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PubMed1992

A study of the epidemiology of preterm labor.

A case-control study was designed in order to identify risk factors associated with preterm labor. All cases fulfilling the criteria of eligibility as preterm labor and attending the Ain Shams University Maternity Hospital during the period from January 1991 to June 1991 were included in the study. In the meanwhile, all women delivering after the 37th week of gestation during that period and in the same hospital and matched according to age (+/- 5 years) were included as the control group. Two hundred and thirty four cases and 216 controls were included in the study. An interview was performed to fill an epidemiologic and clinical questionnaire. Results showed that the lower the socioeconomic standard, the more the risk for preterm labor (p < 0.05), smoking whether active or passive is associated with preterm labor (p < 0.001), threatened or induced abortion, unwanted pregnancy, psychological trauma and surgical intervention during current pregnancy are associated with preterm labor (p < 0.001). History of preterm labor is associated with the present condition (p < 0.001). Anemia, hypertension, body weight less than 70 kgm are associated with preterm labor (p < 0.001).

Adult↗
PubMed1992

Intracervical prostaglandin E2 gel. Safety for outpatient cervical ripening before induction of labor.

Cervical ripening prior to induction of labor is often necessary for medical complications of pregnancy. We proposed to prospectively determine the safety of administering prostaglandin E2 (PGE2) gel intracervically in an outpatient setting. Four hundred forty-six patients underwent 515 gel procedures as outpatients. Trained perinatal nurses placed 0.5 mg of PGE2, prepared in a standard methylcellulose base, in the intracervical canal. The PGE2 dose was administered every two hours for a total of three doses if labor did not start. The patient was sent home two hours after the last dose if she was not in active labor. Labor started in 90 patients (20%) during the gel procedure; they were admitted to the labor-and-delivery unit. The remaining patients were discharged. Eighty-eight patients (20%) were later admitted in active labor prior to scheduled induction. One patient (0.02%) was found to have occasional prolonged decelerations on admission and underwent a cesarean section two hours after admission; the Apgar scores were 8 and 9 and the arterial pH, 7.21. Hyperstimulation with excessive intrauterine activity caused significant deceleration of the fetal heart rate in four patients (0.8%), two of whom required transfer to the labor-and-delivery unit but none of whom needed a cesarean section for fetal distress. PGE2 gel can be administered safely intracervically as an outpatient procedure by trained perinatal nurses.

Ambulatory Care↗
PubMed2004

Can differences in labor induction rates be explained by case mix?

OBJECTIVE: To determine whether differences in case mix account for variations in labor induction rates between hospitals and whether case mix adjustment is helpful in evaluating hospital induction rates. STUDY DESIGN: Using a New York State birth certificate database, factors associated with induction of labor were entered into a logistic regression to calculate labor induction probabilities. The probabilities were used to calculate expected induction rates at each of 16 regional hospitals. Each hospital's observed and expected induction rates were compared to determine the degree of residual variation. RESULTS: Excluding women who delivered by cesarean section without labor, the regional labor induction rate was 20.8%, with a 3.9-fold difference between the highest and lowest hospital rates (P < .0001). Adjusting for risk factors explained only 12.6% of the variation in induction rates. Risk adjustment to compare labor induction rates had a minimal effect on rank ordering of rates but made clearer some hospitals' rates. CONCLUSION: Differences in case mix do not explain labor induction rate variation, but adjustment for case mix may aid in interpreting rates at individual hospitals.

Adult↗
PubMed2004

Comparison of intrathecal levobupivacaine with and without fentanyl in combined spinal epidural for labor analgesia.

