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PubMedDate not supplied

Use of upright positioning with epidural analgesia: findings from an observational study.

PURPOSE: To present research findings and related nursing implications from an observational study designed to evaluate the use of upright positioning during second stage labor with patients who had received low-dose epidural analgesia. STUDY DESIGN AND METHODS: This descriptive study evaluated outcomes from a sample of 74 healthy women having their first childbirth. They had all received epidural analgesia during the first and second stages of labor. Data were also collected by nurses on the use of birthing beds, and the extent of physical and emotional support the women needed while following the upright positioning study protocol. RESULTS: All women were able to maintain upright positions throughout the second stage of labor following epidural analgesia administration. No adverse neonatal outcomes or maternal problems (such as excessive vaginal bleeding) were documented. CLINICAL IMPLICATIONS: Although women were capable of assuming upright positions during second stage, the study results indicated that constant physical and emotional support was necessary for most women. Future research on methods to prepare women for multiple position options after administration of low-dose epidural analgesia should be undertaken. In addition, nurses should evaluate the benefits of upright positioning in terms of facilitating progress of labor.

Adolescent↗
PubMed1996

The intensity of labor pain in grand multiparas.

BACKGROUND: The purpose of the current study was to investigate differences in pain experiences and requirements for pain control in parturients with different birth experience. Previous studies have shown that the labor pain experience is significantly less intense in multiparas than in primiparas and requirements for analgesic treatment have therefore been assumed to be minimal in this group. METHODS: The pain experience during labor was assessed by 70 consecutive grand multiparas (a minimum of five previous deliveries) compared to that of primiparous (n=70) and II-V parous women (n=70). Pain intensity was repeatedly assessed on a pain intensity scale (0-10) according to the progress of cervical dilatation at the first and second stage of labor. RESULTS: During the latent phase of cervical dilatation (0-3 cm) grand multiparas had a median pain score of 3 compared to 4 in II-V paras and 6 in primiparas (p<0.001). At the end of the first stage and during the second stage the intensity of pain in grand multiparas was significantly higher compared to that in primiparas (median scores 7 to 8 vs 6 to 7, p<0.05). Epidural blocks were administered to 40% of primiparas, 3% of II-V paras and to no grand multiparas (p<0.0001). Twenty-one percent of grand multiparas rated their pain as intolerable (pain scores 9-10) during the second stage compared to 10% of primiparas (p<0.05%). On the third day after delivery, 47% of grand multiparas regarded their analgesia insufficient. CONCLUSIONS: The majority of parturients, including grand multiparas, suffered from intense pain during labor. After delivery, a significant number of grand multiparas felt that they had received insufficient pain relief.

Analgesia, Obstetrical↗
PubMedDate not supplied

[Optimization of anesthesiological management of the delivery in women with moderate and high myopia].

Eye fundus, functional state of retina, intraocular pressure, central hemodynamics and cerebral circulation were examined in 290 patients with moderate or severe myopia and in 25 healthy women during pregnancy, in parturition period and after labors. 255 labors were conducted by way of natural maternal passages under prolonged epidural anesthesia at the first and second stages of labor. Epidural anesthesia was accompanied by decreasing vasoconstriction and both cerebral and ocular circulation improvement. There was no any progress in myopia in a year after delivery. The labor by way of normal maternal passages were proved to be carried out under epidural anesthesia in patient with moderate and severe myopia.

Anesthesia, Epidural↗
PubMed2006

Oxytocin-associated rupture of an unscarred uterus in a primigravida.

BACKGROUND: Intrapartum rupture of the unscarred uterus is an uncommon event, usually associated with such risk factors as grand multiparity, malpresentation, history of gestational trophoblastic disease, or instrumented delivery. Rupture during first pregnancy is extremely rare. CASE: A 30-year-old primigravid woman was admitted for labor augmentation with oxytocin at 40.5 weeks of gestation. The oxytocin infusion rate was increased during the first and second stages of labor despite contractions occurring at a rate of 4-5 per 10 minutes. The uterus ruptured during second stage. Despite emergency cesarean delivery, the baby had evidence of severe asphyxia. CONCLUSION: This case of uterine rupture in a primigravida with no prior uterine surgery and a structurally normal uterus underscores the importance of careful contraction monitoring and judicious control of oxytocin infusion rates.

