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PubMed2003

Prevalence and predictors of women's experience of psychological trauma during childbirth.

BACKGROUND: The increased acceptance of the prevalence of trauma in human experience as well as its psychological consequences has led to revisions of diagnostic criteria for the disorder. The three purposes of this study were to examine the rates at which women experienced psychological trauma in childbirth, to explore possible causal factors, and to examine possible factors in the development of the disorder. METHODS: One hundred and three women from childbirth education classes in the Atlanta metropolitan area completed a survey in late pregnancy and a follow-up interview approximately 4 weeks after the birth. RESULTS: The childbirth experience was reported as traumatic by 34 percent of participants. Two women (1.9%) developed all the symptoms needed to diagnose posttraumatic stress disorder, and 31 women (30.1%) were partially symptomatic. Regression analysis showed that antecedent factors (e.g., history of sexual trauma and social support) and event characteristics (e.g., pain in first stage of labor, feelings of powerlessness, expectations, medical intervention, and interaction with medical personnel) were significant predictors of perceptions of the childbirth as traumatic. The pain experienced during the birth, levels of social support, self-efficacy, internal locus of control, trait anxiety, and coping were significant predictors of the development of posttraumatic stress disorder symptoms after the birth. CONCLUSIONS: These findings suggest several intervention points for health care practitioners, including careful prenatal screening of past trauma history, social support, and expectations about the birth; improved communication and pain management during the birth; and opportunities to discuss the birth postpartum.

Adult↗
PubMed2002

Optimal timing of elective caesarean section in Belgian White and Blue breed of cattle: the calf's point of view.

The purpose of this study was to evaluate whether the timing of elective caesarean section (ECS) during parturition affects pulmonary and metabolic adaptation to extra-uterine life in healthy Belgian White and Blue (BWB) calves delivered at term. Vaginal palpation was performed and deliveries divided into six categories of timing for ECS: cervix closed (TECS 1); passive and active cervical dilatation (TECS 2 and TECS 3); full cervical dilatation (TECS 4); spontaneous rupture of allantoic (TECS 5) and amniotic (TECS 6) membranes. One hundred and eighteen BWB calves were examined at birth, 5, 15, 30, 45 and 60 min and 2, 3, 6, 12 and 24 h after birth using the following measurements: physical examination (time between birth and sternal recumbency [T-SR]); heart rate (mHR); arterial blood gas analyses (arterial partial pressure in oxygen [PaO(2)], in carbon dioxide [PaCO(2)], arterial haemoglobin oxygen saturation [SaO(2)], alveolo-arterial difference in oxygen [AaDO(2)]); pulmonary function tests using the oesophageal balloon catheter technique (respiratory rate [RR], total pulmonary resistance [R(L)], dynamic lung compliance [C(Ldyn)], tidal volume [V(T)] and minute volume [V(E)]); arterial and venous blood acid-base balance analyses (arterial and venous pH [pHa and pHv], bicarbonate concentration [HCO(3)a and HCO(3)v], base excess [BEa and BEv]); rectal temperature (RT); jugular venous blood sampling for determination of metabolic variables (blood glucose [G], plasma lactate [L], serum cortisol [C], plasma noradrenaline [NA] and adrenaline [A] concentrations); haematological variables (red blood cell count [RBC], total haemoglobin concentration [Hb], Packed Cell Volume [PCV]) and passive immune transfer variables (total serum protein [TP] and beta(2)gammaglobulin [beta(2)gamma] concentrations).TECS significantly (P</=0.05) influenced PaO(2), SaO(2), AaDO(2), RR, V(T), V(E), C(Ldyn), RT, G, NA, A, RBC, Hb and TP: compared to TECS> or =4 calves, TECS< or =3 calves showed lower PaO(2), SaO(2), V(T), C(Ldyn), RT, G, NA, A, RBC, Hb and TP and higher AaDO(2), RR, V(E). TECS differences progressively decreased and disappeared between 6 and 12 h after birth in TECS 2 and 3 calves but remained up to 24 h in TECS 1 calves. Improved postnatal respiratory and metabolic adaptation in TECS> or =4 calves were mainly related to differences in exposure to labour and subsequent hormonal surge: catecholamines, particularly A, enabled more effective removal of lung liquid and/or release of surfactant which contribute to better gas exchanges and induced greater energy mobilization to maintain adequate body temperature. It was concluded waiting for full cervical dilatation before performing CS should be encouraged because it promotes postnatal respiratory and metabolic adaptation in full-term BWB calves.

