Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Labor Stage, First”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 955 records · Page 53Linked to original sources
PubMed1999

How useful is cervical dilatation in patients with cervical stenosis who are participating in an in vitro fertilization-embryo transfer program? The Bourn Hall experience.

OBJECTIVE: To evaluate the place of cervical dilatation performed at the initial visit in an IVF-ET cycle in patients with known cervical stenosis. DESIGN: Retrospective study. SETTING: A tertiary care assisted conception unit. PATIENT(S): Fifty-seven patients who failed to conceive after a previous ET attempt and in whom the ET was classified as "difficult." INTERVENTION(S): Cervical dilatation under general anesthesia after pituitary suppression and before gonadotropin stimulation. MAIN OUTCOME MEASURE(S): Ease of the ET procedure and clinical pregnancy rate. RESULT(S): Eighteen (31.6%) of 57 women who failed to conceive after a previous attempt at IVF-ET achieved a clinical pregnancy after cervical dilatation. In 40 patients (70.2%), the subsequent ET was classified as "easy," whereas in the other 17 (29.8%), it remained difficult. The pregnancy rate was significantly higher when the ET was easy than when it was difficult (40% versus 11.8%, P<.05). CONCLUSION(S): In patients with cervical stenosis and a previous difficult ET, cervical dilatation during the initial visit leads to an easier subsequent ET and improves the pregnancy rate.

Adult↗
PubMed2002

Intravaginal misoprostol vs. expectant management in premature rupture of membranes with low Bishop scores at term.

OBJECTIVES: To evaluate the efficacy of vaginal misoprostol for cervical ripening and labor induction in premature rupture of membranes (PROM) cases with low Bishop scores at term. METHODS: Sixty-two PROM cases who fulfilled the criteria of 36 weeks of completed gestation, not in active labor, singleton pregnancy with vertex presentation, normal fetal heart rate reactivity, amniotic fluid index >5 cm and Bishop score <5, consented to participate in the study. Thirty-one of the cases were included in study group and a 50-microg misoprostol tablet was placed in the posterior vaginal fornix. Another 31 cases were included in control group and managed expectantly. Treatment success was defined as an interval from membrane rupture to delivery of <24 h. RESULTS: The mean admittance-delivery interval was significantly shorter in the study group (8.68+/-4.40 h) compared with the control group (26.22+/-18.98 h, P=0.001) and the mean interval from membrane rupture to delivery were also significantly shorter in the study group (19.37+/-7.20 h) than the control group (33.05+/-20.85 h, P=0.001). Oxytocin necessity was significantly lower in the study group than the control group (45.2% vs. 100%, P=0.00051). Tachysystole occurred more frequently in the study group (8 cases, 25.8% vs. 2 cases, 6.5%, P=0.038). There were no difference between two groups with regard to birth weights, 1- and 5-min Apgar scores and the need for neonatal intensive care unit. CONCLUSIONS: It is effective, safe and economic to use misoprostol vaginally in PROM cases with low Bishop scores at term.

Administration, Intravaginal↗
PubMed1997

Maternal perception of sound-provoked fetal movement in the early intrapartum period.

OBJECTIVE: To determine the relationship between maternal perception of sound-provoked fetal movement in the early intrapartum period and perinatal outcome. METHOD: 739 singleton pregnant women of at least 32 weeks gestation who were admitted to the labor ward, underwent the maternal perception of sound-provoked fetal movement test. All were in the latent phase of labor with singleton cephalic presentation. The result of maternal perception of sound-provoked fetal movement was compared with the perinatal outcome using sensitivity, specificity, negative predictive value, positive predictive value and accuracy. RESULTS: When 739 pregnant women were compared to the perinatal outcome, maternal perception of sound-provoked fetal movement had sensitivity 100%, specificity 98.9%, positive predictive value 15.1%, negative predictive value 100%, and accuracy 90.1%. CONCLUSION: The finding suggested the usefulness of maternal perception of sound-provoked fetal movement as an effective screening test to identify fetuses at risk in the early intrapartum period because of its high sensitivity and specificity. This is a simple and inexpensive test for evaluating fetal well-being in a primary health care setting.

Acoustic Stimulation↗
PubMed1997

Potential roles for gonadal steroids and insulin-like growth factor I during final cervical ripening.

