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PubMed1998

Can labor with breech presentation be induced?

Our objective was to evaluate the efficacy and safety of labor induction in women with a breech presentation, and an unripe cervix. We conducted a retrospective, matched-paired study on patients with breech presentation and an unripe cervix (n = 23), who underwent induction of labor using extra-amniotic saline instillation. The women were compared to three matched control groups: 46 women with vertex presentation and an unripe cervix, whose labor was induced by the same method, 23 with breech presentation who underwent a vaginal trial of labor, and 23 women with breech presentation who underwent a cesarean section without a trial of labor. In the study group, 12 women (52.2%) delivered vaginally. Rates of Apgar score, birth trauma, and maternal morbidity were similar in all groups. Induction of labor in patients with a breech presentation and an unripe cervix may be attempted in selected cases as it seems to be efficacious (vaginal delivery rate of 52.2%) and safe for both fetus and mother.

Adult↗
PubMedDate not supplied

Trends and issues in labor induction in the United States: implications for clinical practice.

The labor induction rate is at an all-time high in the United States. Although induction of labor is recommended as a therapeutic option only when the benefits of expeditious birth outweigh the risks of continuing the pregnancy, a "psychosocial indication" has become a common rationale for elective induction in the United States. It is unlikely that all women are provided with a complete discussion of the cascade of interventions that frequently accompany labor induction and the risks of cesarean birth. Although at first glance elective labor induction may seem more convenient, an appreciation of the inconvenience of the greater rates of interventions, the longer labor and overall hospital stay, the higher costs, the additional attention required by the primary health care provider when complications occur, and the risk of an adverse outcome for a mother or baby after an elective procedure with subsequent litigation should cause everyone to exercise caution and reevaluate current practice. Professional organizations should take proactive steps to advocate for pregnant women so they are fully aware of the risks and benefits. A public campaign to discourage elective labor induction for nulliparous women is worth serious consideration.

Adult↗
PubMed1998

Changes in fetal plasma corticotropin-releasing hormone during androstenedione-induced labor in the rhesus monkey: lack of an effect on the fetal hypothalamo-pituitary-adrenal axis.

Androstenedione infusion to pregnant monkeys leads to premature labor and live delivery. Androstenedione-induced labor also increased placental CRH messenger RNA and peptide to concentrations observed at term in pregnant monkeys. Placental CRH may modulate fetal pituitary-adrenal function during pregnancy in primates. This study tested the hypothesis that androstenedione-induced premature delivery in pregnant monkeys results from androstenedione-induced increases in placental CRH, which stimulate premature activation of the fetal pituitary-adrenal axis. The hypothesis was tested by comparing fetal umbilical vein (FUV) plasma CRH, ACTH, dehydroepiandrosterone sulfate, and cortisol concentrations at cesarean section in fetuses from mothers undergoing spontaneous, term labor (group I), with those in fetuses from mothers undergoing androstenedione-induced, premature labor (group II) and with those from mothers not in labor (group III). In addition, gestation-related changes in maternal plasma CRH concentrations were investigated, and CRH immunoactivity was characterized by Sephadex G50 chromatography in pooled maternal plasma extracts. FUV CRH concentrations were similarly elevated in group I and group II fetuses, compared with group III fetuses. Despite similar FUV blood gases in all fetuses, FUV ACTH and dehydroepiandrosterone sulfate concentrations were higher in group I fetuses than in group II or group III fetuses. The majority of CRH immunoactivity coeluted with synthetic human CRH. Maternal plasma CRH concentrations showed a modest increase with gestation in the rhesus monkey. These data: 1) demonstrate that androstenedione treatment of pregnant monkeys at 0.8 of gestation elevates fetal plasma CRH to similar concentrations measured at term; 2) do not support the hypothesis that androstenedione-induced delivery in the monkey results from premature activation of the fetal pituitary-adrenal axis by placental CRH; but 3) do support a role for activation of the fetal hypothalamo-pituitary-adrenal axis in association with spontaneous term labor in the monkey; and 4) demonstrate important interprimate species differences in maternal CRH physiology.

Androstenedione↗
PubMed1992

Oxygen consumption and ventilation during normal labor.

