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PubMed1985

Latent phase of labor in normal patients: a reassessment.

The vaginal examination data (dilation, station, and time) were examined from 2845 consecutive uncomplicated patients who were admitted in early labor to Cleveland Metropolitan General Hospital between January 1, 1979 and December 31, 1982, using data from the computer database of the Perinatal Clinical Research Center. The length of the latent phase of labor was calculated in 2479 of these patients to form the study group. Individual effects of parity and the cervical dilation on the length of the latent phase of labor resembled Friedman's results from 20 years ago. Furthermore, the average and prolonged lengths of the latent phase confirmed that labors have not changed appreciably in 20 years. However, multivariable analysis and standard stepwise regression on all of the vaginal examination data revealed that the largest influence on the length of latent labor was the admitting cervical dilation. Parity had only a small effect when cervical dilation was controlled. Thus, a multiparous patient may progress as slowly as a primiparous patient if they both are admitted with a low cervical dilation.

Adolescent↗
PubMed1980

The use of two-channel telemetric systems in obstetrics: an ideal monitoring method for oral PGE2 induction of labor.

Our results demonstrate that free mobility in labor has many advantages. Because of the accelerated uterine contractility, the induction-delivery interval is shortened. No unphysiologic baseline pressure alterations were found. The maximal labor amplitudes did not differ from bedside-monitored labor. No FHR-changes occurred and the fetal outcome was excellent. Being able to move about, women are not influenced by the unfamiliar surroundings of modern labor wards. Pain relief and breathing are better than in the recumbent position. The ideal compound to support labor is oral PGE2.

Administration, Oral↗
PubMed1980

Urinary bladder distention: effect on labor and uterine activity.

To study quantitatively the effect of urinary bladder distention on labor and uterine activity, 68 patients requiring catheterization were studied. All patients were in the active phase of labor and had transcervical intrauterine pressure monitoring. Patients were studied in the same lateral position for 30 minutes before and after a catheterization interval, during which time uterine activity units were quantitated on line and changes were noted in cervical dilation and station and contraction frequency and tonus. Results were analyzed for the entire study group, for individual patients, and by urine volumes (10 to 550 ml) obtained at catheterization. Total uterine activity units increased in 43 patients and decreased in 25 after catheterization, but when compared with expected increases calculated from the slopes of the precatheterization interval in individual patients, there were 36 increases and 32 decreases. Individual slopes of uterine activity increased in 36 and decreased in 31 cases. There were no differences when the data were analyzed by urine volume, parity, or bith weight except possibly at large volumes. Changes in rates of cervical dilation and descent of the presenting part conform to the expected normal labor pattern. Within the limits of this study, emptying the urinary bladder has no effect on the course of labor or uterine activity based on the dynamic model of labor.

Adolescent↗
PubMed1996

ACOG technical bulletin. Dystocia and the augmentation of labor. Number 218--December 1995 (replaces no. 137, December 1989, and no. 157, July 1991). American College of Obstetricians and Gynecologists.

The diagnosis of dystocia is currently a leading indication for cesarean delivery in the United States. Efforts to identify abnormal labor and correct abnormal contraction patterns, fetal malposition, and inadequate expulsive efforts may help eliminate many cesarean deliveries without compromising the outcome for either mother or fetus. Cesarean deliveries for dystocia should not be performed in the latent phase of labor or in the active phase of labor unless adequate uterine activity has been achieved. Cesarean deliveries in the second stage of labor may be reduced if, after reevaluation of the fetus and pelvis, there is potential for correction of uterine forces with oxytocin, correction of malposition, operative vaginal delivery, or safe continued observation. Use of either a low-dose or high-dose oxytocin regimen is appropriate for augmentation of labor. Regardless of the regimen used, oxytocin should be administered by trained personnel capable of responding to complications. A physician who has privileges to perform cesarean delivery should be readily available.

Cesarean Section↗
PubMed1977

The influence of acupuncture stimulation during pregnancy: the induction and inhibition of labor.