Adult↗
PubMed1991

Maternal aerobic exercise: newborn effects.

Maternal aerobic exercise during pregnancy may affect the experience of labor for the mother or fetus. Forty-four women who had given birth in the preceding 7 months responded to questions about their exercise habits during pregnancy. Using an exercise prescription formula, respondents were dichotomized into exercise or nonexercise groups. Maternal exercise was associated with a significant decrease in the duration of the second stage of labor (27 minutes vs 59 minutes, p = 0.04) and a reduction in the incidence of obstetric complications (8 vs 19, p = 0.058). The groups showed no significant differences in the number of weeks gestation, duration of the first or third stage of labor, birth weight, birth length, or neonatal Apgar scores at one and five minutes.

Apgar Score↗
PubMed2001

Perineal lacerations during spontaneous vaginal delivery.

BACKGROUND: The aim of the study was to assess the frequency of perineal lacerations during normal spontaneous vaginal delivery and to evaluate potential risk factors. METHODS: The study is based on an analysis of data from the obstetric database of the University Hospital of Vienna and the Semmelweis Women's Hospital Vienna, from February 1999 through to July 1999. Women with vaginal deliveries, uncomplicated pregnancies, uncomplicated first and second stage of labor, gestational age > 37 weeks and pregnancies with cephalic presentation were included. RESULTS: Of 1009 women, 36.2% had perineal lacerations (18.1% had first-degree, 15.2% second-degree, and 2.9% third-degree perineal tears). Univariate logistic regression models showed that only low parity (p = 0.004), the absence of episiotomy (p = 0.0001), and a large head diameter of the infant (p = 0.005) increased the risk for perineal laceration. After adjustment in multivariate analysis, low parity (p = 0.0001), the absence of episiotomy (p = 0.0001) and a large head diameter (p = 0.0004) remained independent risk factors for perineal laceration. Additionally, advanced age of the mother was associated with an increased risk of perineal laceration (p = 0.03). When analyzing the probability for third-degree perineal tears, a strong association with primiparity (p = 0.01), the use of episiotomy (p = 0.0001), a prolonged second stage of labor (p = 0.0001), a large head diameter of the infant (p = 0.01) and the use of oxytocin (p = 0.008) was found. CONCLUSIONS: Primiparous women who are being delivered of a large child are at a greater risk for severe perineal lacerations. In the study population episiotomy did not appear to protect against severe perineal lacerations.

Adolescent↗
PubMed1985

Measurement of transcutaneous pCO2 and pO2 in the fetus during labor.

We used newly developed transcutaneous electrodes to measure continuously the partial pressure of oxygen (tcpO2) and carbon dioxide (tcpCO2) in 34 fetuses during labor, having simultaneous cardiotocography (CTG) and temperature measurements. We observed that tcpO2 and tcpCO2 varied with contractions during the first and second stages of labor. In some cases changes in the transcutaneous values corresponded well with changes in the CTG, we also detected changes in the fetal gas metabolism that were not noticeable on the cardiotocographic tracing. We defined the characteristic of the tcpO2 and tcpCO2 during the second stage of labor and found that the tcpO2 decreased and the tcpCO2 rose at this time.

Carbon Dioxide↗
PubMed1982

Hypoxanthine levels in amniotic fluid: an indicator of fetal hypoxia?

During hypoxia there is an increased formation of hypoxanthine from the consumption of ATP; simultaneously the oxidation into uric acid is decreased. The purpose of this study was to determine possible correlations between hypoxanthine concentrations in the amniotic fluid and states of fetal hypoxia. We obtained 83 amniotic fluid samples from 68 patients during pregnancy or delivery. Hypoxanthine was assayed fluorimetrically according to GARDINER [4]. In the course of pregnancy, hypoxanthine levels in the amniotic fluid rise slightly. A marked increase occurs during delivery (without labor mean = 3.4 +/- 0.9 mumol/l, with labor mean = 7.0 +/- 5.4 mumol/l, p less than 0.02). There is no significant difference in the levels obtained from the first and second stages of labor. In intrauterine fetal death (Fig. 1) and in depressed newborns (Tab. I) there were increased hypoxanthine levels in the amniotic fluid, this was not seen in other complications of pregnancy. Independently from the fetal state increased hypoxanthine concentrations may occur in the amniotic fluid evidently as a consequence of labor activity. Thus the determination of hypoxanthine levels in the amniotic fluid cannot be used for the diagnosis of fetal hypoxia.

