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PubMed2004

Labor analgesia and cesarean delivery: an individual patient meta-analysis of nulliparous women.

BACKGROUND: The authors performed an individual patient meta-analysis of 2,703 nulliparous women who were randomized to either epidural analgesia or intravenous opioids for pain relief during labor from five trials conducted at their hospital. The primary purpose in this meta-analysis was to evaluate the effects of epidural analgesia during labor on the rate of cesarean delivery. METHODS: Between November 1, 1993, and November 3, 2000, 2,703 nulliparous women (2,188 healthy parturients and 515 women with pregnancy-induced hypertension) in spontaneous labor at term were randomized to receive either epidural analgesia or intravenous opioid analgesia in the five studies. Epidural analgesia was initiated with either epidural bupivacaine or intrathecal sufentanil and was maintained with a low-dose (0.0625% or 0.125%) mixture of bupivacaine with fentanyl. Intravenous opioid analgesia was initiated with 50 mg meperidine and 25 mg promethazine hydrochloride and was maintained with intravenous boluses of meperidine as needed. RESULTS: A total of 1,339 nulliparous women were randomized to receive epidural analgesia, and 1,364 women were randomized to receive intravenous meperidine analgesia. There was no difference in the rate of cesarean deliveries between the two analgesia groups (epidural analgesia, 10.5% [140 of 1,339] vs. intravenous meperidine analgesia, 10.3% [141 of 1,364]; adjusted odds ratio, 1.04; 95% confidence interval, 0.81-1.34; P = 0.920). Significantly more women randomized to epidural analgesia had forceps deliveries compared to meperidine analgesia (13% [172 of 1,339] vs. 7% [101 of 1,364]; adjusted odds ratio, 1.86; 95% confidence interval, 1.43-2.40; P < 0.001). Epidural women had longer first and second stages of labor. Women who received epidural analgesia reported lower pain scores during labor and delivery compared to women who received intravenous meperidine analgesia. CONCLUSION: Epidural analgesia compared to intravenous meperidine analgesia during labor does not increase the number of cesarean deliveries.

Adult↗
PubMed2004

Universal nevirapine upon presentation in labor to prevent mother-to-child HIV transmission in high prevalence settings.

OBJECTIVE: To assess the uptake of and adherence to nevirapine to prevent mother-to-child HIV transmission among women of unknown HIV serostatus presenting in labor. We also assessed preliminary efficacy of the approach. DESIGN: Women of unknown HIV serostatus presenting in labor were offered single-dose nevirapine in a prospective cohort study. Two additional contemporaneous comparison populations were also studied. METHODS: We measured uptake by counting the number of women that accepted enrollment when offered. We measured adherence with cord blood nevirapine assay. We measured preliminary efficacy with HIV DNA polymerase chain reaction of infant blood spots at 4-6 weeks of life. RESULTS: Of 1591 women approached in labor, 634 (40%) took up the intervention and received nevirapine, of whom 185 (29%) were HIV infected. Of 179 cord blood specimens from HIV-exposed infants that could be evaluated, 178 (99.4%) had nevirapine detected. This was higher than the 73 of 98 (74%) adherence rate observed in a comparison cohort in which women self-administered nevirapine before presenting to the labor ward (P < 0.001). Of 145 available infant specimens, 17 (11.7%) showed evidence of infection at 4-6 weeks, compared with 12 of 60 (20%) infants born immediately prior to study commencement whose HIV-infected mothers did not receive nevirapine (P < 0.05). CONCLUSIONS: Nevirapine without HIV testing upon presentation in labor was accepted by two-fifths of women. Because therapy is directly observed, adherence is nearly perfect. Labor ward dosing to enhance nevirapine coverage should be considered as an adjunct to antenatal nevirapine administration for prevention of mother-to-child transmission of HIV.

Adult↗
PubMed2005

Magnetic resonance imaging pelvimetry and the prediction of labor dystocia.

