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PubMed2003

Labor induction versus expectant management for postterm pregnancies: a systematic review with meta-analysis.

OBJECTIVE: To compare routine labor induction with expectant management for patients who reach or exceed 41 weeks' gestation. DATA SOURCES: Computerized databases, references in published studies, and textbook chapters in all languages were used to identify randomized controlled trials (RCTs) evaluating induction and expectant management of labor for postterm pregnancies. METHODS OF STUDY SELECTION: We identified RCTs that compared induction and expectant management for uncomplicated, singleton, live pregnancies of at least 41 weeks' gestation and evaluated at least one of the following: perinatal mortality, mode of delivery, meconium-stained fluid, meconium aspiration syndrome, meconium below the cords, fetal heart rate (FHR) abnormalities during labor, cesarean deliveries for FHR abnormalities, abnormal Apgar scores, and neonatal intensive care unit (NICU) admissions. The primary outcomes assessed were cesarean delivery rate and perinatal mortality. TABULATION, INTEGRATION, AND RESULTS: Sixteen studies met inclusion criteria for this review. For each study with binary outcomes, an odds ratio (OR) with 95% confidence intervals (CIs) was calculated for selected outcomes. Estimates of ORs for dichotomous outcomes were calculated using fixed and random-effects models. Homogeneity was tested across the studies. Compared with women allocated to expectant management, those who underwent labor induction had lower cesarean delivery rates (20.1% versus 22.0%) (OR 0.88; 95% CI 0.78, 0.99). Although subjects whose labor was induced experienced a lower perinatal mortality rate (0.09% versus 0.33%) (OR 0.41; 95% CI 0.14, 1.18), this difference was not statistically significant. Similarly, no significant differences were noted for NICU admission rates, meconium aspiration, meconium below the cords, or abnormal Apgar scores. CONCLUSION: A policy of labor induction at 41 weeks' gestation for otherwise uncomplicated singleton pregnancies reduces cesarean delivery rates without compromising perinatal outcomes.

Cesarean Section↗
PubMed1999

Oral misoprostol for third stage of labor: a randomized placebo-controlled trial.

OBJECTIVE: To investigate whether orally administered misoprostol during the third stage of labor is efficient in reducing postpartum blood loss. METHODS: In a double-masked trial, during vaginal delivery women were randomly assigned to receive a single oral dose of misoprostol (600 microg) or placebo in third stage of labor, immediately after cord clamping. The third stage of labor was managed routinely by early cord clamping and controlled cord traction; oxytocin was administered only if blood loss seemed more than usual. Blood loss was estimated by the delivering physician and differences in hematocrit were measured before and after delivery. RESULTS: Mean (+/- standard error of the mean) estimated blood loss (345 +/- 19.5 mL versus 417 +/- 25.9 mL, P = .031) and hematocrit difference (4.5 +/- 0.9% versus 7.9 +/- 1.2%, P = .014) were significantly lower in women who received misoprostol than those who received placebo. Fewer women in the misoprostol group had postpartum hemorrhage (blood loss of at least 500 mL), but that difference was not statistically significant (7% versus 15%, P = .43). Additional oxytocin before or after placental separation was used less often in the misoprostol group (16% versus 38%, P = .047). There were no differences in the length of third stage of labor (8 +/- 0.9 minutes versus 9 +/- 1 minutes, P = .947). There were no differences in pain during third stage of labor, postpartum fever, or diarrhea, but shivering was more frequent in the misoprostol group. CONCLUSION: Oral misoprostol administered in the third stage of labor reduced postpartum blood loss and might be effective in reducing incidence of postpartum hemorrhage.

Administration, Oral↗
PubMed2002

Involvement of oxytocin and vasopressin in the pathophysiology of preterm labor and primary dysmenorrhea.