BACKGROUND: The initiation of epidural infusion immediately after intrathecal (IT) injection to prolong labor analgesia has gained increasing popularity. The effect of additional intrathecal fentanyl on levobupivacaine for labor analgesia has not been fully investigated. We wished to determine if addition of IT fentanyl to IT levobupivacaine in combined spinal epidural (CSE) could prolong obstetric analgesia when epidural infusion is initiated promptly. MATERIAL/METHODS: In this randomized controlled trial, 40 nulliparous parturients in labor were recruited to receive either IT 2.5 mg levobupivacaine (L) or IT 2.5 mg levobupivacaine + 25 microg fentanyl (LF). A 10 ml/h epidural infusion of 0.125% levobupivacaine and 2 microg/ml fentanyl was immediately started. The proportion of parturients who delivered without breakthrough pain and the duration of analgesia were analyzed with the x2 test and Kaplan-Meier technique (using a log-rank test), respectively. Sensory block, motor block, pain scores, and post-block side effects were also evaluated. RESULTS: The percentage of parturients with "successful" blocks, i.e. parturients not requiring further analgesic supplementation, was significantly higher in LF (87.5% vs. 44%, p<0.05). The duration of analgesia was also significantly longer in group LF (mean 530 min +/- SE65 vs. 361 +/- 66, p<0.05). CONCLUSIONS: The addition of 25 microg intrathecal fentanyl to 2.5 mg levobupivacaine as part of CSE for labor analgesia decreased the incidence of labor breakthrough pain and resulted in a longer duration of labor pain relief. This may decrease the need for supplemental labor pain relief and the anesthetists' workload in the delivery suite.

Adult↗
PubMed2005

Enema versus no-enema in pregnant women on admission in labor: a randomized controlled trial.

OBJECTIVE: To compare the maternal and neonatal outcomes between enema and no-enema in pregnant women on admission in labor. MATERIAL AND METHOD: One thousand and one hundred term pregnant women with labor pain were selected randomly on admission to be assigned into two groups at Rajavithi Hospital from 1 February 2002 to 15 June 2002. Five -hundred and thirty-nine cases received enema and five-hundred and sixty one cases received noenema. Seventy three women (39 and 34 cases from the enema and no-enema groups, respectively) were excluded because of cesarean section due to obstetric indications. Five hundred cases received enema and five-hundred and twenty -seven cases received no-enema. All cases were delivered vaginally. RESULTS: There was no statistical significant difference between the two groups with regards to maternal age, gestational age, gravidity, parity, mode of delivery, type of episiotomy and degree of perineal tear. Fecal contamination rate during the second stage of labor was significantly higher in the women who received no-enema (34.9%) in comparision with those receiving enema (22.8% (p < 0.001). No neonatal infection occurred in both groups. Duration of labor was significantly longer in the women who received no-enema (459.8 min) compared with those who received enema (409.4 min) (p < 0.001). CONCLUSION: No-enema methods on admission in labor had significantly more increase infecal contamination in the second stage of labor and longer duration of labor than the enema method But there was no difference in perineal wound infection and neonatal infection between both groups.

Adult↗
PubMed1991

The relationship of maternal exercise on labor, delivery and health of the newborn.

Thirty women were interviewed and divided into active and sedentary groups. Pre-delivery data, information regarding labor and delivery, Apgar scores of the newborn and perceived exertion during labor were recorded and statistically analyzed. Neonates of active women showed slightly higher one-minute Apgars and no difference in fetal weight or five-minute Apgars. Active women indicated lower perceived exertion during labor, longer delivery times and no differences in gestational length, maternal weight gain and time during the first stage of labor. Maternal weight gain in both groups correlated positively with fetal weight. A higher fetal weight indicated a slightly higher five-minute Apgar. Primaparas showed no difference in the first stage of labor although longer delivery time was noted. No differences in levels of medication during labor were revealed although the youngest and oldest subjects required cesarean delivery. Obese women labored longer, indicated higher perceived exertion and higher fetal weights.

Adolescent↗
PubMedDate not supplied

Relationship of psychological factors in pregnancy to progress in labor.

