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PubMed1995

Maternal anthropometry and idiopathic preterm labor.

OBJECTIVE: To assess the etiologic role of maternal short stature, low pre-pregnancy body mass index (BMI), and low rate of gestational weight gain in idiopathic preterm labor. METHODS: We carried out a three-center case-control study of 555 women with idiopathic onset of preterm labor (before 37 completed weeks), including two overlapping (ie, nonmutually exclusive) subsamples: cases with early preterm labor (before 34 completed weeks) and cases with recurrent preterm labor (before 37 completed weeks plus a history of prior preterm delivery or second-trimester miscarriage). Controls were matched to cases by race and smoking history. All subjects responded in person to questions about height, pre-pregnancy weight, gestational weight gain, and obstetric and sociodemographic histories. RESULTS: Maternal height, pre-pregnancy weight, and gestational weight gain demonstrated excellent test-retest reliability, with intra-class correlation coefficients of 0.97, 0.99, and 0.91, respectively. Based on matched analyses, women with a height of 157.5 cm or less had an increased risk of idiopathic preterm labor (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.25-2.74), as did those with a pre-pregnancy BMI less than 19.8 kg/m2 (OR 1.63, 95% CI 1.09-2.44) or a gestational weight gain rate less than 0.27 kg/week (OR 1.74, 95% CI 1.16-2.62). Conditional logistic regression models containing all three anthropometric variables and controlling for parity, marital status, language, age, and education yielded virtually identical point estimates and CIs. CONCLUSION: Maternal short stature, low pre-pregnancy BMI, and low rate of gestational weight gain may lead to shortened gestation by increasing the risk of idiopathic preterm labor.

Anthropometry↗
PubMed1988

Changes in urinary 6-keto-prostaglandin F1 alpha excretion during pregnancy and labor.

Urinary excretion of 6-keto-PGF1 alpha was measured by high pressure liquid chromatography and radioimmunoassay at various stages of pregnancy and labor. In the first trimester of pregnancy, urinary 6-keto-PGF1 alpha concentrations were not different from those measured before pregnancy, but they showed a significant increase in the second trimester of pregnancy (p less than 0.001). The levels rose further in the third trimester, although this increase was not statistically significant when compared to levels obtained in the second trimester. There was no evidence for a significant change in 6-keto-PGF1 alpha excretion with the onset of labor. During well-established, progressive labor mean values of 6-keto-PGF1 alpha excretion were about twice as high as before the onset of labor, but the range of values during labor was so wide that there was no statistical difference with values obtained in the second half of pregnancy. It is concluded that the increase in the urinary excretion of 6-keto-PGF1 alpha occurs later in pregnancy than the increase in TXB2 excretion and that labor at term is not associated with marked changes in 6-keto-PGF1 alpha excretion.

6-Ketoprostaglandin F1 alpha↗
PubMedDate not supplied

Water immersion and the effect on labor.

The use of warm water immersion (WI) by women for relaxation during labor is being used around the world; however, there is little available research as to the effects of WI. We conducted this prospective, randomized, and controlled study to determine the safety and effect of WI on the woman in labor. We studied 93 subjects between 36 and 41 weeks' gestation, in active labor, with intact membranes, and without major medical or obstetric complications. Subjects in the WI group utilized a tub in labor along with other pain relief measures such as ambulation, rest, showers, and analgesics. Subjects in the no-WI group could use all available methods of pain relief except WI. Water immersion did not alter the rate of cervical dilation, change the contraction pattern, change the length of labor, or alter the use of analgesia. The rates of chorioamnionitis and endometritis were not altered by WI. Although we did not demonstrate an improvement in progression of labor by WI, there was no evidence of increased maternal, neonatal, or infectious morbidity.

Adult↗
PubMed1990

Relationships between pain, cognitive activity and epidural analgesia during labor.

