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PubMed1992

Labor after prior cesarean section.

1. All women with PCS should be considered candidates for vaginal delivery. Certain high-risk factors then should be used to recommend elective repeat cesarean section. Currently, a scar in the active segment of the uterus is considered an absolute contraindication to labor. 2. Women should be informed of the chances of success (which in most instances are excellent), course of action in labor, and the rare risk of uterine rupture. 3. Women in a very low risk category (one low-transverse PCS) should be managed like any laboring patient but including fetal monitoring. 4. The remaining laboring patients may benefit from more intensive intrapartum surveillance, including continuous electronic fetal monitoring, early rupture of the fetal membranes, and placement of an intrauterine pressure catheter. 5. The labor course in women with PCS will depend on the number of vaginal deliveries achieved previously and the stage of labor reached before the cesarean section was done. 6. Labor disorders in patients with PCS, as in all patients, should be diagnosed and managed promptly. 7. Neither oxytocin nor epidural use is contraindicated in these patients. As in any patient, care should be taken to avoid iatrogenic uterine hyperstimulation. 8. Uterine rupture may have many different presentations. However, the most common is abnormal fetal heart rate patterns that are especially variable or prolonged decelerations. 9. Most uterine ruptures can be repaired and do not require hysterectomy. Hysterectomy may be the appropriate choice in some situations. 10. A history of a prior uterine rupture is not a contraindication to future childbearing, but it may place the woman at greater risk for a repeat event.

Female↗
PubMed1991

Searching: expectant fathers' experiences during labor and birth.

When expectant fathers are present and view labor and birth as a couple experience, they are co-laboring in one of three roles: coach, teammate, or witness. Within these roles are various degrees and types of engagement. Men in the role of coach experience high degrees of physical and mental engagement. Teammates fluctuate between high and low degrees of physical and mental engagement, and witnesses remain at low degrees of engagement until the second stage of labor, when they experience high degrees of mental engagement. The expectant fathers' experience is influenced by the labor guides' activities of gatekeeping, leading, and informing. Men either maintain or redefine their role during labor and birth. Men who experience a sense of not belonging or who are uncomfortable with their role will redefine their role by using the strategy of searching for place. Searching for place involves the steps of identifying an alternative role, engaging in the new role, testing the role, and evaluating the effectiveness of the alternative role. Men who experience a sense of belonging in their new role will maintain this role. May posed the question, "Is it time to fire the coach?" This theory, which requires further testing and validation, does address May's question. Perhaps it is not time to fire the coach, as May indicated, but it is time to provide couples with options in the role expectant fathers play during labor and birth. This theory can guide nurses in relatively risk-free interventions for the expectant father. Nurses can assist expectant fathers in finding a place in labor and birth that will enhance a mutually satisfying birthing experience.

Adult↗
PubMed2005

Continuous compared with intermittent epidural infusion on progress of labor and patient satisfaction.

OBJECTIVE: To compare continuous with intermittent epidural infusion on the duration of labor and patients' satisfaction in nulliparous women. METHODS: Nulliparous women who requested epidural analgesia during labor were randomly allocated to receive either a continuous infusion of 0.125% bupivacaine with 2 microg/mL fentanyl at a rate of 8 mL/h (group A) or intermittent bolus of 10 mL of 0.25% bupivacaine on demand (group B). Controls were nulliparous women who did not receive epidural analgesia (group C). Included were singleton term pregnancies with cervical dilatation between 2 cm and 5 cm. A comparison was made between the groups regarding the duration of the active phase and the second stage of labor and patients' satisfaction. Secondary outcomes investigated were the mode of delivery, analgesia-related complications, and intrapartum and postpartum complications. Cord pH and Apgar score measured neonatal outcome. RESULTS: Sixty-three parturients were randomly assigned to receive continuous infusion, and 64 received intermittent bolus infusion. Sixty-three patients served as controls. Mean duration of the active phase and the second stage of labor were not statistically different between groups A and B. Each technique produced comparable analgesia, achieving equivalent maternal satisfaction, with no apparent complications. The active phase of labor was prolonged by an average of 60 minutes and the 2nd stage by an average of 36 minutes regardless of the type of epidural compared with controls. The mode of delivery and maternal and neonatal outcome were not significantly different among the 3 groups. CONCLUSION: This study provides evidence that both continuous and intermittent epidural infusion produce comparable analgesia achieving equivalent maternal satisfaction with no difference regarding the duration of labor between them. Although patients receiving epidural analgesia experienced longer labors compared with controls, both mothers and neonates were unharmed.

