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PubMed2004

Indicated labor induction with vaginal prostaglandin E2 increases the risk of cesarean section even in multiparous women with no previous cesarean section.

AIMS: To evaluate the impact of induction of labor with vaginal tablets of prostaglandin E2 on the rate of cesarean section (CS), and to identify possible predictors of successful vaginal delivery. METHODS: 1541 consecutive women admitted for induction of labor with vaginal tablets of PGE2 were retrospectively compared with 574 consecutive women with spontaneous onset of labor. RESULTS: Maternal age, nulliparity, previous CS, gestational age, and birth weight were similar in the study and control groups. The CS rate was twofold higher in the study group (20.7% vs 10.6%). CS rates in the study and control groups were 26.9% and 12.8% for the nulliparous women, and 11.2% and 5.1% for the multiparous women with no previous CS. Neither group had major maternal or fetal complications. A logistic regression model and stepwise analysis showed that nulliparity, previous CS, maternal age, number of PGE2 applications, birth weight, and the induction of labor by itself were independent significant risk factors for increased CS rate. CONCLUSIONS: Induction of labor with vaginal PGE2 tablets results in a vaginal delivery rate of 79.3%, with apparently no serious maternal or fetal complications. Nulliparity, and previous CS are the most significant risk factors for increased CS rate. However, even after these risk factors are excluded and controlling for possible predictors for CS, PGE2 induction is independently associated with a twofold increase in CS rate, most often because of labor dystocia.

Administration, Intravaginal↗
PubMed2004

Maternal plasma procalcitonin concentrations in patients with preterm labor and intact membranes--prediction of preterm delivery and admission-to-delivery interval.

The purpose of this study was to evaluate procalcitonin (PCT) plasma levels in pregnancy complicated by preterm labor and to determine their value in the prediction of preterm delivery and the length of the admission-to-delivery interval. The study population consisted of 53 patients with preterm labor and 31 healthy pregnants. The study patients were divided according to the delivery time and to the admission-to-delivery interval. Plasma PCT concentrations were higher in preterm labor than in healthy pregnants. Although at the onset of preterm labor plasma PCT concentrations in patients who delivered prematurely were higher than in patients who, after tocolytic treatment, delivered at term, the difference was not significant. Also in cases of preterm labor delivered within and after three and seven days of admission no differences were observed. The highest values in the prediction of preterm delivery and the length of admission-to-delivery interval corresponded to a PCT concentration of 1.7 ng/ml. These findings suggest that although preterm labor is associated with increased PCT concentrations in maternal plasma, there is no significant association either between plasma concentration of PCT at the moment of threat and preterm delivery, or the admission-to-delivery interval. The predictive value of plasma PCT determinations is unsatisfactory.

Adult↗
PubMed1982

The monitoring of labor by telemetry.

Telemetry and conventional cardiotocography were compared by monitoring the labor of 60 patients with an uneventful pregnancy and delivery in the 38th-42nd week of pregnancy. 31 patients were monitored by telemetry and 29 by cardiotocography. The patients were matched for age (+/- 5 years), duration of pregnancy (+/- 7 days) and parity (I or II). The husband attended labor and delivery in 42% of the cases in the telemetry group and in 59% of the cases in the control group. Induction of labor by amniotomy was performed in 32% of the cases in the telemetry group and in 24% of the cases in the cardiotocography group. The patients monitored subjective pain every half hour during the opening phase. The telemetric patients were encouraged to sit or walk during the first stage. No maternal or fetal complications occurred. All infants were born in good condition with APGAR scores greater than or equal to 7 recorded at one and five minutes. There were 4 operative deliveries in the telemetry group and 5 in the control group. Indications for these were maternal or uterine exhaustion with the exception of two control patients where fetal asphyxia was suspected. The duration of the first stage of labor did not differ significantly between the telemetry and the cardiotocography groups. The telemetric patients received less analgesics than the controls but this difference was not significant. In spite of less analgesia in the telemetry group, the secondparas of the telemetry group experienced significantly less (p less than 0.01) labor pain than the controls. In addition, the secondparas of the telemetry group considered the present labor less painful than the previous one significantly more often than the controls. Among the primiparous patients there was no difference in the amount of pain experienced by the patients.