A prospective study of 32 normal, married primigravidas was conducted to determine the relationship between psychological factors in the third trimester of pregnancy and progress in two defined phases of labor. Data were analyzed for the total group and with five subjects deleted to control partially for the effect of medications. Psychological variables measured in pregnancy had significant correlations with variables measured at the onset of phase two labor. Conflict concerning the acceptance of pregnancy showed the most significant relationships to the phase two labor variables with correlations of .39 with anxiety, .59 with plasma epinephrine, -.70 and -.52 with two adjacent Montevideo units, and .58 with length of labor in phase two (3-10 cm cervical dilation). Other pregnancy variables which significantly correlated with the labor variables were identification of a motherhood role, history of psychological counseling or psychiatric treatment, the trait scale of the State-Trait Anxiety Inventory, and fears related to helplessness, pain, loss of control, and loss of self-esteem. Several psychological variables measured in pregnancy also correlated significantly with length of labor in phase three and type of delivery. The results demonstrate that specific psychological factors in pregnancy are predictive of progress in labor.

Adaptation, Psychological↗
PubMed1989

Controlled trial of a Preterm Labor Detection program: efficacy and costs.

Patient education regarding the signs and symptoms of preterm labor combined with frequent clinical evaluations has been advocated as a means to reduce preterm births. Over a 3.5-year period, the risk for preterm labor was determined in 943 indigent black inner-city women using the Papiernik-Creasy scoring system. High-risk women were allocated randomly to a Preterm Labor Detection Clinic or to serve as high-risk controls. Women with lower risk scores served as low-risk controls. Women from both control groups were not informed of their risk status, and both groups received prenatal care in standard obstetric clinics. Women accepting the Preterm Labor Detection Clinic Program received comprehensive patient education and were seen weekly starting at 22 weeks' gestation. Despite this extensive outpatient program, there were no significant differences between the high-risk groups with respect to mean gestational age at delivery, mean birth weight, or percentage delivering before term as a result of preterm labor or premature rupture of membranes (PROM). Evaluations of inpatient charges revealed no significant differences due to participation in this program, although outpatient clinic utilization and charges were increased significantly for Preterm Labor Detection Clinic patients. Failure of this program to reduce preterm birth may relate to the relatively low overall rate of women presenting in preterm labor with advanced cervical dilation. In contrast, high rates of PROM and fetal death occurred in all three study groups.

Clinical Trials as Topic↗
PubMed1986

Maternal plasma concentrations of catecholamines and cyclic nucleotides during labor and following delivery.

In plasma obtained from seven mothers before, during, and after normal labor and delivery, catecholamine and cyclic nucleotide concentrations were investigated. Dopamine concentration showed a significant elevation on admission to hospital in labor and there were marked increases in norepinephrine and epinephrine concentrations during labor at 10 cm cervical dilatation and immediately after delivery, respectively. No significant change in dopa, cAMP, or cGMP was found during the experimental period. However, since the van Beaumont quotient (J.Appl. Physiol. 34, 102-106) for cAMP did not follow the reduction in plasma volume, the concentration appeared to rise during labor. Positive correlations were observed between epinephrine on one hand, and heart rate and systolic blood pressure on the other, as well as between norepinephrine and cAMP, respectively, during labor. The diminution of epinephrine on the fourth day postpartum might reflect a reduction of emotional stress concomitant with labor. cAMP was found to be quickly cleared from the bloodstream within 2 hours after delivery. These results suggest that plasma concentrations of epinephrine and cAMP, especially epinephrine, are indices of maternal psychological and physiological stress during labor and following delivery.

Adult↗
PubMed1988

Outcome of trial of labor in patients with a single previous low transverse cesarean section for dystocia.

The purpose of this prospective investigation was to evaluate the outcome of trial of labor in women with a history of a single low transverse cesarean section for dystocia in comparison with the outcome in women with a history of cesarean delivery for a reason other than dystocia. During the study period, 89 of 131 patients (68%) with a history of dystocia had a successful trial of labor, compared with 78 of 96 women (81%) who had cesarean delivery for a reason other than dystocia (P less than .025). Within the former group, 79% of women who originally had surgery while still in the latent phase of labor had a successful trial of labor, compared with 61% (.05 less than P less than .10) of patients who had an arrest of dilation in the active phase of labor and 65% (not significant) of those who had an arrest of descent. The only serious complication among study patients was a single instance of uterine scar dehiscence (0.5%). We conclude that approximately two-thirds of patients with a previous cesarean delivery for dystocia will have a successful trial of labor. Of these women, those individuals whose initial operation was performed in the latent phase of labor appear to have the best prognosis for subsequent vaginal delivery.