Adult↗
PubMed2006

A comparison of massage effects on labor pain using the McGill Pain Questionnaire.

The purpose of this study was to describe the characteristics of pain during labor with and without massage. Sixty primiparas in labor were randomly assigned to either a massage or control group and tested using the self-reported Short-Form McGill Pain Questionnaire (SF-MPQ) at 3 phases of cervical dilation: phase 1 dilation (3-4 cm), phase 2 dilation (5-7 cm), and phase 3 dilation (8-10 cm). The massage group received standard nursing care and massage intervention, whereas the control group received standard nursing care only. The results of this study showed: (1) In both groups, as cervical dilation increased, there were significant increases in pain intensity as measured by SF-MPQ; (2) massage lessened pain intensity at phase 1 and phase 2, but there were no significant differences between the groups at phase 3; (3) the most frequently selected five sensory words chosen by both groups were similar at phases 1 and 2- (a) sore, (b) sharp, (c) heavy, (d) throbbing, and (e) cramping, while of the 4 affective classes, "fearful" and "tiring-exhausting" were the most used by participants to describe the affective dimension. The results of this study indicate that, although massage cannot change the characteristics of pain experienced by women in labor, it can effectively decrease labor pain intensity at phase 1 and phase 2 of cervical dilation during labor. Nurses and caregivers could consider using massage to help laboring women through the labor pain.

Adult↗
PubMed2005

Mode of delivery in pregnant women with hypertensive disorders and unfavorable cervix following induction of labor with vaginal application of prostaglandin E.

BACKGROUND: Our aim was to evaluate the mode of delivery in pregnant women with hypertensive disorders and unfavorable cervix following induction of labor with vaginal application of prostaglandin E(2) (PGE(2)) near or at term, and to define the predictors of successful vaginal delivery in such women. METHODS: In a retrospective case-controlled study, pregnant women with hypertension, who underwent labor induction with PGE(2) tablets (study group, n = 284), were compared with women, who underwent elective induction of labor (group 2, n = 115), and women with normal spontaneous onset of labor (group 3, n = 510). RESULTS: The rate of cesarean section (CS) was significantly higher in the study group (25.3%) than in group 2 (14.8%) and in group 3 (9%). Exclusion of the nulliparous women from the study and control groups yielded similar CS rates in the study group (16.9%) and in group 2 (11.1%). Women with pre-eclampsia and the women with chronic hypertension or pregnancy-induced hypertension had similar rates of CS. In logistic regression model, nulliparity, induction of labor with PGE(2), and maternal age, but not hypertensive disorders, were independently and significantly associated with increased risk of CS. CONCLUSIONS: PGE(2) induction of labor is successful in approximately 75% of patients with hypertensive disorders and unfavorable cervix, with apparently no serious maternal or fetal complications. The induction of labor by itself, and not the hypertensive disorders in pregnancy, is independent risk factor for CS.

Administration, Intravaginal↗
PubMed1990

Perinatal predictors of pain and distress during labor.

We sought to determine whether women's attitudes and concerns, confidence in ability to control pain, and practice of pain-control techniques would predict pain and coping or distress-related thought during labor. During the third trimester of their pregnancies, 115 women completed the prenatal self-evaluation inventory and measures of confidence and practice of pain-control techniques. During the latent (less than or equal to 3 cm), active (4-7 cm), and transition (greater than or equal to 7 cm) phases of labor, interviews were conducted to assess levels of pain and the content of women's cognitive activity on a continuum that ranged from coping-related thought to distress-related thought. Women's confidence in their ability to use relaxation techniques and their reported practice of pain-control strategies did predict lower levels of pain and greater coping-related thought during latent labor, but failed to account for pain or coping-distress in active or transition phases of labor. High scores on the Prenatal Self-Evaluation Inventory fear of pain and helplessness scale predicted high levels of distress during latent labor. Two other scales, concern for self and baby and acceptance of pregnancy, were significant predictors of pain and distress in active and transitional labor. The results suggest that, with the shift from latent to active labor, women's fundamental concerns and anxieties become manifest, and may take precedence over the skills acquired through childbirth education in moderating experienced pain and distress.

Adult↗
PubMed1996

Epidural analgesia in labor: an evaluation of risks and benefits.