Adult↗
PubMed1994

Intrauterine growth retardation: fluctuation of fetal pH measured between beginning and at the completion of labor.

UNLABELLED: The aim of this study was to evaluate the fluctuation of fetal pH in blood samples taken at the beginning of labor and at the moment of birth as related to intrauterine growth retardation syndrome. This is a prospective follow-up of term gestations, of which 41 were diagnosed as intrauterine growth retardation (IUGR) and 61 as normal ones. pH was measured in scalp blood sample at the beginning of the labor and in umbilical artery right after birth in both groups respectively. The rate of decrease of pH value in relation to duration of labor was determined for each case. Our results are: 1) Lower baseline pH were found in the IUGR group (pH 7.32 vs 7.34, p < 0.01), lower arterial blood pH at birth/.23 +/- 0.08 vs 7.27 +/- 0.08, p < 0.05). 2) Faster decrease of the pH during the labor (0.019 unit/hour vs 0.012, p < 0.05) as related to IUGR. CONCLUSION: IUGR fetuses are more acidotic at the beginning of the labor, and the rate of decrease of the fetal pH per unit of time during the labor is faster at least in a theoretical situation nevertheless it will require more studies if any practical applications are thought of.

Acidosis↗
PubMed2006

[Periodontal disease: Is it a risk factor for premature labor, low birth weight or preeclampsia?].

OBJECTIVES: To determine if periodontal disease (PD) is a risk factor for premature labor, low birth weight, or preeclampsia, and to look for a potential association between the different clinical forms of PD and the obstetric results indicated. METHODS: This is an analytical, cross-sectional and prospective study of all women who gave birth in Dr. José Penna Hospital, in the city of Bahía Blanca, Argentina, between 1 February and 18 July 2003 and between 1 March and 31 May 2004. Women who met the inclusion criteria (being over 18 years old, having at least 18 teeth, not being diabetic, and having had children who survived labor) underwent a dental exam to look for hemorrhage when teeth were probed, loose teeth, or inflammation of the gums, and any loss of insertion was measured clinically. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated, and the results were adjusted according to smoking status and the presence or absence of anemia. RESULTS: A total of 2,003 births and 1,982 labor episodes were registered. In all, 420 women (21.2%) were excluded from the study because they did not meet the inclusion criteria or because no diagnostic exam could be carried out. Of the 1,562 women who were examined, 809 (51.8%) had at least one of the problems being sought; of these women, 274 (17.5%) had severe periodontal disease, and 535 (34.3%) had gingivitis. In all, there were 149 (9.5%) cases of premature labor; 161 (10.3%) cases of low birth weight, and 157 (10.0%) cases of preeclampsia. No association was noted between PD and premature labor (OR = 1.06; 95% CI: 0.74 to 1.50), low birth weight (OR = 1.05; 95% CI: 0.74 to 1.47), or preeclampsia (OR = 0.99; 95% CI: 0.70 to 1.40). The risk of giving birth to an infant with low birth weight in the subgroup of women who smoked more than 10 cigarettes a day was greater among women who had severe PD than among those who had good oral health (OR = 3.81; 95% CI: 1.46 to 10.05; P = 0.001). Anemia was found to be a risk factor for low birth weight (OR = 1.74; IC 95%: 1.03 to 2.94; P = 0.02). CONCLUSIONS: No significant association was found between PD and premature labor, low birth weight, or preeclampsia.

Adult↗
PubMed1978

Premature labor treatment with ritodrine in multiple pregnancy with three or more fetuses.

