[Childbirth in water: myth or reality?].
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Adult↗
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Results for “Labor Stage, First”
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Fetal acoustic stimulation for rapid intrapartum assessment of fetal well-being.
Fetal heart rate reactions to the fetal acoustic stimulation test (FAST) were prospectively studied in 140 women in early labor. Overall 45 of 140 patients (32%) had one or more complications of pregnancy. All were in the latent phase of labor with a singleton, vertex-presenting fetus. Gestational age ranged from 37-43 wks. The women were screened with a 15-20 min fetal heart rate recording (FHR admission test) before the acoustic stimulation was applied. Results of the FHR admission test and the FAST in women were compared with fetal outcome; which was considered poor when there was perinatal death, a 5 min Apgar score less than 7, fetal distress requiring cesarean section, thick meconium stained amniotic fluid or admission to the neonatal intensive care unit. FAST had better sensitivity (71.4% vs 42.8%), specificity (99.2% vs 97.7%), positive predictive value (83.3% vs 50.0%) and negative predictive value (98.5% vs 97.0%) for poor fetal outcome than the FHR admission test. Fetal acoustic stimulation test in the early intrapartum period may be used as a noninvasive screening method for rapid intrapartum assessment of fetal wellbeing. It may discriminate the compromised from the noncompromised fetus. This clinical application can be helpful in a busy labor room when rapid assessment of fetal health is required.
Acoustic Stimulation↗
Prophylactic amnioinfusion for oligohydramnios: a reevaluation.
OBJECTIVE: To compare the effects of prophylactic amnioinfusion to standard care plus indicated therapeutic amnioinfusion (for variable decelerations) in term patients with oligohydramnios. METHODS: One hundred sixteen term gestations with oligohydramnios (amniotic fluid index less than 5.0 cm) were randomly assigned to receive prophylactic saline amnioinfusion (600-mL bolus followed by 3 mL/minute) or standard obstetric care (control). Control patients who subsequently developed moderate or severe variable decelerations received therapeutic amnioinfusion. RESULTS: There was no significant difference in overall cesarean delivery (21 versus 17%; P = .68), cesarean delivery for fetal distress (7 versus 10%; P = .83), or umbilical gas values between the prophylactic amnioinfusion group (N = 56) and control group (N = 60), respectively. The rate of intrapartum fever was significantly increased among the prophylactic amnioinfusion patients (23 versus 7%; P = .02), although the duration of intrauterine monitoring (8.8 versus 6.5 hours; P = .06) and time from ruptured membranes to delivery (12.3 versus 14.3 hours; P = .51) were not different. Only 22% of the controls developed moderate or severe variable decelerations in the first stage of labor and received therapeutic amnioinfusion. Thus, in approximately four of five term patients with oligohydramnios, neither prophylactic nor therapeutic amnioinfusion would be indicated. CONCLUSIONS: Compared to indicated amnioinfusion, prophylactic amnioinfusion did not improve perinatal outcome. Amnioinfusion should be reserved for term laboring patients with variable fetal heart rate decelerations, rather than all patients with oligohydramnios.
Adult↗
[Determination of intrauterine pressure using catheter-tip transducer inserted outside fetal membranes].
To determining intrauterine pressure outside fetal membranes, we used a catheter-tip transducer to study 20 women before the occurrence membrane rupture. Their mean age was 28.2 +/- 3.4 years and all women were in weeks 37 to 41 of pregnancy when studied. In the first stage of labor, the peak intrauterine pressure was 60.0 +/- 12.5 mmHg (mean +/- SD) when the external os was dilated 4 to 6 cm, 90.0 +/- 14.8 mmHg, at 7 to 8 cm dilation, and 80.0 +/- 11.5 mmHg at 9 cm or greater dilation. Each pressure wave lasted 45 to 55 sec. The highest baseline pressure (28.0 +/- 4.5 mmHg) was obtained when the subjects were sitting. A baseline pressure of 17.0 +/- 4.0 mmHg was obtained in the supine position, as well as a value of 21.0 +/- 3.5 mmHg in the recumbent position. There were no complications related to the catheter-tip transducer. Our findings indicate that this method is both accurate and reliable in determining the amounts of intrauterine pressure to which fetal membranes are subjected.