Adenosine Triphosphate↗
PubMed1994

Duration of labor in patients delivered vaginally after one previous lower segment cesarean section.

OBJECTIVES: To determine the presence or significance of labor patterns in women attempting vaginal birth after a previous cesarean. METHODS: This prospective study was performed for patients who have only had one prior birth by cesarean section. Eighty-four women who had a cesarean section for failure to progress in labor had a trial of labor. RESULTS: Fifty-eight were delivered vaginally. This has been matched to nulliparous and multiparous controls. The duration of the first and second stages of labor were similar in the study group and controls. There was no significant difference in oxytocin requirements among the three groups. CONCLUSIONS: Patients who have had a previous cesarean section for failure to progress, have a duration of labor similar to primiparous patients.

Cesarean Section↗
PubMed2005

[Risk factors associated with high birthweight deliveries].

OBJECTIVE: To examine the influence of possible risk factors, mainly abnormal pregravid maternal body habitus, age, education, parity and pregnancy complications (especially diabetes) on the prevalence of infants with fetal weight 4000 grams and more. The study was also aimed to investigate pregnancy outcome among weight categories. STUDY DESIGN: Retrospective cohort study. SETTING: Gynaecological and Obstetric Clinic Medical Faculty Palacky University and Faculty Hospital Olomouc. METHODS: maternal and neonatal records for 7156 singleton deliveries of two fetal weight categories (2500-3999 grams and > or = 4000 grams) during the 5-year period from 1.1. 2000 to 31. 12. 2004 were reviewed. Univariate and multivariate analysis were performed. Multiple regression models, including maternal age, pregestational BMI (body mass index), education, smoking, alcohol consumption, IVF, anemia in pregnancy, preeclampsia, diabetes, gestational age, pregnancy weight gain, gender of the newborn were constructed to examine relative effect of these factors on the risk of the delivery of a big baby. RESULTS: The prevalence of high birth weight infants was 10.8% in the study sample. There were 774 deliveries of infants birth weight category > or = 4000 g and 6382 deliveries of the babies 2500-3999 g. Significant risk factors from the univariate analysis were gestational age more than 40 weeks (18.2% vs 8.6%, P = 0.00000000), pregnancy weight gain over 13 kg (cutoff) (14.3% vs 7.5%, P = 0.00000000). Compared with normal BMI subjects (19.8-25 kg/m2), obese women (BMI > 30 kg/m2) were at elevated risk for high birth weight delivery (18.1% vs 10.5%, P = 0.00000629) as were overweight women (BMI 25.1-30 kg/m2) (16.6% vs 10.5%, P = 0.00000004). Multiparity versus nulliparity (13.4% vs 8.1%, P = 0.00000000), male gender vs female (13.4% vs 8.0%, P = 0.00000). There were no significant difference with diabetes (12.6% vs 10.8%, P = 0.49089558). Smoking (5.4% vs 11.5%, P = 0.00000052) and low pregravid BMI (< 19.8 kg/m2) (5.7% vs 10.5%, P = 0.00000004) were associated with a lower risk of macrosomia Multiple logistic regression revealed the independent influence of gestational age, pregnancy weight gain, abnormal maternal body habitus, multiparity, male gender and smoking on the fetal growth. Excess fetal weight affects delivery in higher frequency of active management of labor, induction (20.2% vs 16.6%, P = 0.01560228) and cesarean section (20.3 % vs 15.1%, P = 0.00021215). No significant differences were in prolongation of first and second stage of labor and frequency rate of operative vaginal deliveries. No significant differences were noted between the groups regarding health status of live birth children. CONCLUSION: Gestational age over 40 weeks, increased pregnancy weight gain, pregravid maternal body habitus, multiparity and male gender are independent risk factors for high birthweight deliveries.

Birth Weight↗
PubMed2001

The second stage of labor and stress urinary incontinence.