Important sources of oxytocin and vasopressin in the human, apart from the supraoptic and paraventricular nuclei of the brain, may be the fetus during labor as well as the endometrium and decidua of the uterus itself. The release of oxytocin and vasopressin to plasma is under influence of ovarian steroids. The two hormones stimulate uterine contractions in pregnant and non-pregnant women via myometrial oxytocin and vasopressin V1a receptors. At the onset of human labor preterm or at term no clear rise in the maternal plasma concentration of oxytocin and/or vasopressin has been demonstrated, but there may be an increased pulse frequency of the release of oxytocin to plasma with the advance of labor. Vasopressin is more potent than oxytocin on isolated myometrium from women undergoing Cesarean section at term. The myometrial concentration of the two receptors is about equal. At the onset of labor preterm and at term there is a tendency to an increase in the density of oxytocin and vasopressin V1a receptors, but there may be a heterogeneous expression of at least the former receptor between different myometrial cells. In advanced labor or after oxytocin treatment the receptors are markedly downregulated. The importance of oxytocin and vasopressin in mechanisms of preterm labor is confirmed by the therapeutic effect in the condition of the oxytocin and vasopressin V1a receptor blocking oxytocin analogue, atosiban. In women with primary dysmenorrhea the plasma concentration of vasopressin is elevated. The in vivo effect of vasopressin on uterine activity in non-pregnant women is about five times more pronounced than that of oxytocin, and it increases premenstrually. Correspondingly, the density of vasopressin V1a and oxytocin receptors vary to the same degree, and a premenstrual rise in the former receptor is seen. Atosiban and the non-peptide compound, SR 49059, which binds to the two receptors in a similar way as atosiban, are therapeutically effective in dysmenorrhea.

Dysmenorrhea↗
PubMed1997

Production of prostaglandin F2 alpha and E2 in explants of intrauterine tissues of guinea pigs during late pregnancy and labor.

Prostaglandin production in amnion and decidua is considered important for human parturition. We investigated in pregnant guinea pigs, a species similar to women in regard to the endocrinology of pregnancy, whether the production rates of PGE2 and PGF2 alpha in various intrauterine tissues are compatible with a role in parturition. Net production rates were measured at 45, 55 and 65 days of gestation and during labor in amnion, chorion, myo-endometrium, the outer layer of the myometrium, the site of placental implantation, and placenta. Net production rates in amnion increased between 45 days and labor (30-fold for PGE2 and 8-fold for PGF2 alpha, P < 0.0001). During labor, the production rates in amnion of PGE2 (P = 0.006) and PGF2 alpha (P = 0.019) were higher than at 45, 55, and 65 days of gestation. In myo-endometrium, the production rates of PGF2 alpha were higher at 65 days of gestation than at 55 days and during labor (P = 0.046). Addition of arachidonic acid (10(-5) M) increased production of PGE2 and/or PGF2 alpha in all tissues (P < 0.05) except placenta. In amnion, the response to arachidonic acid increased with advancing gestation. This suggests that 1) PGE2 and PGF2 alpha produced by amnion have a potential role in the initiation and maintenance of labor, 2) PGF2 alpha produced by myo-endometrium has a potential role in the initiation of labor, 3) cyclooxygenase(s) are not rate-limiting except in placenta, and 4) the expression of cyclooxygenase in amnion increases with advancing gestation.

Amnion↗
PubMed2001

Labor pain in relation to fetal weight in primiparae.

AIM OF STUDY: To investigate the association between fetal weight and the experience of labor pain in primiparae. METHODS: All primiparae who gave birth at the department of obstetrics, Herning Central Hospital, from 1 September 1998 to 30 April 1999 completed a visual analogue scale (VAS) on the second day after delivery. Pain was scored in the first, the second, and the "repair" stage of labor, respectively, and finally a score was performed for total labor evaluation. RESULTS: 139 primiparae were included. Mean age was 27 years (range 16-40 years), mean fetal weight was 3562g (range 2400-5050g). There was no relationship between fetal weight and pain score. Neither was there any relationship between pain score and maternal age, body mass index (BMI), duration of second stage of labor or the need for instrumental delivery. The score in the stage of perineal repair was significantly lower than in the other stages of labor. CONCLUSION: The experienced pain during labor among primiparae is not influenced by fetal weight.

Adolescent↗
PubMed2000

Amniotic fluid nitric oxide metabolite levels and nitric oxide synthase localization in feto-placental tissues are modified in association with human labor.

Nitric oxide (NO) has a relaxant effect on uterine smooth muscle and may be implicated in maintaining uterine quiescence during pregnancy. In order to investigate the role of nitric oxide in human parturition, we have measured NO metabolite levels in maternal and fetal compartments in association with labor, both at term and preterm. We have also examined the localization and distribution of NO synthase (NOS) isoforms in placentas and fetal membranes after term and preterm delivery by means of immunohistochemistry. Although no differences were present in maternal and fetal blood and in maternal urine among groups, we found that NO metabolite concentrations were higher in amniotic fluid collected from women in labor than in non-laboring patients, both at term (15.4+/-1.6 vs. 6.8+/-0.6 microM/mg creatinine) and preterm (16.7+/-2.0 vs. 7.0+/-0.8 microM/mg creatinine). Ir-bNOS staining appeared to be decreased in fetal membranes collected after spontaneous labor at term and preterm. In contrast, a stronger staining for iNOS was detected in trophoblast cells of fetal membranes from women in labor than in those from non-laboring women. We suggest that NOS isoenzymes in fetal placental tissues are differently regulated and might play different roles during pregnancy.