This study examined the dynamic interplay between subjective pain, pain behavior and cognitive activity during the latent (less than or equal to 3 cm), mid-active (5-7 cm) and transition (greater than or equal to 8 cm) phases of labor in 115 nulliparous women. Subjects received no analgesia during the latent phase and either no analgesia or epidural analgesia during the active and/or transition phase. Data were analyzed according to phase and analgesic condition. For subjects with no epidural analgesia, both the Present Pain Intensity (PPI) and the Present Behavioral Intensity (PBI) scores were correlated within and between phases. In contrast, Coping/Distress scores were weakly correlated between the latent and active labor phases and were unrelated between the active and transition phases. PPI and Coping/Distress scores were highly correlated within the latent phase but were independent within the active and transition phases of labor. PBI and Coping/Distress scores were moderately correlated within the latent and active phases and were unrelated during the transition phase. Epidural techniques reduced subjective pain and pain behavior significantly but had no apparent effect on the coping or distress-related cognitive activity characteristic of active labor. We concluded that coping and distress-related cognitive activity in labor may follow a phase-specific pattern which is relatively independent of pain or pain relief after labor has become active.

Adult↗
PubMedDate not supplied

Phasic maternal prolactin secretion during spontaneous labor is associated with cervical dilatation and second-stage uterine activity.

OBJECTIVE: In this study, we attempted to determine the physiologic roles of prolactin (PRL) and hCG during labor. METHODS: Serial blood samples were collected from 19 women (15 multiparous and four nulliparous) before, during, and after labor; assayed for PRL and hCG; and compared with cervical dilatation and uterine contraction frequency. RESULTS: Prolactin levels decreased in association with progressive cervical dilatation during the first stage of labor and reached a nadir at full dilatation. Thereafter, PRL increased rapidly during the second stage of labor and peaked within 1 hour postpartum. Uterine contraction frequency also increased during the second stage and correlated significantly (r2 = 0.60; P = .0006) with levels of PRL. Levels of hCG increased during labor and peaked at about the time of delivery. CONCLUSION: These data suggest that phasic PRL secretion is associated with cervical dilatation and that after transition to the second stage of labor, uterine contraction frequency may be associated with the increase in PRL levels.

Cervix Uteri↗
PubMed2004

Comparison of maternal mortality and morbidity between trial of labor and elective cesarean section among women with previous cesarean delivery.

OBJECTIVE: This study was undertaken to assess the safety of trial of labor after previous cesarean delivery. STUDY DESIGN: Retrospective cohort study of 308,755 Canadian women with previous cesarean delivery between 1988 and 2000. Occurrences of in-hospital maternal death, uterine rupture, and other severe maternal morbidity were compared between women with a trial of labor and those with an elective cesarean section. RESULTS: Rates of uterine rupture (0.65%), transfusion (0.19%), and hysterectomy (0.10%) were significantly higher in the trial-of-labor group. Maternal in-hospital death rate, however, was lower in the trial-of-labor group (1.6 per 100,000) than in the elective cesarean section group (5.6 per 100,000). The association between trial of labor and uterine rupture was stronger in low volume (<500) than in high volume (> or =500 births per year) obstetric units. CONCLUSION: Trial of labor is associated with increased risk of uterine rupture, but elective cesarean section may increase the risk of maternal death.

Blood Transfusion↗
PubMed2004

Toll-like receptor-2 and -4 in the chorioamniotic membranes in spontaneous labor at term and in preterm parturition that are associated with chorioamnionitis.

OBJECTIVE: The Toll-like receptor-2 and -4 recognize microbial products that are associated with gram-positive and gram-negative bacteria, respectively. This study examined Toll-like receptor-2 and -4 expression in fetal membranes in response to labor at term and histologic chorioamnionitis. STUDY DESIGN: Immunohistochemistry and real-time quantitative reverse transcriptase-polymerase chain reaction were used to examine the chorioamnion from patients with (1) preterm labor and intact membranes, (2) preterm premature rupture of membranes who were delivered < or =34 weeks of gestation, and (3) women at term with or without labor. All groups were stratified on the basis of the presence of histologic chorioamnionitis. RESULTS: Toll-like receptor-2 expression was significantly higher in patients with chorioamnionitis than in patients without this condition (all P < .05). The Toll-like receptor-2 and -4 messenger RNA amounts were significantly higher in membranes from women at term with spontaneous labor than women who were not in labor ( P = .001 and .002, respectively). Toll-like receptor-2 expression was polarized to the basal surface of amniotic epithelial cells in patients without chorioamnionitis, but this distribution was lost in the presence of inflammation. CONCLUSION: Spontaneous labor at term and preterm delivery with histologic chorioamnionitis, regardless of the membrane status (intact or ruptured), are associated with an increased expression of Toll-like receptor-2 and -4 in the chorioamniotic membranes. These observations have implications for understanding the biologic nature of innate immunity.

