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PubMed2001

[Clinical study: the effects of inhaling nitrous oxide for analgesia labor on pregnant women and fetus].

OBJECTIVE: To investigate the effect of the inhalation of nitrous oxide premixed with oxygen (50%:50%) for analgesia labor on maternal and fetus. METHODS: A total of 100 cases of pregnant women were provided with nitrous oxide premixed with oxygen (50%:50%) (control group); Another 100 cases were provided only with oxygen (comparison group). Recording duration of the Labor, way of delivery, bleeding volume, Apgars score, blood gas analysis to maternal radius artery and fetal umbilical blood among all patients. RESULTS: The effect for analgesia labor of the premixed gas was much better than that of control group, but there were no significant differences in time of labor, bleeding volume, Apgars score between the two groups. CONCLUSIONS: The inhalation of nitrous oxide premixed with oxygen (50%:50%) for analgesia labor benefits pregnant women because of keeping them being a good mental and physical condition. The inhalation of nitrous oxide for analgesia labor is a safe, effective and easy method.

Adult↗
PubMed2001

[Correction of occipito-posterior by maternal postures during the process of labor].

OBJECTIVE: To investigate the effect on correction of occipito-posterior (OP) by changing maternal posture during labor. METHODS: One hundred normal primigravida with head OP position in the latent phase of labor were randomly divided into 2 groups: Group A (n = 50), women were instructed to lay on the same lateral posture with the fetal spine during labor in order to correct the fetal position from OP to occipito anterior (OA); Group B (n = 50) lay on the opposite side to the fetal spine. The OP position was diagnosed by vaginal examination or B ultrasound, and the course of labor and mode of delivery were observed. RESULTS: Thirty-four women delivered vaginally (68%) in group A, with 27 of them turned to OA position (54%); spontaneously while they were 22 (44%) and 12 (24%) in group B respectively, a significant difference was shown (P < 0.005). The average time interval for the 1st stage was (13.5 +/- 6.5) hour and (17.1 +/- 7.2) hour for group A and B respectively, also a significant difference was noted (P < 0.01). CONCLUSION: To instruct women in labor to take the lateral recumbent position with the same side of fetal spine for correcting OP to OA is an effective method. It may increase vaginal deliveries and shorten the first stage of labor, thus reduce dystocia due to OP position. This method is simple and effective, and maybe adopted in most obstetric units.

Adult↗
PubMed2000

[Study of parturient-controlled epidural blockade for labor analgesia].

To explore the feasibility of parturient-controlled epidural blockade for labor analgesia, 44 primiparas requesting labor analgesia (Group I) were selected for testing the above method according to the ASA (American Society of Anesthesiology) Class I or II. Forty-six primiparas were selected as control (Group II). The conditions of control group were similar to those of Group I in all aspects except labor analgesia. The results showed that in Group I labor pain was significantly relieved 5 minutes after anesthesia, and almost eliminated 15 minutes after anesthesia; 95% parturients achieved adequate analgesia. Systolic pressure, diastolic pressure, heart rate and respiratory rate were significantly decreased 5 minutes after anesthesia but still in normal range. The uterine contraction, labor process, delivery mode, postpartum hemorrhage, side effects and neonatal Apgar's score had no significant difference between the two groups. It is suggested that the parturient-controlled epidural blockade is efficiently applied to labor analgesia.

Adult↗
PubMed1982

Labor emigration and economic development.

"This article is concerned with the extent to which labor migration is advantageous to the labor exporting country. It focuses on development consequences of labor emigration with a view toward the formulation of policies which can shape those consequences into a positive force for development, discussing a wide variety of potential costs and benefits generated by labor emigration. The issue of private versus public choice relative to emigration is examined, as [are] the major economic benefits and costs of labor emigration and the influence of development objectives on the valuation of these costs and benefits. Policies by which emigration countries may increase the benefits from labor emigration and reduce the costs are outlined."

Cost-Benefit Analysis↗
PubMedDate not supplied

[Labor supply and economic fluctuations: Brazil, 1979-1986].

"The purpose of this article is to study how the Brazilian labor supply responded to the business cycle of the period 1979-1986. In doing so, the article analyzes the growth and the structure of the Brazilian labor force as well as its demographic traits over that time span. The analysis focuses on the cyclical sensitivity of the labor force participation rate (LFPR) of particular labor force groups. The study breaks down the LFPR by age, sex, schooling and family income. The main finding is that the labor supply measured by the time series behavior of the LFPR is sensitive to the business cycle although the direction and the degree of responsiveness varies among labor force groups." (SUMMARY IN ENG)

Age Factors↗
PubMed2002

[Management of threatening preterm labor with intact membranes: indications for antibiotics].