Adult↗
PubMed2000

Adverse effects of epidural analgesia in labor.

OBJECTIVE: To examine the influence of epidural analgesia on labor and delivery in nulliparous and multiparous women. DESIGN: Data were collected on 847 consecutive parturients with singleton pregnancy and vertex presentation (384 nulliparous and 463 multiparous). The obstetrical and labor characteristics including maternal age, parity, gestational age, previous cesarean section, instrumental delivery, mode and timing of analgesia, mode of delivery, indications for cesarean section or instrumental delivery were analyzed comparing patients who received epidural analgesia with women who received systemic analgesia. RESULTS: Epidural analgesia was administered in 233 nulliparous and 141 multiparous women. A stepwise logistic regression analysis revealed that epidural analgesia independently affected the rate of non-spontaneous delivery and the duration of the second stage of labor in nulliparous (P=0.0017 and P=0.0036, respectively) and multiparous (P=0.001 and P=0.0081, respectively) women. Epidural analgesia independently affected the duration of labor only in nulliparous women (P=0.0001). CONCLUSION: Women should be informed that prolongation of labor and increase in nonspontaneous deliveries should be expected when choosing epidural analgesia in labor.

Adult↗
PubMed2001

Reduced pain tolerance during and after pregnancy in women suffering from fear of labor.

Pain tolerance in women suffering and not suffering from fear of labor during and after pregnancy were compared. Twenty women with labor fear and 20 control women were subjected to a cold pressor test (CPT) on average 1 month before delivery and 9 months later. Half the volunteers were nulliparous and half parous. Pain endurance time (PET) and intensity of pain (Visual Analogue Scale, VAS) during CPT was assessed. Patients in the fear group tolerated CPT for a significantly shorter time than did women without fear both in pregnancy (154.8+/-109.9 s vs. 282.5+/-60.1 s (mean+/-SD), P<0.001), and in the postpartum period (128.6+/-111.7 s vs. 279.6 +/-60.3 s, P=0.002). Those with labor fear experienced CPT as significantly more painful than did the controls both during pregnancy (VAS 6.68+/-1.9 vs. 3.78+/-2.0 (mean+/-SD), P<0.001) and after (VAS 7.73+/-1.5 vs. 5.92+/-3.0, P=0.04). PET and VAS values correlated during pregnancy (r=-0.62, P<0.001), but not after pregnancy (r=-0.30, not significant). Parity was not associated with either PET or VAS scores. As a rule, pain in all women during CPT was regarded to be lower during pregnancy than after pregnancy (VAS 4.87+/-2.4 vs. 6.60+/-2.6, P=0.001). Patients with fear of labor were characterized by pain intolerance also in circumstances other than labor. This fact may indicate enhanced sensitivity to pain-causing mechanisms in women who develop fear of labor.

Adult↗
PubMed1990

Maternal position, labor, and comfort.

The purpose of this study was to determine if women who assumed upright positions during the phase of maximum slope would have a shorter phase of maximum slope in their labor and experience more comfort than women who assumed recumbent positions. Forty laboring women were randomly assigned to either an upright or recumbent position group. Subjects assumed the positions of their assigned group during the phase of maximum slope in their labor (cervical dilatation from 4 cm to 9 cm). Every hour during the phase of maximum slope, each subject was examined vaginally to determine her cervical dilatation and assessed for her level of comfort using the Maternal Comfort Assessment Tool. Women in the upright position group had a significantly shorter phase of maximum slope in labor, but did not significantly differ in comfort level from women in the recumbent group. Newborn Apgar scores were not significantly different between the two groups. Nurses need to be aware that the upright labor positions have the distinct advantages of facilitating efficient uterine contractions and reducing the duration of the phase of maximum slope in labor, with no increase in the discomfort experienced or adverse effect on newborn well-being.

Adolescent↗
PubMed1998

Prediction of successful induction of labor: comparison of transvaginal ultrasonography and the Bishop score.

