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PubMed1993

Association between epidural analgesia during labor and fever.

BACKGROUND: Epidural analgesia has been associated in previous research with an increase in maternal temperature. METHODS: Three studies were done: a retrospective chart review of women in labor, a prospective cohort study of women in labor, and a case-control study of newborns with fever. The prospective study enrolled 28 women, 14 of whom received epidural analgesia. Maternal temperature was measured hourly with a tympanic membrane thermometer. Other variables examined included duration of labor, duration of ruptured membranes, and room temperature. To further explore the possible association between maternal epidural exposure and newborn fever, a case-control study of newborns with fever at birth was carried out. RESULTS: In both the retrospective and prospective studies of women in labor, the duration of epidural analgesia was correlated with maximum maternal temperature during labor, with an increase, in the prospective study, of 0.07 degrees C per hour of exposure to epidural analgesia (P = .002). Controlling for other variables did not change the magnitude of this effect or its statistical significance. Similar trends were seen in the newborn's first temperature in both the prospective study of women in labor and the case-control study of newborns, but the associations were not significant (P = .07 and .08, respectively). CONCLUSIONS: Epidural analgesia is associated with an increase in maternal temperature during labor and possibly with an elevation of newborns' first temperatures.

Analgesia, Epidural↗
PubMed1993

Management of preterm labor and prevention of premature delivery.

Preterm births continue to be the leading cause of perinatal mortality despite efforts to prevent preterm labor. Tocolytic therapy with beta-mimetic drugs was believed to be the solution for preterm labor, but the Canadian Preterm Labor Investigators Group recently reported that the use of ritodrine had no significant beneficial effect. Despite the various methods presently used for the management of preterm labor and prevention of premature delivery, the incidence of preterm birth remains unchanged. Health professionals must remain optimistic, however, and continue to investigate causes, whether they are social or medical, and to seek the unknown. Nursing personnel should play an important role in this area as health promoters and educators of patients. Nurses should also collaborate with other health professionals to determine effectiveness of therapy and the causes of preterm labor. For instance, this author is currently involved in a research project seeking barriers to prenatal care using a questionnaire and reviewing maternal records in order to determine length of labor and its relationship to subsequent preterm labors. The goals of the Year 2000 National Health Objective for low birth weight and infant mortality are not likely to be attained. Prematurity has gained national attention, however, and with public and professional awareness, perhaps this problem will decrease.

Ambulatory Care↗
PubMed1977

Creatine kinase isoenzyme activity in human placenta and in serum of women in labor.

Creatine kinase (EC 2.7.3.2) isoenzymes in extracts of human placenta and in serum from nonpregnant women and women in labor were separated on columns containing diethylaminoethyl-cellulose and assayed. The distribution of the isoenzymes in placenta (n = 10) was 80% BB (200 +/- 66 U/g (wet weight), 19% MM (49 +/- 30 U/g), and 1% MB (2.6 +/- 1.7 U/g); The geometric mean for the serum BB activity of the nonpregnant women (n = 50) was 0.6 +/- 1.5 U/liter, as compared to 3.0 +/- 1.4 U/liter for patients in labor who had normal deliveries (n = 92). The arithmetic mean for serum BB activity of labor patients with induced labor (n = 20), premature labor (n = 7), cesarian section (n = 6), or hypertension and pre-eclampsia (n = 6) did not differ significantly from the arithmetic mean BB activity for serum of labor patients with normal deliveries. However, the arithmetic mean serum BB activity of patients with stillbirths (n = 7) was significantly smaller than the arithmetic mean for normal labor patients.

Chromatography, DEAE-Cellulose↗
PubMedDate not supplied

Body experience differences of women with preterm labor.

