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An evaluation of late attenders in labour in Alexandra.

To study why women present in late labour we interviewed 70 parturients in our labour room for a period of 8 days in March 1990. When presenting 19% were 8-10 cm dilated and 81% were 0-7 cm dilated. The group was stratified into those in early labour (0-7 cm of cervical dilatation) and in late labour (8 cm or more) and compared for all variables studied. Only a few differences were statistically significant. Early comers were less likely to have strong uterine contractions and more likely to have intact membranes at presentation. Late comers were more likely to report a number of delaying factors or to have financial worries. Twenty nine percent of Alexandra residents and only 6% of outsiders reported difficulty in finding transport to labour room after the onset of labour. Almost half of Alexandra residents did not have access to public transport, ambulance or own transport. The relative risk for late coming was: 9 for women reporting a number of delaying factors outside their control; 6 for those with financial worries or with ruptured membranes; 4 for unbooked cases or with current addresses in Alexandra; 3 for women with a normal past obstetric history or with a previous delivery outside the AHC; 2 for those worried with hospital referrals, with a previous rural address, for less than 1 year in Alexandra or with a normal current ANC. Women who came late in labour were more likely to need hospital referral or to have come to the labour unit walking.

Adult↗

[Continuous monitoring of fetal oxygen saturation (FSpO2) using intrapartum fetal pulse oximetry (IFPO) in the diagnosis of acute fetal hypoxia].

OBJECTIVE: The aim of the study was to evaluate the possibility of lowering the Caesarean Section rate in patients presenting the signs of intrauterine hypoxia on CTG tracing by evaluating the foetal oxygen saturation (FSpO2) by means of intrapartum foetal pulse oximetry (IFPO). DESIGN: Open prospective study. SETTING: 1st Department of Gynecology and Obstetrics, Medical Faculty of Masaryk University, Brno. METHODS: From January 1, 1999 to December, 1999 68 patients were enrolled in the study. For the application of the IFPO sensor the patient had to meet the following criteria: patient's informed consensus, pregnancy > or = 36 weeks, regular uterine contractions, rupture of membranes, cervical dilatation of > or = 2 cm, singleton pregnancy, cephalic occiput presentation, no sings of vaginal infection, acute foetal hypoxia on CTG tracing: (baseline heart rate < 100 beats/min of different patterns. Progressive bradycardia: baseline heart rate gradually decreases between contractions (DIP II, DIP 0). Persisting bradycardia, baseline < 80 beats/min. Baseline tachycardia (> 150 beats/min) with reduced variability and/or severe variable (DIP 0) and late decelerations (DIP II). The IFPO used--Nellcor N-400. In all patients that fulfilled the above mentioned criteria during the first stage of labor the sensor was applied preferably on the posterior cheek of the foetus and the FSpO2 values were continuously monitored up to the complete dilatation. The threshold of the intrapartum foetal hypoxia (FSpO2 values) was considered < 30% for more than 10 minutes. In cases of normal FSpO2 values the delivery was conducted vaginally even if the CTG tracing continued to signalise++ intrauterine hypoxia. In case of pathologic FSpO2 values, Caesarean Section was performed. RESULTS: IFPO is an easy feasible method and in all cases the values of FSpO2 were obtained. The method has no serious side effects neither in the mother nor in the foetus. Nevertheless the presence of the sensor in the uterine cavity provokes often unpleasant feelings and limits the mother in free movements. In all suspicious CTG tracings (17) no Caesarean Sections were performed after the verification of the foetal hypoxia by means of FSpO2 evaluation. In 51 patients a pathologic CTG tracing indicating the performance of Caesarean Section was present. After FSpO2 evaluation the Caesarean Section was performed only in 11 (21.6%) patients. The remaining 40 (78.4%) delivered vaginally. Between these two groups there was statistical difference in the values of FSpO2 and postpartum cord pH. The state of newborns evaluated according to the Apgar score did not significantly differ in the two groups. CONCLUSION: These preliminary results indicate that taking in an account foetal SpO2 evaluated by IFPO in the 1st stage of labor in cases of pathologic CTG tracing (late and variable deceleration) indicating Caesarean Section, > 50% of these may be saved with identical perinatal outcome (Apgar scores, cord pH).