OBJECTIVE: To determine whether transvaginal ultrasonography of the cervix before induction of labor is a better predictor of successful induction than the Bishop score. STUDY DESIGN: Eighty-six consecutive patients scheduled for induction of labor underwent digital cervical examination followed by transvaginal ultrasonography to measure cervical length and to determine the presence of wedging. Patients were induced with either oxytocin or intracervical prostaglandin E2 gel followed by oxytocin when required. The agent for induction was selected on the basis of the digital examination. The primary outcome criteria were successful induction and the duration of labor. RESULTS: Successful induction and the duration of labor were significantly associated with the Bishop score and cervical length. Cervical wedging was associated only with successful induction. However, in a logistic regression model that included these parameters as independent variables, only the Bishop score and parity were significantly correlated with successful induction and the duration of labor. CONCLUSIONS: Transvaginal ultrasonographic evaluation of the cervix before induction of labor does not improve the prediction of cervical inducibility obtained by the Bishop score.

Adult↗
PubMedDate not supplied

Inhibition of prostaglandin synthesis and its effect on uterine activity during established premature labor in sheep.

OBJECTIVE: Continuous infusion of the selective prostaglandin synthase type-2 inhibitor nimesulide, together with the oxytocin receptor antagonist atosiban, inhibits glucocorticoid induction of labor in sheep. We evaluated the effectiveness of this treatment commencing after the onset of premature labor when prostaglandin concentrations are already significantly elevated. METHODS: Premature labor was induced in chronically cannulated fetuses by constant fetal dexamethasone infusion. After the onset of active labor in each ewe, defined as uterine electromyographic (EMG) activity twice basal levels, ewes received combined nimesulide and atosiban (20.0 and 4.12 mg/kg per day, respectively; n = 6) or vehicle (n-methyl-2-pyrrolidone and saline each 1 mL/hour; n = 4) infusions for 48 hours. Maternal and fetal plasma PGFM (13,14-dihydro-15-keto PGF2alpha, the stable metabolite of prostaglandin (PG) F2alpha) and PGE2 concentrations were measured before, during, and after infusions. RESULTS: Four nimesulide- and atosiban-treated ewes successfully completed the 48-hour infusion period with no deliveries occurring during inhibitor treatment, or up to 6 hours after inhibitor treatment. Delivery was delayed in two other ewes, compared with control animals. Uterine EMG activity in nimesulide- and atosiban-treated ewes (n = 4) was significantly reduced during the 48-hour inhibitor treatment period. Maternal and fetal prostaglandin concentrations were significantly decreased in inhibitor-treated ewes during and after the infusions. CONCLUSIONS: The combination of nimesulide and atosiban treatment for 48 hours successfully inhibited the progression of active premature labor to delivery. This study further supports the potential value of this treatment regime for the inhibition of premature labor.

Animals↗
PubMedDate not supplied

Prostaglandin endoperoxide H synthase-1 and -2 mRNA levels and enzyme activity in human decidua at term labor.

OBJECTIVE: To determine the labor-related changes of prostaglandin endoperoxide H synthase (PGHS) activity and PGHS-1 and -2 abundance in term decidua and to assess the contribution of the PGHS isoforms to the total PGHS activity present in the tissue. METHODS: Decidua was collected after elective cesarean delivery (CD) or spontaneous labor (SL) at term. Prostaglandin endoperoxide H synthase activity was determined in microsomal fractions, and PGHS-1 and -2 mRNA levels were measured by ribonuclease protection assays. Prostaglandin endoperoxide H synthase-1 and -2 mRNAs were localized in tissue sections by in situ hybridization. RESULTS: Prostaglandin endoperoxide H synthase specific activity in decidua microsomes at CD was 111 +/- 3 pg prostaglandin-E2/minute/microgram protein (mean +/- standard error, N = 10 patients), not different from enzyme activity measured after SL (110 +/- 27 N = 10 patients, P = .97, Wilcoxon's rank sum test). Prostaglandin endoperoxide H synthase-1 mRNA abundance in CD tissues was 0.283 +/- 0.047 relative densitometric units (mean +/- standard error, n = 26 patients), which did not change with labor (SL: 0.329 +/- 0.073, n = 20 patients, P = .68). Prostaglandin endoperoxide H synthase-2 mRNA abundance was also unaffected by labor (CD: 0.933 +/- 0.255, n = 27 patients; SL: 0.714 +/- 0.179, n = 23 patients, mean +/- standard error, P = .66). Prostaglandin endoperoxide H synthase specific activity was positively and significantly (P < .05) correlated with both PGHS-1 and -2 mRNA levels. In situ hybridization showed the pervasive presence of both PGHS mRNAs in decidua cells with no detectable changes associated with labor. CONCLUSION: Both isoforms of PGHS are present in term decidua and contribute to enzyme activity and prostaglandin production. Mechanisms regulating decidual prostanoid biosynthesis at labor do not involve changing the levels of expression of the two PGHS isoforms.

