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PubMed1996

Memory for labor pain: context and quality.

The accuracy of memory for labor pain context and quality was examined in 33 women who had given birth 3-4 years previously, utilizing the McGill Pain Questionnaire and unstructured recollections of childbirth events. Subjects displayed very good memory for the context of labor pain but poor memory for its quality. In order to test whether recall was influenced by semantic information a second study investigated the extent and type of knowledge which exists about the nature of labor pain amongst 33 women who had never given birth. The description of labor pain provided by nuliparous women was found to be similar in terms of category selection and descriptors to that of parous women. This suggests that women have available semantic information about labor pain which may influence their pain recall or even their assessment of a pain experience.

Adolescent↗
PubMed1985

ACTH, beta-endorphin and met-enkephalin: peripheral modifications during the stress of human labor.

We investigated the psychoneuroendocrine and emotional correlates of the natural stress situation of human labor. State anxiety, subjective pain, plasma ACTH, peripheral plasma beta-lipotropin (Beta-LPH), beta-endorphin (Beta-EP), and met-enkephalin (Met-Enk) were serially evaluated at six predetermined time points before, and after labor in a sample of 14 women with normal pregnancies. State anxiety and subjective pain showed a progressive increase during labor, with a levelling during the final stage. Plasma Beta-EP and ACTH showed a similar progressive increasing from baseline until the end of labor. Beta-LPH showed no significant modification. Met-Enk remained at nearly baseline values throughout labor, with a marked progressive rise in the postpartum stage. The findings of this study seem to confirm the role of plasma Beta-EP as a stress hormone. Possible relationship between pain and anxiety curves and plasma Beta-EP are discussed in light of psychobiological studies on stress, the opioid system and analgesia. Plasma Met-Enk, according to our findings, should probably not be regarded as a stress hormone. Its rise in the postpartum stage might be as one of the psychoneuroendocrine mechanisms maintaining elevated prolactin levels during lactation.

Adrenocorticotropic Hormone↗
PubMed1991

Labor pain: effect of maternal position on front and back pain.

The purpose of this study was to determine whether women in labor report less pain when they are in a vertical (sitting or standing) position than in a horizontal (side-lying or supine) position. Pain scores were obtained from 60 women in early labor (dilation 2-5 cm) who alternated between the two positions. The results show that about 35% of women feel less front pain and 50% feel less back pain when they are in a vertical position than in a horizontal position. The decrease in continuous back pain (83%) was particularly impressive, but the front and back pains associated with contractions were significantly diminished as well. These results, taken together with those of earlier studies, indicate that many women in early labor have less pain and are generally more comfortable in a vertical than in a horizontal position. Since early labor comprises a substantial proportion of the entire process of labor and delivery, any simple procedure which alleviates pain without danger to mother or child, such as shifting from a horizontal to a vertical position, should be promoted and employed.

Adolescent↗
PubMed1991

Isolation of multiple substances in amniotic fluid that regulate amnion prostaglandin E2 production: the effects of gestational age and labor.

The present study was undertaken to evaluate the effects of whole amniotic fluid (AF) and fractions of AF on amnion cell prostaglandin E2 (PGE2) production. Amnion cells were grown to confluence and then incubated in the presence of AF, or fractions thereof, obtained at 17-19 weeks gestation (MID), at term prior to the onset of labor (NIL), and at term after spontaneous onset of labor (LABOR). All whole AFs were stimulatory to amnion cell PGE2 production (p less than 0.001) but the stimulation by NIL and LABOR AFs was significantly greater (p less than 0.001) than stimulation by the MID AF. Fractionation of the AFs from the three groups (n = 9-10 per group) revealed multiple discernable peaks of stimulatory activity in each group. The majority of peaks had retention times that were similar among the three groups, and peak stimulatory activities were greater in NIL and LABOR samples than in MID samples.

Amnion↗
PubMed1995

Distribution of arachidonic, eicosapentaenoic, docosahexaenoic and related fatty acids in ovine endometrial phospholipids in late gestation and labor.