Acute Disease↗

[Fetal oxygen saturation during normal delivery].

The aim of the study is to monitor fetal oxygen saturation--SpO2 during uncomplicated labour; to assess normal values and compare them to the data from fetal blood analysis and from clinical finding in the newborn. The study includes 53 pregnant women in term during active labour without evidence of fetal distress. Study is carried out with Nellcor-N 400--a system for measuring fetal pulse oxymetry and fetal pulse rate; oxygen sensor FS-14 and printer P-400 /Nellcor Bennet Incorporation/. Fetal pulse rate is monitored by cardiotograph Hewlett Packard. Mean duration of monitoring during first stage of labour is 98 +/- 48 min, versus 37 +/- 11 min during second stage. Mean values of SpO2 are 48.8 +/- 10% during the first stage of labor v/s 46 +/- 9.6% during second stage. Baby is born in good health--Apgar score more than 7 and mean pH value from umbilical artery 7.25. The conclusion is made that pulse oxymetry is an easy non invasive method for fetal monitoring without side effects concerning woman on labour and fetus. A relatively large range of variations of normal values is observed.

Adult↗

Acupuncture for cervical ripening and induction of labor at term--a randomized controlled trial.

OBJECTIVE: The aim of this study was to evaluate whether acupuncture at term can influence cervical ripening, induce labor and thus reduce the need for postdates induction. METHODS: On the estimated date of confinement (EDC) women were prospectively randomized to an acupuncture group (AG) or a control group (CG). Data of 45 women were evaluated (AG, n = 25; CG, n = 20). Inclusion criteria were as follows: confirmed EDC, uncomplicated course of pregnancy, singleton pregnancy in cephalic presentation. Exclusion criteria were as follows: cervical dilation > 3 cm, active labor, premature rupture of membranes, previous cesarean section, pathologies in mother or fetus. Women were examined at 2-day intervals. The cervical length was measured with vaginal ultrasonography, cervical mucus was obtained for a fetal Fibronectin test and the cervical status was assessed according to the Bishop score. In the AG, the points Hegu (Large Intestine 4) and Sanyinjiao (Spleen 6) were pierced on both sides every second day. If women were not delivered 10 days after EDC, labor was induced by administering vaginal prostaglandin tablets. RESULTS: The cervical length in the AG was shorter than that in the CG on day 6 and day 8 after EDC (P = 0.04 for both). In the AG the time period from the first positive Fibronectin test to delivery was 2.3 days, while that in the CG was 4.2 days (P = 0.08). The time period from EDC to delivery was on average 5.0 days in the AG and 7.9 days in the CG (P = 0.03). Labor was induced in 20% of women in the AG (n = 5) and in 35% in the CG (n = 7) (P = 0.3). Overall duration of labor, and first and second stage of labor were not different in the two groups. In 56% of women who underwent acupuncture (n = 14) and in 65% of controls (n = 13), Oxytocin was used to augment labor. (P = 0.54). CONCLUSION: Acupuncture at points LI4 and SP 6 supports cervical ripening at term and can shorten the time interval between the EDC and the actual time of delivery.

Acupuncture Points↗

[Effect of diazepam on fetus after intravenous administration during the active phase in labour].

To investigate the effects of diazepam on fetal heart rate and Apgar scoring administered intravenously during the active phase in labour, sixty-two normal term parturients during the active phase of labour with the cervical dilation to 3-5 cm were randomly divided into two groups, diazepam group (n = 32) and control group (n = 30). In diazepam group, 10 mg diazepam was administered intravenously. The concentrations of diazepam in maternal and cord serum were measured by high performance liquid chromatography after birth and the fetal heart rates were monitored by electronic monitor before or after administration of diazepam and Apgar scores were determined immediately after birth. The results showed that the mean level of diazepam in umbilical cord serum was markedly higher than that of maternal serum. Fetal heart base line mutation in diazepam group was weaker than that of the control group. Apgar scores in the neonates of diazepam group was lower than those of the control group. The results indicate that the use of diazepam in pregnant women during active phase of labour may cause depression of fetus.

Adult↗