Uterine response to electroacupuncture stimulation of specific sites of the extremities is demonstrated in 60 pregnant women--48 cases for labor induction and 12 cases for inhibition of premature labor. In the 34 term, post-term, and 7 intrauterine fetal death cases, induction of labor was attempted; in 32 cases delivery was achieved, resulting in a success rate of 78%. In 7 cases of midterm abortion attempts, all failed to respond. Of the 12 cases of premature labor, with the exception of 1 case, all carried the pregnancy to term, resulting in a success rate of 91.6%. Based on these clinical observations, electroacupuncture may become a useful tool in controlling labor. The possible mechanism of action is discussed. Further investigation and standardization of this technique is proposed.

Acupuncture Therapy↗
PubMed1997

[The results of the limited use of episiotomy in managing the second stage of labor].

The purpose is to asses the effect of restrictive use of mediolateral episiotomy on the spontaneous laceration of the low birth canal. The material includes 613 labors some of which gave birth with indication for episiotomy and control group of 441 retrospective cases with routine management of the second period of labor. The restrictive use of episiotomy decreases the rate from 45.6% in the routine practice to 32.8%. The reduced rate of episiotomy has as a consequent increase rate of second degree perineal laceration adn insignificant increase of vaginal lacerations. The management of restrictive and liberal use of mediolateral episiotomy has not effect on third and four degree perineal laceration, on the accessory tears of the vagina and on the rate of perineotomy. If from all labors are subtracted operative deliveries, surgical intervention for repairing the laceration of the birth canal and pathology of the placental period the rate of labors without any intervention is only 13.3%. Our results suggest that labor nowadays is operative activity.

Bulgaria↗
PubMed2006

Complications associated with cesarean section in the second stage of labor.

OBJECTIVE: To determine maternal and neonatal complications associated with cesarean section done in the second stage of labor. METHOD: Cohort study comparing cesarean sections done in the second stage of labor (cases) with those done for poor progress in the first stage (controls). Only singleton cephalic live pregnancies at 36 weeks or more, without previous cesarean section, were included. RESULT: There were 39 cases and 39 controls. Cesarean section in the second stage of labor took significantly longer (median 45 vs. 30 min; P<0.001), and was associated with more frequent postoperative pyrexia (10 vs. 2; P=0.012). There were more neonatal admissions in the case group (17 vs. 3; P<0.001). Hypoxic ischemic encephalopathy was more frequent in infants following second-stage cesarean section (8 vs. 1; P=0.013), as was subaponeurotic hemorrhage (6 vs. 0; P=0.012). CONCLUSION: Cesarean section in the second stage of labor is associated with significant intraoperative and neonatal morbidity.

Adolescent↗
PubMed2002

[Mechanisms of the stagnation of dilatation in the active phase of labor].

OBJECTIVE: Our study was designed to explain determinants of nonprogressive labor in nulliparous patients. STUDY DESIGN: One hundred consecutive nulliparous patients have got a cesarean section for active-phase arrest of labor after two hours of active management. Intrauterine pressure was monitored for all of them and a X-ray pelvimetry was done after surgery. RESULTS: Eighty-three percent of patients showed X-ray data considered as normal; hypotonic labor was found in 50% of cases and occiput posterior position in 60%. CONCLUSIONS: Our results suggest that occiput position and functional dystocia are more common in case of nonprogressive labor than abnormal measurements of the obstetrical pelvis.

Dystocia↗
PubMedDate not supplied

Progression of labor pain in primiparas and multiparas.

The purpose of this study was to systematically describe the dimensions of pain during the progression of labor in primiparas and multiparas. Fifty primiparas and 88 multiparas were assessed for pain when the cervix was dilated 2-4 cm, 5-7 cm, and 8-10 cm. The sensory component of in-labor pain was more severe than the affective component for both primiparas and multiparas throughout labor and delivery except during Stage III when primiparas reported more intense affective pain. Primiparas reported more intense sensory pain in Stages I and III and more intense affective pain in all three stages of labor than the multiparas even though they consumed significantly more pain medications than the multiparas.

Adolescent↗
PubMed1996

[Study of psychological nursing to ease pain during labor].