BACKGROUND: Intrapartum epidural analgesia has become increasingly popular because it is the most effective method of providing pain relief during labor. Much attention is given to its safety and efficacy, and many health care providers and consumers are unaware of its potential drawbacks. This article reviews the literature about the effects of epidural analgesia on the mother and infant. METHODS: We performed a computer-assisted MEDLINE search for articles and a review of bibliographies from articles on epidural analgesia. When reported data were incomplete, authors were contacted for more detailed information. RESULTS: The most common procedure-related complications, hypotension, inadvertent dural puncture, and headache, are easily treated and usually self-limited. Permanent morbidity and mortality are rare. Retrospective studies and randomized controlled trials both demonstrate that epidural analgesia is associated with increases in duration of labor, instrument vaginal delivery, and cesarean birth. To date only three trials randomized patients to narcotic versus epidural groups, and all showed a twofold to threefold increase in cesarean section for dystocia. Limiting epidural use in nulliparous labor and delaying its placement until after 5 cm of cervical dilation may reduce the risk of operative intervention for dystocia. Epidural analgesia may also increase intervention for fetal distress. Several studies show its association with maternal fever in labor. Its association with chronic back pain, neonatal behavioral changes, and maternal-infant bonding are more tenuous and require further study. CONCLUSIONS: Epidural analgesia is a safe and effective method of relieving pain in labor, but is associated with longer labor, more operative intervention, and increases in cost. It must remain an option; however, caregivers and consumers should be aware of associated risks. Women should be counseled about these risks and other pain-relieving options before the duress of labor.

Analgesia, Epidural↗
PubMed1992

Reliving birth: maternal responses to viewing videotape of their second stage labors.

To learn about women's responses to their second stage labors and the care they received, women (N = 20) whose second stage labors had been videotaped were interviewed postpartally and shown their videotapes. Often women found the videotape viewing to be intensely emotional, especially when they heard noises they made. Women frequently commented upon details they hadn't remembered, their reactivated memory for labor pain, and the "weird" experience of watching themselves in labor. The authors recommend that women who watch their labor videotapes do so with a caregiver or supportive companion. They should be forewarned that the experience may be intense; details of their labors may be vividly recalled or women may see labor events on the videotape of which they were previously unaware.

Adolescent↗
PubMed2002

Hydrotherapy in labor.

PURPOSE: To review the literature on hydrotherapy in labor to direct prescription of the intervention and design studies to test its effectiveness. METHODS: Studies of hydrotherapy were identified via searching literature and electronic databases. FINDINGS: A primary effect of immersion is a central blood volume bolus, which occurs almost immediately after bathing begins. Subjective maternal responses to bathing in labor have been favorable. No maternal or infant infections have been attributed to bathing by parturients with either intact or ruptured membranes. Maternal bathing in labor does not appear to affect infant Apgar scores or stress hormones at birth. No clear evidence exists to indicate that hydrotherapy increases cervical dilation, increases fetal descent, reduces uterine dyskinesia, shortens labor, decreases use of epidurals or analgesia, or decreases rates of operative delivery or hemorrhage. CONCLUSIONS: Study findings indicate support for using hydrotherapy for relief of rapid pain and anxiety in labor. A methodical approach must be taken to determine for whom and under what circumstances intervention with hydrotherapy in labor is efficacious. Studies of the maternal and fetal effects of hydrotherapy in labor, including mechanisms of action, as well as large, prospective, randomized clinical outcome trials with control for intervening variables, are needed to help practitioners decide whether to prescribe hydrotherapy.

Adult↗
PubMed1998

IL-15, a novel cytokine produced by human fetal membranes, is elevated in preterm labor.

PROBLEM: Interleukin (IL)-15 is a novel cytokine known to have functions similar to those of IL-2 in the cell-mediated immune response. The objectives of this study were to determine whether IL-15 levels change in labor or preterm labor and to identify the regulatory agents and the site of production of IL-15. METHOD OF STUDY: Amniochorionic membranes were cultured in an organ explant system and were stimulated with lipopolysaccharides (LPSs). Samples were subjected to reverse transcriptase-polymerase chain reaction (RT-PCR) using specific primers for IL-15 and IL-2. The localization of mRNA and protein was accomplished by in situ hybridization and immunocytochemistry. IL-15 was measured in culture media and amniotic fluid from term and preterm gestations by enzyme-linked immunoadsorbent assay (ELISA). RESULTS: RT-PCR indicated the expression of IL-15 mRNA in the amniochorion. In situ hybridization and immunocytochemistry documented that mRNA and peptide for IL-15 are found in amnion, chorion, and decidual cells. ELISA results indicated no significant increase of IL-15 peptides in the culture media after LPS stimulation. Maximum levels of this cytokine were seen in the amniotic fluid (AF) of women with preterm labor compared to term labor. AF levels were not higher in preterm-labor patients with proved infection compared with those without infection. RT-PCR-based detection also showed the presence of two isoforms of IL-15 mRNA known to code for two different leader peptide sequences. IL-2 mRNA expression was not observed in the fetal membranes. CONCLUSIONS: The presence of IL-15 mRNA and peptide in the amniochorion and decidua and its increased presence in the AF during preterm labor suggests a possible role for IL-15 in preterm labor. Amniochorion is also shown to possess two IL-15 isoform leader sequences, the differential expression of which may be involved in the regulation of IL-15 secretion.