Oxygen consumption (VO2) and minute ventilation (VE) were measured breath-by-breath for 10 min periods in the third trimester of pregnancy in 16 healthy women. These measurements were repeated during the first stage of labor in eight of the women. The 10-min mean VO2 was 3.56 ml/kg/min (+/- 0.82 SD) at term and 4.28 ml/kg/min (+/- 0.93) during labor, for an average increase of 23 percent (+/- 28 percent, p = 0.04) from third trimester to labor. The mean VE was 0.15 L/kg/min (+/- 0.03) at term and increased significantly (p = 0.05) to 0.24 L/kg/min (+/- 0.11) during labor for an average increase in VE of 65 percent (+/- 78 percent). Peak VO2 and VE occurred during contractions with five-breath average peak VO2 being 86 percent (+/- 53%) above the 10-min mean value at term and VE increasing 167 percent (+/- 154 percent) from third trimester to peak values during labor. These data may be useful in identifying patients at risk for developing respiratory insufficiency during labor. We propose an algorithm for approaching the obstetric patient with respiratory disease.

Adolescent↗
PubMed1980

Serum lactic acid dehydrogenase and isoenzymes during pregnancy and labor.

Total serum lactic acid dehydrogenase activity (LDH) and the levels of LDH isoenzymes were investigated in 14 women during early pregnancy (8--16th week), in 28 women during late pregnancy (29--37th week), in 73 at term (38--42nd week) and in 27 during labor (38--42nd week). LDH activity was found to be elevated in severe pre-eclampsia and in chronic hypertensive women during pregnancy as well as during normal and dysfunctional labor. No change was established in total serum LDH during normal pregnancy. LDH 1 was increased during late pregnancy and at term. In severe pre-eclampsia and during normal labor it was decreased. LDH 2 was also decreased in severe pre-eclampsia and during dysfunctional labor. LDH 3 was decreased during late pregnancy but increased in severe pre-eclampsia. No change was observed in LDH 4 during pregnancy, or in labor. LDH 5 was increased in normal and dysfunctional labor.

Adult↗
PubMed1988

Duration of labor. An analysis of influencing factors.

9703 labors at Akershus Central Hospital during the period January 1979 to January 1984 were analysed to see which factors influenced the duration of labor. Median duration was 8.2 h for nulliparas, 5.3 h for multiparas. Parity greater than one had no influence on duration. Induced labors were 1.9 h (nulliparas) and 1.4 h (multiparas) shorter than those with spontaneous onset. Stepwise linear regression showed that duration of labor was positively correlated with the weight of the infant, duration of pregnancy, weight gain and prepregnant weight. It was negatively correlated with mother's height. Mother's age did not influence duration of labor. Occiput posterior presentation and extensions of the head prolonged labor in nulliparas, but not in multiparas, while breech presentation had no influence.

Adolescent↗
PubMed1999

Gender differences in determinants of temporary labor migration in China: a multilevel analysis.

Data from a 1998 migration survey in Hubei province are used to examine gender differences in the determinants of temporary labor migration from a multi-level perspective. The authors find that community level factors play a key role in temporary labor migration; models omitting community level variables are poor in predicting temporary labor migration. Significant gender differences exist in determinants of temporary labor migration. For men, temporary labor migration is mainly a response to community level factors; individual or household characteristics have little predictive power. For women, by contrast, temporary labor migration is predominantly determined by individual characteristics; community level factors are not as important.

Asia↗
PubMed1992

Progesterone concentrations in maternal and fetal serum are lower during functional dystocia than in normal labor.

Concentrations of progesterone and estradiol (E2) were measured in parturient serum and in fetal cord serum during normal labor and in women with functional dystocia. In the study group, there were no cases of cephalopelvic disproportion. In oxytocin-resistant dystocia, the course of labor could not be corrected with oxytocin. To ascertain the effect of oxytocin, we included a number of women whose labor had been induced with oxytocin, followed by normal cervical dilatation and descent of the fetus. All the parturients were grouped retrospectively into those with normal labor and those with dystocia, based on previous definitions. The serum concentrations of progesterone in both the fetal cord and maternal vein were found to be significantly lower in the oxytocin-resistant dystocia group than in women in spontaneous normal labor and those with oxytocin-induced labor and normal progression (P less than .05-.005). Oxytocin had no evident effect on the serum concentration of either progesterone or E2, nor did concentrations vary following epidural blockade. Serum E2 concentrations in the maternal vein were similar in all delivery groups. Fetal cord E2 serum concentrations were similar in all vaginal deliveries. Women with the most severe oxytocin-resistant dystocia, delivered by cesarean, had significantly lower serum concentrations of E2 in fetal cord serum compared with the vaginally delivered women (P less than .001).

