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PubMed1981

[Working out a system for the parameters of intra-uterine pressure wave forms. A comparative study of spontaneous labour and induced labor (author's transl)].

The tracings of intra-uterine pressure changes that are made during normal labours in primiparous patients, whether the labours were normal or accelerated with oxytocin, were analysed using a semi-automatic time-lag with the help of system of 25 parameters. The classical data of pressures and of time have been made up with a study of the minima and maxima of pressure measurements and the drawing up of new indices to characterise the pressure wave form. A study of the correlations between the different groups of parameters made it possible to make a summary of the information from a smaller number of data which were identical for the two groups of delivery. In particular working out the surfaces dose not seem to give extra information over and above that derived from a simple calculation of the length and intensity of the contractions. A comparative statistical study confirms that in accelerated labour there is a rise in the basal tone, in the maximum pressure and in the frequency of contractions, and shows a minimal scatter of the values obtained which demonstrated that oxytocin has a regulating effect. Using parameters for the shape of contractions, quite independently of the units chosen to measure, has made it possible to design a typical form for the graph for each group of labours.

Female↗
PubMed1998

Inducing labor with a sustained-release PGE2 vaginal insert. Experience at a community hospital.

OBJECTIVE: To determine the safety of initiating labor using a sustained-release prostaglandin E2 (PGE2) vaginal insert at a nonuniversity-based community hospital. STUDY DESIGN: Data were compiled from a chart review of all cases in which the insert (Cervidil) was used during a 16-month period. Continuous uterine activity and fetal heart rate (FHR) tracings were evaluated for 12 hours after dosing. The onset of regular uterine contractions or of active labor and the reason for any premature removal of the insert were sought. RESULTS: Regular contractions ensued in 62 (35.8%) of 173 pregnancies. Primary reasons for removal of the insert in 59 (34.1%) cases were active labor (38), ruptured membranes (11), uterine hyperstimulation (7) and a nonreassuring FHR tracing. The average time from insertion until premature removal was 5.7 +/- 1.3 (SD) hours (95% confidence interval, 3.3-8.2). The insert fell out in nine (5.2%) cases. Cesarean delivery for failed labor induction was necessary in five (2.9%) cases. All immediate neonatal outcomes were reassuring. Following inservice training, nurses were capable of inserting and removing the insert. CONCLUSION: This PGE2 vaginal insert, administered and removed by attending nurses, is associated with very low rates of uterine hyperstimulation and failed induction. Premature removal of the insert occurred in 34.1% of cases.

Administration, Intravaginal↗
PubMed2003

Spontaneous versus induced labor after a previous cesarean delivery.

OBJECTIVE: To compare maternal and neonatal outcomes in spontaneous versus induced labor after one previous cesarean delivery. METHODS: Women with one previous cesarean delivery who had spontaneous labor between January 1992 and January 2000 were compared with those whose labor was induced. RESULTS: Three thousand seven hundred forty-six patients had a trial of labor (2943 spontaneous, 803 induced). Those induced had more frequent early postpartum hemorrhage (7.3% versus 5.0%; odds ratio [OR] 1.66; 95% confidence interval [CI] 1.18, 2.32), cesarean delivery (37.5% versus 24.2%; OR 1.84; 95% CI 1.51, 2.25), and neonatal intensive care unit (NICU) admission (13.3% versus 9.4%; OR 1.69; 95% CI 1.25, 2.29). There was a trend toward higher uterine rupture rates in those with induced versus spontaneous labor (0.7% versus 0.3%, P =.128) and for patients undergoing dinoprostone (prostaglandin E(2)) induction versus other methods (1.1% versus 0.6%, P =.62), although neither difference achieved statistical significance. CONCLUSION: Induced labor is associated with an increased rate of early postpartum hemorrhage, cesarean delivery, and neonatal ICU admission. The higher rate of uterine rupture in those who had labor induced was not statistically significant.

Adult↗
PubMed1999

Lumbar sympathetic blocks speed early and second stage induced labor in nulliparous women.

BACKGROUND: Rapid cervical dilation reportedly accompanies lumbar sympathetic blockade, whereas epidural analgesia is associated with slow labor. The authors compared the effects of initial lumbar sympathetic block with those of epidural analgesia on labor speed and delivery mode in this pilot study. METHODS: At a hospital not practicing active labor management, full-term nulliparous patients whose labors were induced randomly received initial lumbar sympathetic block or epidural analgesia. The latter patients received 10 ml bupivacaine, 0.125%; 50 microg fentanyl; and 100 microg epinephrine epidurally and sham lumbar sympathetic blocks. Patients to have lumbar sympathetic blocks received 10 ml bupivacaine, 0.5%; 25 microg fentanyl; and 50 microg epinephrine bilaterally and epidural catheters. Subsequently, all patients received epidural analgesia. RESULTS: Cervical dilation occurred more quickly (57 vs. 120 min/cm cervical dilation; P = 0.05) during the first 2 h of analgesia in patients having lumbar sympathetic blocks (n = 17) than in patients having epidurals (n = 19). The second stage of labor was briefer in patients having lumbar sympathetic blocks than in those having epidurals (105 vs. 270 min; P < 0.05). Nine patients having lumbar sympathetic block and seven having epidurals delivered spontaneously, whereas seven patients having lumbar sympathetic block and seven having epidurals had instrument-assisted vaginal deliveries. Cesarean delivery for fetal bradycardia occurred in one patient having lumbar sympathetic block. Cesarean delivery for dystocia occurred in five patients having epidurals compared with no patient having lumbar sympathetic block (P = not significant). Visual analog pain scores differed only at 60 min after block. CONCLUSIONS: Nulliparous parturients having induced labor and receiving initial lumbar sympathetic blocks had faster cervical dilation during the first 2 h of analgesia, shorter second-stage labors, and a trend toward a lower dystocia cesarean delivery rate than did patients having epidural analgesia. The effects of lumbar sympathetic block on labor need to be determined in other patient groups. These results may help define the tocodynamic effects of regional labor analgesia.