OBJECTIVE: To analyse the benefits and disadvantages of systematic antibiotic therapy in patient presenting a preterm labor with intact membranes. METHODS: We reviewed French and English reports on Medline using to the following key words: "antibiotic therapy and preterm labor, preterm labor, streptococcus B, vaginose, mycoplasma, antenatal infection". RESULTS: The systematic prescription of antibiotics is not recommended for patients presenting preterm labor who have intact membranes and no symptoms of infection. The benefit of antibiotics is small and shows a tendency to prolong the pregnancy and the reduction of maternal infection. No benefit has been shown for neonatal results. When early-onset neonatal sepsis develops in a case in which antepartum chemoprophylaxis was used, the isolated bacteria will present an increasing risk of bacterial drug resistance. Local treatment (cream or pessary) do not belong in the treatment of threatening preterm labor and are not recommended for the prevention of prematurity or materno fetal infection. Risk groups of patients who present a positive vaginal colonization are subject to discussion. Studies do not allow us to ascertain that antibiotics have a beneficial effect on prematurity in these groups. Antibiotics are recommended for the treatment of asymptomatic bacteriuria. This treatment reduces prematurity and maternal infections. Despite poor consensus criteria, if threatening preterm labor is associated with a bacteriuria, experts usually recommend treatment.

Anti-Bacterial Agents↗
PubMed2002

[Misoprostol and oxytocin for induction of cervical ripening and labor in patients with term pregnancy and premature membrane rupture].

OBJECTIVE: To evaluate the effect of the concurrent administration of intravaginal misoprostol and oxytocin for cervical ripening and labor induction on length labor, mode of delivery and perinatal outcomes. PATIENTS AND METHODS: One hundred seven patients with singleton pregnancy at term, vertex presentations, premature rupture of membranes and Bishop scores of < or = 4 were randomly assigned to receive one of three treatments: Group I: Intravenous oxytocin plus intravaginal misoprostol (n = 36); Group II: Intravenous oxytocin plus placebo intravaginal (n = 34); Group III: Intravaginal misoprostol plus intravenous placebo. The time interval from induction to beginning of the labor, from induction to delivery, mode of delivery and perinatal outcomes were measured. RESULTS: The mean time from induction to beginning of labor was different between the groups: Group I: 48.75 minutes, Group II: 107.50 minutes, Group III: 95.94 minutes (p = 0.0024). The mean time in minutes from induction to delivery was different between the groups: Group I: 359.83; Group II: 537.05; Group III: 474.54 (p < 0.05). The frequency of tachysystole, mode of delivery and perinatal outcomes were similar among the three groups. CONCLUSIONS: Oxytocin that is administered simultaneously with intravaginal misoprostol for cervical ripening and labor induction in patients with pregnancies at term, premature rupture of membranes and Bishop scores < 4 make the labor beginning quickly, significantly shortens induction to delivery times without affecting the mode of delivery and with no apparent adverse maternal and perinatal effects.

Adult↗
PubMed2003

[Observation of course of placental separation by continuous dynamic ultrasonography during third stage of labor].

OBJECTIVE: To investigate the physiologic course of third stage of labor, and to judge the optimal time of natural placental separation permitted. METHODS: To observe and record the course of third stage of labor by continuous dynamic ultrasonography and to estimate the total amount of blood loss from placental separation within two hours after delivery by the method of weighing lost blood. RESULTS: Third stage of labor can be divided into four phases: the latent phase (4.37 +/- 3.78) min, the contraction phase (1.48 +/- 0.97) min, the detachment phase (0.50 +/- 0.00) min, and the expulsion phase (0.62 +/- 2.23) min. In 85% of the puerperas the third stage of labor takes about 10 minutes (average 6.94 minutes). The amount of postpartum hemorrhage and the risk of the patient increased prominently if the time of stage of labor was longer than 10 minutes (P < 0.01). CONCLUSION: The third stage of labor must be limited in 10 minutes to prevent postpartum hemorrhage.

Adult↗
PubMed2003

The nature and management of labor pain: part I. Nonpharmacologic pain relief.

Pain in labor is a nearly universal experience for childbearing women. A recent evidence-based symposium on the nature and management of labor pain brought together family physicians, obstetricians, midwives, obstetric anesthesiologists, and childbirth educators to discuss a series of commissioned systematic reviews. Although management of labor pain plays a relatively minor role in a woman's satisfaction with childbirth compared with the quality of the relationship with her maternity caregiver and the degree of participation she has in decision making, it is an important topic for women and their caregivers. Nonpharmacologic methods of pain relief such as labor support, intradermal water blocks, and warm water baths are effective techniques for management of labor pain. An increased availability of these methods can provide effective alternatives for women in labor.