Dystocia↗
PubMed2005

[Reference values range of the fetal oxygen saturation and its dispersal during labor without cardiotocographic evidence for fetal distress].

UNLABELLED: The objective of this study is to establish the reference values range of the fetal oxygen saturation during the first and the second period of labor and their dispersal according to the extent of cervical dillatation in cases with normal FHR--absence of fetal hypoxia and asphyxia of the newborn. MATERIAL AND METHODS: This is a prospective study which involves 94 women with normal FHR. All of the newborns are with umbilical artery pH values greater than 7.15 and 5 min Apgar score greater than 7; there was no necessity for any reanimation procedures, assisted ventilation or intensive care treatment. The fetal oxygen saturation (SpO2) is monitored by fetal pulseoxymeter Nellcor N 400, fetal sensors FS - 14. Cardiotocographic monitoring is carried out simultaneously. Blood is obtained from the fetal scalp during labor for blood gas and pH analysis, and umbilical artery pH as well as the Apgar score of the newborn are determined. RESULTS: The average monitoring time during the first period of labor is 107.19+/-29.49 min. with reliability of the recordings 86.54+/-6.10%. The average monitoring time for the second period of labor is 36.72+/-8.31 min. with reliability of the recordings 75.42 +/-9.61%. The mean SpO2 values are 48.71+/-5.52% during the first period and 47.30+/-4.62% during the second period of labor. The reference SpO2 values ranging between the 25-th and 75-th percentile in fetuses with normal FHR are 46-52 % for the first and 44-50 % for the second period. The results for fetal SpO2 during the different stages of cervical dillatation are as follows: for 4-5 cm - 49.49+/-5.12%, for 6-7 cm - 48.76+/-5.42%, for 8-9 cm - 48.39+/-5.49%. CONCLUSIONS: The fetal SpO2 dispersal during cervical dillatation of 4-5, 6-7 and 8-9cm accordingly demonstrates a nonsignificant decrease of SpO2 for the different groups (p>0.05). The fetal SpO2 dispersal between the first and the second period of labor also demonstrates decrease of SpO2 values and shows a minor statistically significant difference (p < 0.05 - Repeated measures ANOVA), which is considered to be within the normal range and does not reflect on the newborn's well-being.

Apgar Score↗
PubMed1991

Does epidural anesthesia affect the course of labor and delivery?

The progress of labor ideally leads to a normal, spontaneous, vaginal delivery. Many factors--maternal, fetal, obstetrical and anesthetic--may collectively contribute to delaying or precluding an ideal outcome. Adverse outcomes of labor and delivery must be clearly defined in terms of maternal, fetal, or neonatal morbidity or mortality, and should be distinguished from abnormal data (such as fetal heart rate, duration of labor, and incidence of low forceps deliveries) that are only indirectly related to outcome. Epidural anesthesia is not a singular phenomenon. Variations and subtle nuances in the administration of epidural anesthesia create a vast array of potential anesthetic regimens. To discover the anesthetic methods that provide excellent analgesia with no adverse effects on the course of labor is an ideal goal that has not yet been achieved. To approach this goal, the answers to several questions are needed. Are study patient groups adequately matched for risk factors? Are obstetrical practices well-defined with respect to elective versus indicated use of instrumental or cesarean delivery methods? Do the risks of instrumental delivery outweigh the benefit of perineal analgesia associated with epidural anesthesia? Is it possible to provide optimal analgesia throughout stage two labor without tending to increase the risk of instrumental delivery? Can delayed pushing during stage two labor increase the probability of spontaneous vaginal delivery with continuous epidural anesthesia? Well-controlled clinical trials and refinements in both anesthetic and obstetric techniques are necessary to resolve such issues so that every parturient (and fetus) may undergo a safe and painless delivery.