Animal Husbandry↗
PubMed2003

Outcome of prolapsed chorioamniotic membrane: relationship between the degree of herniation, infection, and pregnancy prolongation.

Our objective was to determine the outcome predictor of conservative bed rest therapy for prolapsed chorioamniotic membrane. We could perform tocolysis for 61 women, 41 of visible membrane (group A) and 20 of protruding membrane (group B). The duration of pregnancy prolongation and gestational age (in weeks) at delivery in group A were significantly larger than in group B ( p < 0.05). Outcome of neonates was also significantly different between two groups ( p < 0.05). In 37 women of group A (90%) and 10 of group B (50%; group D), signs of infection were negative throughout the admission to delivery with conservative therapy (white blood cell counts </= 13000/microL and CRP values </= 1.0 mg/dL). In group D, pregnancy was prolonged 23.9 days, which was significantly longer than in group B ( p < 0.05). This study suggests that pregnancy prolongation for prolapsed membrane with conservative therapy depends on the success of prophylactic treatment for infection.

Adult↗
PubMed2007

Dynamics of cervical remodeling during pregnancy and parturition: mechanisms and current concepts.

The cervix serves as a protective barrier from invading microorganisms and as a structural barrier to delivery of the fetus. Among all biological processes, the phenomenal connective tissue remodeling that occurs in the cervix during and after parturition is unparalleled in scope and magnitude. The process of connective tissue remodeling in the cervix during pregnancy occurs in four stages: softening, ripening, dilation, and repair. Although overlapping in time, each stage is uniquely regulated. Results from studies using serial measurements of cervical length indicate that cervical ripening precedes myometrial contractions of labor by several weeks, suggesting that parturition in women is a process of long duration and that uterine contractions of labor are late events in the parturition process. A clear understanding of the biologic mechanisms that regulate cervical remodeling during pregnancy is needed to influence the preterm birth rate and to develop strategies to prevent preterm dilation of the cervix.

Animals↗
PubMed1987

Cardiorespiratory fitness during pregnancy and its effect on outcome.

To determine the effects of aerobic fitness on pregnancy and the newborn, 20 primigravid subjects were studied throughout gestation and immediately postpartum. The subjects were classified as trained (T = 10) or untrained (UT = 10) based on the heart rate response to submaximal cycle ergometry testing done in each trimester. There was no difference between groups in the length of gestational period (T = 40.75; UT = 40.75 weeks) nor weight gained vs prepregnancy measures (T = 13.92; UT = 13.30 kg). The first stage of labor was extended in the UT, 13 h 58.8 min vs 11 h 18.0 min. UT had a longer second stage, 90.57 vs 70.0 min for T. Stage 3 was also prolonged in UT, 15.17 vs 7.43 min. In both groups medication was used equally. Two of the ten T females had Caesarean sections vs three of the ten in the UT group. The mean Apgar scores at 1 and 5 min were: T = 7.70, 9.20; UT = 7.90, 9.33, respectively. The birth weights of the T babies were marginally higher than the UT newborns (3733.00 vs 3679.97 g). All babies were healthy and without apparent abnormalities. There appears to be no positive or negative effects of maternal fitness on the newborn. The reduction in the active stage of labor in the T group may reflect their improved fitness levels.

Adult↗
PubMed1980

[The determination of verapamil in maternal and fetal blood (author's transl)].

During the late first stage of labor and during the second stage of labor seven women in labor received an intravenous infusion during 60-110 minutes of verapamil at 2 g/k/per minute. Immediately following delivery of the infant, maternal and cord blood was drawn and the verapamil level measured by gas chromatography. The serum levels in the maternal blood were from 5.4 to 33.6 ng/ml. (Mean value 19.3 +/- 3.3 ng/ml) and the cord blood concentrations were 4.3-17.8 ng/ml (Mean value 8.5 +/- 1.9 ng/ml). The mean fetal serum level of verapamil was 51.4% of the mean maternal value.