Adult↗
The role of steroid hormones in cervical ripening.
Dehydroepiandrosterone sulphate (DHEA-S), estradiol (E2), estriol (E3), progesterone (P4) and cortisol (F) maternal plasma concentrations were determined using enzyme or fluoroimmunoassays in 28 healthy pregnant women prior to the induction of labour, performed for various reasons, in order to evaluate their impact on cervical ripening. Mean maternal and gestational ages were 24.7 +/- 3.6 years and 39.1 +/- 1.9 weeks, respectively, and the gravidity ranged from 0-4. The subjects were divided according to cervical maturity into Group A (n = 13, Bishop scores > 4) and Group B (n = 15, Bishop scores < 4). There were no statistically significant differences observed between the two groups as to concentrations of oestradiol, oestriol, progesterone and cortisol. However, significantly higher concentrations of DHEA-S were found in group A compared to group B (1335 +/- 885 ng/ml and 558.2 +/- 191.4 ng/ml, respectively), (p < 0.001). In conclusion, the high DHEA-S concentrations in maternal plasma may play an important role in pregnancy by producing favourable cervical conditions for delivery or by triggering the labour itself.
Adult↗
Cervical dilation: accuracy of visual and digital examinations.
OBJECTIVE: To determine the accuracy of visually versus digitally determined cervical dilation. METHODS: We studied 64 pregnant women with rupture of the amniotic membranes. One of two residents performed a speculum examination, estimated the dilation and effacement visually, and noted whether fetal parts or amniotic membranes were present. The same examiner then determined digitally the cervical dilation and effacement and station of the presenting part. RESULTS: There was a statistically significant correlation between visually and digitally determined cervical dilation (r = 0.78, P < .001). CONCLUSION: Visual estimation of cervical dilation correlates well with digital examination.
Adult↗
Intrauterine pressure wave characteristics of the upper and lower uterine segments in parturients with active-phase arrest.
OBJECTIVE: To determine the gradient of pressure between the upper and the lower uterine segments of parturients with non-progressing labor and to see whether the gradient correlates with subsequent successful oxytocin augmentation. METHODS: Fifteen women with active-phase arrest of labor were monitored with two intrauterine pressure transducers before and after oxytocin augmentation. Seven parturients without arrest of labor were evaluated for comparison. One intrauterine pressure transducer was inserted into the upper and one into the lower uterine segment of each subject. Overall, 444 contractions were assessed using the mean active pressure method. RESULTS: A total of 16 patients delivered vaginally. Nine received oxytocin augmentation, and all had significantly higher pressure in the upper segment than in the lower both before and after oxytocin (P < .001). Six women delivered by cesarean had a reversed gradient of uterine activity, with the lower segment contracting significantly more strongly than the upper uterine segment both before (P = .002) and after oxytocin (P = .001). CONCLUSION: Pressure gradients between the upper and lower uterine segments in the active phase might predict the likelihood of success of oxytocin augmentation.
Case-Control Studies↗
Epidural analgesia for labour using a continuous infusion of bupivacaine and alfentanil.
Seventy women who requested epidural pain relief in labour received a continuous epidural infusion at 8 ml h-1, which contained either 0.25% bupivacaine (n = 29), or a mixture of 0.125% bupivacaine and 0.005% alfentanil (n = 31), assigned randomly. Increments of 4 ml 0.25% bupivacaine were given on demand to prevent residual pain from uterine contractions. The two groups were compared for motor block of the lower limbs, number of increments required, type of delivery and neonatal Apgar scores. The group of women receiving the mixture of bupivacaine and alfentanil required between them seven increments; the group receiving bupivacaine alone required 15. One of the women receiving the mixture and eight of the women receiving bupivacaine alone had almost complete motor block. There were no differences in the mode of delivery or in the neonatal Apgar scores.
Adult↗
Cervical dilation: accuracy of visual and digital examinations.
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Cervix Uteri↗
Comparison of thrombelastography with common coagulation tests in preeclamptic and healthy parturients.