Anesthesia, Epidural↗
PubMed1991

[Active management of labor].

Eighty three primigravidae patients at the end of latency labor, erased cervix, 3 cm dilation, vertex presentation and adequate pelvis, were studied. Two groups were formed: 53 patients in the study group, who received active management of labor, and 30 patients in the control group, treated in the traditional way. In all the patients a graphic recording of labor, was carried out; it included all the events, and as labor advanced, a signoidal curve of cervical dilatation, was registered, as well as the hyperbolic one for presentation descent. The study group received the method in a systematized manner, as follows: 1. Peridular block. 2. Amniotomy. 3. IV oxytocin one hour after amniotomy. 4. FCR monitoring. 5. Detection of dystocia origin. Materno-fetal morbidity was registered in both groups, as well as cesarean section rate, instrumental delivery and its indications, labor duration, and time of stay in labor room. Diminution of above intems and opportune detection of dystocia, were determined. It was concluded that a constructive action plan, starting at hospital admission in most healthy women, allows a normal delivery of brief duration.

Adolescent↗
PubMed1990

Antepartum uterine activity characteristics differentiating true from threatened preterm labor.

Daily antepartum nursing contact and ambulatory uterine activity monitoring have been used for the early detection of preterm labor. However, it may be difficult to separate true labor from false labor. In this study, the uterine activity records of 110 women at risk for preterm birth with excessive contraction frequencies were evaluated by blinded reviewers. Maternal symptomatology and uterine activity characteristics such as low-amplitude high-frequency contractility, contraction amplitude, contraction duration, contraction interval, and contraction rhythmicity were assessed for their ability to differentiate true from threatened preterm labor. Neither maternal symptomatology nor any uterine activity characteristic other than contraction frequency could differentiate true from threatened preterm labor. Antepartum uterine activity monitoring should continue to rely on contraction frequency to identify the woman at risk for premature labor.

Adult↗
PubMedDate not supplied

Use of labor graphs in a community hospital.

The large series reported by Friedman have established the importance of the time factor in relation to cervical dilatation and station of the presenting part during labor. Variations of the rate of dilatation and descent may be evident using a graph with the upper values of normal. This study was conducted in a Community hospital with an average of 200 deliveries a month. The attending physician followed labor as usual, unaware of the graphic recordings. The outcome of the labors with normal and abnormal graphic patterns were compared. There was a correlation between the abnormal labor pattern, arrest of cervical dilatation, with abdominal deliveries and lower apgar scores. The recognition of abnormal labors does not require a profound understanding of labor nor the range of normalcy.

Apgar Score↗
PubMed1988

Preterm labor in twin pregnancies: prediction by cervical assessment.

Patients attending a twin pregnancy antenatal clinic underwent cervical palpation at each visit to calculate a cervical score by subtracting dilatation from length. Prediction of the onset of labor by cervical assessment was studied in 223 already parous women with twin pregnancies who ultimately labored spontaneously. The lower the score, the shorter was the mean time until delivery, although there existed a subgroup of patients who had ripe cervices for several weeks before the onset of labor. The cervical score itself appeared to give better prediction of labor than did changes in the score. Cervical assessment identified a group of twin pregnancies at especially high risk of preterm labor, in that 76% of patients with a score of -2 or less at or before 34 weeks delivered preterm. There was no evidence that labor was precipitated by vaginal examination, although this requires further study.

Cervix Uteri↗
PubMed1987

Effect of amniotic membrane rupture on length of labor.

Between January 1, 1979, and December 21, 1982, 2564 medically and obstetrically normal patients, admitted to the hospital with intact amniotic membranes during the latent phase of labor, were matched for spontaneous or artificial rupture of the membranes at similar cervical dilations. Spontaneous rupture of the membranes occurred earlier and was more likely in the latent phase of labor than was artificial rupture of membranes, which tended to occur nearer to or in the active phase of labor, and at lower pelvic stations. When matched by cervical dilation, spontaneous membrane rupture was associated with more rapid cervical dilation. Stepwise regression analysis confirmed that membrane rupture had a significant but small effect on labor length and rate of cervical dilation. Pelvic station and maternal parity had a smaller association with labor length than did membrane rupture. Cervical dilation at the time of membrane rupture appeared to be the most important factor associated with the length of labor.