PROBLEM: To determine whether body changes described and evaluated by women with preterm labor differed from those of women with normal pregnancies. METHODS: Experiences of weight, appetite, activity, and mood change experiences for four sequential time intervals of pregnancy from 41 women with preterm labor and 23 women with normal pregnancies were analyzed using log-linear procedures. FINDINGS: The pregnancies of women with preterm labor were characterized by greater frequencies of worrisome body changes up until the 28th week. CONCLUSIONS & IMPLICATIONS FOR NURSING: Preterm labor was discussed as a problem of body image organization. Women with preterm labor have greater difficulty assimilating and accommodating to the body changes of pregnancy. A model of body change for preterm labor pregnancy was described. Study findings emphasized the importance of psychoemotional phenomena in preterm labor childbearing outcomes.

Affect↗
PubMedDate not supplied

Characterization of the inflammatory cytokines in the vagina during pregnancy and labor and with bacterial vaginosis.

OBJECTIVES: 1) To characterize the presence of interleukin-1 alpha (IL-1 alpha), interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha) in the vagina during pregnancy and in labor; 2) to compare the vaginal levels of these inflammatory cytokines between laboring and nonlaboring patients; and 3) to compare the vaginal levels of these cytokines between women with and without bacterial vaginosis (BV). METHODS: Vaginal fluid was obtained by lavage from pregnant women with intact membranes at various gestational ages and during labor at term. These samples were analyzed for specific cytokine levels using standard enzyme-linked immunosorbent assay techniques. A Gram stain, wet mount, and pH were obtained from the vaginal fluid and were used to diagnose BV. The Mann-Whitney U test was used to evaluate the individual cytokine levels between groups, with P < .05 considered statistically significant. RESULTS: There was a wide range of vaginal cytokine levels found in our pregnant population (N = 72). Vaginal levels of IL-1 beta (median 1070 versus 245.7 pg/mL) and IL-6 (9.0 versus 0 pg/mL) were found to be significantly elevated in laboring patients as compared with nonlaboring patients (P = .005 and P = .002, respectively). There were no significant differences in the levels of IL-1 alpha and TNF-alpha between the laboring and nonlaboring women. Interleukin-1 beta was also found to be significantly elevated in the group of patients with BV (3364 versus 245.7 pg/mL; P = .01), particularly those who were nonlaboring (P = .003). In each individual patient, there was a wide variation in the levels of the four different cytokines. CONCLUSIONS: Measurable levels of the inflammatory cytokines IL-1 alpha, IL-1 beta, IL-6, and TNF-alpha were present in the vagina during pregnancy and labor. Vaginal levels of IL-1 beta and IL-6 were found to be significantly elevated in laboring patients as compared with nonlaboring patients. Vaginal levels of IL-1 beta were also significantly elevated in nonlaboring patients with BV.

Body Fluids↗
PubMed1997

A randomized trial of one-to-one nurse support of women in labor.

BACKGROUND: Health researchers and provider groups have recommended that women in labor should receive continuous professional support. The objective of our study was to compare the risks and benefits of one-to-one nurse labor support with usual intrapartum nursing care. METHODS: A randomized, controlled trial was conducted in a 637-bed university hospital in Montreal, Quebec, with 413 nulliparous women who were at more than 37 weeks' gestation, carrying singletons, and in labor. Women with scheduled cesarean section, scheduled induction, breech presentation, presence of paid labor support, or cervical dilatation over 4 cm were excluded. One-to-one care consisted of the presence of a nurse during labor and birth who provided emotional support, physical comfort, and instruction for relaxation and coping techniques. Usual care consisted of care for two or three laboring women with various types of supportive activities. RESULTS: A beneficial trend due to one-to-one nurse support was found with a 17 percent reduction in risk of oxytocin stimulation (relative risk of experimental vs control = 0.83; 95% confidence interval = 0.67, 1.04). No significant differences were found in overall labor durations and overall rates of total cesarean section, cesarean section for cephalopelvic disproportion, epidural analgesia, admission to the neonatal intensive care unit, instrumental vaginal delivery, and perineal trauma. CONCLUSIONS: The beneficial trend attributed to one-to-one nursing in reduction of oxytocin stimulation suggests that implementation of recommendations for continuous professional support by intrapartum nursing staff may be appropriate in North America.

Adult↗
PubMed1998

The effect of labor on the acid-base status of the newborn.