Modern treatment for anovulatory infertility increases the incidence of multiple pregnancies with three or more fetuses and predisposes to prematurity with high perinatal mortality and mortidity. Premature labor was successfully treated in four multifetal pregnancies with ritodrine hydrochloride, a beta-mimetic drug relaxing the uterus. Another patient misdiagnosed as false labor was not treated and lost three out of four premature babies. Beta-mimetic treatment is indicated in multiple pregnancies even in false labor, or when painless progress in cervical dilatation is observed, to avoid asymptomatic progression into true labor. In contrast to singleton pregnancies, advanced labor with more than four centimeters cervical dilatation should not preclude good chances for successful treatment. Persistence in treatment and repreated use of the most effective intravenous route combined with oral ritodrine administration is needed because of marked tendency to recurrences of premature labor. Progressive increase in the dose of oral ritodrine may be indicated by decrease in therapeutic response. Maternal tachycardia should be considered as an index of patient responsiveness to the beta-mimetic treatment. The therapy is most successful when the patient is hospitalized from the first episode of treatment until at least the 37th week of pregnancy. This is probably less expensive than prolonged hospitalization of several prematures in an intensive care nursery.

Adult↗
PubMed1990

Serum concentrations of progesterone and 5 alpha-pregnane-3,20-dione during labor and early post partum.

Serum 5 alpha-pregnane-3,20-dione (5 alpha DHP) and progesterone (P) concentrations were studied in 11 women with uncomplicated pregnancies and deliveries during spontaneous labor and immediately after delivery. Blood samples were drawn 3-6 times during labor, as soon as possible post partum and 1, 3, 6 and 12 h post partum. P and 5 alpha DHP were analysed using RIA methods. There were no significant changes during labor in serum concentration of P and 5 alpha DHP, the values being 366 nmol/l +/- 25 SE and 128 nmol/l +/- 16 SE respectively. Whereas an earlier study has shown a significant decrease in 5 alpha DHP serum concentration between late pregnancy and spontaneous labor, this study showed no decrease during labor, indicating that the decrease occurred before the onset of labor. After parturition, the elimination of P from serum was faster and proportionally greater than for 5 alpha DHP, with a half-life of 38 min for P and 58 min for 5 alpha DHP. About 2-3 h post partum the serum concentrations stabilized just above luteal phase values. 12 h post partum, P and 5 alpha DHP were 12% and 23% respectively of pre-partum values.

5-alpha-Dihydroprogesterone↗
PubMed1995

Serial antenatal monitoring compared with labor induction in post-term pregnancies.

OBJECTIVE: In view of the increased risk of obstetric and perinatal complications in post-term pregnancy, and the lack of consensus regarding clinical routines for fetal surveillance and labor induction, the aim of this prospective controlled study was to compare obstetric and perinatal outcome after serial monitoring until 43 weeks of gestation with that after labor induction at 42 gestational weeks. MATERIALS AND METHODS: A study group of 193 gravidae scheduled for serial monitoring until 43 weeks of gestation was compared with a control group of 205 gravidae admitted for induction of labor at 42 weeks. A third, high-risk, group comprised gravidae (from either of the foregoing groups) who had to be admitted for emergency induction of labor owing to increased fetal risk (i.e., the presence of oligohydramnios or a small-for-gestational-age fetus). RESULTS: The frequency of labor induction was significantly lower in the study group than among controls (p < 0.001), but the two groups did not differ in obstetric or perinatal outcome. As compared with these two low-risk groups, the high-risk group was characterized by significantly higher frequencies of instrumental delivery (p < 0.01), operative delivery for fetal distress (p < 0.001) and infants requiring neonatal intensive care (p < 0.001). CONCLUSION: As the wait-and-see policy with serial monitoring resulted in a lower rate of labor induction, but not in a lower rate of instrumental delivery or perinatal complication, medically the two routines would appear to be comparable. However, an individual approach with intensified fetal surveillance is to be recommended, as it is vital to identify post-term pregnancies where the fetus is at increased risk. The use of such new techniques as umbilical artery flow velocimetry would no doubt improve the management of high-risk post-term pregnancies.

Cardiotocography↗
PubMedDate not supplied

Predicting the duration of the first stage of spontaneous labor using a neural network.