100 labouring women were selected in the hospital and divided into psychological support group and control group randomly (50 in each group) in this study. The former was given psychological education and support by special staff and the later was managed in routine methods. The result showed that the serious pain rate of the psychological support group was lower than that of the control group in the first stage of labour (P < 0.01). There was a significant difference between the pain levels in two groups in the second stage of labor (P < 0.05). The time of the first stage, the second stage, and total labor course in the psychological support group was shorter than that of the control group (P < 0.05). The normal labor rate of the psychological support group was much higher than that of the control group (P < 0.001). This study indicated that providing psychological support to the parturients may reduce the pain level during delivery and decrease the difficult labor rate.

Female↗
PubMed2004

Rapid HIV-1 testing during labor: a multicenter study.

CONTEXT: Timely testing of women in labor with undocumented human immunodeficiency virus (HIV) status could enable immediate provision of antiretroviral prophylaxis. OBJECTIVES: To determine the feasibility and acceptance of rapid HIV testing among women in labor and to assess rapid HIV assay performance. DESIGN, SETTING, AND PATIENTS: The Mother-Infant Rapid Intervention At Delivery (MIRIAD) study implemented 24-hour counseling and voluntary rapid HIV testing for women in labor at 16 US hospitals from November 16, 2001, through November 15, 2003. A rapid HIV-1 antibody test for whole blood was used. MAIN OUTCOME MEASURES: Acceptance of HIV testing; sensitivity, specificity, and predictive value of the rapid test; time from blood collection to patient notification of results. RESULTS: There were 91,707 visits to the labor and delivery units in the study, 7381 of which were by eligible women without documentation of HIV testing. Of these, 5744 (78%) women were approached for rapid HIV testing and 4849 (84%) consented. HIV-1 test results were positive for 34 women (prevalence = 7/1000). Sensitivity and specificity of the rapid test were 100% and 99.9%, respectively; positive predictive value was 90% compared with 76% for enzyme immunoassay (EIA). Factors independently associated with higher test acceptance included younger age, being black or Hispanic, gestational age less than 32 weeks, and having had no prenatal care. Lower acceptance was associated with being admitted between 4 pm and midnight, particularly on Friday nights, but this may be explained in part by fewer available personnel. Median time from blood collection to patient notification of result was 66 minutes (interquartile range, 45-120 minutes), compared with 28 hours for EIA (P<.001). CONCLUSIONS: Rapid HIV testing is feasible and delivers accurate and timely test results for women in labor. It provides HIV-positive women prompt access to intrapartum and neonatal antiretroviral prophylaxis, proven to reduce perinatal HIV transmission, and may be particularly applicable to higher-risk populations.

AIDS Serodiagnosis↗
PubMedDate not supplied

Labor induction with a prenatal diagnosis of fetal macrosomia.

Since our institution has a low cesarean rate (14%), it was our hypothesis that the rate of cesarean delivery in patients who underwent induction for macrosomia would be similar to the cesarean rate in patients with similar birth weights who entered labor spontaneously. A retrospective analysis of cases seen from December 1993 to July 1995 revealed 53 nondiabetic patients who underwent induction for fetal macrosomia. These study patients were matched to the next nondiabetic patient delivering a child of equal or greater birth weight who entered labor spontaneously. Maternal demographics, labor characteristics, and neonatal outcome data were reviewed. There were no differences between the induction and spontaneous labor groups in maternal age, gestational age, rate of nulliparity, incidence of shoulder dystocia, Apgar scores, or vaginal birth after prior cesarean delivery. The cesarean delivery rate was higher in the induction group when compared to the spontaneous labor group (36% vs. 17%, P < 0.05) despite a lower birth weight in the induction group (4,102 +/- 374 g vs. 349 g, P < 0.05). Regional analgesia was administered more frequently in the induction group (38% vs. 53%, P < 0.05). An increased risk of cesarean delivery was observed in subjects undergoing induction for the indication of fetal macrosomia. These data support a plan of expectant management when fetal macrosomia is suspected.

Analgesia↗
PubMed2001

Hydrotherapy in labor.