The quantitative distribution of phospholipid (PL) fatty acids from ovine endometrial tissues taken at 105 (n = 3) and 131 and 147 (n = 5) days of gestation age (dGA) and in spontaneous labor (SL, n = 3) is reported. Phosphatidylcholine (PC), phosphatidylethanolamine (PE), phosphatidylinositol (PI), phosphatidylserine (PS), and lysophosphatidylcholine (LPC), were separated by thin layer chromatography (TLC) and analyzed for fatty acid composition by quantitative gas chromatography (GC). Saturates are found mainly in PS and PI and unsaturates predominantly in PC and PE. The major long-chain polyunsaturated fatty acids (LC-PUFA), arachidonic acid (AA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA), are found primarily in PC, PE, and PI. AA accumulates in PC, PI and PS (p < 0.05) from late gestation to term and significantly declines in PC and PS (p < 0.02) during labor, suggesting that ovine endometrium is a possible source of prostaglandin (PG) precursors. EPA decreases significantly from around 105 dGA to term and at labor in PC (p < 0.02) and in PI (p < 0.01), which may indicate the involvement of 3-series PGs in the regulation of uterine contraction. Unsaturation index (UI) and total PUFA increase from late gestation to term in PE (p < 0.05) and decrease during labor (p < 0.05). The ratios of n-6/n-3 PUFA increase in PI (p < 0.05) and in PC (p < 0.01) during labor mainly due to the decline of EPA in these PL.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

Labor epidural catheter reactivation or spinal anesthesia for delayed postpartum tubal ligation: a cost comparison.

STUDY OBJECTIVES: To evaluate the costs and resource consumption associated with utilizing epidural catheters placed during labor versus spinal anesthesia for postpartum tubal ligation. To examine maternal demographics, anesthetic management variables, and time interval from delivery until surgery for association with epidural catheter reactivation success rate. DESIGN: Retrospective study. SETTING: University hospital labor and delivery center. PATIENTS: 120 consecutive postpartum patients with tubal ligations performed between June 1991 and December 1993. INTERVENTIONS: Postpartum women scheduled for tubal ligation with labor epidural catheters in place either had local anesthetic injected via the epidural catheter (n = 45) or had the catheter removed without reinjection and spinal anesthetic administered (n = 20). Patients with inadequate epidural anesthesia went on to receive spinal anesthesia. Women without a labor epidural catheter received spinal anesthesia (n = 55). MEASUREMENTS AND MAIN RESULTS: Adequate anesthesia for tubal ligation was achieved in 78% of women after reinjection of their epidural catheter. Operating room (OR) and anesthesia times were highest when epidural catheter reactivation was unsuccessful, intermediate when epidural catheter reactivation was successful, and lowest with initial spinal anesthesia (p < 0.05). The longer OR and anesthesia provider times associated with epidural catheter reactivation increased patient charges on average of $176 compared with the initial use of spinal anesthesia. CONCLUSIONS: Spinal anesthesia for postpartum tubal ligation was associated with lower anesthesia professional fees and OR charges compared with attempted reactivation of epidural catheters placed during labor. Anesthesiologists should weigh the cost advantages of spinal anesthesia against the small, but increased probability of headache after dural puncture.

Analgesics, Opioid↗
PubMed2004

Labor induces a maternal inflammatory response syndrome.

OBJECTIVE: We studied the effect of labor on maternal neutrophil phenotype. STUDY DESIGN: Neutrophil apoptosis with inflammatory cytokines and the expression of CD11b, CD34 and toll-like receptor 4 (TLR4) were assessed with flow cytometry in women at uncomplicated vaginal delivery (VD), and elective cesarean section (ElCS) without labor, emergency cesarean section with (EmCSL+) or without (EmCSL-) labor. RESULTS: Spontaneous neutrophil apoptosis is delayed in maternal neutrophils after VD, EmCSL+ or EmCSL- versus ElCS. In all groups lipopolysaccharide delayed apoptosis and increased CD11b expression. Elevated TLR4 expression in ElCS was associated with lipopolysaccharide responsiveness. CD34 was diminished in VD, indicating increased cell maturity. CONCLUSION: Normal labor primes the neutrophil and may enhance antibacterial function by inducing a mild maternal inflammatory response syndrome. Delayed neutrophil apoptosis may promote the neutrophilia seen in women after VD. We suggest that labor of any duration may be immunologically beneficial to the parturient.