OBJECTIVE: To study whether magnetic resonance imaging (MRI) pelvimetry has the ability to identify those women who require cesarean delivery for labor dystocia. METHODS: From July 2003 to April 2004, nulliparous women scheduled for a labor induction for prolonged pregnancy (42 weeks) were asked to participate in a pelvimetry study. Those who consented underwent fast-acquisition MRI that included two 90-second acquisitions to evaluate fetal biometry and volumetry and maternal pelvimetry, including novel measurements of pelvic bony and soft tissue volumes as determined by MRI. Information about each patient's pregnancy, labor course, and neonatal outcome was prospectively collected. Pelvimetry results for those women undergoing operative delivery for labor dystocia were compared with those who did not. Single fetal and maternal pelvic measurements, as well as ratios of both, were analyzed. In addition, previously described radiographic pelvimetry techniques and formulas to predict dystocia were used. RESULTS: One hundred one women underwent MRI, and 22 of these underwent cesarean delivery for dystocia. No single fetal measurement was statistically associated with dystocia. Several maternal pelvic measures, fetal-to-maternal ratios, and previously reported pelvimetric techniques were significantly associated with dystocia. The ratio of magnetic resonance (MR) fetal head volume to pelvic soft tissue volume had statistical significance (P = .04). Receiver operator characteristic curves were developed for the different measurements, ratios, and formulas studied to assess whether any of the techniques could accurately predict labor dystocia requiring operative delivery. The area under the curve values ranged from 0.6 to 0.8, with the ratio of MR head volume to pelvic soft tissue being 0.7. These values suggest that MRI can identify those women at greatest risk for dystocia, but it cannot with accuracy predict which ones will require a cesarean. CONCLUSION: We found significant associations with MRI pelvimetry and labor dystocia, but MRI was not a significant improvement over previously described pelvimetric techniques. LEVEL OF EVIDENCE: II-3.

Adult↗
PubMed1993

Nurses' care during labor: its effect on the cesarean birth rate of healthy, nulliparous women.

This retrospective study was designed to determine the influence of nurses' care during labor and delivery on the cesarean birth rate of healthy, nulliparous women. Labor and delivery nurses in a large, nonprofit hospital were grouped according to the cesarean birth rates of their healthy, nulliparous patients in spontaneous labor. Large differences in cesarean birth rates between nurses in the lowest quintile (near 4.9%) and the highest quintile (near 19%) were not explained by differences in maternal age and gravidity, attendance of mother at childbirth class, insurance status, reliance on public assistance, physician who attended labor, use of epidural anesthesia, augmentation of labor, dilation when the nurse assumed care, infant weight, or gestational age. In multivariate analysis, the elapsed time between when the nurse assumed care and birth was significantly shorter for patients of nurses in the lowest quintile of cesarean birth rate (4.4 hrs) compared with patients of nurses in the highest quintile (5.6 hrs). The former were also less likely to have forceps used to assist vaginal delivery than the latter (13% vs 26%). Nurses in the lowest quintile of cesarean birth rates were more likely to use a form to record psychosocial data than nurses in the highest quintile (35% vs 15%). The study suggests that nurses' care during labor is an important factor influencing cesarean birth rates.

Adult↗
PubMedDate not supplied

One-to-one nurse labor support of nulliparous women stimulated with oxytocin.

OBJECTIVE: To compare the benefits of one-to-one nurse labor support with the benefits of usual intrapartum nursing care in women stimulated with oxytocin. DESIGN: A secondary analysis of a randomized controlled trial. SETTING: A 637-bed university hospital. PARTICIPANTS: One hundred nulliparous women 37 weeks or more gestation, carrying singletons, in labor with vertex presentation, stimulated with oxytocin, less than 5 cm dilated at baseline, and not scheduled for cesarean delivery or induction nor having paid labor support present. INTERVENTIONS: One-to-one care consisted of the presence of a nurse during labor and birth who provided emotional support, physical comfort, and instruction on relaxation and coping techniques. Usual care consisted of care for 2-3 laboring women with supportive activities varying by nurse. MAIN OUTCOME MEASURE: Cesarean delivery. RESULTS: A beneficial trend because of one-to-one nurse support, with a 56% reduction in risk of total cesarean deliveries [RR of experimental vs. control = 0.44 (95% confidence interval = 0.19 to 1.01)]. CONCLUSION: The beneficial trend in reducing cesarean deliveries attributed to one-to-one nursing in women stimulated with oxytocin suggests that continuous support by intrapartum nursing staff may benefit women stimulated with oxytocin during labor.

Cesarean Section↗
PubMed2001

Models of division of labor in social insects.

Division of labor is one of the most basic and widely studied aspects of colony behavior in social insects. Studies of division of labor are concerned with the integration of individual worker behavior into colony level task organization and with the question of how regulation of division of labor may contribute to colony efficiency. Here we describe and critique the current models concerned with the proximate causes of division of labor in social insects. The models have identified various proximate mechanisms to explain division of labor, based on both internal and external factors. On the basis of these factors, we suggest a classification of the models. We first describe the different types of models and then review the empirical evidence supporting them. The models to date may be considered preliminary and exploratory; they have advanced our understanding by suggesting possible mechanisms for division of labor and by revealing how individual and colony-level behavior may be related. They suggest specific hypotheses that can be tested by experiment and so may lead to the development of more powerful and integrative explanatory models.