Female↗
PubMed2001

Dystocia among women with symptomatic uterine rupture.

OBJECTIVE: The purpose of this study was to analyze cervical dilatation patterns among women with uterine rupture by means of a mathematic model and to use the results to determine optimal intervention criteria. STUDY DESIGN: This was a case-control review that compared a case patient group of 19 women with uterine rupture during labor with control groups with either no previous cesarean deliveries, vaginal birth after cesarean delivery, or failure of attempted vaginal birth after cesarean delivery. The mathematic model quantified dilatation and adjusted for conditions specific to each patient. Case patients were compared with matched control subjects by means of paired t tests, analysis of variance, odds ratios, and conditional logistic regression. RESULTS: Dystocia was present in 31.6% to 47.4% of patients with uterine rupture, versus 2.6% to 13.2% of the control group with no previous cesarean deliveries (P< or =.001). The incidence of an arrest disorder among patients with uterine rupture was similar to that seen in the control group with failure of attempted vaginal birth after cesarean delivery. However, the interval from diagnosis to rupture or cesarean delivery was 5.5 +/- 3.3 hours among case patients with uterine rupture and 1.5 +/- 1.3 hours in the control group with failure of attempted vaginal birth after cesarean delivery. CONCLUSION: When cervical dilatation was lower than the 10th percentile and was arrested for > or =2 hours, cesarean delivery would have prevented 42.1% of the cases of uterine rupture and resulted in excess 2.6% and 7.9% cesarean delivery rates among women with no previous cesarean deliveries and women with vaginal birth after cesarean delivery, respectively.

Case-Control Studies↗
PubMed1998

Inflammatory cytokines in newborn infants.

Serum levels of IL-1beta, IL-6 and TNF-alpha were measured in 48 healthy, termed neonates on the 1st (N1), 5th (N5) and 40th (N40) day after birth, compared with those in maternal serum (MS), umbilical cord (UC) and adult controls. Cytokine values in N1 and N5 were significantly elevated, than those in UC and in controls (P<0.0001). IL-1beta and IL-6 declined significantly from N1 to N40 (P<0.0001), while TNF-alpha increased significantly from N1 to N5 and declined thereafter. MS infinity IL-1beta and IL-6, but not MS infinity TNF-alpha, were significantly higher than those of controls (P<0.0001). IL-1beta values depended on the mode of delivery. In conclusion, the increased concentrations of IL-1beta, IL-6 and TNF-alpha during the perinatal period might suggest their involvement in an inflammation-like process during normal parturition, and reflect also a newborn immune response to the stress of delivery and environmental changes.

Adult↗
PubMed2005

Correlation between visual examination of the cervix and digital examination.

OBJECTIVE: To determine the correlation between visual assessment of the cervix and digital examination. METHODS: Prospective study of patients presenting to Labor and Delivery. Exclusion criteria were preterm premature ruptured membranes (PPROM) and placenta previa. Visual and digital assessments of cervical dilation, effacement, position, and station of fetal presenting part were made. Correlation between visual and digital examinations was measured using Spearman rank correlation coefficient (COR). A p-value<0.05 was considered significant. RESULTS: The study involved a total of 107 patients at a mean gestational age of 32.3 weeks (range 17-41). Seven patients had ruptured membranes, and 46 were nulliparous. Visual assessment correlated with digital examination for all parameters measured with Spearman rank correlation coefficients between 0.618 and 0.686 (all significant at p<0.001). Correlations between visual and digital assessment of cervical dilation, effacement, station, and position were not as strong (0.291-0.699), but remained significant (p<0.02) in a subgroup of 50 preterm patients<34 weeks gestation. CONCLUSION: Visual assessment correlates with digital examination of the cervix. This correlation remained significant in a subset of preterm patients with intact membranes.

Cervix Uteri↗
PubMed1991

Evaluation of the epidemiology of hepatitis B virus cross-infection in a maternity hospital.