OBJECTIVE: This study was undertaken to investigate the potential association between prolonged second stage of labor and stress urinary incontinence. STUDY DESIGN: A retrospective, population-based study was performed. A random, case-controlled sample of 85 cases and 88 controls was identified by means of a standard computerized patient database. Subjects were identified by International Classification of Diseases, Ninth Revision codes, and medical records were reviewed. The median follow-up time from delivery was 7.8 years for cases and 7.2 years for controls. Multiple logistic regression was performed to test for an association between stress urinary incontinence and variables of interest. RESULTS: The data suggest that for all women who labored the length of the second stage of labor for the first delivery was not associated with stress urinary incontinence (odds ratio, 1.07; P =.42; 95% confidence interval, 0.9-1.3). However, forceps delivery was associated with a significant increase in stress urinary incontinence risk (odds ratio, 10.4; P =.04; 95% confidence interval, 1.2-93.4). CONCLUSION: Length of second stage of labor was not associated with stress urinary incontinence. However, the odds of having a later diagnosis of stress urinary incontinence was 10 times higher for women who underwent forceps delivery.

Adult↗
PubMed1982

Fetal catecholamine release in response to labor and delivery.

Umbilical arterial plasma norepinephrine and epinephrine were measured using a sensitive, specific radioenzymatic assay. Plasma catecholamines were correlated with umbilical arterial blood gases, durations of the first and second stages of labor, duration of rupture of the membranes, fetal heart rate tracings, and fetal sex. Significant correlations were observed for plasma norepinephrine versus fetal pH and PO2 and plasma epinephrine versus pH but not PO2. The majority of the fetal heart rate tracings demonstrated either a normal baseline or mild variable decelerations. The plasma catecholamines and blood gases were similar in these 2 groups. Significant elevations of both plasma catecholamines were observed with those tracings commonly associated with fetal distress; however, the number of infants was small. No sex differences were observed in plasma norepinephrine or epinephrine or in responsiveness. The results suggest that the human fetus at term responds to acidosis and hypoxia with a graded catecholamine release. This may be an important adaptive mechanism.

Adult↗
PubMed2006

[Characteristics of uterine contraction and stages of labor under continuous epidural block anesthesia].

OBJECTIVE: To observe the characteristics of uterine contraction and stages of labor during delivery under continuous epidural block anesthesia. METHODS: Totaling 213 parturients in spontaneous labor under epidural block anesthesia with dilated cervical orifice of 3 cm were monitored for the contraction cycle, duration, intensity and curve types of uterine contraction, and recordings were made for 30 min before and 30, 60 and 120 min after the anesthesia took effect, respectively. The duration of the active phase in the first, second and third stages of labor was compared between 421 cases with anesthesia and 237 without anesthesia. RESULTS: Significant difference was noted in the objective indexes of uterine contraction recorded after anesthesia had taken effect (P<0.05) in comparison with those before anesthesia, suggesting significantly attenuated uterine contraction after anesthesia, whereas these indexes underwent no significant further variation as compared between different time points after anesthesia (P>0.05). The average active phase in the first stage was significantly shorter in anesthesia group than that in the control group (P<0.05), but the average duration of the second and third stages of labor differed little between the two groups with appropriate use of oxytocin under strict monitoring (P>0.05). The rates of obstetric forceps utilization and use of oxytocin were higher in anesthesia group than in the control group (P<0.05). CONCLUSION: Epidural block anesthesia produces certain influences on uterine contraction and stages of labor during delivery, for which appropriate treatment measures may prove beneficial.

Adult↗
PubMedDate not supplied

[Choice of local anesthetic for epidural anesthesia in physiological labor].

In comparative analysis of epidural anesthesia by bupivacaine and ropivacaine the latter was shown to give smaller motor block and so can be applied at the end of both first and second stage of labor. Adequate anesthesia provides uneventful course of the second stage of labor, decreases its duration and eliminates the disorders of central hemodynamics and hormonal homeostasis. Currently naropin seems to be anesthetic of choice for epidural anesthesia of in labor by way of natural maternal passages.

Amides↗
PubMed1995

The effect of oxytocin receptor blockade on parturition in guinea pigs.