Analgesia, Epidural↗
PubMed1995

Oxytocin to induce labor.

Oxytocin is a highly successful and safe agent for inducing labor and has a fairly large therapeutic index. It has, however, minimal, but not trivial, antidiuretic and vascular activity when used in large doses. Therefore, to induce labor, low-dose oxytocin dosing regimens that produce efficacious uterine activity and avoid side effects are recommended. Oxytocin should be used in the lowest possible doses necessary to effect a clinical response. Diligence must be exercised when monitoring labor and fetal well-being. Hofbauer, the first to use oxytocin to induce labor, said in 1927 that oxytocin, "with its power of producing regular, rhythmical and forcible uterine contractions, should be regarded as a most beneficent and valuable agent, which, however, should always be employed with care and a realisation of its limitations and dangers." His words remain valid today.

Contraindications↗
PubMed1997

Timing of the switch from myometrial contractures to contractions in late-gestation pregnant rhesus monkeys as recorded by myometrial electromyogram during spontaneous term and androstenedione-induced labor.

Pregnant rhesus monkeys were studied to determine the precise time in relation to photoperiod of the onset, and the nature, of the switch in myometrial activity patterns from contractures to contractions. We investigated both spontaneous term labor and androstenedione-induced preterm labor. Under general anesthesia at 127 +/- 2 days gestation (dGA) (mean +/- SEM), 16 pregnant rhesus monkeys were instrumented with maternal femoral arterial and venous catheters and myometrial electromyogram electrodes. Eight animals (group I) received continuous i.v. infusion of intralipid (n = 7) or saline (n = 1) that was started at 143.3 +/- 2 dGA and maintained until the spontaneous onset of term labor. Nine animals (group II) received continuous i.v. infusion of androstenedione that was started at 139 +/- 0.4 dGA and maintained until the onset of prematurely induced labor. Myometrial activity was recorded continuously. All monkeys in both groups demonstrated nocturnal switches in myometrial activity from contractures to contractions. The mean time of onset of the switch in group I and group II monkeys was similar, occurring at 0.7 +/- 0.4 h or 0.8 +/- 0.5 h, respectively, after the onset of darkness. Group II monkeys demonstrated greater regularity in both the time of onset and the repetitive occurrence each night once the switch occurred, as well as greater consistency in duration in their switch patterns, than did group I monkeys.

Androstenedione↗
PubMed1988

Changes in plasma cyclic AMP and cyclic GMP during spontaneous labor and labor induced by oxytocin, prostaglandin F2 alpha and prostaglandin E2.

To investigate the response of cyclic nucleotides to the oxytocic agents administered for induction of labor, plasma concentrations of cyclic AMP (cAMP) and cyclic GMP (cGMP) were determined by radioimmunoassay during spontaneous labor and labor induced by oxytocin (OT), prostaglandin F2 alpha (PGF2 alpha), or PGE2 (PGE2). Subjects were 7 Japanese women in each labor group. Plasma cAMP levels significantly rose at the time of crowning of the fetal head in all 4 groups. They did not increase until that time in the 3 labor groups (spontaneous, OT-induced, and PGF2 alpha-induced labor groups). In the PGE2-induced labor group, plasma cAMP levels were significantly higher at labor onset (mean +/- SEM = 16.5 +/- 1.3 pg/ml) when compared to the pretreatment values (13.7 +/- 1.0 pg/ml), and increased thereafter gradually toward the time of crowning of the head (26.3 +/- 2.0 pg/ml). Plasma cGMP levels in the OT-induced group significantly rose after the onset of labor and remained at a high level until expulsion of the fetus. Plasma cGMP levels in the other groups did not change significantly throughout labor. These results suggest that cAMP may be involved in the labor process induced by PGE2, and that cGMP may be in that induced by OT.

Cyclic AMP↗
PubMed1977

Reproductive performance after prostaglandin-induced labor.

The data of this follow-up study fail to prove that elective induction of labor at term by amniotomy and intravenously or orally administered PGF2alpha or PGE2 has an untoward effect on reproductive performance. If, however, the procedure is complicated by a serious degree of sustained uterine hyperstimulation, permanent damage to the internal cervical os may ensue, as illustrated by one of our patients.

Abortion, Spontaneous↗
PubMed1992

[Diagnosis of vasa praevia by amnioscopy. Value of induced labor. A case report].

The authors report a case of vessel praevia diagnosed at routine examination prior to the induction of labour. They emphasize the dramatic risk of very serious hemorrhage occurring after rupture of the membranes and the value of prophylactic caesarean section once the diagnosis is known. Routine use of amnioscopy in determining whether the timing of labour is appropriate and the increased alertness which this imposes to the obstetrician appear to be the only method for the prevention of these dramatic complications. In the future, colour Doppler will offer an earlier diagnostic method.

Cesarean Section↗