OBJECTIVE: To determine the hepatitis B infection risk in a university hospital of obstetrics and gynecology. SETTING: The University Hospital of Obstetrics and Gynecology, The University of Sarajevo, Yugoslavia. DESIGN: Staff members were divided into three groups: 73 doctors, 184 medical technicians working in delivery rooms, and 55 medical technicians working with postnatal care. The patients were 63 women, aged 17 to 39 years (mean = 26.11 years), pregnant for the first time and in the first stage of labor. Participants all had a negative history of hepatitis B and no known contact with the hepatitis B virus. RESULTS: The incidence of hepatitis B infections among physicians, technicians, and postnatal care technicians was 1.36%, 3.8%, and 3.6%, respectively. The incidence among patients was 4.76%. The daily infection risk varied between 1% and 17% of all deliveries. CONCLUSIONS: The risks of transmission of the hepatitis B virus to hospital workers in this setting is indeed high enough to make a case for hepatitis B vaccination in susceptible staff members. Even if vaccination of staff members is carried out, hygienic measures to prevent the transmission of bloodborne infection between patients and from patients to staff are of the utmost importance.

Adolescent↗
PubMed2005

Simple instrument for measuring cervical dilatation during labour.

The construction of a simple disposable instrument for the measurement of cervical dilatation is described. The instrument consists of two clips, a measuring tape and a flexible tube. The measuring tape is fixed to one clip and threaded through the flexible tube, which is fixed to the other clip. The clips are attached to opposing cervical rims at 3 o'clock and 9 o'clock and the differential displacement of the marking on the measuring tape and free end of the flexible tube is measured. Laboratory measurements were performed in order to determine the error of measurement. The absolute error of measurement with this instrument is 1.5 mm. Clinical measurements were performed on 12 parturients with a single foetus in vertex position and 3 to 4 cm cervical dilatation. The results of measurements were within +/-1 cm error margin of manual assessments. No adverse effects were noted due to the use of the instrument. The instrument did cause minor discomfort to patients during application.

Adult↗
PubMed1976

Extradural analgesia in obstetrics: a controlled trial of carbonated lignocaine and bupivacaine hydrochloride with or without adrenaline.

Four local anaesthetic solutions (2% carbonated lignocaine with or without adrenaline and 0.5% bupivacaine HCl with or without adrenaline) were used randomly for 335 continuous lumbar extradural blocks in labour. Carbonated lignocaine caused a more rapid onset of analgesia than bupivacaine HCl. The addition of adrenaline made little difference to the onset times, prolonged markedly the duration of analgesia with carbonated lignocaine and had little effect on the duration of analgesia with bupivacaine HCl. Tachyphylaxis was a feature with carbonated lignocaine and adrenaline, but not with the other solutions. The incidence of unblocked segments was 7-9% in the four groups. The incidence of unilateral analgesia was 6% with plain lignocaine and 13% in the other groups. Complete pain relief occurred more frequently with bupivacaine HCl than with carbonated lignocaine and the use of adrenaline had little effect on the degree of analgesia.

Anesthesia, Epidural↗
PubMed1982

Effect of extradural analgesia using bupivacaine and 2-chloroprocaine on intervillous blood flow during normal labour.

The effect of lumbar extradural analgesia on intervillous blood flow (IBF) during labour was studied in 26 healthy parturients using an i.v. bolus injection of xenon-133. There was a 19% decrease (n.s.) in mean IBF in six parturients (non-extradural control group). Mean IBF increased by 37.5% when 0.25% bupivacaine 10 ml was used and by 35.2% when 2% 2-chloroprocaine 10 ml was used (n.s.). When the two extradural groups were combined, the mean difference between IBF1 and IBF2 was 45 +/- 112 ml min-1 dl-1. This increase is statistically significant (P less than 0.05). The improvement in IBF after extradural block was considered to be a result of the decreased uterine vascular resistance, as no significant changes were observed in arterial pressure, uterine activity or uterine tone.

Adult↗
PubMed2004

Cervical dilatation has a positive impact on the outcome of IVF in randomly assigned cases having two previous difficult embryo transfers.