Anesthesia, Obstetrical↗
PubMed2003

The nature and management of labor pain: part II. Pharmacologic pain relief.

A group of family physicians, obstetricians, midwives, obstetric anesthesiologists, and childbirth educators attended an evidence-based symposium in 2001 on the nature and management of labor pain and discussed a series of systematic reviews that focused on methods of labor pain management. Parenteral opioids provide modest pain relief in labor, and little evidence supports the use of one agent over another. Epidural analgesia is used during labor in most large U.S. hospitals, and its use is rapidly increasing in small hospitals. Although epidural analgesia is the most effective form of pain relief, its use is associated with a longer labor, an increased incidence of maternal fever, and increased rates of operative vaginal delivery. The effect of epidural analgesia on rates of cesarean delivery is controversial. Nitrous oxide provides a modest analgesic effect, but it is used less often in the United States than in other developed nations. Paracervical block provides effective analgesia in the first stage of labor, but its use is limited by postblock bradycardia. Research is needed regarding which pain-relief options women would choose if they were offered a range of choices beyond epidural analgesia or parenteral opioids.

Analgesia, Epidural↗
PubMed2003

Value of routine urine culture in the assessment of preterm labor.

OBJECTIVE: To assess the utility and expense of routine urine culture in women evaluated for preterm labor. STUDY DESIGN: A retrospective study of 1,429 patients evaluated for preterm labor over a calendar year. Patients evaluated for preterm labor were identified using the hospital's admissions database and then cross-referenced with the hospital microbiology laboratory's database to identify those who had urine cultures sent as part of their evaluation. The charts of patients with a positive urine culture were further reviewed to evaluate the diagnosis and outcome. RESULTS: Five hundred twelve urine cultures were sent for analysis of preterm labor, and 6 (1.2%) reported growth of > 100,000 colonies of a single bacterium. Of these 6 patients, 5 reported symptoms consistent with a urinary tract infection, while the 6th was asymptomatic. Fisher's exact test showed no clinical significance for a positive urine culture as a predictor of preterm delivery (P = .68). Sensitivity was 0.7% (95% CI, 0.0-4.3), and specificity was 98.6% (95% CI, 96.7-99.5). A cost difference of $29,676 existed between charges and reimbursements. A positive culture was not a significant risk factor for preterm delivery. The 1 patient who delivered preterm with a positive culture probably had cervical incompetence as the cause of preterm delivery. CONCLUSION: The routine use of urine cultures in the assessment of preterm labor is costly and adds little value to obtaining a diagnosis except in the presence of specific complaints at our institution. Urine culture identified a single patient with asymptomatic bacteriuria being evaluated for preterm labor, and she probably had another etiology for her advanced cervical examination.

Adult↗
PubMed2003

[Survey of the practice of cervical ripening and labor induction in France].

OBJECTIVES: Labor induction is a widespread medical practice in France. The medical or obstetric indications for induction as well as the protocols used probably vary from one maternity to another. The objective of this national survey was to describe current medical practices and procedures in France, regarding labor induction and cervical ripening, eight years after the national consensus on labor induction management. A second objective was to assess mothers' opinion on the induction of their labor/level of satisfaction on their childbirth experience. MATERIALS AND METHODS: The sample of maternities was randomly extracted from a list published by the French Ministry of Health. Sampling was performed according to maternity size, geography, and private vs public. Medical information was collected on consecutive labor induction cases in each maternity. Mother's opinions were estimated through a score based on the validated Labour Agentry Scale. RESULTS: Within the 38 maternities included, 21 (55.3%) were public, and 17 (44.7%) private. 1192 women were included in this study and 1090 (91.4%) answered the questionnaire on level of satisfaction. Global rate of elective induction (no medical or obstetric indication) was 24.8% (n=295). Prostaglandins are almost as widely used as oxytocin (45.8% and 47.7% of total labor inductions, respectively). Mostly used methods of delivering prostaglandin are intravaginal (27.1%), controlled-release pessaries (10.2%) and intracervical (8.1%). Among the elective inductions, an important rate of unfavorable cervix was found (n=81, 27.5%) as well as a quite high level of use of prostaglandins (n=51, 17.3%). The statistically independent criteria linked to a high satisfaction score are an older age (OR=1.58; CI 95% [1.80-3.33]), an elective induction (OR=2.44; IC 95% [1.80-3.33]) and a favorable cervix (OR=1.47; [1.08-1.98]). CONCLUSION: The use of prostaglandins in labor induction and cervical ripening is now widespread in France. This technique is not always used in accordance with available scientific data. These results should lead health professionals to set up an evaluation process for their practices, when these are not based on clear scientific evidence.