Antigens, Surface↗
PubMed2004

Prospective randomized controlled trial of fetal fibronectin on preterm labor management in a tertiary care center.

OBJECTIVE: The purpose of this study was to investigate the effect of the rapid fetal fibronectin on the length of hospital stay and the use of preterm labor interventions in a tertiary care center. STUDY DESIGN: Women who were seen in the Labor and Delivery Unit with symptoms of preterm labor were assigned randomly to receive fetal fibronectin (n=46 women) or to preterm labor management without fetal fibronectin (n=51 women). Physicians were not blinded to the result; groups were compared. RESULTS: There was no difference between groups in demographic or obstetric characteristics, the hours spent in labor and delivery, the number of women who were admitted to the antepartum service, the length of stay, or medical interventions. When the results for women with a negative fetal fibronectin test were compared to women with a positive fetal fibronectin test, a significant difference was found in admissions to the antepartum service (P=.032) and the length of stay (P=.008). CONCLUSIONS: A negative fetal fibronectin test was associated with fewer admissions to the antepartum ward and a shorter length of stay.

Adult↗
PubMed2004

Matrix metalloproteinase-8 is expressed in human chorion during labor.

OBJECTIVE: The purpose of this study was to investigate the expression of matrix metalloproteinase-8 by human fetal membranes during labor. STUDY DESIGN: Fetal membranes were obtained from women who underwent normal labor or elective cesarean delivery at term. Matrix metalloproteinase-8 levels in fetal membranes were determined by enzyme-linked immunosorbent assay and Western blot; the expression of the matrix metalloproteinase-8 gene was detected by reverse transcription-polymerase chain reaction. Immunohistochemistry and in situ hybridization was performed to localize matrix metalloproteinase-8 protein and messenger RNA in intact membranes. RESULTS: Matrix metalloproteinase-8 protein levels were increased 5-fold in fetal membranes from labor compared with membranes that were obtained from cesarean delivery. Western blots confirmed the presence of matrix metalloproteinase-8 in protein extracts. Reverse transcription-polymerase chain reaction, in situ hybridization, and immunohistochemistry demonstrated that matrix metalloproteinase-8 messenger RNA and protein were expressed almost exclusively in the chorion after labor. CONCLUSION: We conclude that matrix metalloproteinase-8 is produced primarily by chorionic cells in human fetal membranes and that the level of matrix metalloproteinase-8 protein and messenger RNA expression in fetal membranes increases during labor.

Blotting, Western↗
PubMed2004

Acupuncture for labor pain management: A systematic review.

Acupuncture is widely used to alleviate symptoms in a variety of painful conditions. In obstetrics and gynecology, acupuncture has also been applied to a range of conditions including labor pain. This systematic review aims to critically evaluate the evidence on analgesic effect of acupuncture during labor. Computerized literature searches of 7 databases were performed for randomized clinical trials (RCTs) of acupuncture involving needle insertion for pain during labor. Three RCTs were identified and their methodologic quality was generally good. Two RCTs compared adjunctive acupuncture with usual care only and reported a reduction of meperidine and/or epidural analgesia. One placebo acupuncture controlled trial showed a statistically significant difference in both subjective and objective outcome measures of pain. No adverse events were reported in any of the trials. It is concluded that the evidence for acupuncture as an adjunct to conventional pain control during labor is promising but, because of the paucity of trial data, not convincing. Further research is warranted to clearly define its place in labor pain management.

Acupuncture Therapy↗
PubMed2006

Fetal macrophages are not present in the myometrium of women with labor at term.