Cesarean Section↗
PubMed2001

IL-1beta and IL-8 in human fetal membranes: changes with gestational age, labor, and culture conditions.

PROBLEM: Interleukin (IL)-1beta and IL-8 are associated with labor. This study aimed to characterize their concentrations in fetal membranes and any changes in these with advancing gestation and to define as to whether there are interactions between the membranes in their expression. METHOD OF STUDY: mRNA and protein content of amnion and choriodecidua at increasing gestations and before and after labor at term were quantified. Membranes were also collected before and after labor, separated, and cultured. Protein production was measured by ELISA. RESULTS: IL-1beta and IL-8 concentration increased in third trimester amnion and choriodecidua. Further increased expression of mRNA of both cytokines was found after labor in both membranes except IL-8 production by amnion. Choriodecidua produced more of each cytokine than amnion, however, no interaction between the membranes was demonstrated by culture. CONCLUSIONS: Increasing expression of IL-1beta and IL-8 in amnion and choriodecidua in the third trimester and after labor supports a role for these cytokines in the establishment of labor.

Amnion↗
PubMed1999

Effect of labor analgesia on breastfeeding success.

BACKGROUND: The effect of labor analgesia on breastfeeding success is not well defined. Some authors have hypothesized that labor analgesia may affect lactation success. The purpose of this observational study was to determine if intrapartum analgesia influenced breastfeeding success at 6 weeks postpartum in a setting that strongly supported breastfeeding. METHODS: Healthy women with uncomplicated term pregnancies who planned to breastfeed consented to a telephone interview. We recorded demographic data, labor induction status, delivery mode, and analgesic medications. At between 6 and 8 weeks postpartum, patients were asked to describe breastfeeding use, problems encountered, solutions derived, sources of support and information, and satisfaction. We created a logistic regression model using intrapartum analgesia information and controlling for demographic factors previously correlated with lactation success. RESULTS: We enrolled 189 women, contacted 177 women postpartum, and obtained complete data on 171 women. Of these, 59 percent received epidural analgesia, 72 percent breastfed fully, and 20 percent breastfed partially (> 50% of infant nutrition) at 6 weeks postpartum. After controlling for demographics and labor outcome, we could not demonstrate a correlation between breastfeeding success at 6 to 8 weeks and labor analgesia. CONCLUSIONS: In a hospital that strongly promotes breastfeeding, epidural labor analgesia with local anesthetics and opioids does not impede breastfeeding success. We recommend that hospitals that find decreased lactation success in parturients receiving epidural analgesia reexamine their postdelivery care policies.

Adult↗
PubMed1999

A comparison of breast stimulation and intravenous oxytocin for the augmentation of labor.

BACKGROUND: Breast stimulation to augment labor has been used for centuries in tribal societies and by midwives. In recent years it has been shown to be effective in ripening the cervix, inducing labor, and as an alternative to oxytocin for the contraction stress test. This study compared the effectiveness of breast stimulation with oxytocin infusion in augmenting labor. METHODS: Women admitted to the labor ward were eligible for the study if they had inadequate labor with premature rupture of the membranes and met inclusion criteria. They were assigned to oxytocin augmentation or breast stimulation (manual or pump), and were switched to oxytocin in the event of method failure. Outcomes included time to delivery, intervention to delivery, proportion of spontaneous deliveries, and Apgar scores. One hundred participants were needed in each arm of the study to demonstrate a 2- to 3-hour difference in delivery time, with a power of 80 percent. RESULTS: Analysis was performed on 79 women, of whom 49 were in the breast stimulation group and 30 in the oxytocin group. Sixty-five percent of the participants failed breast stimulation and were switched to oxytocin infusion. Although augmentation start to delivery was shorter for the oxytocin group (p < 0.001), no differences in total labor time occurred between the groups. Nulliparas receiving breast stimulation had more spontaneous (relative risk 1.7, p = 0.04), and fewer instrumental deliveries than those receiving oxytocin (relative risk 0.2, p = 0.02). No significant differences in adverse fetal outcomes occurred between the study groups. CONCLUSIONS: The small number of participants and a variety of problems with the conduct of the study prevented the formulation of reliable conclusions from the results. However, the study provided important insights into the feasibility and problems of developing a high-quality randomized trial of augmentation by breast stimulation.