Amnion↗
PubMed2005

The Maternal-Fetal Medicine Unit cesarean registry: trial of labor with a twin gestation.

OBJECTIVE: The purpose of this study was to identify the success rates and risks in women with a twin pregnancy who attempt a trial of labor after cesarean delivery. STUDY DESIGN: Cases were identified in the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network's Cesarean Registry with a woman with a twin pregnancy who had had at least 1 previous cesarean delivery. RESULTS: During the study period (1999-2002), 412 women fulfilled the study criteria, and 226 women had elective repeat cesarean delivery. Of the 186 women (45.1% of total) who attempted a trial of labor, 120 women were delivered successfully (success rate, 64.5%), and 66 women (35.5%) had a failed trial of labor. Thirty of the failed trials of labor involved a vaginal delivery for twin A and cesarean delivery for twin B. Women who attempted a trial of labor with twins had no increased risk of transfusion, endometritis, intensive care unit admissions, or uterine rupture when compared with elective repeat cesarean delivery. Fetal and neonatal complications were uncommon in either group at>or=34 weeks of gestation. CONCLUSION: A trial of labor with twins after previous cesarean delivery does not appear to increase maternal morbidity. Perinatal morbidity is uncommon at>or=34 weeks of gestation.

Adult↗
PubMed2006

Uterine transcriptomes of bacteria-induced and ovariectomy-induced preterm labor in mice are characterized by differential expression of arachidonate metabolism genes.

OBJECTIVE: The purpose of this study was to identify changes in gene expression that are associated with preterm labor induced by either bacteria or ovariectomy. STUDY DESIGN: Pregnant mice (14.5 days of gestation) were allocated to: (1) intrauterine injection of heat-inactivated Escherichia coli; (2) media alone; (3) ovariectomy; or (4) sham operation. The uterine transcriptome was studied with photolithographic, very short oligonucleotide-based microarrays, and arachidonate metabolism genes were assayed with quantitative reverse transcriptase-polymerase chain reaction. Significance was determined by analysis of variance. RESULTS: Microarray-based gene expression changes in the arachidonate metabolism pathway are associated globally with bacteria-induced preterm labor (P < or = .0031) and ovariectomy-induced preterm labor (P < or = .00036). Quantitative real-time reverse transcriptase-polymerase chain reaction measurements demonstrated that bacteria-induced preterm labor substantially increased the expression of genes involved in prostaglandin synthesis. In contrast, ovariectomy-induced preterm labor increased the expression of genes involved in lipoxin, leukotriene, and hydroxyeicosatetraenoic acid synthesis. CONCLUSION: Bacteria-induced and ovariectomy-induced preterm labor each express a different balance of genes that are required for the synthesis of prostaglandins, lipoxins, leukotrienes, and hydroxyeicosatetraenoic acids.

Animals↗
PubMed2004

Precipitate labor: higher rates of maternal complications.