Amnion↗
PubMed2003

Peroxisome proliferator-activated receptor isoform expression changes in human gestational tissues with labor at term.

Peroxisome proliferator-activated receptors (PPARs) are a family of nuclear receptors that are involved in lipid metabolism, differentiation, proliferation, cell death, and inflammation. Three subtypes have been identified: PPAR-alpha, -delta, and -gamma. We have previously shown presence of PPAR-gamma mRNA in the amnion, choriodecidua, and placenta, and its level of expression was unchanged with labor. To evaluate whether PPAR-alpha and -delta subtypes are present in intrauterine tissues, placentae were obtained from women at term after spontaneous vaginal delivery (TSL; n = 15) and elective caesarean section before labor (TNL; n = 15). Northern blot analyses were used to evaluate the mRNA for PPARs. Activities of PPARs were assessed using JEG3 choriocarcinoma cells transfected with a PPAR-response element reporter construct (pTK-PPREx3-luc) and treated with PPAR ligands. The PPAR-gamma-specific ligand rosiglitazone induced PPAR response element (PPRE)-mediated activity in a concentration-dependent manner, whereas the PPAR-gamma-specific irreversible inhibitor GW9662 fully inhibited this induction. However, GW9662 only partially inhibited 15-deoxy-Delta12,14-prostaglandin J2 (15d-PGJ2)-induced luciferase activity, suggesting that 15d-PGJ2 may also activate either of the other isoforms. PPAR-alpha and -delta are expressed in the amnion, choriodecidua, and placental villous tissues. In the amnion, although for PPAR-alpha no significant difference in expression was observed with labor, PPAR-delta expression increased significantly (p < 0.001). In the choriodecidua, expression of PPAR-alpha declined with labor (p < 0.01), whereas, as in the amnion, PPAR-delta expression increased (p < 0.05). In the placenta, both PPAR-alpha and -delta expression increased with labor (p < 0.005). The changes observed with labor suggest that regulation of PPAR expression and function may have roles to the mechanisms that maintain pregnancy or initiate labor.

Amnion↗
PubMed1998

Effect of the duration of labor on postpartum postvoid residual bladder volume.

In order to investigate the possibility of protracted labor as a risk factor for postpartum urinary retention and to study the relation between duration of labor and postpartum day 1 postvoid residual bladder volume, the postpartum postvoid residual bladder volume (PVRBV) of a group of patients was studied using ultrasonography. Out of 707 patients investigated during a 2-month study period, a homogeneous group of 164 patients, with possible risk factors for postpartum urinary retention being controlled, was studied. The homogeneous group's postpartum day 1 postvoid residual bladder volumes were assessed by ultrasonography and analyzed with respect to the duration of labor. The incidence of postpartum urinary retention ( > or = 150 ml) was 11% in this homogeneous group. Labor duration longer than or equal to 800 min was associated with a higher incidence of postpartum urinary retention (chi2 test; p < 0.05). Moreover, there is a direct relationship between the duration of labor and PVRBV which is described by a quadratic regression curve. Protracted labor longer than or equal to 800 min is a risk factor for postpartum urinary retention. The PVRBV is directly related to the duration of labor.

Female↗
PubMed1990

Digoxin-like immunoreactive substance and preterm labor.

An endogenous digoxin-like substance (DLIS) that may be related to preterm labor has been studied. Using a commercially available radioimmunoassay kit. DLIS levels were determined in 110 women, of whom 33 were in preterm labor, 27 were in labor at term, 26 had normally ongoing pregnancies before term and were not in labor, and finally 24 were at term but not in labor. Mean DLIS levels of women in preterm labor was found to be significantly high (greater than 0.2 ng/ml, p less than 0.05). Whether this finding points to a causative role for DLIS in preterm labor remains to be further investigated.