Adult↗
PubMed2003

[Study on controlling the blood glucose level of gestational diabetes mellitus sufferer regularly during labor].

OBJECTIVE: To study the maternal blood glucose management of gestational diabetes mellitus during the labor and relationship of maternal blood glucose in labor and neonatal blood sugar. METHODS: A prospective study on maternal blood glucose monitoring and control during labor was carried in 40 pregnant women with abnormal glucose metabolism. We adjusted maternal blood glucose by low-dosage constant insulin drop during labor. RESULTS: Maternal blood glucose in labor arranged between 3.8 approximately 11.2 mmol/L, and low-dosage constant insulin drop was used in 17 cases (42.5%). The neonatal blood glucose was (4.0 +/- 1.5) mmol/L following delivery and (3.9 +/- 1.0) mmol/L at 24-hour postpartum. There were 2 cases with neonatal hypoglycemia. The neonatal blood glucose of the rest 23 cases was (4.2 +/- 1.5) mmol/L, and (3.9 +/- 1.0) mmol/L at 24-hour postpartum, and 1 case with neonatal hypoglycemia. There was no the difference of the blood glucose level of newborns between mothers with abnormal glucose metabolism and the normal pregnant women. CONCLUSION: It is necessary to monitor and control the blood glucose level by low dose constant insulin during labor in pregnant women with abnormal glucose metabolism.

Adult↗
PubMed2003

[Evolution of indications for cesarean section between 1991 and 2000 in materials from the Pathology Clinic in the Department of Pregnancy and Labor, Pomeranian Medical University in Szczecin].

The present study was designed to analyze retrospectively the course of 2693 pregnancies and deliveries between 1999 and 2000 at the Department of Pathology of Pregnancy and Labor, Pomeranian Academy of Medicine in Szczecin. Attention was focused on the frequency of cesarean sections including preventive and urgent cases, obstetric and paraobstetric pathologies complicating pregnancy, perinatal and maternal mortality. The efficacy of diagnosing fetal distress in pregnancy and labor by continuous fetal monitoring with cardiotocography versus ultrasonography, in particular umbilical artery Doppler velocimetry, was studied. The material consisted of 2693 pregnant women (1476 (54.8%) primiparous and 1217 (45.2%) multiparous) aged 15-46 years, and their 2802 newborns. Gestational age varied between 23 and 43 weeks. Two groups were formed: I--1268 women delivering by cesarean section between 1991 and 1995; II--1425 women delivering by cesarean section between 1996 and 2000. In 1995/1996, complete ultrasonography supplemented with umbilical artery Doppler flow and intrauterine invasive intervention (cordocentesis, amnioinfusion, amnioreduction, intrauterine fetal blood transfusion) were introduced, as well as screening for diabetes in pregnancy and immunological tests for anticardiolipin antibodies. At that time, the Program of Improved Prenatal Care in Poland was fully implemented. Moreover, the Intensive Therapy of Newborns Uni was established at the Department of Pathology of Pregnancy and Labor. Depending on the moment the decision to perform cesarean section was taken, the prospective group was divided into two groups: antenatal (group P--1036 gravida) and intranatal (group S--1657 parturients). Depending on indications for cesarean section, urgent (N) were distinguished from preventive (Pr) cases. CTG interpretation was performe using qualitative and semi-quantitative Fischer's method. CTG recordings during labor were interpreted according to the qualitative method proposed by FIGO in 1987. An analysis of PI, S/D, RI, and flow curve (absence (AEDF) or reversion (REDF) of end-diastolic umbilical artery blood flow) in umbilical artery Doppler velocimetr was performed. A decrease of more than two standard deviations from average valu for several pregnancy time intervals was regarded as pathological. The absence (AEDF) or reversion (REDF) of end-diastolic umbilical artery blood flow was considered to be a high risk factor. The status of newborns was assessed using 5 min Apgar score and parameters o acid-base equilibrium in umbilical artery blood. The following conclusions were drawn: 1. Analysis of cases during the last decade of the 20th century revealed: --increased rate of cesarean sections with a shift in indications from urgent to preventive; --increase in obstetric risk associated with higher percentage of complication during pregnancy; --higher percentage of cesarean sections in premature labor; --correlation between premature labor and increased risk of poor newborn statu --decrease in perinatal mortality of newborns. 2. Analysis of methods for antepartum fetal monitoring revealed: --abnormal CTG patterns and abnormal blood flow in umbilical artery with ab sence or reversion of end-diastolic blood flow the coexistence of which were diagnostically effective for prediction of poor newborn status. 3. Analysis of fetal monitoring methods revealed: --normal intrapartum CTG patterns and normal antepartum blood flow in umbilical artery were markers of good newborn status; --abnormal CTG patterns and abnormal blood flow in umbilical artery had lim ited predictive value regarding poor newborn status. 4. Evolution of indications for cesarean section was multifactorial in character. New and more effective methods for fetal monitoring are needed.