OBJECTIVE: The study was aimed to identify risk factors and to elucidate pregnancy outcome following precipitate labor, i.e. expulsion of the fetus within less than 3 h of commencement of contractions. METHODS: A comparison of patients with and without precipitate labor, delivered during the years 1988-2002, was conducted. Patients who underwent cesarean deliveries were excluded from the analysis. A multiple logistic regression model, with backward elimination, was performed to investigate independent risk factors for precipitate labor. RESULTS: The number of vaginal deliveries that occurred during the study period was 137,171. Of these, 99 were precipitate. Independent risk factors for precipitate labor, using a backward, stepwise multivariate analysis were: placental abruption (odds ratio (OR) = 30.9, 95% confidence interval (CI) 15.9-60.4, P < 0.001); fertility treatments (OR = 3.9, 95% CI 1.7-9.0, P = 0.002); chronic hypertension (OR = 3.1, 95% CI 1.2-7.8, P = 0.015); intrauterine growth restriction (IUGR) (OR = 2.9, 95% CI 1.2-6.8, P = 0.014); prostaglandin E2 induction (OR = 1.9, 95% CI 1.1-3.5, P = 0.045); birth weight < 2,500 g (OR = 1.8, 95% CI 1.1-3.1, P = 0.020); and nulliparity (OR = 1.7, 95% CI 1.1-2.6, P = 0.014). No significant differences were noted between the groups regarding perinatal complications such as meconium stained amniotic fluid, perinatal mortality and low Apgar scores. However, there were higher rates of maternal complications in the precipitate labor group such as cervical tears and grade 3 perineal tears (18.2% versus 0.3%, P < 0.001; and 2.0% versus 0.1%, P < 0.001, respectively), post-partum hemorrhage (13.1% versus 0.4%, P < 0.001); retained placenta (2.0% versus 0.5%, P = 0.02); the need for revision of uterine cavity and packed-cells transfusions (34.3% versus 4.9%, P < 0.001; and 11.1% versus 1.1%, P < 0.001, respectively) and prolonged hospitalization (27.6% versus 19.2%, P = 0.035) as compared to the controls. CONCLUSION: Precipitate labor is associated with higher rates of maternal complications.

Adult↗
PubMed2005

Misoprostol use for labor induction in developing countries: a prospective study in Guinea.

BACKGROUND: The purpose of this study was to assess the efficacy, side effects and cost of misoprostol regimens in various obstetrical situations frequently occurring in developing countries. STUDY DESIGN: One hundred and four parturient women with indications for labor induction received different regimens of misoprostol in the range of 50-800 microg according to their gestational age. Misoprostol was administered by the vaginal route, every 6h without exceeding four doses. RESULTS: All indications for labor induction concerned women with a gestational age of more than 30 weeks, except in the intrauterine death cases. The mean overall duration of labor was 7.8 h (+/-4.6 h). The mean amount of misoprostol used was 226 microg (+/-196 microg). The difference in the mean labor duration between the four indications for induction was statistically significant (P<0.01). It was also significant for the mean total dose of misoprostol used. Total dose of misoprostol and Bishop score were inversely proportional. Two caesarean deliveries and two uterine ruptures were recorded, but no maternal deaths. The mean Apgar score was 8.0 (+/-1) at 1 min and 9.5 (+/-0.8) at 5 min. In our series, four fetal deaths occurred. The mean cost of misoprostol for labor induction was around US$ 1, with a range of 0.05-4. CONCLUSIONS: The use of vaginal misoprostol appears to be relevant in developing countries in cases where labor induction is indicated. Nevertheless, the advantages of misoprostol (low cost, facility of storage) are counter-balanced by side-effects (C-section, uterine rupture) which can be harmful for the mother and also for the newborn.

Administration, Intravaginal↗
PubMed2005

When to induce labor for post-term? A study of induction at 41 weeks versus 42 weeks.

OBJECTIVE: To evaluate the pregnancy outcomes of two policies of timing of induction of labor for post-term pregnancies. STUDY DESIGN: It is a retrospective study in a University obstetric unit from 1997 to 2002. Five thousand eight hundred and ninety-two singleton, cephalic pregnancies with gestational age at delivery at or more than 41 completed weeks were studied. They were divided into two groups. Group A included women who delivered from January 1997 to February 1999 when the policy of the department was to induce labor for post-maturity at 42 weeks of gestation. Group B included those delivered between March 1999 and December 2002 when the timing of induction for post-term was advanced to 41 weeks. The intrapartum characteristics, delivery and perinatal outcomes were analyzed by Student's t-test and Chi-square test for continuous and categorical variables, respectively. RESULTS: Two thousand one hundred and seventy-six women were studied in Group A and 3716 in Group B. Twenty-nine percent of these pregnancies in Group A required induction of labor whereas 20.3% were for post-term. In Group B, 58% of pregnancies had labor induction and 55% for post-maturity. For the pregnancies undergoing induction of labor for post-term, both the duration of labor (P<0.001) and the need of intrapartum epidural analgesia were increased (OR 1.3, 95% CI: 1.0-1.6) in Group B. However, there was no significant difference in the mode of delivery, apgar scores and stillbirths between the two study periods. CONCLUSION: Compared to routine induction at 42 weeks, induction at 41 weeks is associated with a significantly higher risk of use of medical interventions and associated complications, with no observable benefits.