To create a neural network that predicts the length of the first stage of term labor. Two hundred patients with gestations > or = 36 weeks, in spontaneous active labor are the study group: 159 for training and 41 for testing; 4 training set patients had second-stage cesarean section for obstructed labor. The network is designed with Brainmaker MacIntosh 1.0 (California Scientific Software). Inputs are uterine activity, estimated fetal weight, position, station, and gestational age; maternal parity, age, height, weight, membrane status, and cervical dilatation. Actual first stages are regressed on those predicted by the network or by a standard partogram set. Differences between actual first stage lengths and those predicted by the neural network or partogram are compared with t-tests; while the proportions of first stages accurately predicted within 1 or 2 h are compared for both methods with chi-square tests. The network trained in 4 h (1388 runs) to a 0.15 tolerance. The network predictions have significantly higher correlation (r = 0.88) than do standard partograms (r = 0.35) with actual first stage durations. Mean differences between predicted and actual first stages are significantly lower for network output than with partograms; these differences increased with first stages exceeding 3 h; 100% of trained network values are within 2 h of actual first stage length. The network performs similarly for a new set of 41 previously unseen labors. This neural network predicts the length of the first stage of spontaneous labor and uses inputs readily available to obstetricians. It outperforms typical partograms for estimating this important feature of normal labor. Future application for intrapartum prognosis could be based on this successful design.

Artificial Intelligence↗
PubMed1999

Induction of c-Jun mRNA without changes of estrogen and progesterone receptor expression in myometrium during human labor.

To elucidate the endocrine mechanism of human parturition, the expression of c-Jun and c-Fos mRNA were examined in relation to estrogen receptor (ER) and progesterone receptor (PR) in human myometrium. c-Jun mRNA was detected in all myometrial tissues (n=5) during labor but not before labor (n=5) and in oxytocin-resistant postterm pregnancy (n=3). c-Fos mRNA was detected in only one myometrial tissue from a woman in labor. The distribution and intensity of immunostaining for ER and PR were semiquantitatively scored. During the late pregnancies, no significant difference was seen in the receptor scores for myometrial ER and PR between the patients who experienced labor and those who did not. Receptor scores for ER and PR were significantly lower in postterm pregnancy than in late pregnancy, regardless of the labor status. These data suggest that there are no changes in ER and PR in human myometrium during parturition. On the other hand, postterm pregnancy is associated with low ER and PR. c-Jun, induced during labor without changes in ER and PR, may play a role as a signaling mechanism in human myometrium.

Adult↗
PubMed1999

Preterm labor.

Preterm labor is the leading cause of perinatal morbidity and mortality in the United States. It is characterized by cervical effacement and/or dilatation and increased uterine irritability before 37 weeks of gestation. Women with a history of preterm labor are at greatest risk. Strategies for reducing the incidence of preterm labor and delivery have focused on educating both physicians and patients about the risks for preterm labor and methods of detecting preterm cervical dilatation. Methods used to predict preterm labor include weekly cervical assessment, transvaginal ultrasonography, detection of fetal fibronectin and home uterine activity monitoring. As yet, it is unclear if any of these strategies should be routinely employed. At present, management of preterm labor may include the use of tocolytic agents, corticosteroids and antibiotics.

Female↗
PubMedDate not supplied

[Induction of labor by misoprostol, an analog of PGE1. A prospective study of 200 cases].

We carried out a prospective study of 200 pregnant women who required induction of labor at full term, at the Lalla Meryem maternity unit of the Ibn Rochd University Hospital, Casablanca, between January 1st 1996 and June 30th 1997. The aim of this study was to evaluate the efficacy, tolerance and acceptance of misoprostol (Cytotec) as a drug for inducing labor in unfavorable conditions (Bishop < 5). Misoprostol (a PGE1 analog) was administered to the women via the vagina, with a dose of 1/4 tb (50 mg) given every 6 hours, and a maximum of 3 doses (150 mg). If labor had not begun 18 h after the start of the protocol, misoprostol induction was considered to have failed. We found that misoprostol failed to induce labor in 5% of cases, Syntocinon was required in 40% of cases and the interval between misoprostol insertion and vaginal delivery was 13.3 + 11.1 h. The rate of delivery by cesarean section was 22% and the mean amount of misoprostol required was 1.3 doses (66 mg). The mean cost of labor induction was 0.6 FF, the frequency of uterine hyperstimulation was 3.5% and maternal, fetal and neonatal tolerance was good. Our results confirm that intravaginal misoprostol is very effective and well tolerated for the induction of labor in pregnant women at full term, in unfavorable obstetric conditions.