Maternal anxiety and pain prolong labor and contribute to fetal distress. Hydrotherapy during labor may promote relaxation and decrease pain without the risks caused by other treatments. In this pilot study the psychophysiological effects of hydrotherapy on maternal anxiety and pain during labor were examined. Using a randomized, pretest-posttest control group design with repeated measures, 18 term parturients were assigned to a control or an experimental group. Experimental subjects were placed in a tub of 37 degrees C water for 1 hr during early labor. The Wilcoxon two-sample test revealed statistically significant effects. At 15 min bathers' anxiety and pain scores were decreased compared to nonbathers. At 60 min bathers' pain scores were decreased compared to nonbathers. After 15 min of immersion, bathers had a significantly greater increase in plasma volume than nonbathers. No significant differences were found in urine catecholamines or maternal-fetal complications. The small sample limits conclusions, but the findings offer preliminary support for the therapeutic effects of bathing in labor for acute, short-term anxiety and pain reduction.

Adult↗
PubMed2000

Enemas during labor.

BACKGROUND: The use of enemas during labor usually depends on the preference of the attending physician and available resources. However enemas cause discomfort in women and increase the costs of delivery. OBJECTIVES: The objective of this review was to assess the effects of enemas during the first stage of labor on infection rates in mothers and newborns, duration of labor, perineal wound dehiscence in the mother, perineal pain, faecal soiling and costs. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register, Database of Abstracts of Reviews of Effectiveness, Medline and reference lists of articles. SELECTION CRITERIA: Randomised trials in which an enema was administered during the first stage of labor and which included assessment of possible neonatal or puerperal morbidity or mortality. DATA COLLECTION AND ANALYSIS: Selected studies were assessed by three reviewers independently. MAIN RESULTS: Two trials involving 665 women were included. These showed no clear difference in infection rates for puerperal mothers (odds ratio 0.61, 95% confidence interval 0.36 to 1.04) or newborn children. REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate the use of routine enemas during the first stage of labor.

Enema↗
PubMedDate not supplied

Umbilical cord vascular cell adhesion molecule concentration following labor.

OBJECTIVE: This study was designed to determine if VCAM concentrations are increased in serum from neonates delivered vaginally compared to those delivered by cesarean in the absence of labor at term. METHODS: Serum was collected from umbilical cords immediately after delivery of term uncomplicated pregnancies either prior to onset of labor by scheduled cesarean or following labor. VCAM concentration was determined by commercial ELISA. RESULTS: Mean VCAM concentration was significantly higher in the laboring (1,106.2 +/- 279 ng/ml) than the nonlaboring group (906.9 +/- 217 ng/ml, P = 0.01). CONCLUSIONS: Increases in neonatal serum VCAM concentrations may represent a response to enhanced lipid peroxidation and oxidative stress during labor as well as a component of the normal fetal immune response.

Case-Control Studies↗
PubMed2004

Sonographic cervical length in threatened preterm labor in a South African population.

OBJECTIVE: In a previous study conducted in the UK we demonstrated that only 8% of women with threatened preterm labor deliver within 7 days. Furthermore, delivery within 7 days occurred in less than 1% of women presenting with a sonographically measured cervical length > or = 15 mm, compared to 37% in those with cervical length < 15 mm. In this study we investigate the potential value of cervical length in the prediction of outcome of threatened preterm labor in a South African population. METHODS: We examined 63 women with singleton pregnancies presenting with regular and painful uterine contractions at 24-36 (mean, 31) weeks of gestation. Women in active labor, defined by the presence of cervical dilatation > or = 3 cm, and those with ruptured membranes were excluded. On admission to the hospital a transvaginal scan was performed to measure the cervical length. The subsequent management was determined by the attending obstetrician. The primary outcome was delivery within 7 days of presentation. RESULTS: Delivery within 7 days of presentation occurred in 20/63 (32%) pregnancies, including 20 of the 30 (67%) cases with cervical length < 15 mm and none of the 33 cases with cervical length > or = 15 mm. Logistic regression analysis demonstrated that the only significant contributor in the prediction of delivery within 7 days was cervical length (odds ratio 0.67; 95% CI 0.54-0.85; P = 0.001) with no significant independent contribution from maternal age, gestational age, body mass index, parity, use of antibiotics, previous history of preterm delivery, cigarette smoking, contraction frequency or use of tocolytics. CONCLUSION: In this South African population, which had a high incidence of delivery within 7 days of presentation with threatened preterm labor, sonographic measurement of cervical length is equally effective as in a lower-risk population in distinguishing between true and false labor.