BACKGROUND: There has been some controversy regarding the effect that a long labor can have on fetal well-being. This study was undertaken to evaluate the effect of duration of labor both the first and second stage on the acid-base variables in the umbilical artery of the newborn. METHODS: Bloodsampling was attempted from all infants born at our department between October 1994 and September 1995. Nineteen hundred and forty-one live infants were delivered during the period. Sampling was unsuccessful in 264 cases and after excluding infants with operative delivery, multiple gestations, breech presentation, prematurity, postmaturity and infants small for gestational age 1255 remained singleton, term infants with vertex presentation and non-operative vaginal birth. RESULTS: We found no correlation between duration of the first stage of labor and neither pH nor base excess in umbilical artery blood. There was a significant correlation between duration of the second stage of labor and both the pH and base excess. For vaginal nulliparas we found that pH=7.30-0.016 x second stage duration in hours and base excess=-3.71-0.692 x second stage duration in hours. For women with previous vaginal births pH=7.31-0.029 x second stage duration in hours and base excess=-2.38-1.306 x second stage duration in hours. CONCLUSIONS: We find no correlation between duration of the first stage of labor and umbilical artery pH or base excess. We do find a correlation between duration of the second stage of labor and the umbilical artery pH and base excess. However, a prolongation of the second stage with as much as three hours would give an expected lowering of the umbilical artery pH with only 0.05 and of base excess with 2.1 mmol/l for vaginal nulliparas and correspondingly with 0.09 and 3.9 mmol/l in women with previous vaginal births. This effect on pH and base excess is so small that it is hardly clinically relevant and we do not find any support for the belief that a long labor -- in the absence of other risk factors -- is to the disadvantage of the fetus.

Acid-Base Equilibrium↗
PubMed1998

The effect of intrathecal and epidural narcotic analgesia on the length of labor.

A number of studies have shown conflicting results on the effect of epidural (EPI) analgesia on the length of labor. Combined spinal-epidural (CSE) and intrathecal analgesia (ITA) techniques have been used to provide pain relief for parturients, but currently there are few studies comparing EPI, CSE, and ITA techniques and their effect on the length of labor. Intrathecal opioids provide immediate pain relief for the parturient without autonomic, sensory, or motor blockade. The purpose of this retrospective study is to identify the effects of ITA on the length of labor compared with other regional anesthesia techniques. A total of 213 uncomplicated obstetric charts were reviewed in a 70-bed Air Force hospital that provided EPI, CSE, and ITA for obstetrical patients. The study consisted of the following four groups: (1) CSE (n = 76), (2) EPI(n = 41), (3) ITA (n = 49), and (4) no regional analgesia (NR) (n = 47). The results showed that the length of first-stage labor was statistically significantly less for those who received ITA compared with those who received CSE, EPI, and NR (P < .001). Second-stage labor was statistically significantly shorter for the NR group compared with the CSE and EPI groups (P < .01). No statistically significant difference was found between the length of second stage for ITA and NR groups. ITA analgesia shortened the first stage significantly in both primipara and multipara patients (P < .01). These results imply that the use of intrathecal opioids in the obstetrical patient does not prolong labor and seems to shorten the first stage of labor in both the primipara and multipara patients.

Adult↗
PubMed1979

Outcome of normal and dysfunctional labor in different racial groups.

Spontaneous labor in patients of different racial groups has been studied relating progress and outcome to whether labor was dysfunctional as defined by the partogram and action line. Forty-three percent of primigravidas and 17.6 to 25.8% of multigravidas passed the action line and had a lower admission cervical dilatation and a longer observed first stage than those patients whose labor progress remained to the left of the action line. White and black primigravidas whose labor progressed to the right of the action line had lower 1 and 5 minute Apgar scores and delivered heavier babies than those to the left. The cesarean section rates were 1.6% and 1.4% (left) and 7.6% and 18.2% (right) in white and black primigravidas, respectively. The cesarean section rate was significantly higher in black primigravidas irrespective of the relationship to the action line due to the high incidence of the complications of hypertension such as fetal distress and abruptio placentae in those in normal labor as well as those in dysfunctional labor due to cephalopelvic disproportion in those patients whose cervimetric progress went to the right of the action line.