OBJECTIVE: To determine whether gonadal steroids and insulin-like growth factor I influence the final cervical remodeling during parturition. METHODS: Cervical biopsies were obtained transvaginally before labor (n = 10) and after spontaneous cervical ripening and vaginal delivery (n = 20). Levels of estrogen and progesterone receptors, their messenger RNAs, insulin-like growth factor I messenger RNA, and serum estradiol and progesterone were measured. Collagen and proteoglycan concentrations and compositions were measured to estimate the degree of cervical ripeness. RESULTS: The concentrations of estrogen and progesterone receptors decreased in comparison with the clinically unripe cervix before labor. The median estrogen receptor concentration (range) decreased from 10 (2-18) to 4.5 (2-14) fmol/mg protein (P < .01), and the progesterone receptor concentration from 105.5 (32-153) to 74 (30-115) fmol/mg protein (P < .05), whereas their messenger RNA levels were unchanged. The insulin-like growth factor I messenger RNA concentration declined from 16.1 (8.4-20.4) at term to 8.9 (1.5-18.5) amol/microgram DNA after parturition (P < .01). The collagen solubility by pepsin increased, but not significantly, and the collagen concentration was unchanged. The concentration of small proteoglycans, mainly decorin, decreased from 1.59 (1.20-1.97) to 0.84 (0.24-1.41) micrograms/mg wet weight (P < .001), and the concentration of versican increased, but not significantly (P = .07). CONCLUSION: Concentrations of estrogen and progesterone receptors and insulin-like growth factor I messenger RNA were decreased significantly after spontaneous cervical ripening in comparison to levels before labor. These changes coincided with a tendency toward increased collagen solubility and a decline in concentration of small proteoglycans, which probably alters collagen organization, thus allowing for cervical softening and dilation. These observations suggest that gonadal steroids influence the final cervical remodeling during parturition, an influence perhaps mediated by insulin-like growth factor I.

Adult↗
PubMed1999

Active-phase labor arrest: oxytocin augmentation for at least 4 hours.

OBJECTIVE: To assess a labor-management protocol that mandated at least 4 hours of oxytocin augmentation before cesarean delivery for active-phase labor arrest. METHODS: We prospectively evaluated term gravidas in spontaneous labor with active-phase labor arrest (cervix at least 4 cm dilated and 1 cm or less of cervical progress in 2 hours). Exclusion criteria included nonvertex presentation, previous cesarean, multiple gestation, and a nonreassuring fetal heart rate tracing or chorioamnionitis at the time of labor arrest. After the diagnosis of active-phase arrest, oxytocin was initiated with an intent to achieve a sustained uterine contraction pattern of greater than 200 Montevideo units. Cesarean delivery was not performed for labor arrest until at least 4 hours of a sustained uterine contraction pattern of greater than 200 Montevideo units, or a minimum of 6 hours of oxytocin augmentation if this contraction pattern could not be achieved. RESULTS: Five hundred forty-two women were managed by the protocol, and 92% delivered vaginally. The subsequent vaginal delivery rate for parous women who had not progressed (1 cm of cervical dilation or less) despite 2 hours of oxytocin augmentation was 91%, and it was 74% for nulliparas. With no labor progress after 4 hours of oxytocin augmentation, the subsequent vaginal delivery rates were 88% for parous women and 56% for nulliparas. There were no severe maternal complications. One neonate had persistent fetal circulation and one had a positive blood culture, but both did well. CONCLUSION: Extending the minimum period of oxytocin augmentation for active-phase labor arrest from 2 to at least 4 hours was effective and safe.

Female↗
PubMed1999

Station at onset of active labor in nulliparous patients and risk of cesarean delivery.

OBJECTIVE: To determine whether term nulliparas with an unengaged vertex presentation at onset of active labor have a higher risk for cesarean delivery. METHODS: A retrospective cohort of 1250 randomly chosen nulliparous patients at 37-42 weeks' gestation who delivered between 1988 and 1989 were selected. Four hundred forty-seven patients were excluded because of nonvertex presentation, cesarean delivery before active phase of labor, multiple gestation, delivery at less than 37 weeks' or greater than 42 weeks' gestation, induction of labor, or missing charts. For the purpose of this study, active labor was defined as regular contractions with cervical dilatation of at least 3 cm. The station at onset of active labor was recorded. Engagement was considered to be at station 0 or below. RESULTS: Of the 803 patients in the study group, 567 presented unengaged and 236 patients presented engaged. The cesarean rates differed significantly between the two groups: 14% of those unengaged compared with 5% of those engaged (chi2 = 11.9, P < .001). After adjusting for confounding variables, engagement at the time of onset of active labor was associated with lower risk of cesarean delivery (odds ratio .512, 95% confidence interval .285, .922). CONCLUSION: Eighty-six percent of nulliparas with an unengaged vertex at onset of active labor delivered vaginally. Engaged vertex at the onset of active labor was associated with a lower risk of cesarean delivery.