Administration, Intravaginal↗
PubMed2000

[Aminopeptidases activity in the amniotic fluid in women in labor with EPH-gestosis].

The thesis of this work was to compare the aminopeptidases activity in the amniotic fluid obtained during the physiological labor and during the labor of pregnant with EPH-gestosis, in presence of the beta-naphtlamidic L-amino-acids (alanine, leucine, phenylalanine, tyrosine, histidine, cysteine) chromogenic substrates. It was assumed the 3-7 times increase in the aminopeptidases activity counted to the proteins from the labored with EPH-gestosis comparing to the labored in physiological labor. Among the used substrates the highest activity in both groups of labored women was measured in presence of substrates with exact amino-acids in this order: L-Ala > L-Leu > L-Phe > L-Tyr > L-His > L-Cys.

2-Naphthylamine↗
PubMed2000

Clinical and sonographic fetal weight estimates in active labor with ruptured membranes.

OBJECTIVE: To determine and compare the accuracy of clinical and sonographic estimates of fetal weight (EFW) in active labor with ruptured membranes. STUDY DESIGN: Clinical and sonographic EFWs were obtained on 107 term patients in active labor, with cervical dilatation of 4 cm or more and ruptured membranes. Accuracy of birth weight was determined by calculating percentage error, absolute percentage error and ratio of estimates within 10% of actual birth weight for all stages of labor. Statistical analysis was by paired t test, Wilcoxon sign test, chi 2 test and Mann-Whitney U test; P < .05 was considered significant. RESULTS: Absolute percentage errors were lower by the sonographic method at all stages. Except for the second stage of labor, the rates of birth weight +/- 10% were higher with the sonographic method than with the clinical method (83.17% vs. 60.75% and 84.9% vs. 63.44%, respectively). Estimations performed in the first stage were more accurate than in the second stage with both methods (absolute error of 7.82 +/- 5.5 vs. 12.38 +/- 4.9 for clinical and 5.44 +/- 5.99 vs. 9.08 +/- 3.19 for sonographic). CONCLUSION: During active labor with ruptured membranes, sonographic EFWs are more accurate than clinical estimations. The accuracy of both methods is reduced during the second stage of labor.

Adult↗
PubMed2000

[Fetal pulse oximetry in second stage of labor].

OBJECTIVE: To compare the mean values of fetal oxygen saturation with fetal heart rate pattern in the second stage of labor (Melchior classification) MATERIAL AND METHODS: The study included 30 parturients in gestational age 37-41 weeks. Fetal oxygen saturation was recorded and averaged over the last 30 min of the second stage of labor Simultaneously, fetal heart rate and uterine contractions were monitoring. Fetal heart rate patterns were assessed according to Melchior's classification. At birth, the cord acid-base parameter (pH) was calculated. RESULTS: The lowest value of fetal oxygen saturation over the last 30 min of labor was 10%, the highest 60%, and the mean value 39.1 +/- 12.5%. Statistically, significant correlation between the mean value of oxygen saturation over the last 30 min of labor and pH arterial values (n = 25, p = 0.004, r = 0.42) was found. There was no statistically significant correlation between fetal oxygen saturation and pH venous values (n = 24, p. = 0.006, r = 0.49), but trend towards significance could be observed. Statistical analysis revealed that arterial pH was significantly correlated to Melchior's classification. The lowest pH and FSpO2 values coexisted with type 3 and 4 of FHR patterns according to Melchior's classification. CONCLUSIONS: The mean values of fetal oxygen saturation over the last 30 min of labor significantly correlate with arterial pH values. These values correlate with FHR abnormalities according to Melchior's classification. Fetal pulse oximetry seems to be an important, additional method assessing fetal well-being in the second stage of labor.

Adult↗
PubMed2001

Maternal serum tumor necrosis factor-alpha in patients with preterm labor.