Age Factors↗
PubMed1990

The course of labor after endurance exercise during pregnancy.

This study was designed to test the hypothesis that continuation of a regular running or aerobics program, or both, during the latter half of pregnancy would have a negative effect on the course and outcome of labor. The onset, course, and outcome of labor were independently monitored in 131 well-conditioned recreational athletes who had an uneventful first half of pregnancy. Daily exercise performance was quantitated before conception and throughout pregnancy. Comparisons were made between the 87 women who continued to exercise regularly at or above 50% of their preconceptional level throughout pregnancy and the 44 who discontinued their regular exercise regimen before the end of the first trimester. The incidence of preterm labor was similar in the two groups (9%). Labor began significantly earlier in the exercise group (277 +/- 6 vs 282 +/- 6 days). The women who continued to exercise had a lower incidence of abdominal (6% vs 30%) and vaginal (6% vs 20%) operative delivery, and active labor was shorter (264 +/- 149 vs 382 +/- 275 min) in those who were delivered vaginally. Finally, clinical evidence of acute fetal stress (meconium, fetal heart pattern, and Apgar score) was less frequent in the exercise group (50% vs 26%), although birth weight was reduced (3369 +/- 318 vs 3776 +/- 401 gm). These data negate the initial hypothesis and indicate that, in well-conditioned women who regularly perform aerobics or run, continuation of these exercise regimens has a beneficial effect on the course and outcome of labor.

Adult↗
PubMed2004

Sleep in late pregnancy predicts length of labor and type of delivery.

OBJECTIVE: The purpose of this study was to test the hypothesis that fatigue and sleep disturbance in late pregnancy are associated with labor duration and delivery type. STUDY DESIGN: In a prospective observational study of 131 women in their ninth month of pregnancy, objective (48-hour wrist actigraphy) and subjective (sleep logs and questionnaires) measures were used to predict labor outcomes using analysis of variance and logistic regression. RESULTS: Controlling for infant birth weight, women who slept less than 6 hours at night had longer labors and were 4.5 times more likely to have cesarean deliveries. Women with severely disrupted sleep had longer labors and were 5.2 times more likely to have cesarean deliveries. Fatigue was unrelated to labor outcomes. CONCLUSION: Health care providers should prescribe 8 hours of bed time during pregnancy to assure adequate sleep and should include sleep quantity and quality in prenatal assessments as potential predictors of labor duration and delivery type.

Adolescent↗
PubMed2006

Alterations in uterine sodium pump abundance may contribute to the onset and progression of term and preterm labor in mice.

OBJECTIVE: Other investigators have shown that reductions in active sodium pump units increase uterine contractility. Therefore, our goal was to determine whether uterine sodium pump abundance is decreased in mouse models of term and preterm labor. STUDY DESIGN: Mice were studied during the final one-third of pregnancy. Other pregnant mice had preterm labor induced with lipopolysaccharide and were studied at timed intervals thereafter. Uterine sodium pump alpha3-isoform messenger RNA and protein were measured. Data were analyzed by analysis of variance. RESULTS: Uterine sodium pump alpha3-isoform messenger RNA fell significantly from day 14 to day 18 and remained low on the day of birth. Uterine sodium pump alpha3-isoform protein levels decreased significantly also. In lipopolysaccharide-induced preterm labor, uterine sodium pump alpha3-isoform protein, but not messenger RNA, decreased significantly. CONCLUSION: Sodium pump alpha3-isoform protein levels decreased in uterus before term labor and lipopolysaccharide-induced preterm labor. These findings are similar to those in humans, which suggests that this mouse model may be useful in the study of the sodium pump in human pregnancy. Reductions in sodium pump number can increase uterine contractile force and may contribute to labor.

Animals↗
PubMed1997

Influence of gestational age on the time from spontaneous rupture of the chorioamniotic membranes to the onset of labor.