Female↗
PubMed2004

Maternal serum levels of dehydroepiandrosterone sulfate and labor induction in postterm pregnancies.

OBJECTIVES: To study the relationship between maternal endogenous dehydroepiandrosterone sulfate (DHEAS) levels, success of labor induction, and Bishop scores in postterm pregnancies. METHODS: There were 65 postterm pregnancies. Group 1 consisted of women spontaneously in the active phase of labor, and group 2 of women with hypotonic uterine contractions whose labor was inducted by oxytocin. Levels of DHEAS were studied from venous blood samples. Demographic data and Bishop scores were recorded. RESULTS: The demographic characteristics of patients were similar, but DHEAS levels were higher in group 1 than in group 2 (P<0.001). Linear regression analysis showed a significant relationship between DHEAS and Bishop scores. DHEAS levels in women delivered vaginally were significantly higher than in women delivered by cesarean section. From the receiver operating characteristics (ROC) curve, DHEAS levels might determine the mode of delivery and success of labor induction; however, Bishop scores do not. CONCLUSIONS: DHEAS levels may be an important factor influencing the efficiency of labor and the success of labor induction in postterm pregnancies.

Adult↗
PubMed2006

Increased intravenous fluid intake and the course of labor in nulliparous women.

OBJECTIVE: To compare the effect of 2 regimens of intravenous fluid therapy on the course of labor. METHODS: In a prospective, randomized, double-blind study of 300 nulliparous pregnant women at term conducted at a teaching hospital, 153 women received 125 mL and 147 received 250 mL of intravenous fluid per hour. The groups were matched and analysis was done using the t, chi(2), and Fisher exact tests. P<0.05 was considered statistically significant. RESULTS: In the group that received intravenous fluid at a rate of 250 mL per hour the mean+/-S.D. duration of labor was significantly shorter (253+/-97 vs. 386+/-110 min; P = 0.0001), the frequency of labor lasting both more than 10h and more than 15 h was statistically lower (4.8% vs. 13.8%; P=0.001 and 0% vs. 4.5%; P=0.02, respectively), and the frequency of oxytocin administration was significantly lower (8.1% vs. 20.4%; P=0.001). There was a trend toward a lower frequency of cesarean deliveries in the 250-mL group (16% vs. 22.8%; P=0.1). CONCLUSION: A greater volume per hour of intravenous fluid than is commonly administered to nulliparous women in active labor is associated with significantly shorter duration of labor and lower frequency of both prolonged labor and oxytocin administration.

Adolescent↗
PubMedDate not supplied

Context and process of informed consent for pharmacologic strategies in labor pain care.

The care of women experiencing labor pain often challenges midwives to provide ethical informed consent for the pharmacologic strategies common in most of America's childbearing environments. A systematic approach to this clinical dilemma begins with a conceptual understanding of the origins of labor pain stimuli, factors affecting their central nervous system processing, and the differentiation of the concepts of pain, suffering, and comfort. These concepts can be integrated into a labor pain care, rather than pain management, model for clinical practice. Because most midwives provide care for laboring women in acute care hospitals, the midwife must also understand how the standards of the Joint Commission on Accreditation of Healthcare Organizations influence the behavior of other professionals in the health care environment for laboring women and the process of informed consent. A systematic approach to informed consent for pharmacologic strategies for labor pain care strategies should begin during pregnancy and includes full, unbiased disclosure of the nature, benefits, risks, side effects, and efficacy of all methods that are available in the chosen birth setting.

Analgesia, Obstetrical↗
PubMed2005

Initial characterization of the microenvironment that regulates connective tissue degradation in amniochorion during normal human labor.