Adult↗
PubMed1996

Connexin-26 and connexin-43 are differentially expressed and regulated in the rat myometrium throughout late pregnancy and with the onset of labor.

Gap junctions are characteristically increased in the myometrium during term and preterm delivery and are thought to be essential for the development of labor contractions. The expression of connexin-43 (Cx-43), the major myometrial gap junction protein, is increased during delivery (associated with an increase in the plasma estradiol/progesterone ratio) and after estradiol treatment of ovariectomized nonpregnant rats. However, Cx-43 is only 1 member of at least 16 proteins encoded by this family of gap junction genes. Using a RT-PCR method, we identified the presence of another member of this family, Cx-26, in laboring rat myometrium. The temporal expression pattern of Cx-26 was assessed using Northern and Western analyses. In contrast to Cx-43, whose expression is low throughout the pregnancy but increases immediately before the onset of labor (day 23), the expression of Cx-26 increased on day 17, reached maximal levels between days 19-21, and fell to low levels before the onset of labor. Treatment of pregnant rats with progesterone beginning on day 20 (which blocks both the increase in Cx-43 expression and the onset of labor) maintained the elevated expression of Cx-26. Induction of preterm labor in rats after ovariectomy on day 17 inhibited the normal preterm increase in Cx-26 transcripts. Progesterone treatment of these animals reversed the effects of ovariectomy. Immunofluorescence data identified Cx-26 antigen in the cell membranes of myometrial cells and in the luminal and glandular epithelium of the endometrium in the late pregnant (day 21) uterus. These data suggest that the role of gap junction formation in the myometrium in relation to the maintenance of pregnancy and the onset of labor is much more complex than previously recognized. Myometrial cell-cell communication is afforded by at least two different gap junction proteins, Cx-43 and Cx-26, that not only exhibit temporally distinct patterns of expression but are also subject to differential regulation.

Animals↗
PubMed1998

TNF, IL-1, IL-6, IL-8 and soluble TNF receptors in relation to chorioamnionitis and premature labor.

Inflammatory cytokines seem to play a key role in mechanisms initiating labor. Since cytokine levels are higher in preterm than in term labor, it has been hypothesized that labor-inducing effects of cytokines are inhibited by an upregulated production of cytokine antagonists, such as soluble cytokine receptors, at early stages of gestation. In this study, TNF, IL-1, IL-6, IL-8 and soluble TNF receptors (sTNFRs) were measured in amniotic fluid samples from a) 39 women in premature labor, b) 25 women who where not in labor but delivered prematurely, and c) 33 women in term labor. Fifty-four of the placentas from premature deliveries were evaluated for presence of histological chorioamnionitis. Chorioamnionitis was associated with increased levels of TNF, IL-1 and IL-6, whereas elevated IL-1, IL-6 and IL-8 concentrations were found in premature parturition with no signs of infection. Concentrations of sTNFR were lower in preterm than in term deliveries. The present study confirms the participation of inflammatory cytokines in parturition. Multivariate analysis suggests a dominant, role of IL-1 in the presence of chorioamnionitis, whereas IL-6 seems to be more important during idiopathic premature labor. TNFR data do not support the hypothesis that production of cytokine antagonists is upregulated prematurely to prevent partirution.

Amniotic Fluid↗
PubMed1987

The maternal serum cortisol levels after onset of labor.

We measured maternal cortisol levels after the onset of labor. Blood from 82 primiparas and 48 multiparas were collected 124 times and 60 times, respectively. When duration of labor was within 3 hr, there were no differences in cortisol levels between the primiparous (n = 11, 50.4 +/- 7.0 micrograms/100 ml, mean +/- S.E.) and multiparous (n = 14, 37.8 +/- 4.3 micrograms/100 ml). However, when duration of labor was from 3 to 6 hr, cortisol levels in the primiparas (n = 20, 59.7 +/- 5.1 micrograms/100 ml) were significantly (p less than 0.05) higher than those in the multiparas (n = 22, 46.8 +/- 2.9 micrograms/100 ml). In cases of duration of labor from 6 to 9, cortisol level of the primiparas (n = 24, 64.3 +/- 4.4 micrograms/100 ml) were also significantly (p less than 0.05) higher than those in multiparas (n = 12, 49.4 +/- 4.7 micrograms/100 ml). When duration of labor was more than 9 hr there was no significant difference in cortisol level between the primiparas and multiparas. Maternal cortisol level had a significant (p less than 0.01) negative correlation (n = 166, r = -0.243, Y = -0.09X + 30.47) with unconjugated estriol level. These data suggest that maternal cortisol levels after the onset of labor are slightly different between the primiparous and multiparous, and that maternal unconjugated estriol levels decrease owing to reduction of the feto-placental blood circulation accompanied with uterus contraction during labor.