Adolescent↗
PubMed2001

Maternal analgesia during labor disturbs newborn behavior: effects on breastfeeding, temperature, and crying.

BACKGROUND: Newborns not exposed to analgesia, when placed on the mother's chest, exhibit an inborn prefeeding behavior. This study was performed to assess the effects of different types of analgesia during labor on the development of spontaneous breastfeeding movements, crying behavior, and skin temperature during the first hours of life in healthy term newborns. METHODS: Video recordings were made of 28 newborns who had been dried and placed in skin-to-skin contact between their mother's breasts immediately after delivery. The video recordings were analyzed blindly with respect to infant exposure to analgesia. Defined infant behaviors were assessed every 30 seconds. Group 1 mothers (n = 10) had received no analgesia during labor, group 2 mothers (n = 6) had received mepivacaine via pudendal block, and group 3 mothers (n = 12) had received pethidine or bupivacaine or more than one type of analgesia during labor. RESULTS: All infants made finger and hand movements, but the infant's massagelike hand movements were less frequent in infants whose mothers had received labor analgesia. A significantly lower proportion of group 3 infants made hand-to-mouth movements (p < 0.001), and a significantly lower proportion of the infants in groups 2 and 3 touched the nipple with their hands before suckling (p < 0.01), made licking movements (p < 0.01), and sucked the breast (p < 0.01). Nearly one-half of the infants, all in groups 2 or 3, did not breastfeed within the first 2.5 hour of life. The infants whose mothers had received analgesia during labor had higher temperatures (p = 0.03) and they cried more (p = 0.05) than infants whose mothers had not received any analgesia. CONCLUSIONS: The present data indicate that several types of analgesia given to the mother during labor may interfere with the newborn's spontaneous breast-seeking and breastfeeding behaviors and increase the newborn's temperature and crying.

Adult↗
PubMed2001

Women's perceptions of helpful and unhelpful nursing behaviors during labor: a study in Taiwan.

BACKGROUND: The job of the nurse in labor and delivery is not only to ensure a safe delivery but also to create a positive and satisfying childbirth experience. Few studies have been conducted of women's perceptions about the ideal image of the obstetric nurse during labor, and most previous studies involved only North American or European women. The purpose of this study was to assess Taiwanese women's perspectives about their encounters with obstetric nurses during labor. METHODS: Interviews of a convenience sample of 50 mothers experiencing normal childbirth in Taiwan were conducted. The interviews were tape recorded and transcribed, and the transcriptions were analyzed to develop coding categories and identify themes. RESULTS: Sixty percent of the participants reported having received helpful nursing behaviors only; 38 percent reported having received both helpful and unhelpful nursing behaviors. Helpful labor-coping measures that were valued by participants included performing roles of emotional support providers, comforters, information/advice providers, professional technical skills providers, and advocates. Forty percent of the participants reported that some nurses had hindered their labor-coping ability by failing to provide emotional support, comfort measures, adequate or correct information/advice, or to perform technical duties. CONCLUSIONS: The ideal nursing image encompasses the roles of emotional supporter, comforter, information/advice provider, professional/technical skill provider, and advocate. The findings may help obstetric team members better understand patients' needs, and enable them to provide better support during labor and to prevent unhelpful nursing behaviors.

Adult↗
PubMedDate not supplied

[Scientific evidence on labor duration from systematic reviews].

OBJECTIVE: We examined the evidence of systematic reviews in the Cochrane Library on interventions that influence the duration of labor. MATERIAL AND METHODS: Of the 208 Cochrane Pregnancy and Childbirth systematic reviews, 69 deal with labor and birth of which 20 address the effect of intrapartum interventions. We analyzed the reviews with respect to those interventions that affected the duration of birth. RESULTS: Six reviews, related to 5 interventions (amniotomy, epidural analgesia, continuous support, amnioinfusion, and maternal position), reported a significant effect on the duration of labor. Six found no significant effect on labor duration. The remaining eight reviews did not assess the effect of the intervention on labor duration. DISCUSSION: Interventions that have a significant influence on labor duration may interact with each other. Therefore, perinatal databases should ascertain not only if but also when an intervention has been performed.

Adult↗