Cesarean Section↗
PubMed1999

Epidural analgesia and active management of labor: effects on length of labor and mode of delivery.

OBJECTIVE: To determine whether cervical dilatation at the time of placement of patient-requested epidural affects cesarean rates or lengths of labors in actively managed parturients. METHODS: The charts of 255 women randomized to active management of labor (n = 125) or control protocols (n = 130) were reviewed and stratified to early epidural placement (up to 4 cm cervical dilatation) versus late placement (more than 4 cm). RESULTS: Women with early epidural placement had shorter labors than those with late placement (11.6 +/- 4.6 versus 13.2 +/- 5.6 hours; P = .02). Active management reduced the length of labor compared with controls regardless of epidural timing, with a reduction of 1.4 hours in early epidural placement (10.9 +/- 4.7 versus 12.3 +/- 4.3 hours; P = .04) and 3.6 hours in those with later placement (11.0 +/- 3.6 versus 14.6 +/- 6.2 hours; P = .004). Cesarean rates did not vary significantly (early 14.5% versus late 7.9%; P = .21). Early epidural placement did not lengthen the second stage of labor or increase operative vaginal delivery rates. CONCLUSION: Early epidural placement did not affect lengths of labor or cesarean rates and was actually associated with shorter labor compared with late epidural placement. Women managed actively in labor, regardless of timing of epidural placement, had shorter labors than controls.

Adult↗
PubMed2002

Messenger ribonucleic acid levels of interleukin-1 beta, interleukin-6 and interleukin-8 in the lower uterine segment increased significantly at final cervical dilatation during term parturition, while those of tumor necrosis factor alpha remained unchanged.

OBJECTIVE: To investigate the content of tumor necrosis factor alpha, interleukin-1 beta, interleukin-6 and interleukin-8 messenger ribonucleic acid (mRNA) in the lower uterine segment during term parturition. STUDY DESIGN: mRNA extracts from the lower uterine segment obtained from 53 women undergoing non-elective caesarean section at term were analyzed by semi-quantitative reverse transcriptase polymerase chain reaction. The patients were grouped according to cervical dilatation (less than 2 cm, n=18; 2 to less than 4 cm, n=13; 4-6 cm, n=7; more than 6 cm, n=15) at the time of caesarean section. RESULTS: Interleukin-1 beta and interleukin-8 mRNA-contents at more than 6 cm cervical dilation were significantly higher than at less than 2 cm. The levels of interleukin-6 were already significantly increased in the 4-6 cm group, while the tumor necrosis factor alpha ribonucleic acid content did not change during parturition. CONCLUSION: The process of cervical dilatation during parturition at term is associated with an increased expression of interleukin-1 beta, interleukin-6 and interleukin-8 mRNA in the lower uterine segment. These findings support the theory that the activation of the inflammatory network plays an important role in the progress of cervical dilatation.

Cervix Uteri↗
PubMed1998

Emergency cervical cerclage: a study between duration of cerclage in situ with gestation at cerclage, herniation of forewater, and cervical dilatation at presentation.

OBJECTIVE: To investigate the effectiveness of emergency cerclage in prolonging pregnancy and its effect on pregnancy outcome in patients with cervical incompetence. STUDY DESIGN: Retrospective review of patients who had emergency cervical cerclage performed for cervical incompetence. 19 patients between 16 and 30 weeks' gestation with (1) cervical effacement, (2) cervical dilatation of at least 1 cm, (3) herniation of intact fetal membranes through the cervical os, (4) absence of established labor, and (5) absence of clinical evidence of infection were studied. The duration of cerclage in situ, gestation at delivery and birth weight were analyzed. RESULTS: The mean duration of cerclage in situ was 47.5+/-48.6 days. The mean gestation at delivery was 30.5+/-6.6 weeks and the mean birth weight was 1730+/-1105 grams. The duration of cerclage in situ was significantly longer when the procedure was performed at or before 20 weeks' gestation (Mann-Whitney U test, P<0.02), or when there had been no herniation of forewater (HFW) at the time of presentation (Mann-Whitney U test, P<0.05). CONCLUSIONS: Gestation at cerclage and the presence of herniation of forewater (HFW) at presentation of cervical incompetence significantly affect the duration of emergency cerclage in situ.

Adult↗
PubMed1998

Fetal cardiotocography and acid-base status during cesarean section.