Abdomen↗
PubMedDate not supplied

Pharmacotherapy of preterm labor.

Physiological factors initiating the birth process, problems associated with preterm labor, and use of pharmacotherapeutic agents to treat preterm labor are reviewed. Human parturition appears to be initiated by a combination of factors, the interplay of which is not well understood. In many cases, the threat posed by preterm labor is difficult to assess. Because the stringency of patient-selection criteria varies widely among studies, success rates of different drugs used to arrest labor are difficult to compare. For both short-term and long-term tocolysis, beta 2-sympathomimetic agents (betamimetics) can be used. These drugs, which include isoxsuprine, ritodrine, terbutaline, albuterol, nylidrin, fenoterol, metaproterenol, and hexoprenaline, are believed to affect intracellular calcium concentrations in the myometrium. Ritodrine is the only drug in this class currently approved by the FDA for inhibition of labor. Terbutaline has been shown to be effective in halting uterine contractions and is substantially less expensive than ritodrine. Calcium channel-blocking agents such as nifedipine and verapamil are being investigated for inhibition of labor. Magnesium sulfate, another calcium antagonist, has long been used as a tocolytic. Other agents discussed are ethanol, diazoxide, the prostaglandin synthetase inhibitors (e.g., indomethacin and aspirin), and progestational steroids. Pharmacotherapy should be individualized on the basis of the patient's clinical condition, presence of other disease states, and side effects associated with available tocolytic agents. To date, a betamimetic with selective beta 2 effects, such as terbutaline or ritodrine, is the most valuable agent for inhibition of preterm labor.

Adrenergic beta-Agonists↗
PubMed1984

The body boundary experience of women in labor: a framework for care.

This paper discusses the relevance of a body boundary framework for considering the nursing care needs of the woman during labor. Careful analysis of the woman's behaviors during labor reveals three distinct body boundary-oriented phases. These include: (a) a controlled-boundary intact phase, (b) a regressive-boundary permeable phase, and (c) a desperate-boundary diffuse phase. The first two phases occur in all labors; the last phase occurs when the woman is unable to remain in control of her body because of extreme body boundary distortions. The primary nursing care objective for the laboring woman should be to help the woman maintain a sense of body boundary intactness throughout her labor. Achieving this important objective requires that the nurse be aware of when and how the woman uses the nurse's presence to foster feelings of boundary intactness. The nurse involved in the care of the woman in labor must be an interaction specialist. She needs to be adapt at reading the woman's body cues, in understanding the meaning of her behaviors, and in providing care at appropriate times using appropriate contact modalities. Offering the woman help and understanding based on knowledge of body boundary changes during labor optimize the woman's ability to endure and will enhance her chances for feeling positively about herself in the childbearing endeavor.

Adaptation, Psychological↗
PubMed1984

Comparison of magnesium sulfate, terbutaline and a placebo for inhibition of preterm labor. A randomized study.

Magnesium sulfate has been recommended as a safe and effective agent for inhibiting preterm labor. Its reported adequacy as a tocolytic agent, however, has not been substantiated by randomized, controlled trials. To assess the efficacy of magnesium sulfate, we initiated a prospective, randomized study comparing the capabilities of magnesium sulfate, terbutaline and a placebo (5% dextrose in lactated Ringer's solution) for labor inhibition. The study population consisted of 54 patients between 26 and 34 weeks of gestation and in preterm labor. The diagnosis of labor was made if, following hydration, persistent uterine contractions occurred at a frequency of at least three in a ten-minute period and cervical examination suggested active labor. Success was defined as postponement of delivery for at least 48 hours after initiation of therapy. Despite a trend toward increased efficacy in the terbutaline group there were no significant differences between the three treatment groups with regard to capability of delaying delivery at least 48 hours. Also, there were no significant differences between the groups with regard to gestational age at delivery, birth weight and neonatal survival. The fact that delivery occurred in less than 48 hours of approximately one-half the patients under the best of circumstances emphasizes the need for more effective techniques for the inhibition of preterm labor and the need for a better understanding of the mechanisms involved in the initiation of preterm labor.

