of delivery and other maternal and infant outcomes. METHODS: We undertook a systematic review and meta-analysis of randomised controlled trials (RCT) of ambulation or upright positions versus recumbency in the first stage of labour among women with effective first-stage epidural analgesia in an uncomplicated pregnancy. Trials were identified by searching Medline, Embase and CINAHL databases and the Cochrane Trials Register to March 2004. Trial eligibility and outcomes were prespecified. Group tabular data were obtained for each trial and analysed using meta-analytic techniques. RESULTS: There were five eligible RCT, with a total of 1161 women. There was no statistically significant difference in the mode of delivery when women with an epidural ambulated in the first stage of labour compared with those who remained recumbent: instrumental delivery (relative risk (RR) = 1.16, 95% confidence interval (CI) 0.93-1.44) and Caesarean section (RR = 0.91, 95% CI 0.70-1.19). There were no significant differences between the groups in use of oxytocin augmentation, the duration of labour, satisfaction with analgesia or Apgar scores. There were no apparent adverse effects of ambulation, but data were reported by only a few trials. CONCLUSIONS: Although ambulation in the first stage of labour for women with epidural analgesia provided no clear benefit to delivery outcomes or satisfaction with analgesia, neither were there are any obvious harms.

Analgesia, Epidural↗
PubMed1991

Outcomes of 1001 midwife-attended home births in Toronto, 1983-1988.

A retrospective descriptive study of 1001 midwife-attended home births in Toronto, Ontario, was carried out between January 1983 and July 1988. Interviews with 26 midwives and reviews of client records provided data on maternal age, socio-economic status, gestation, ruptured membranes, length of labor, episiotomies and perineal lacerations, transfer to hospital of mother or baby or both, infant resuscitation, and breastfeeding. Of 1001 planned home births, 361 involved primiparous women, of whom 245 (68%) remained at home and 116 (32%) required transfer of mother or baby to hospital during labor or the first four postpartum days. Of the 640 multiparous births, 591 (92%) women remained at home and 49 (8%) required transfer to hospital. Among women transferred, 91 had spontaneous vaginal births, 34 had forceps deliveries, and 35 had cesarean sections. Variables significantly associated with maternal transfer for both primiparas and multiparas were length of latent and active phases of the first stage of labor, length of the second stage of labor, and duration of ruptured membranes. Five neonates were transferred and two died, one each after birth at home and in hospital. There were no maternal deaths. The proportion of mothers breastfeeding without supplement at 28 days postpartum was 98.6 percent.

Adult↗