BACKGROUND AND OBJECTIVES: Epidural analgesia/anesthesia is often beneficial in the management and treatment of preeclampsia. However, some preeclamptic patients have a coagulopathy that is a contraindication to regional anesthesia. A routine coagulation battery (RCB) consisting of prothrombin time, partial thromboplastin time, platelet count, and bleeding time, is commonly performed to assess coagulation status. Thrombelastography (TEG) is a measure of clotting that allows evaluation of overall coagulation activity. The goal of this study was to examine whether TEG can predict normal and abnormal coagulation as diagnosed by RCB in healthy and preeclamptic parturients. METHODS: Forty-seven parturients participated in this prospective study, performed early in the first stage of labor. Twenty healthy parturients (group I), 19 mild (group II), and 8 severe preeclamptic/eclamptic parturients (group III) had RCB and TEG performed. RESULTS: Five patients (1, group I; 3, group II; 1, group III) had a normal RCB, but a mildly abnormal TEG (prolonged K, small alpha) (specificity = 0.88). Five of 27 preeclamptic parturients (1, group II; 4, group III) had abnormal RCBs. Three of these 5 patients had thrombocytopenia with normal bleeding times and TEGs. Two patients had thrombocytopenia and prolonged bleeding times and abnormal TEGs (sensitivity = 0.40). CONCLUSION: Thrombelastography is not an effective means of predicting abnormal coagulation, as diagnosed by RCB, in preeclamptic parturients, using currently defined normal TEG values for nonpregnant patients. However, an abnormal TEG maximum amplitude value always correlated with a prolonged bleeding time. Therefore, TEG may be useful in assessing platelet function in the presence of thrombocytopenia. Further studies are warranted.
Adult↗
The length of active labor in normal pregnancies.
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Female↗
[Causes of active phase arrest].
OBJECTIVE: To evaluate factors affecting active phase arrest. METHOD: Retrospective study from 1992 to 1994 was performed. A total of 166 pregnant women were included, 83 in to the active phase arrest group and 83 in normal group. RESULTS: There were significant differences in the average birth weight and the prevalence of abnormal fetal presentation between the 2 groups. The time length of the latent phase was another factor influencing active phase arrest. CONCLUSION: With normal pelvis, the high birth weight, abnormal presentation and prolonged latent phase were active phase arrest.
Adult↗
Lack of effect of walking on labor and delivery.
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Delivery, Obstetric↗
[Pentazocine as an analgetic in labor].
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Anesthesia, Obstetrical↗
Ovine maternal and fetal plasma oxytocin concentrations before and during parturition.
To study the relationships between fetal and maternal oxytocin (OT) levels and the initiation of labor in sheep, paired maternal and fetal plasma OT concentrations (microunits per ml) were measured by RIA. Samples were obtained daily from pregnant ewes and their fetuses for 5 days before spontaneous delivery and frequently during the first and second stages of labor and during the 3 h after delivery. The mean maternal plasma OT concentration during the first stage of labor was not different from that preceding labor. In contrast, the mean maternal plasma OT level during stage 2 of labor was significantly higher than the earlier baseline maternal values or the mean paired fetal concentration. There was no significant increase in the mean fetal plasma OT concentration before delivery. The newborn plasma OT concentration was elevated 15 min after delivery. From these data, we conclude that in the sheep, 1) the onset of labor is not associated with increased maternal plasma OT levels, 2) cervical or vaginal distension may be the stimulus for maternal OT release during stage 2 of labor, 3) an increase in the fetal plasma OT concentration does not occur before the initiation of labor or during the course of labor, and 4) stress in the final moments of labor or in early neonatal life may be responsible for elevated cord and early neonatal plasma OT levels.
Animals↗
Does chondroitin sulfate defend the human uterine cervix against ripening in threatened premature labor?
OBJECTIVE: This study was undertaken to investigate changes in chondroitin sulfate levels in the cervix and the physiologic role of chondroitin sulfate isomers in the process of cervical ripening. STUDY DESIGN: Uterine cervical mucus samples were obtained from 57 women (7 nonpregnant women, 19 at preterm gestation, 9 at term gestation, 16 during the first stage of term labor, and 6 with threatened premature labor). Chondroitin sulfate isomer (chondroitin 0-sulfate, 4-sulfate, and 6-sulfate) concentrations in cervical mucus were measured by high-performance liquid chromatography. The effect of exogenous chondroitin sulfate on hyaluronidase activity in cervical mucus was evaluated by gel permeation chromatography of fluorolabeled hyaluronic acid. RESULTS: Chondroitin sulfate concentrations in cervical mucus were increased significantly (P <. 05) in the threatened premature labor group compared with the preterm and term groups. However, the same finding was not observed in the first stage of term labor. Exogenous chondroitin sulfate inhibited hyaluronidase activity in mucus. CONCLUSION: Chondroitin sulfate may defend against cervical ripening in threatened premature labor.