Extracellular matrix degradation in fetal membranes leading to its rupture is coupled to myometrial activity and cervical ripening during human normal labor. Mechanisms which modulate collagen degradation in amniochorion during labor have not been elucidated. Initial characterization of the effect of different blood compartments on connective tissue degradation in amniochorion during human labor was explored. Amniochorion explants were stimulated with plasma of maternal venous blood, umbilical cord blood or placental blood, obtained from women with pregnancies at term, with or without labor. MMP-2 and MMP-9 activities were quantified in conditioned media by gelatin-zymography as an index of connective tissue degradation. Collagen content was measured in tissue explants and collagen fibrils distribution was examined by electron microscopy. Placental plasma from term pregnancies, with or without labor, is enriched with soluble signals that enhance the in vitro MMP-9 production by amniochorion. Accompanying ultrastructural distortion of collagen fibers and demonstration of collagen degradation fragments confirmed induction of extracellular matrix degradation. Control experiments in which MMP-9 activity was blocked with TIMP-1 resulted in inhibition of all the above mentioned changes. These results suggest that placental intervillous space is a functional compartment in which mediators capable to induce collagen degradation in amniochorion are selectively expressed during human labor.

Amnion↗
PubMed2004

Monocyte chemotactic protein-1 expression is increased in human gestational tissues during term and preterm labor.

OBJECTIVE: Microarray analysis was used to characterize the labor-selective transcriptome of the human myometrium during labor. One highly up-regulated transcript, monocyte chemotactic protein-1 (MCP-1), was further characterized. METHODS: Expression of MCP-1 was evaluated in the myometrium, the placenta, the gestational membranes (GM) and the amniotic fluid (AF) by real time RT-PCR, Northern blot analysis and ELISA. The level of immunoreactive (IR) MCP-1 content of primary myometrial cultures treated with inflammatory cytokines was quantified by ELISA. RESULTS: Up-regulation of the myometrial MCP-1 transcript in term laboring patients was demonstrated by microarray and confirmed by real time (RT)-PCR and Northern blot analysis. Increased MCP-1 transcripts were demonstrated in GM during term labor. The IR content of myometrial MCP-1 was increased during term labor and in the AF from patients experiencing preterm delivery. Levels of IR MCP-1 increased in myometrial cultures in response to interleukin 1-beta. CONCLUSION: The expression of myometrial MCP-1 was significantly increased during term labor and was similarly increased in vitro in response to interleukin 1-beta, a pro-inflammatory substance known to play a role in preterm birth. The increased IR content of MCP-1 within the AF preceding preterm delivery may render this protein a useful predictor of preterm birth.

Adult↗
PubMed2000

Activity and expression of 15-hydroxyprostaglandin dehydrogenase in cultured chorionic trophoblast and villous trophoblast cells and in chorionic explants at term with and without spontaneous labor.

OBJECTIVE: The aim of this study was to investigate whether any changes occurred at term before and with labor in the 15-hydroxyprostaglandin dehydrogenase messenger ribonucleic acid level and in the 15-hydroxyprostaglandin dehydrogenase activity in cultured chorionic and villous trophoblast cells and in chorionic explants. STUDY DESIGN: Twelve placentas (labor group [vaginal delivery], n = 6; nonlabor group [elective cesarean delivery], n = 6) were collected. Chorionic trophoblast and villous trophoblast cells and chorionic disks were obtained, cultured, and incubated with 282-nmol/L prostaglandin F(2)(alpha). Medium was collected to measure the 13,14-dihydro-15-keto metabolite of prostaglandin F(2)(alpha), and the cells and disks were snap-frozen to quantify 15-hydroxyprostaglandin dehydrogenase messenger ribonucleic acid expression by Northern blot analysis. RESULTS: The formation of the 13,14-dihydro-15-keto metabolite of prostaglandin F(2)(alpha) was significantly lower in the labor group than in the nonlabor group for both sets of cultured cells and for chorionic explants. 15-Hydroxyprostaglandin dehydrogenase messenger ribonucleic acid expression was lower in the chorionic trophoblast cells and chorionic disks of the labor group than those of the nonlabor group. However, the 15-hydroxyprostaglandin dehydrogenase messenger ribonucleic acid level in the villous trophoblast cells did not differ between the labor and nonlabor groups. CONCLUSION: Prostaglandin metabolic activity in the chorion is reduced significantly at the time of labor.

Blotting, Northern↗