The mechanism of the onset of labor is unknown in humans and guinea pigs. Contrary to most other species, progesterone withdrawal appears not to precede the onset of labor. To elucidate the role of oxytocin in the onset and maintenance of labor, guinea pigs were fitted with vascular catheters, an intraabdominal pressure catheter and an array of uterine electromyogram electrodes. An oxytocin antagonist (des-Gly9-[D-Trp2,Thr4,Orn8]dC6-oxytocin, 20 micrograms/kg per h, n = 11) or saline solution (n = 12) was infused starting on day 66 of gestation (term is 69 d). Oxytocin receptor blockade resulted in decreased uterine activity and a prolonged expulsive phase (second stage) of labor. Fetal delivery was delayed and fetal mortality was increased. The onset of the expulsive phase of labor was delayed but maximum uterine activity occurred in time together with a timely change in uterine electromyogram activity from a prepartum to a postpartum pattern following an unaltered progressive increase in baseline uterine activity. This indicates that oxytocin is requisite for the normal progress of the first and second stage of labor, but has no involvement in the mechanism of the onset and the timing of labor.

Animals↗
PubMed2001

A comparison of spontaneous labor with induced vaginal tablets prostaglandin E2 in grand multiparae.

OBJECTIVE: To compare the outcome of labor in grandmultiparous patients (para >5) who had induction of labor with prostaglandin E2 vaginal tablets with grandmultiparous patients in spontaneous labor, and to observe the complications during induction of labor. METHODS: A retrospective case control study was carried out at King Faisal Military Hospital, Khamis Mushayt between January 1993 through until December 1994. This included 64 grandmultiparous patients that were induced with prostaglandin E2 vaginal tablets. Ninety grandmultiparous patients who went into labor spontaneously served as controls. Maternal and fetal data extracted from their hospital record files included age, parity, indication for induction, Bishop score at induction, total dose of prostaglandin used and complications of induction of labor. Other information were length of labor, need for syntocinon augmentation, blood loss during the 3rd stage of labor, mode of delivery, birth weight, sex and Apgar score at 10 minutes. RESULTS: No serious complication of induction of labor such as rupture of the uterus was noted in the subjects studied. There were no significant differences when the mean age and parity of patients in the 2 groups were compared (P>0.05) but there was difference in the gestational age at delivery (p=0.00). There was no significant difference in the mean length of first and 2nd stages of labor. The cesarean section rate was 11% and 8% in the cases and controls, while the need for syntocinon augmentation was twice in the cases than controls, 27% vs 14%. These were not statistically significant. CONCLUSION: We conclude that induction of labor with prostaglandin E2 vaginal tablets may not have adverse effect on the outcome of labor compared with patients in spontaneous labor. It may be safe to use prostaglandin E2 vaginal tablets for induction of labor in the grand- multiparae. We recommend a randomized prospective trial to validate these observations.

Administration, Intravaginal↗
PubMed1986

Subcutaneous emphysema, pneumomediastinum, and pneumothorax in labor and delivery.

Hamman's syndrome occurs rarely in the setting of labor and delivery. In this report 187 cases of Hamman's syndrome, with and without objective evidence of pneumothorax, are summarized and the literature reviewed. Most of the women were primiparous, and first and second stages of labor were of normal duration (18.3 and 4.1 hour, respectively). Average fetal size (7 pounds, 14 ounces) was also found to be within normal limits. Signs, symptoms, and pathophysiology are reviewed and treatment discussed.

Adolescent↗
PubMed2001

Labor pain effects on colostral milk beta-endorphin concentrations of lactating mothers.

beta-Endorphin (beta-EP) levels of colostral milk are approximately two-fold higher than in plasma of lactating women, in who concentrations peak at term, after the first and second stages of labor. We investigated the effect of labor pain and vaginal parturition on colostral beta-EP concentrations (beta-endorphin (125)I RIA, Incstar Corp., Stillwater, Minn., USA) of at-term nursing mother, in comparison to those having undergone elective cesarean section. Our results show that colostral milk beta-EP concentrations of mothers who delivered vaginally are significantly higher on the 4th postpartum day (6.0 +/- 0.5 vs. 4.3 +/- 0.4 pmol/l, respectively; p < 0.01) than colostral levels of mothers who underwent cesarean section. These data indicate the important influence of the labor process on the colostral opioid galactopoiesis. It is suggested that labor and parturition pain may increase colostral milk beta-EP concentrations of lactating mothers in order to help the newborn overcome the stressful perinatal events of natural labor and delivery.

Adult↗