OBJECTIVE: To assess the fetal well-being during cesarean section, in relation to the previous fetal condition. DESIGN: Observational study. SETTING: University Hospital. PATIENTS PARTICIPANTS: 204 women undergoing cesarean section (203 intrapartum cesarean sections): 177 with general anesthesia and 27 with spinal anesthesia. MATERIAL AND METHODS: We compared the fetal heart records of the last 30 min before cesarean section (during the first stage of labor) with those during cesarean section. Scalp blood analysis 30 min before the beginning of anesthesia induction was compared with umbilical artery analysis at delivery. MAIN OUTCOME MEASURES: Cardiotocography. Acid-base analysis. Apgar scores. RESULTS: During cesarean section there was a reduction in uterine activity, an increase in silent tracings and a decrease in late decelerations. Umbilical artery pH was lower than scalp pH (7.23+/-0.06 vs 7.30+/-0.06). Oxygen saturation was also lower (14.43+/-8.58% vs 18.99+/-8.4%). The values of pCO2 and of base deficit were higher. During cesarean section low values of modified Fischer scores were associated with low pH values of umbilical artery and low Apgar scores. CONCLUSION: Silent tracings appearing during cesarean section usually do not indicate fetal distress. Poor intracesarean fetal heart tracings were associated with worse indicators of neonatal well-being. Although umbilical pH were lower than scalp values, when the correction described in the literature was applied, the difference was of little clinical relevance. It is concluded that anesthesic, pharmacological and surgical events have slight repercussion in fetal well being. However, in a few cases fetal heart monitoring during cesarean section could detect otherwise undiagnosed cases of transient acidemia or depression in the fetus.

Acid-Base Equilibrium↗
PubMed2002

Effect of kappa opioid agonists on visceral nociception induced by uterine cervical distension in rats.

Although uterine distension in rats results in an escape reflex, there exists no model of uterine cervical distension (UCD), the pain stimulus during the first stage of labor. The aims of this study were to develop such a model in virgin rats and to test whether peripherally restricted kappa opioid receptor (KOR) agonists (ADL 10-0101, ADL 10-0102, ADL 10-0116) inhibit responses to UCD. Under intravenous (i.v.) pentobarbital and alpha-chloralose anesthesia, fine metal rods were inserted in both uterine cervical osses through a small midline laparotomy. UCD was performed by manual separation of the rods (25-100 g). Single-unit afferent responses in hypogastric nerve or reflex rectus abdominis electromyographic (EMG) activity were determined before and after i.v. KOR agonists. UCD resulted in a stimulus-dependent increase in single-unit afferent activity. Units could be characterized as low threshold (mean threshold 6.6+/-2.7 g), or high threshold (mean threshold 55+/-8.8 g); all were C fibers, all responded to topical bradykinin. ADL 10-0116 (10 mg/kg) reduced the afferent response to UCD. Reflex EMG response occurred over a distension force range of 25-100 g, unaffected by i.v. saline. All three KOR agonists produced a dose-dependent, naloxone-reversible inhibition of the EMG response with a potency relationship of ADL 10-0102 (ED50 0.04 mg/kg)>ADL 10-0101 (ED50 0.65 mg/kg)=ADL 10-0116 (ED50 0.60 mg/kg). These data support the use of acute UCD as a noxious stimulus, inducing afferent and reflex activity. Like other visceral stimuli, UCD is sensitive to inhibition by KOR agonists.

Analgesics, Opioid↗
PubMed1997

Simultaneous monitoring of head-to-cervix forces, intrauterine pressure and cervical dilatation during labour.

In many westernized countries, the caesarean section role has now reached 15% or more, most commonly because of slow progress in labour. In order for labour to result in a vaginal delivery, the uterine cervix must dilate to allow the foetus to travel through the birth canal. This process is driven by uterine contractions, but the mechanisms by which the contractions result in cervical dilatation are still far from clear. The force exerted by the presenting part (foetal head) on the cervical tissue during contractions (head-to-cervix force, HCF) has been shown to be the variable with the best correlation with cervical dilatation. Unfortunately, the mechanism by which these two variables are related is still poorly understood. In order to investigate the relationship between head-to-cervix force, intrauterine pressure (IUP) and cervical dilatation, we have developed a system for their simultaneous and continuous monitoring during labour. The HCF is measured by using a novel intrauterine probe which is slipped alongside the foetal head so as to lie sandwiched between the latter and the cervix. The probe is fitted with six specially designed miniature force sensors, spaced 1.8 cm apart, which respond linearly and approximate the behaviour of load cells. They are interfaced with a PC by circuitry that allows auto-zeroing and drift compensation. The system enables simultaneous acquisition of intrauterine pressure and foetal heart rate (measured using a Sonicaid Meridian foetal monitor) via a serial link, together with continuous cervical dilatation measured by a caliper-like device applied to the cervix. Some preliminary data are presented, which suggest that the system can be used to investigate the role played by head-to-cervix force and intrauterine pressure in the cervix dilatation process.