Our goal was to assess the influence of gestational age on the timing of labor onset following spontaneous rupture of the chorioamniotic membranes. The 24,831 patients in the Nova Scotia Atlee perinatal database from 1986 to 1992 whose membranes ruptured prior to labor onset and had live births were analyzed using life-table analysis methods. The probability of labor onset at specified intervals following rupture was markedly lower when rupture occurred earlier in gestation. Pregnancies of < 33 weeks' gestation were less than half as likely as term pregnancies to proceed to labor within 24 hours and pregnancies of 33-36 weeks' gestation were 50-75% as likely as term pregnancies to progress within that period. These data provide clear evidence that the earlier in gestation the rupture occurs, the less likely labor onset is within specified time periods. This pattern supports the contention that preterm rupture of membranes is etiologically distinct from preterm labor.

Amnion↗
PubMed2004

Induction of labor after one prior cesarean: predictors of vaginal delivery.

OBJECTIVE: To estimate the characteristics most associated with vaginal birth in patients undergoing induction of labor after 1 prior cesarean delivery. METHODS: All patients who presented for induction of labor from 1996 to 2001 with a history of 1 prior cesarean delivery were identified. Relevant demographic and obstetric data were abstracted from the charts. Univariate analysis was used to identify predictive factors associated with vaginal birth after cesarean. Binary logistic regression was further used to identify which factors were independently associated with the outcome measure. RESULTS: Of the 429 women included in the study, 334 (77.9%) had a successful trial of labor. In the final binary logistic regression equation, prior vaginal delivery (odds ratio [OR] 3.75; 95% confidence interval [CI] 1.96, 7.18) remained independently associated with an increased chance of a vaginal delivery after a trial of labor. Conversely, prior cesarean delivery for dystocia (OR 0.46; 95% CI 0.27, 0.79), induction on or past the estimated date of delivery (OR 0.46; 95% CI 0.27, 0.78), need for cervical ripening (OR 0.35; 95% CI 0.20, 0.61), and maternal gestational or preexisting diabetes (OR 0.16; 95% CI 0.06, 0.40) were all factors associated with a decreased likelihood of achieving a successful trial of labor. CONCLUSION: Several factors are available which may assist in identifying patients with the best chance of vaginal delivery after an induction of labor in the presence of a prior low-transverse cesarean scar. LEVEL OF EVIDENCE: II-2

Adult↗
PubMed2002

A diminished intrapartum amniotic fluid index is a predictive marker of possible adverse neonatal outcome when associated with prolonged labor.

OBJECTIVE: To determine whether a diminished intrapartum amniotic fluid volume represents a risk of adverse neonatal outcome when it occurs in conjunction with prolonged labor. METHODS: The intrapartum amniotic fluid index (iAFI) was measured in 242 parturients over 35 weeks of gestation during 1st-stage labor, and the umbilical artery blood gas was analyzed at delivery. The subjects were divided into group A (n = 99), having a diminished amniotic fluid volume (iAFI < or = 8.0 cm) and group B (n = 143), having a normal amniotic fluid volume (iAFI 8.1-20.0 cm), and selected antenatal, delivery, and neonatal variables were compared. In addition, the two groups were subdivided according to the duration of labor. Statistical analysis was performed using independent Student's t test, Mann-Whitney U test, chi-square analysis, and Fisher's exact test where appropriate. p < 0.05 was considered significant. RESULTS: The patient characteristics and pregnancy outcomes were similar in groups A and B, as were the incidences of an umbilical artery blood pH <7.20 and/or an Apgar score <7 (group A 9.5%, group B 10.1%). In group A, however, the incidence of an adverse neonatal outcome was 23.5% in cases in whom the duration of labor was longer than 8 h which was significantly higher than in cases in whom the duration of labor was 8 h or less (2.8%; p < 0.01). In group B, the incidence of an adverse neonatal outcome was similar in the two subgroups. CONCLUSIONS: The risk of an adverse neonatal outcome is higher in patients with diminished amniotic fluid volume if labor is prolonged. Consequently, determination of the iAFI could be a useful admission test.