Animals↗
PubMedDate not supplied

Child labor, gender, and health.

It is often forgotten that child labor is part of a multi-generational problem due in part to the failure to educate girls. Although the literacy rate for women has improved over the last two decades, in many countries it is less than half that of their male counterparts. This in turn leads to nutritional deficiencies, poverty, and poor health. While many researchers address the immediate health effects of child labor on the child laborers, this article addresses the issue of child labor from a broader perspective, one that identifies child labor as a contributor to intergenerational poverty, malnutrition, and limited educational attainment. Child labor and nutrition are important issues in both educational attainment and health status.

Adolescent↗
PubMed1996

Search for the most predictive tests of fetal well-being in early labor.

The aim of the study was to evaluate the admission CTG alone and in combination with the following tests: fetal acoustic stimulation test (FAST), maternal perception of sound provoked fetal movement (mpSPFM), amniotic fluid index (AFI), and umbilical artery doppler studies in early labor. 1092 singleton pregnancies in cephalic presentation, and with intact amniotic membranes at 37 weeks gestation or more, were admitted in early labor to the labor ward at the National University Hospital, Singapore. Admission tests were performed, and labor managed according to established labor ward protocol. Of all the tests performed, only the results of the admission CTG and color of the amniotic fluid were known to the obstetrician. If the admission CTG is normal, AFI is > 5 cm and there is an acceleratory responses to FAST the incidence of fetal distress is low. In the presence of a reactive admission CTG and in the absence of thick meconium, fetal heart rate response to FAST and the AFI provided a better selection of the high risk fetus that would require closer monitoring or early delivery. When the admission CTG was suspicious, FAST, AFI, and blood flow velocity waveform studies may allow more confident prediction of the ability of the fetus to withstand the stresses of labor.

Acoustic Stimulation↗
PubMed2006

The health impact of child labor in developing countries: evidence from cross-country data.

OBJECTIVES: Research on child labor and its effect on health has been limited. We sought to determine the impact of child labor on children's health by correlating existing health indicators with the prevalence of child labor in selected developing countries. METHODS: We analyzed the relationship between child labor (defined as the percentage of children aged 10 to 14 years who were workers) and selected health indicators in 83 countries using multiple regression to determine the nature and strength of the relation. The regression included control variables such as the percentage of the population below the poverty line and the adult mortality rate. RESULTS: Child labor was significantly and positively related to adolescent mortality, to a population's nutrition level, and to the presence of infectious disease. CONCLUSIONS: Longitudinal studies are required to understand the short- and long-term health effects of child labor on the individual child.

Adolescent↗
PubMed2001

Organized labor, public health, and tobacco control policy: a dialogue toward action.

An action-oriented conference, Organized Labor, Public Health, and Tobacco Control Policy, was held in September 2000 in Boston, Massachusetts. Labor union leaders, tobacco control and public health activists, researchers, and practitioners met for two days to: 1) learn about existing labor-based tobacco control initiatives; 2) educate one another about resources, barriers, and opportunities for labor-public health joint action on tobacco policy; 3) and identify where agendas overlap and form the basis for specific next steps in collaborative efforts in tobacco-related research, training, and advocacy. This report summarizes presentations and participant discussions to inform readers of the information exchanged and of the enthusiasm shared by conference participants translated into a set of joint recommendations for increased labor-based and joint labor-public health action to reduce the burden of tobacco on working people.

Journal Article↗
PubMedDate not supplied

Investigation on subclinical aspects related to intestinal parasitic infections among Thai laborers in Taipei.

BACKGROUND: The migration of foreign workers from developing regions to developed countries may potentially lead to transmission of intestinal parasitic infections. In order to determine the relationship between intestinal parasitic infections and the health status of foreign workers, 302 Thai laborers brought to Taiwan were examined in this study. Nine species of parasites were found in 64.9% of laborers; Opisthorchis viverrini, hookworm, Strongyloides stercoralis, Giardia lamblia, Trichuris trichiura, Fasciolopsis buski, Taenia sp, Echinostoma sp, Entamoeba coli. METHODS: From June 1992 to December 1993, a total of 302 Thai laborers, participating in the mandatory entry health examination at Chang-Gung Memorial Hospital, Lin-Kou Medical Center were interviewed and examined. These subjects underwent a physical examination, chest roentgenography, and serological tests for human immunodeficiency virus antibody, syphilis (VDRL), and hepatitis B surface antigen. RESULTS: Among the 302 Thai laborers examined, 196 (64.9%) were found to be infected with 1 to 5 species of parasites. All 193 infected Thai laborers were treated in Taiwan. Two or 3 courses of pyrantel pamoate, mebendazole, praziquantel, and metronidazole were administered to 119, 45, 24, and 5 infected patients respectively. After 1 week of treatment, all results of stool examinations were negative. CONCLUSION: Acquisition of infection has been determined to be related to the consumption of koipla, a dish prepared from uncooked freshwater fish. Not unexpectedly, in the present study, it was found that this species was the most important intestinal parasite among Thai laborers and was significantly associated with the consumption of koipla.