OBJECTIVE: The basic mechanisms responsible for human parturition remain to be elucidated. The influx of fetal leukocytes into the myometrium has been recently proposed to be a crucial event in the onset of murine parturition. Surfactant protein-A has been implicated in the initiation of labor. In mice, it is thought that surfactant protein-A induces migration and subsequent activation of amniotic fluid macrophages of fetal origin, which then invades the myometrium. The present study was conducted to determine whether fetal macrophages invade the myometrium of women in labor. STUDY DESIGN: Placental bed biopsy specimens were obtained from patients in labor who delivered male neonates at term (n = 7). Myometrial sections of postpartum hysterectomy specimens obtained from women who delivered of male neonates (n = 3) were also analyzed. Formalin-fixed, paraffin-embedded sections were immunostained for CD68 or CD14 (which are markers for macrophages); immunoreactive myometrial macrophages were specifically procured by laser capture microdissection. Sex typing was done by polymerase chain reaction for the amelogenin gene with genomic DNA that was isolated from the macrophages. Chromogenic in situ hybridization with a Y chromosome-specific probe was also performed on paraffin-embedded histologic sections. RESULTS: Amelogenin allelotypes of the macrophages were consistent with female alleles in all cases that were tested, indicating a maternal origin. Chromogenic in situ hybridization demonstrated the absence of Y chromosome-positive mononuclear cells in the myometrium in all cases. CONCLUSION: These observations, from a limited number of cases, suggest that migration of fetal macrophages from the amniotic cavity or the chorioamniotic membranes into the myometrium does not occur during human labor. The trafficking of fetal macrophages in labor seems to be different in humans and mice.

Female↗
PubMed2006

Induction of labor and cesarean delivery by gestational age.

OBJECTIVE: Studies of cesarean delivery (CD) rates among women undergoing induction of labor (IOL) often compare such women to women experiencing spontaneous labor at similar gestational ages. We sought to examine the association between IOL at various gestational ages and CD, accounting for the effect of increased gestational age among the comparison group who were managed expectantly. STUDY DESIGN: We conducted a retrospective cohort study of all term, singleton, cephalic presentation pregnancies delivered at our institution over 15 years excluding cesarean deliveries before labor. For each gestational age of induction, we created a comparison group of women who were undelivered at that gestational age, and who experienced labor at some future gestational age. RESULTS: In women undergoing IOL at 38 weeks gestation, the CD rate was 11.9% as compared to 13.3% (P = .42) of women beyond 38 weeks gestation. The CD rate for induction of labor compared to ongoing pregnancy was 14.3% versus 15.0% (P = .62) at 39 weeks, 20.4% versus 19.0% (P = .41) at 40 weeks, and 24.3% versus 26.0% (P = .39) at 41 weeks. When controlling for potential confounding, there was a higher rate of CD among women with expectant management beyond 38 weeks (adjusted odds ratio [AOR] 1.80; 95% CI 1.29-2.53), 39 weeks (1.39; 95% CI 1.08-1.80), and 40 weeks (AOR 1.27; 95% CI 1.00-1.62). CONCLUSION: Our findings suggest that IOL may not increase a woman's risk of CD when compared to expectant management. While this question has been addressed prospectively at 41 weeks gestation, it requires further examination at earlier gestations and among various subgroups.

Cesarean Section↗
PubMed2005

Arg16 homozygosity of the beta2-adrenergic receptor improves the outcome after beta2-agonist tocolysis for preterm labor.

BACKGROUND: Beta(2)-adrenergic receptor (beta(2)AR) agonists are not consistently successful when administered as tocolytic therapy. The beta(2)AR displays genetic variability; an arginine-to-glycine substitution at codon 16 (Arg16Gly) has been shown to increase receptor desensitization in response to agonist exposure, whereas a substitution of glutamate for glutamine at codon 27 (Gln27Glu) decreases down-regulation. We have demonstrated that homozygosity for Arg16 protects against preterm delivery. Our goal was to determine whether beta(2)-agonists are more effective in women with the Arg16 genotype and preterm labor. METHODS: Sixty white women with preterm labor between 24 and 34 weeks' gestation were treated for 48 hours with intravenous hexoprenaline. The effect of tocolysis and outcome of pregnancy were recorded. The beta(2)AR genotypes at codons 16 and 27 of ADRB2 were determined. A control group of 116 women delivered at term was also genotyped. RESULTS: Preterm labor was not associated with beta(2)AR genotype at codon 16 (17% of patients with preterm labor were Arg16 homozygotes versus 19% of control subjects) or codon 27. Gestation was significantly prolonged in Arg16 homozygotes (median, 69 days; interquartile range, 63-79 days) compared with the other 2 genotypes (median, 58 days; interquartile range, 2-72 days) (P = .04). Tocolysis was 100% successful in delaying delivery for 48 hours in Arg16 homozygotes (n = 10), just failing to achieve statistical significance (P = .069). In contrast, only 37 of 50 women carrying 1 or 2 glycine alleles (74%) had delivery delayed by more than 48 hours with tocolysis. Neonatal outcomes were significantly better in babies born to mothers homozygous for arginine than in women with 1 or 2 Gly16 alleles. CONCLUSIONS: This is the first study examining the pharmacogenetics of beta(2)AR agonist therapy for preterm labor. It appears that Arg16 homozygosity improves pregnancy outcome after beta(2)-agonist tocolysis. The relatively low frequency of Arg16 homozygotes in our population limited the power of this investigation. Future assessments of tocolytic therapy may need to assess beta(2)AR genotype.