Adult↗
PubMed1994

A prospective evaluation of the signs and symptoms of preterm labor.

OBJECTIVE: To describe the time relation between symptoms, contractions, and the clinical diagnosis of preterm labor. METHODS: We analyzed the records from 57 women who were enrolled in a previously reported trial of home uterine monitoring and who developed preterm labor while using the monitor. In a post hoc descriptive study of signs and symptoms during the 7 days preceding a diagnosis of preterm labor, we reviewed uterine contraction records and study records of the responses to a standard list of questions about potential symptoms of preterm labor. RESULTS: Monitored contraction frequency increased on the day of preterm labor diagnosis, from an average of fewer than three per hour to five per hour, but was not increased on any of the days before the day of diagnosis. Neither symptoms nor contraction monitoring strips indicated any significant changes more than 24 hours before the clinical diagnosis was made. Self-palpated and monitored contractions were the most common symptoms of preterm labor. CONCLUSION: A clinical diagnosis of preterm labor is preceded by an increase in self-palpated and monitored contractions and other symptoms for less than 24 hours.

Adult↗
PubMed1994

Incremental increases in oxytocin infusion regimens for induction of labor at term in primigravidas: a randomized controlled trial.

OBJECTIVE: To compare induction of labor by intravenous oxytocin in regimens increasing incrementally at 15- and 30-minute intervals. METHODS: In a randomized controlled trial, 124 primigravidas requiring induction of labor by oxytocin infusion were randomly allocated to incremental increases at 30-minute intervals (62 patients) or 15-minute intervals (62 patients). The main outcomes assessed were mode of delivery, complications of labor and delivery (precipitate labor, hyperstimulation, postpartum hemorrhage, perineal tears, puerperal pyrexia), and number of days in the hospital. RESULTS: The 30-minute incremental regimen resulted in less precipitate labor (odds ratio 0.233, 95% confidence interval [CI] 0.042-0.55, chi 2 = 4.133), less uterine hyperstimulation (odds ratio 0.17, 95% CI 0.015-1.906), and reduced length of stay in the hospital (difference in medians 3 days, 95% CI for difference in medians 2-4 days). The induction-delivery interval was longer with 30 minutes (median 8 hours) than with 15 minutes (median 5 hours) (difference in medians 2 hours, 95% CI for difference in medians 0-3 hours). With the 30-minute interval, there was a reduction in the occurrence of postpartum hemorrhage, perineal tears, and puerperal pyrexia, but these differences did not reach statistical significance. CONCLUSION: For the induction of labor in primigravidas, 30-minute incremental increases in the infusion rate of oxytocin were superior to a 15-minute incremental protocol in reducing the incidence of hyperstimulation and precipitous labor.

Adult↗
PubMed1993

Induction of labor and risk of sudden infant death syndrome.