Adult↗
PubMed1994

Epidural analgesia in active management of labor.

OBJECTIVES: To examine the determinants of epidural analgesia in the active management of labor. To examine the association of epidural with instrumental delivery and cesarean section. STUDY DESIGN: Observational study in a teaching hospital with a uniform active labor management and availability of epidural analgesia on demand. A thousand consecutive nulliparous women at term, were assessed. RESULTS: Requests for epidural anesthesia were predominantly expressed at the time the patient was notified that spontaneous labor was going to be augmented by the administration of oxytocin, or later, when this latter treatment caused labor to be subjectively more arduous. In induced labor, the same observation applied to a greater degree, still. Operative delivery was significantly more frequent in patients with epidural. However, when the incidence of operative delivery was adjusted for the use of oxytocin, the significance between patients with epidural versus the others abated. CONCLUSION: The use of oxytocin in active management of labor results in a high demand for epidural when this is available on demand. This, however, need not be associated with an increased incidence of operative delivery.

Adult↗
PubMedDate not supplied

Child labor still with us after all these years.

Child labor is a major threat to the health of children in the United States. The U.S. Department of Labor estimates that more than four million children are legally employed and that another one to two million are employed under illegal, often exploitative conditions. Across the United States, child labor accounts for 20,000 workers compensation claims, 200,000 injuries, thousands of cases of permanent disability, and more than 70 deaths each year. Agriculture and newspaper delivery are the two most hazardous areas of employment for children and adolescents. Poverty, massive immigration, and relaxation in enforcement of Federal child labor law are the three factors principally responsible for the last two decades' resurgence of child labor in the United States. Control of the hazards of child labor will require a combination of strategies including vigorous enforcement, education, and public health surveillance.

Accidents, Occupational↗
PubMed2001

[Low concentration Ropivacaine in labor epidural analgesia. A prospective study on obstetric and neonatal outcome].

BACKGROUND: Epidural analgesia effectively alleviates labor pain. However controversy exists about the effect of epidural analgesia on labor outcome. The aim of this study is to assess the effect of a low concentration local anesthetic (ropivacaine 0.08%) in labor epidural analgesia (LEA) on labor pain relief, on the incidence of cesarean sections and instrumental vaginal deliveries, and on neonatal outcome. METHODS: In the period April 1998 - July 2000, 323 women in active labor with live, singleton and in vertex presentation fetuses at term of gestation were included in this prospective study. Women with pre-gestational and/or obstetric diseases or previous caesarean deliveries were excluded. One-hundred and five patients requiring - by written informed consent - LEA were allocated to receive standardised protocol of a low concentration local anesthetic (ropivacaine 0.08%) coadministered with opioid (sufentanil): ropivacaine group. The remaining 239 parturients who didn't require LEA were included in the control group. RESULTS: The demographic characteristics of the two groups were similar; 12 (10.4%) patients receiving LEA delivered by cesarean section, 17 (14.8%) by vacuum extractor whereas 86 (74.8%) had a spontaneous delivery. The risk of cesarean section (adjusted for age, BMI, parity, neonatal weight and gynecologist) resulted lower, even if not significantly, in the ropivacaine group (OR 0.9; 95% IC: 0.6-1.3), while a significant increased instrumental vaginal delivery rate has been reported, although little numbers reduce statistical significance. Neonatal outcome was unaffected by the use of LEA. CONCLUSIONS: The conclusion is drawn that a lower concentration of ropivacaine (0.08%) in LEA produces good labor pain relief with no detectable adverse effects on mother and neonate, and without significantly increasing cesarean section rate.

Adult↗
PubMed2006

[Level of urocortin mRNA during labor and effect of urocortin on myometrial contractility in vitro].