Analog-Digital Conversion↗
PubMed2002

Quantitation and localization of inflammatory cytokines interleukin-6 and interleukin-8 in the lower uterine segment during cervical dilatation.

PURPOSE: Cervical dilatation during parturition is associated with a significant increase of interleukin (IL)-6 and IL-8. The purpose of this study was to localize the respective messenger RNA and to quantitate their protein levels during various stages of dilatation. METHODS: Protein extracts from 34 biopsy specimens of the lower uterine segment at various stages of cervical dilatation (<2, 2 to <4, 4-6, and >6 cm) were subjected to enzyme linked immunosorbent assay for IL-6 and IL-8 to document their concentration. The respective mRNA expression was studied using reverse transcriptase PCR using IL-6 and IL-8 specific primers. Localization of IL-6 and IL-8 was done by in situ hybridization using biotinylated probes. RESULTS: The IL-6 and IL-8 concentrations increased significantly in the lower uterine segment tissues at 4-6 cm of dilatation. Expression of IL-8 was seen in all the tissues at or more than 4 cm dilatation, whereas IL-6 expression was inconsistent. In situ hybridization localized IL-6 and IL-8 mRNA to the glandular epithelium. CONCLUSIONS: The increase in the inflammatory cytokines (IL-6 and IL-8) during parturition is associated with cervical effacement.

Biopsy↗
PubMed1999

Ignác Semmelweis and the etiology of fetal and neonatal sepsis.

It is well-known that Ignác Semmelweis discovered the etiology and prophylaxis of puerperal sepsis. However, few historians have focused on his understanding of the pathophysiology of fetal and neonatal sepsis. Based on several key observations, Semmelweis realized that puerperal fever (also known as "childbed fever") could be transmitted to the fetus, especially when the first stage of labor was prolonged and multiple examiners performed vaginal examinations while their fingers were contaminated. This insight was particularly valuable in that it helped him decipher the mystery of puerperal sepsis. This paper presents some of these concepts and supporting evidence.

Female↗
PubMedDate not supplied

Perinatal outcome of vaginally delivered twin gestations with a larger twin B.

OBJECTIVE: To study the perinatal outcome of vaginally delivered twins when twin B is more than 250 g larger than twin A. STUDY DESIGN: Maternal and neonatal charts of live-born, nonanomalous twins, >25 weeks' gestation and vaginally delivered over a period of 17 years were reviewed. The results of this review were distributed among two groups: (1). those with twin B more than 250 g larger than twin A (DeltaBW>250) and (2). those where the difference was <250 g (DeltaBW<250). For vaginally delivered twin gestations, the perinatal outcome of twin B in the group DeltaBW>250 was compared to that of its co-twin, and to that of twin B in the group DeltaBW<250. RESULTS: Of the 679 twin gestations reviewed, 138 (20.6%) were in the group DeltaBW>250, of whom 73 (52.9%) delivered vaginally despite malpresentation in 39.7%. The vaginally delivered twin pregnancies in the groups DeltaBW>250 (n=73) and DeltaBW<250 (n=303) had similar demographics, parity, presentation, gestational age at delivery, and duration of the first stage of labor. Discordant twins were more frequent in the group DeltaBW>250 (26.0 versus 9.5%, p=0.001). Twin B in the group DeltaBW<250 was smaller, with higher incidence of growth restriction, low 5 min Apgar score, and hyperbilirubinemia compared to twin B in the group DeltaBW>250. There was no difference in the incidence of intraventricular hemorrhage, seizures, sepsis, neonatal death, and median nursery stay. Except for a lower median Apgar score at 1 min in twin B and a longer median nursery stay in twin A, twins A and B in the group DeltaBW>250 were similar regarding all other neonatal outcome variables. CONCLUSIONS: When twin B is more than 250 g larger than A, and both are delivered vaginally, the perinatal outcome is similar to its co-twin as well as to that of twin B of all other vaginally delivered twins. That twin B is larger than A is not itself a contraindication to attempted vaginal delivery.

Adult↗