BACKGROUND: The difficulty of embryo transfer has been reported to affect success rates in some centres, but not in others. Cervical dilatation has been proposed as a means to overcome difficult embryo transfer, but consistent criteria for patient selection are lacking. In a prospective randomized study, we examined the influence of cervical dilatation 1-3 months before embryo transfer on the outcome of IVF in cases having difficult embryo transfer in two previously failed IVF cycles. METHODS: Two alternative methods of embryo transfer preparation were evaluated in 283 randomly assigned women having difficult embryo transfers in two previously failed IVF attempts. Randomization was made using a computer-generated random number table. Cervical dilatation before starting any IVF treatment was used in 145 cases, and no dilatation was performed in 138 cases. RESULTS: The cervical dilatation group yielded a significantly higher pregnancy rate than the non-dilated group (40% versus 24%; P < 0.01). Likewise, the implantation rate (24.1% versus 14.9%; P < 0.01) and the live birth rate (34.48% versus 19.56%; P < 0.01) were significantly higher in the dilatation group than in the non-dilated group. CONCLUSIONS: In patients with prior difficult embryo transfer, cervical dilatation 1-3 months before embryo transfer lead to an improved pregnancy rate.

Adult↗
PubMed2003

Cervical dilatation related to uterine electromyographic activity and endocrinological changes during prostaglandin F(2alpha)-induced parturition in cows.

The temporal relationship between changes in cervical dilatation, uterine electromyographic (EMG) activity, and maternal plasma concentrations of estradiol 17beta (E(2)), progesterone (P(4)), and 13,14-dihydro-15-keto-prostaglandin-F(2alpha) (PGFM), was investigated in six parturient cows. Calving was induced with a single injection of a synthetic analogue of prostaglandin F(2alpha) (PG) on Day 274 of gestation. Cervical dilatation was measured continuously by measuring the transit time between two implanted ultrasound crystals while at the same time uterine EMG activity was measured through two silver electrodes sutured on the myometrial surface until the expulsive stage of calving had been reached. In blood samples collected at 4-h intervals, starting at the moment of PG injection, the mean plasma E(2) concentration gradually increased and was significantly elevated at 28 h after PG injection. At 4 h after PG treatment, the mean P(4) concentration had dropped significantly and continued to decrease until a value of around 1 ng/ml was reached, where it stayed until the onset of expulsion. Mean plasma PGFM concentrations increased steadily after PG injection, reaching significantly elevated concentrations at 20 h after treatment. In the five cows that delivered calves in anterior positions, uterine EMG activity, expressed as root mean square (RMS in microV), started to increase at a mean interval (+/- SD) of 13.1 +/- 3.7 h following PG treatment. The increase in EMG activity was significantly correlated with changes in plasma PGFM concentrations. In these cows, dilatation of the caudal cervix started after a mean (+/- SD) interval of 28.5 +/- 1.5 h following PG treatment and dilatation progressed at a mean (+/- SD) rate of 2.25 +/- 0.24 cm/h. In one cow with a calf in the posterior position, uterine EMG activity and dilatation started at 15.8 h and 31.8 h, respectively, after induction of calving. We conclude that a predictable sequence of physiological changes occurs around induction of calving, which allows specific timing of future studies on cellular and biochemical changes within the cervix during parturition.

Animals↗
PubMed1999

Human cervical ripening is associated with an increase in cervical inducible nitric oxide synthase expression.

The mechanisms that ultimately regulate cervical ripening during parturition remain largely unknown. A possible role for nitric oxide (NO) has recently emerged; however, the expression of NO synthase (NOS) within the human cervix in the ripening process has not been investigated. The purpose of this study was to identify cell types in the human cervix that contain NOS isoforms and to examine changes in their expression during the ripening process and the nonpregnant state. Inducible NOS (iNOS) immunoreactivity was observed in the epithelial cells and stromal spindle cells in 17 of 20 biopsies from cervices obtained within 10 min postpartum, but in only 4 of 12 nonpregnant controls (p = 0.03). Endothelial NOS (eNOS) immunoreactivity was restricted to vascular endothelia in all sections, whereas neuronal NOS was not detectable. Inducible NOS activity in the postpartum group was 3.2 times that of the control group (p = 0.0005), whereas constitutive NOS activity remained unchanged in both groups (p = 0.222). Competitive reverse transcription-polymerase chain reaction revealed no differences in the expression of iNOS (p = 0.443) or eNOS mRNA (p = 0.409). The existence of iNOS in the human postpartum cervix suggests that increased production of NO, probably induced by cytokines, may be relevant to the process of natural cervical ripening in humans.

Adult↗