Amnion↗
PubMed1978

Plasma oxytocin in initiation of labor.

Serial radioimmunoassay measurements of plasma oxytocin (OT) in maternal venous blood have been carried out in 15 patients, during pregnancy, labor, and delivery. Fetal plasma OT was also measured in the blood from the umbilical vein and umbilical artery. The results indicate that: (1) during pregnancy, plasma OT is present in maternal blood; (2) the quantity of plasma OT increases with advancing pregnancy; (3) no OT surge occurs around the onset of labor; (4) the plasma OT surge occurs with cervical dilatation and vaginal distention. The data indicate that OT does not play a primary role in the initiation of labor and support the concept that OT most likely contributes to formation of prostaglandins through the uterine contractions OT produces. OT surges, frequently called spikes, have been observed to occur during pregnancy as well as during labor. During the course of labor, OT surges have been encountered in association with rupture of the membranes, vaginal examination, and descent of the vertex, and have occurred almost consistently with maximal cervical and vaginal distention. Such OT surge was suppressed by effective spinal and pelvic regional anesthesia. Therefore, this surge is consistent with the Ferguson reflex described in experimental animals, and it represents the first evidence that the Ferguson reflex, in fact, exists in human beings. Evidence is presented here that an excess of OT in fetal blood over that found in maternal plasma was associated with hypertonic, irregular, tumultuous or prolonged labor and with mild to moderate fetal hypoxia and fetal distress peculiar to abnormal uterine contractions.

Adolescent↗
PubMed1983

Oxytocin and the initiation of human parturition. IV. Plasma concentrations of oxytocin and 13,14-dihydro-15-keto-prostaglandin F2 alpha during induction of labor by artificial rupture of the membranes.

The influence of artificial rupture of the membranes on plasma levels of 13,14-dihydro-15-keto-prostaglandin F2 alpha (PGFM) and oxytocin was examined in 23 pregnant women at term. Serial blood samples were collected before and 15 minutes, 2 hours, 5 hours, and 8 hours after artificial rupture of the membranes. A significant rise in the concentration of plasma PGFM was observed at 15 minutes in the majority of women (20 of 23), but the magnitude of this early rise or the lack thereof was not related to the subsequent course of labor. The concentration of plasma PGFM at 2 hours was, on the other hand, significantly correlated with the induction-delivery interval. Amniotomy, by itself, induced labor and delivery when the increased PGFM levels were maintained from 2 to 5 hours after the procedure (n = 16). In those cases where Pitocin stimulation was required for adequate uterine contractions, it was found that plasma PGFM levels had declined to initial values at 2 hours. Pitocin infusions then partially reversed this decline. In one patient, the cervix failed to dilate in spite of prolonged Pitocin infusion which did not induce significant uterine contractions, and the infusion did not reverse the marked fall in plasma PGFM after the early but transient rise. Mean plasma oxytocin levels did not rise significantly during labor induced by artificial rupture of the membranes and were, on the average, similar to the levels observed during the first stage of spontaneous or oxytocin-induced labor. Considering the previously demonstrated maximal levels of uterine oxytocin receptors in early labor, the absence of a rise in the plasma oxytocin levels does not negate a role for oxytocin in working synergistically with prostaglandins in the mechanism of labor.

Amnion↗
PubMed1984

Outcome of induced labor in 931 term pregnancies.

An analysis of 931 consecutive inductions of labor over an eight-year period is presented. The success rate was 90.4%. Spontaneous vaginal delivery was achieved in 83.5% of cases and the induction-delivery interval was less than 12 hours in 82.6% of cases. The preinduction state of the cervix most significantly influenced the outcome of labor, followed by maternal age and parity. Provided induction of labor was by synchronous use of forewater amniotomy and oxytocin titration, labor outcome was regularly predictable two hours after induction using the concept of latent period of labor and the cervical dilatation at eight hours from the induction. When the latent period was two hours or less, 64.2% of the patients delivered within eight hours, and vaginal delivery was achieved in all women in whom the cervical dilatation was 8 cm or more at eight hours from the induction of labor. The maternal complication rate was 12.1%, the early neonatal morbidity was 11.6%, and the stillbirth rate was 2.3%.

Adolescent↗