Abortion, Threatened↗
PubMed2005

The prevalence and clinical significance of amniotic fluid 'sludge' in patients with preterm labor and intact membranes.

OBJECTIVE: To determine the prevalence and clinical significance of amniotic fluid (AF) 'sludge' observed during transvaginal ultrasound examination of the cervix in patients with preterm labor and intact membranes, and in those with uncomplicated pregnancies. METHODS: This retrospective study included patients with preterm labor and intact membranes (n = 84) and those with uncomplicated term pregnancies (n = 298). The outcome variables included the occurrence of documented microbial invasion of the amniotic cavity (MIAC), histological chorioamnionitis, examination-to-delivery interval, admission to the neonatal intensive care unit (NICU), a composite neonatal morbidity, perinatal death, and delivery within 48 h, 7 days, and < 35 weeks and < 32 weeks. Statistical analysis included Chi-square test, stepwise logistic regression analysis and survival analysis. RESULTS: The prevalence of AF 'sludge' was 1% (3/298) in patients with uncomplicated term pregnancies and 22.6% (19/84) in those with preterm labor and intact membranes. Among patients with preterm labor and intact membranes: (1) cervical length < or = 15 mm was present in 58.3% (49/84) of the patients; (2) the prevalence of MIAC and histological chorioamnionitis was 12.1% (7/58) and 32.9% (25/76), respectively; (3) the rate of spontaneous preterm delivery within 48 h, 7 days, and < 32 weeks and < 35 weeks of gestation was 13.6% (8/59), 28.8% (17/59), 39.5% (17/43) and 50.8% (30/59), respectively; (4) patients with AF 'sludge' had a higher frequency of positive AF cultures [33.3% (6/18) vs. 2.5% (1/40), P = 0.003] and histological chorioamnionitis [77.8% (14/18) vs. 19% (11/58), P < 0.001] than those without AF 'sludge'; (5) a higher proportion of neonates born to patients with AF 'sludge' was admitted to the NICU [64.3% (9/14) vs. 12.9% (8/62), P < 0.01], had a composite neonatal morbidity [36.8% (7/19) vs. 13.8% (9/65), P = 0.04] and died in the perinatal period [36.8% (7/19) vs. 4.6% (3/65), P = 0.001] than those born to women without 'sludge'; (6) a higher proportion of patients with AF 'sludge' had spontaneous delivery within 48 h [42.9% (6/14) vs. 4.4% (2/45), P = 0.001], within 7 days [71.4% (10/14) vs. 15.6% (7/45), P < 0.001], < 32 weeks [75% (9/12) vs. 25.8% (8/31), P = 0.005] and < 35 weeks [92.9% (13/14) vs. 37.8% (17/45), P < 0.001] than those without AF 'sludge'; and (7) patients with AF 'sludge' had a shorter examination-to-delivery interval than those without AF 'sludge' [AF 'sludge' median, 1 (IQR, 1-5) days vs. no AF 'sludge' median, 33 (IQR, 18-58) days; P < 0.001]. CONCLUSION: The presence of AF 'sludge' in patients with preterm labor and intact membranes is a risk factor for MIAC, histological chorioamnionitis and impending preterm delivery.

Adult↗
PubMed1996

Women's labor force transitions in connection with childbirth: a panel data comparison between Germany, Sweden and Great Britain.

"In this paper we make use of the panel aspects of the German GSOEP, the Swedish HUS and the British BHPS data...[to analyze] labor force transitions triggered by child births of different birth orders.... We find that German and British women have even higher full-time labor force participation than Swedish women 12 months before the birth of the first child. The difference is more pronounced for second and third births than for first births. We suggest that these differences are caused by different family policy regimes where Germany can be characterized as a breadwinner regime and Sweden a regime oriented towards equal role sharing of father and mother. Our results on determinants of being in the labor force both after and before the birth of a child as well as determinants of the tempo of entering the labor force after birth show that women's own human capital is important both in Germany and Great Britain, whereas in Sweden also less educated women have entered the labor force by the time the child is 2 years old."

Birth Order↗