OBJECTIVE: To evaluate maternal serum tumor necrosis factor-alpha (TNF alpha) levels in patients with preterm labor without clinical signs of chorioamnionitis and to compare these with levels in nonlaboring controls. STUDY DESIGN: The study group consisted of 44 patients with a singleton pregnancy admitted to our department with the diagnosis of preterm labor between 26 and 36 weeks' gestation. The control group consisted of 25 healthy consecutive patients with a singleton pregnancy without preterm contractions who were seen for routine antenatal visits. Maternal serum TNF alpha was measured using a solid-phase, two-site chemiluminescent enzyme immunometric assay method, and levels were compared in patients with preterm labor and nonlaboring controls. RESULTS: The median maternal serum TNF alpha level for patients with preterm labor was 29.4 pg/mL (range, 12.3-173) as compared with 23 pg/mL (range, 11.9-62.7) in the control group (P = .031). Among 44 patients with preterm labor, 14 (32%) delivered within one week of admission. The median maternal serum TNF alpha level was significantly higher in patients who delivered within one week than in those who delivered after one week and controls (71.3 pg/mL [range, 28-173]) versus 22 pg/mL (range, 12.3-86) versus 23 pg/mL (range, 11.9-62.7) (P < .0001). CONCLUSION: TNF alpha was elevated in patients with preterm labor, suggesting a role for maternal serum TNF alpha in its initiation.

Adult↗
PubMed2001

[Factors predicting outcome of trial of labor after prior cesarean section in a developing country].

OBJECTIVE: To determine factors predictive of the outcome of trial of labor after cesarean section in women living in developing countries. MATERIAL: and methods. A retrospective study of 313 cases of trial of labor was conducted in patients with a history of at least one prior cesarean section. Multiple logistic regression was used to identify predictive factors. The adjusted odds ratios with 95% confidence intervals (95%CI) were used to indicate risk of failure of the trial of labor when the factor was present. RESULTS: The rate of vaginal birth was 71.6%. Factors significantly predictive of failure of trial of labor were birth weight>3000 g (OR=2.68; 95%CI: 1.57-4.57), no previous vaginal delivery (OR=1.71; 95%CI: 1.26-3.76) and maternal age>28 years (OR=1.71; 95%CI: 1.01-2.90). CONCLUSION: Trial of labor should be proposed in most women with one previous cesarean section. A prior history of vaginal delivery is the best predictor of the positive outcome of trial of labor.

Adolescent↗
PubMedDate not supplied

Comparative analysis of the effectiveness of misoprostol and prostaglandin E(2) in the preinduction and induction of labor.

BACKGROUND: Amniotomy and oxytocin infusion are the routine methods most frequently applied to induce labor. These methods are not effective when the cervix is unripe. Prostaglandins may accelerate the process of cervical ripening independently of the stimulation of uterine contractions, since they induce the formation of a gap junction (spread of excitation) and release uterine contractions. The purpose of this study is a comparative analysis of the effectiveness and safety of misoprostol and PGE2 in the process of cervical ripening and inducing labor in patients at full term delivery with a live fetus and indications for inducing labor due to an unripe uterine cervix. MATERIAL AND METHODS: The experimental group consisted of 30 patients at 38-41 weeks of gestation who received misoprostol administered into the posterior vaginal fornix (group M). The control group included 26 patients at 39-42 weeks of gestation in whom labor was induced using natural prostaglandin E(2) (group P). RESULTS: There were no statistically significant differences in maternal age, body weight and height, or uterine cervical ripening between the two groups of patients. The average time of gestation was 0.92 weeks shorter in group M. The time from administration of the drug to the onset of regular contraction activity of the uterus and delivery of an infant was shorter in the group of patients receiving misoprostol intravaginally. CONCLUSIONS: Our results would seem to indicate that misoprostol is an effective drug that can be used for elective preinduction and induction of labor. However, the application of this drug to induce labor with a live fetus requires special caution and care, as well as continuous cardiotocographic monitoring to assure the safety of both the mother and the infant.

Cervical Ripening↗