Cervical Ripening↗
[Effect of peridural analgesia on labor progress].
Epidural analgesia (EDA) is the most effective method of intrapartum pain relief. Its influence on the course of labor continues to be controversial. Although a cause-and-effect relationship has not been proven, this form of analgesia has been blamed for a host of adverse maternal/fetal events during labor, including prolonged first and second stage of labor, dystocia, malrotation of the fetal head and an increased risk of operative delivery (instrumental delivery, Caesarean section). Our own data from the Department of Obstetrics and Gynaecology at the University of Leipzig demonstrate that women with epidural analgesia had a longer duration of labor (the greater proportion taking more than 13 hours), although labor was often already protracted before the start of epidural analgesia. Early epidural analgesia with a cervical dilatation of less than 4 cm does not have any negative impact on the progress of labor. The duration of second-stage pushing and the rate of instrumental deliveries were not increased in our patients. Although the Caesarean section rate for women with an EDA was elevated, the total proportion of secondary Caesarean section remained unchanged despite increased use of EDA. Our findings suggest that women selected for intrapartal EDA already represent a population with an increased risk of an unfavourable course of labor, priming of the cervix, increased need of oxytocin and nulliparity. Pain relief in itself is sufficient indication for the use of intrapartal epidural analgesia.
Adolescent↗
Ropivacaine, 0.1%, plus sufentanil, 0.5 microg/ml, versus bupivacaine, 0.1%, plus sufentanil, 0.5 microg/ml, using patient-controlled epidural analgesia for labor: a double-blind comparison.
BACKGROUND: This study compared the administration of 0.1% ropivacaine and 0.5 microg/ml sufentanil with that of 0.1% bupivacaine and 0.5 microg/ml sufentanil via patient-controlled epidural analgesia route during labor. METHODS: Two hundred healthy pregnant women at term with a single fetus with a vertex fetal presentation were randomized in a double-blind fashion to receive either 0.1% ropivacaine and 0.5 microg/ml sufentanil or 0.1% bupivacaine and 0.5 microg/ml sufentanil using a patient-controlled epidural analgesia pump (5-ml bolus dose, 10-min locked-out period, no basal infusion). Pain score on a visual analog scale, Bromage score (0-3), level of sensory block, patient-controlled epidural analgesia ratio, drug use, supplemental boluses, and side effects were recorded at 30 min and then hourly. Mode of delivery, duration of first and second stages of labor, umbilical cord pH, Apgar scores of the newborn, and a measure of maternal satisfaction were recorded after delivery. RESULTS: No differences were seen between the two groups for pain scores on a visual analog scale during labor, volume of anesthetic solution used, mode of delivery, or side effects. Motor block during the first stage of labor was significantly less in the ropivacaine group than in the bupivacaine group (no motor block in 97.8 of patients vs. 88.3%, respectively; P < 0.01). Duration of the second stage of labor was shorter in the ropivacaine group (1.3 +/- 1.0 vs. 1.5 +/- 1.2 h [mean +/- SD]; P < 0.05). Maternal satisfaction was greater in the bupivacaine group (91 +/- 13 mm for contraction, 89 +/- 19 mm for delivery on a visual scale: 0 = not satisfied at all, 100 = fully satisfied) than in the ropivacaine group (84 +/- 21 and 80 +/- 25 mm; P < 0.0001). Patients in the ropivacaine group requested more supplemental boluses to achieve analgesia during the second stage of labor than those in the bupivacaine group (29.7 vs. 19.8%, respectively, requested one or more supplemental boluses; P < 0.05). CONCLUSIONS: Delivered as patient-controlled epidural analgesia, 0.1% ropivacaine and 0.5 microg/ml sufentanil produce less motor block but are clinically less potent than 0.1% bupivacaine and 0.5 microg/ml sufentanil.
Adult↗