OBJECTIVE: To examine the expression of urocortin mRNA during labor and the effect of urocortin on myometrial contractility, and to investigate its role in the onset and progress of labor. METHODS: (1) Semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR), using beta-actin as internal standard was applied to determine the levels of urocortin mRNA in human placenta and myometrium from the group of cesarean section before (10 cases) and during (10 cases in latent phase and 10 cases in active phase) labor. (2) The isolated myometrial strips of pregnant women (n = 24) were prepared. The effects of urocortin with or without prostaglandin F(2alpha) (PGF(2alpha)) and oxytocin on myometrial contractility were evaluated by areas under the curve. RESULTS: (1) Semi-quantitative RT-PCR showed that the expression level of urocortin mRNA in placenta and myometrium after the onset of labor were higher than before labor (1.23 +/- 0.52, 1.32 +/- 0.22; 0.83 +/- 0.38, 0.94 +/- 0.13, respectively, P < 0.05). (2) Urocortin itself did not affect myometrial tension development at all concentrations tested, but it markedly increased PGF(2alpha)-induced myometrial contractility. The average area under the curve of controls was (2.12 +/- 0.15) cm(2) and of study strips was (3.90 +/- 0.33) cm(2) (P < 0.05); urocortin did not increase the myometrial response to oxytocin compared with controls (P > 0.05). CONCLUSION: The study indicates urocortin may indirectly modulate myometrial contractility during labor.

Adult↗
PubMed1987

The role of antepartum testing in the management of postterm pregnancies with heavy meconium in early labor.

The documented association between heavy meconium in early labor and increased perinatal morbidity and mortality has alerted physicians to the presence of a potential high-risk fetal condition and to the possible need for immediate fetal blood pH determination. The purpose of this study was to determine whether antepartum fetal assessment can predict whether a postterm fetus with heavy meconium in early labor is at low or high risk for an adverse perinatal outcome. Eight hundred thirty-nine postterm patients were followed with antepartum testing, consisting of twice-weekly fetal heart rate (FHR) testing and ultrasonic amniotic fluid volume estimation. Overall, patients with heavy meconium in early labor had a significantly greater frequency of fetal distress. However, when women with heavy meconium in early labor were separated according to their antepartum testing results, those with normal results were found to have no greater risk for fetal distress or perinatal morbidity than women with normal testing and subsequently clear amniotic fluid. These findings suggest that postterm patients with heavy meconium in early labor and normal antepartum testing can be managed in labor in the same manner as low-risk patients without meconium.

Amniotic Fluid↗
PubMed1994

Anthropometric evaluation of agricultural laborers in selected parts of Thailand.

For the design of farm machinery, body dimension data is essential. There are little such anthropometric data available on agricultural laborers from developing countries. This research, therefore, aimed to collect anthropometric data of agricultural laborers in selected parts of Thailand. Forty-four physical dimensions of both 50 men and 50 women agricultural laborers were measured. These laborers were selected randomly from two provinces in the central plains of Thailand. The average body dimensions, standard deviation and 5th, 10th, 50th, 90th, and 95th percentiles were determined. No significant difference was observed in most of the body dimensions of men and women laborers in different age groups used in this study. Body dimensions of length were in constant proportion to stature. The body dimensions of Thai laborers obtained in this study were also compared with the data of body dimensions from some Asian as well as Western countries.

Adult↗
PubMedDate not supplied

Labor analgesia and anesthesia in a patient with spinal muscular atrophy and vocal cord paralysis. A rare and unusual case report.

BACKGROUND AND OBJECTIVES: A case of labor analgesia and anesthesia in a 23-year-old woman with spinal muscular atrophy and vocal cord paralysis is reported. As spinal muscular atrophy is a progressive degenerative disorder of spinal anterior horn cells, with generalized neuromuscular weakness as a common sequela, the goal of anesthetic management is to provide satisfactory labor analgesia and anesthesia with minimal compromise of respiratory function. METHODS: A lumbar epidural anesthetic technique was used to provide satisfactory labor analgesia and anesthesia for a low forceps delivery. RESULTS: The anesthetic technique provided a safe delivery. As the patient was awake, she was able to assist with the expulsion phase of labor. The rare published reports of spinal muscular atrophy and obstetric management are reviewed, the known pertinent physiologic derangements of the syndrome in concert with pregnancy being detailed, along with any information provided regarding anesthetic techniques. CONCLUSIONS: It is believed that labor analgesia and anesthesia can be provided adequately with lumbar epidural techniques. An understanding of the physiology underlying spinal muscular atrophy is essential to safe anesthetic management of the laboring parturient.

Adult↗