Female↗
PubMed1991

Catechol-O-methyltransferase activity in red blood cells in threatened preterm labor; effect of indomethacin and nylidrin.

Catecholamines that are released in excess during human labor are inactivated mainly by catechol-O-methyltransferase (COMT). To ascertain whether uterine contractions are associated with changes in COMT activity in red blood cells (RBCs), we studied 25 women with established threat of preterm labor between 25 and 33 weeks of gestation, 25 gestational age-matched control women not experiencing uterine contractions, 25 women who were in term labor, and 25 non-pregnant healthy women. COMT activity in pregnant women without uterine contractions (median 0.3, range 0.1-0.8 pmol/mg/min) was lower (p less than 0.05) than that in non-pregnant control series (median 0.5, range 0.3-0.7 pmol/mg/min). RBCs' COMT activity in women with preterm labor (median 0.6, range 0.2-1.1 pmol/mg/min) was greater (p less than 0.05) than that in pregnant and non-pregnant control women, but similar to that during term labor (median 0.5, range 0.2-1.7 pmol/mg/min). Women with preterm labor were treated with indomethacin (12 women) or nylidrin (13 women). Nylidrin treatment was accompanied by a 35% rise in COMT activity 3 h later, whereas indomethacin caused no significant change. Apart from cessation of uterine contractions during tocolysis, 13 women went into labor before the 37th gestational week, but their pretreatment COMT activity (median 0.7, range 0.2-1.1 pmol/mg/min) did not differ from COMT activity in women whose pregnancy proceeded to term (median 0.5, range 0.3-1.0 pmol/mg/min).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Effects of labor on serum levels of insulin and insulin-like growth factor-binding proteins at the time of delivery.

BACKGROUND: The purposes of this study were to explore whether serum levels of insulin, insulin-like growth factor-I (IGF-I), insulin-like growth factor-binding protein-1 (IGFBP-1) and IGFBP-3 in both maternal and fetal compartments were affected by the stress of labor, and to investigate the relationship between the fetal birthweight and serum levels of insulin, IGF-I and IGFBPs. METHODS: Blood samples were collected at the time of delivery from 147 parturients with vaginal delivery and 128 cases of Cesarean section (112 cases without labor and 16 cases with arrest of cervical dilatation during the active phase of labor). Serum concentrations of insulin, IGF-I, IGFBP-1 and IGFBP-3 were determined by radioimmunoassays (insulin, IGFBP-1 and IGFBP-3) and immunoradiometric assay (IGF-I). RESULTS: Maternal circulating IGFBP-1 levels in parturients with normal spontaneous delivery (NSD) and in subjects receiving Cesarean section (CS) due to arrest of cervical dilatation during active phase of labor were higher than those undergoing scheduled CS without labor. By contrast, insulin levels in both maternal and umbilical cord serum were higher in parturients with CS without labor than those with NSD. No difference in maternal serum IGFBP-3 levels was observed between NSD and CS at the time of delivery. As for all measurements (insulin, IGF-I, IGFBP-1 and IGFBP-3), serum levels in pregnant women (from both NSD and CS) were strikingly higher than those in the fetus. Serum levels of IGFBP-1 in umbilical cords from both groups of NSD (p < 0.02) and scheduled CS (p < 0.01) were inversely correlated with birthweight (BW). By contrast, serum concentration of insulin and IGF-I in umbilical cords from NSD (p < 0.005 and p < 0.01; respectively) and scheduled CS (p < 0.01 and p < 0.05; respectively) were positively related to BW. CONCLUSIONS: From the present results, we conclude that insulin appears to be a regulator for circulating IGFBP-1 during pregnancy. The fetal growth may not be well reflected by maternal serum IGFBP-1 levels, nor by IGFBP-3. By contrast, cord serum IGFBP-1 from CS group without labor may preeminently reflect fetal weight. In additional, serum concentration of insulin and IGF-I in umbilical cord may also be good indicators to reflect the result of neonatal birthweight.

Adult↗