Adrenergic beta-2 Receptor Agonists↗
PubMed2004

Induction of labor with prostaglandin E2 in women with previous cesarean section and unfavorable cervix.

OBJECTIVE: To study the pregnancy outcome of induction of labor with prostaglandin E2 (PGE2) in women with one previous lower segment cesarean section. METHODS: A retrospective cohort design was used. The study sample included 1028 consecutive women with one previous cesarean section, of whom 97 underwent induction of labor (study group) and 931 were admitted with spontaneous onset of labor (control group). Vaginal tablets of PGE2 were used for cervical ripening in the study group. Mode of delivery, neonatal outcome, indications for cesarean section, and rate of uterine rupture were compared between the groups. RESULTS: There were no significant differences between the study and control groups in mean (+/-S.D.) maternal age (30.9 +/- 4.7 years versus 31.2 +/- 4.8 years, P = 0.6), gestational age at delivery (39.2 +/- 1.8 weeks versus 39.3 +/- 1.6 weeks, P = 0.36), overall rate of cesarean section (36% versus 37.3%, P = 0.8), rates of low 5-min Apgar score < or =7 (3.1% versus 3.7%, P = 0.67) or cesarean section performed for nonreassuring fetal heart rate (6.1% versus 3.1%, P = 0.1). There were four cases of uterine rupture, all in the control group compared to none in the study group (nonsignificant). CONCLUSION: The findings suggest that induction of labor in women with one previous cesarean section does not increase the risk of cesarean section rate and does not adversely affect immediate neonatal outcome. We cautiously suggest that when there is no absolute indication for repeated cesarean section, induction of labor may be considered.

Adult↗
PubMed2004

Women's attitude toward analgesia during labor--a comparison between 1995 and 2001.

OBJECTIVE: To compare the attitude of gravid women towards analgesia during labor in 1995 and 2001, in Israel. METHOD: Women in the third trimester of pregnancy were asked to complete an antepartum questionnaire regarding the mode of analgesia they preferred during their labor. The questionnaire was distributed twice, once in 1995 and again in 2001, in order to study changing attitudes. RESULTS: Study participants included 114 women in 1995 and 125 in 2001. There were no differences between the groups in maternal age, gestational age, gravity, parity, or level of education. In 1995, 57% of the women were interested in having epidural analgesia during labor, compared to 66% in 2001 (P < 0.001). The preference for opioids decreased from 31.5% in 1995 to 18.5% in 2001 (P < 0.001). In 1995, none of the women questioned opted for avoiding all kinds of analgesia, whereas in 2001, 8% did so. CONCLUSION: Women's attitudes to analgesia during labor have changed over the last 6 years. Epidural block has become very popular, while opioids use lost its popularity; at the same time, there has been an increase in the number of women who prefer to avoid all kinds of analgesia during labor.

Adult↗
PubMed2005

Lipid peroxidation and antioxidant activity in patients in labor with nonreassuring fetal status.