Adolescent↗
PubMed1992

[The use of prostaglandins for labor conduction in its latent phase].

We wanted to know enprostil efficacy, an E2 prostaglandin analogous as a labor conductor in it's latent phase in term pregnancies. 188 patients were included, 52% received intracervical enprostil and 48% were treated with oxytocin. The labor evolution, resolution and complications were watch over. 15 patients (15.6%) of the study group required labor conduction with oxytocin because it was inhibited after peridural anesthesia. The main pregnancy resolution was vaginal via; only 6.3% of the study group subjected cesarean section against 10.3% of the witness group and the most frecuent indication was stationary dilation (1 and 8 cases respectively). The time of the latent phase and total labor was lower statistically in the study group. The observed complications were post-labor hemorrhage (3.1%), polysystolia (4.1%) and vomiting (5.2%), without significant difference with the witness group. We conclude that intracervical enprostil help cervical mature. shortenning latent phase and total labor, disminish oxytocin requeriment and cesarean incidence by cervical alterations without compromise maternal-fetal morbi-mortality.

Enprostil↗
PubMed1992

A critical assessment of preterm labor prevention strategies.

Preterm birth is second only to congenital diseases in causing morbidity and mortality in infants. To prevent preterm labor and delivery, a number of strategies have been developed. When choosing a strategy to prevent preterm birth, however, physicians must remember that preterm delivery arises from three separate conditions: iatrogenic preterm labor, premature rupture of membranes, and idiopathic preterm labor. Many of the programs that have been developed focus on patients who are at high risk for iatrogenic preterm birth and premature rupture of membranes, but do not include patients who are likely to experience idiopathic preterm labor. Since idiopathic preterm labor is the most common cause of preterm birth and is the most amenable to early intervention with tocolytic agents, more preterm labor education efforts should be included in prenatal care programs. In addition, further research is needed to delineate which features of preterm birth prevention programs are responsible for the beneficial effects that have been observed.

Clinical Trials as Topic↗
PubMed1991

[Induction of labor--personal results].

In a five-year period (1981-85) the authors analyzed the labor induction rate and the injuries of mothers and newborns in relation to them. They had 13.12% of inductions. The mortality and birth rate was 1.73 0/1000. Early neonatal mortality was 1.52 0/1000, and perinatal mortality (on the five-year material) 3.25 0/1000. This is in the group of low perinatal mortality (10.0 0/1000). Labor induction demands permanent CTG control during labor, as well as labor in the hospital, which they had. The prematurity rate has decreased thanks to better prepartal evaluation (from 14.06 0/1000 to 1.24%) of criteria for the indication of labor induction. They found a significant difference between labor induction and obstetric interventions, as well as between birth injuries and obstetric interventions.

Female↗
PubMed1991

Continuous emotional support during labor in a US hospital. A randomized controlled trial.

The continuous presence of a supportive companion (doula) during labor and delivery in two studies in Guatemala shortened labor and reduced the need for cesarean section and other interventions. In a US hospital with modern obstetric practices, 412 healthy nulliparous women in labor were randomly assigned to a supported group (n = 212) that received the continuous support of a doula or an observed group (n = 200) that was monitored by an inconspicuous observer. Two hundred four women were assigned to a control group after delivery. Continuous labor support significantly reduced the rate of cesarean section deliveries (supported group, 8%; observed group, 13%; and control group, 18%) and forceps deliveries. Epidural anesthesia for spontaneous vaginal deliveries varied across the three groups (supported group, 7.8%; observed group, 22.6%; and control group, 55.3%). Oxytocin use, duration of labor, prolonged infant hospitalization, and maternal fever followed a similar pattern. The beneficial effects of labor support underscore the need for a review of current obstetric practices.

Adolescent↗