Adult↗
PubMed1989

[Correlation between the levels of catecholamines (noradrenaline, adrenaline) and adrenal steroids (DHA-S, cortisol) in maternal and fetal blood during pregnancy and labor].

It is known that both catecholamines (CA) and cortisol (F) levels elevate during labor. To determine the correlation between adrenal steroids and medullary function, maternal blood was collected during pregnancy, first stage of labor (MVI) and at delivery (MVII). Umbilical arterial and venous blood (UA, UV) was also obtained at delivery. Further, ACTH or dexamethasone (Dx) was given during the first stage of labor, and maternal blood was collected before and 30 minutes after the administration. Plasma levels of CA[noradrenaline (NA), adrenaline (Ad)] were extracted by trihydroxyindole method and were measured by HPLC. DHA-S and F levels were determined by specific RIA. Results are as follows: 1. No apparent change was observed in maternal NA and Ad levels throughout pregnancy. DHA-S levels were high in first trimester and decreased as pregnancy advanced, while F levels showed an increase trend as pregnancy progressed. 2. All hormone levels in maternal blood increased remarkably during labor. A significant negative correlation between F and Ad levels at delivery was noted. When F levels were elevated by ACTH administration, Ad levels decreased. Ad levels elevated when F levels were suppressed by Dx administration. 3. NA, Ad and DHA-S levels in cord blood were higher than those in MVII. Levels of F in maternal blood were higher than those in cord blood. A significant correlation of F in MVII and UA was observed. These results indicate that the suppressive effect of F may be involved in the mechanism of Ad secretion, though the secretion of Ad increased with F in the course of labor. The response of fetal adrenal to the stress of labor may be different from that of maternal adrenal since a significant correlation was not noticed between the levels of Ad and cortisol in cord blood as was found in maternal blood.

Adrenocorticotropic Hormone↗
PubMed1976

Predictive value of cervical dilatation rates in labor in multiparous women.

A modified version of Philpott's partogram, previously used by us to analyze patterns of labor in primiparous and grand multiparous women in Israel, was applied to multiparous women. The results for labor in multiparous women closely resemble those found for primiparous and grand multiparous labors. The rate of cervical dilatation, as measured early in the active phase of labor [initial rate (IR)], is an accurate indicator of the outcome of labor. Ninety-eight percent of all multiparas with an IR of cervical dilatation of 0.75 cm/h or greater delivered spontaneously. Sixty-two percent of women with an IR of less than 0.75 cm/h required an assisted delivery or cesarean section. Mean IR of cervical dilatation for spontaneous deliveries, assisted deliveries, and cesarean sections were, respectively, 1.53, 0.67, and 0.46 cm/h. No significant differences were observed among different population groups. Cervical dilatation rates among all parities appeared similar. The only major difference was in dilatation rates for assisted delivery in primiparas, which were faster than in labors in multiparous or grand multiparous women.

Adolescent↗
PubMed1987

Circadian incidence of labor onset hour in preterm birth and chorioamnionitis.

Normal labor begins most frequently between midnight and 2 AM, presumably because of an unidentified circadian labor-activating mechanism. We used records of the Collaborative Perinatal Project to determine whether such a circadian mechanism is present with intrauterine growth retardation (IUGR) or preterm birth, and whether chorioamnionitis is associated with alternative patterns. In the absence of chorioamnionitis, both preterm births and term births with IUGR demonstrated nocturnal labor onset distributions like those of control term deliveries, which had a peak incidence at 1:45 AM and an amplitude of 35%. With chorioamnionitis, in contrast, there was a different circadian distribution of term labor onset hour, with a peak at 7:45 PM and a 32% amplitude. A similar trend was found among preterm births. These data suggest the presence of the normal nocturnal labor-activating mechanism in both growth-retarded term deliveries and a defined subset of preterm deliveries. Chorioamnionitis appears to be associated with a prominent, unidentified alternative labor-activating mechanism that is maximal in the evening.

Chorioamnionitis↗