OBJECTIVE: To investigate whether induction of labor is related to the occurrence of sudden infant death syndrome (SIDS) using a population-based, case-control study. METHODS: Cases comprised infants born between 1984-1988 in Washington state who died of SIDS according to their death certificate (ICD-9-CM 798.0) (N = 728). For comparison, we randomly selected a group of infants born in these same years who did not die of SIDS (N = 3021). Information regarding the pregnancy, labor, delivery, and condition of the newborn was obtained from the infants' birth certificates. RESULTS: Among the indications for induction that were examined, we found a slightly elevated risk of SIDS associated with advanced gestational age (greater than 41 completed menstrual weeks) (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.0-1.8). A similar proportion of cases and controls had induced labors (OR 1.2, 95% CI 0.7-2.1). Although there was little or no apparent risk associated with induction among infants who had term gestations (37-41 completed menstrual weeks; OR 1.2, 95% CI 0.6-2.2), an increased risk was found among infants who had gestations of 42 weeks or greater (OR 3.0, 95% CI 0.7-12.5). We did not observe this trend with augmentation of labor. CONCLUSION: Our findings do not support an overall association between the methods used for induction of labor in the United States and the occurrence of SIDS. The elevated risk of SIDS observed in relation to induction of labor among infants who had post-term gestations raises the possibility that infants who do not spontaneously initiate labor may suffer some neuroregulatory or other abnormality involved in the pathogenesis of SIDS.

Adult↗
PubMedDate not supplied

Assessment of uterine and umbilical artery velocimetry during latent and active phases of normal labor.

Twenty healthy parturients in active labor were monitored with continuous wave Doppler to assess changes in uterine and umbilical velocity waveforms. Each case served as its own control. Tracings of fetal heart rate monitoring were normal in all patients. The analysis of the waveforms included the peak systolic/end-diastolic ratio for the umbilical circulation (umbilical artery), and the systolic minus diastolic velocity divided by systolic velocity (resistance index) was used as an indication of downstream resistance in the uterine arteries. Recordings from umbilical, left and right uterine arteries were obtained during various stages of progression of labor as indicated by Friedman's curve. In latent phase labor with intact membranes, as well as in three consecutive measurements throughout active phase labor until delivery, umbilical artery systolic/end-diastolic ratios, before, during and after contraction did not change--2.2 +/- 0.5, 2.3 +/- 0.6, 2.2 +/- 0.3 and 2.5 +/- 0.7 (NS). No changes in the resistance to flow in the left and right uterine arteries were recorded during both latent and active phases of labor--0.53 +/- 0.09, 0.52 +/- 0.1, 0.5 +/- 0.07, 0.56 +/- 0.07 (NS) and 0.59 +/- 0.1, 0.57 +/- 0.1, 0.56 +/- 0.1, 0.59 +/- 0.08 (NS), respectively. These results suggest stability of the fetal cardiovascular system ensuring continuous constant gas exchange process during labor, enabling most term fetuses to tolerate labor to a degree where minimal if any metabolic changes occur.

Adult↗
PubMed1993

Clinical and environmental predictors of preterm labor.

OBJECTIVE: To determine the magnitude of risk for preterm labor associated with specific clinical and environmental factors. METHODS: Using a case-control design, 266 women with preterm labor and 512 controls were interviewed and their medical records reviewed. Crude and adjusted odds ratios were calculated for each risk factor. Population-attributable risks were estimated. RESULTS: Third-trimester bleeding, twin gestation, and chorioamnionitis at presentation were strongly associated with preterm labor (odds ratios 11.2-48.3). A history of a prior preterm delivery, vaginal bleeding in the first or second trimester, maternal diethylstilbestrol exposure, uterine anomalies, and urinary tract infection during pregnancy were associated to a lesser extent (odds ratios 1.6-5.4), as were cigarette smoking and drug use (odds ratios 2.0 and 3.0). Cases who had preterm labor preceded by premature rupture of the membranes had a substantially higher risk of preterm labor if chorioamnionitis, vaginal bleeding early in pregnancy, or urinary tract infection was present. By contrast, women who had intact membranes at the onset of preterm labor carried higher risk when twin gestation, placental abruption, or uterine anomaly was present. The highest population-attributable risks for preterm labor were found in patients with a twin gestation or third-trimester bleeding. CONCLUSIONS: Programs to reduce the preterm delivery rate should consider the attributable risks for the factors they are intended to modify. The attributable risks we obtained suggest that medical strategies to reduce the impact of the clinical variables, especially multiple gestation, and educational programs to decrease smoking and drug use should reduce the preterm delivery rate.

Adult↗