OBJECTIVE: The aim of our study was to evaluate lipid peroxidation products and antioxidant enzyme activity in placental tissue and umbilical cord blood, as a marker for fetal hypoxia in patients in labor with nonreassuring fetal status. STUDY DESIGN: Umbilical cord arterial blood and placental tissue samples were collected from 24 patients with term pregnancies in labor and nonreassuring fetal heart rate (FHR) patterns (study) and 24 women with normal pregnancies in labor and normal FHR tracings (controls) for determination of malondialdehyde (MDA) as a marker for lipid peroxidation and superoxide dismutase (SOD) for the antioxidant activity. Measured values were compared statistically between two groups using independent samples t-test or Mann-Whitney U-test. RESULTS: The median 1min Apgar score was 8 (range 4-9) in the study group and 9 (range 8-10) in the control group, respectively (p < 0.001). There was no statistically significant difference between study and control groups in terms of mean 5 min Apgar scores (p > 0.05). Placental MDA levels in patients with nonreassuring fetal status were found to be significantly elevated compared to the control group (12.14 nmol/g tissue versus 9.75 nmol/g tissue; p < 0.01). The placental SOD activity in the study group was significantly higher (p < 0.01) compared to controls (3.57 U/mg protein versus 2.63 U/mg protein). The umbilical cord blood MDA levels in the study group were higher than in normal pregnancies (4.99 nmol/mL, 3.88 nmol/mL; p < 0.05). The activity of SOD in umbilical cord blood was significantly higher (p < 0.001) in patients with nonreassuring fetal status when compared with the control group (11.62 versus 6.95 U/mL). CONCLUSION: Lipid peroxidation products and antioxidant functions were elevated in the umbilical cord blood and placenta of patients having nonreassuring FHR tracings during labor. These findings indicate that lipid peroxidation products in placenta and umbilical cord blood can be used as a possible marker for fetal hypoxia during labor and SOD levels may discriminate acute from chronic hypoxia. Further investigations are needed with large number of series to clarify the variations of lipid peroxidation and antioxidant activity due to acute or chronic fetal hypoxia.

Adult↗
PubMed2006

Changes of nuclear factor kappa B (NF-kappaB), cyclooxygenase-2 (COX-2) and matrix metalloproteinase-9 (MMP-9) in human myometrium before and during term labor.

OBJECTIVE: To investigate the changes of nuclear factor kappa B (NF-kappaB), cyclooxygenase-2 (COX-2) and matrix metalloproteinase-9 (MMP-9) in human term myometrium before and during term labor. STUDY DESIGN: Myometrium was obtained from women undergoing cesarean delivery at term before (n=16) and after labor (n=12). Immunostaining of NF-kappaB subunits (p65/p50) and Western blot analysis of NF-kappaB subunits, MMP-9 and COX-2 proteins were compared. Human term myocyte cultures were stimulated with IL-1beta. Activation of NF-kappaB was assessed by evaluating changes in the inhibitory protein IkappaB; regulation of COX-2 and MMP-9 levels was studied using Western blot analysis and gelatin zymography. RESULTS: In contrast to a significant increase in the level of COX-2 and MMP-9 proteins, p65 and p50 decreased significantly in the after-labor group compared to the before-labor group. After treatment with IL-1beta, IkappaB was degraded by almost 90% within 5 min and became undetectable by 15 min. IL-1beta stimulation increased the levels of COX-2 protein and the gelatinolytic activities of MMP-9, both of which were inhibited by NF-kappaB inhibitors. CONCLUSIONS: Human term labor is associated with changes in NF-kappaB and increased expression of COX-2 and MMP-9 in the myometrium. NF-kappaB pathway activation and subsequent increments of COX-2 and MMP-9 were observed in human term myocyte cultures.

Cyclooxygenase 2↗
PubMed2005

Rate of increase in oxytocin dose on the outcome of labor induction.

OBJECTIVE: To compare the efficacy and safety of arithmetic and geometric increases in oxytocin infusion dosage during induction of labor. METHODS: A total of 120 pregnant women requiring induction of labor at term were randomly assigned to receive oxytocin at dosages increasing arithmetically or geometrically. Maternal demographics, labor delivery data, and newborn outcomes were compared. The setting was the maternity unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. RESULTS: The mean maximum rates of oxytocin delivery needed to achieve adequate uterine contractions were similar in the 2 groups (24.66+/-8.34 mU/min vs. 26.38+/-8.77 mU/min, P=0.24). Labor duration was significantly shorter in the geometric progression group (496.33+/-54.77 min vs. 421.34+/-63.91 min, P<0.001). There were no differences in the rates of cesarean sections, vaginal deliveries, or uterine hyperstimulation, or in neonatal outcomes. CONCLUSION: A geometric rise in the rate of oxytocin infusion delivery reduced the duration of labor without affecting the rates of cesarean sections and uterine hyperstimulation, or newborn outcomes.

Chi-Square Distribution↗