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PubMed1982

[Changes in the criteria for planned delivery in the National Defense Medical College Hospital with statistical analysis].

Planned deliveries have been attempted with the administration of prostaglandins E2 and F2 alpha since 1978. Eight hundred and eighteen prostaglandins-induced and 729 uninduced deliveries from January, 1978 to July, 1980 were statistically analyzed. The uninduced deliveries included 465 spontaneous and 264 stimulated labors. The cervical ripening was considered the basic requirement stimulated labors. The cervical ripening was considered the basic requirement for labor induction for the first year of study. However, spontaneous labor onset or the membranes rupture occurred before the induction in 52.4% of cases, where babies were large enough (3,052.6 +/- 33.4g, mean +/- SE, n = 154). Therefore, the cervical factor was excluded from the essential requirement for induction. Since the beginning of 1979, labor induction has been performed based on gestational age (38 weeks or more) and uterine fundal length (32cm or more). Laminaria tents were inserted into the unfavorable cervix the night before induction. Delivery time in the day, duration of labor, and birth weight of babies in the induced group were 2.04 +/- 0.18 p.m., 8.0 +/- 0.3 hours and 3,138.8 +/- 12.3g, respectively. Apgar scores and the amount of postpartum hemorrhage were not significantly different from those in the uninduced group. Similar results were obtained between the laminaria subgroup with unfavorable cervix and the non-laminaria subgroup with ripe cervix in the induced primigravidas.

Birth Weight↗
PubMed1996

Does labor start too late?

To determine the optimal time of delivery, in terms of lowest risk of peripartum complications, the relative incidences of the parameters. Abnormal cardiotocogram (CTG), operative vaginal delivery, Apgar < 7 at 1 and 5 min, artery cord blood pH < 7.20, blood loss > 500 ml, epidural anesthesia, and Cesarean section, were retrospectively analysed with regard to mode of labor onset (spontaneous, induced) and gestational age in all deliveries between gestational weeks (GW) 35 + 0/7 and 42 + 6/7 from 1986 through 1993 at Zurich University Hospital (n = 11,834) and additionally with regard to birth weight in the same population from 1987 through 1993 (n = 10,346). The distribution of most parameters was parabolic with nadirs at GW 37-38; the incidence of low Apgar scores and Cesarean sections, however, was lowest nearer term (GW 39-40). Mode of labor onset had little effect (< or = 1 week) on the time of lowest incidence. The birth weight associated with the fewest complications was 3000 g, with the optimal time of delivery being GW 37-38, assuming a birth weight normal for gestational age.

Anesthesia, Epidural↗
PubMed1999

Elective induction of labor at 39 weeks of gestation: a prospective randomized trial.

OBJECTIVE: To clarify the safety of elective induction of labor at 39 weeks of gestation. STUDY DESIGN: Prospective randomized study. SUBJECTS AND METHODS: Uncomplicated nulliparas (N = 194) were randomly assigned at 36 weeks of gestation. Labor was electively induced in 63 women at 39 weeks of gestation in the active management group (I group, N = 98). Spontaneous labor onset was expected with semi-weekly nonstress test (NST) and amniotic fluid index (AFI) by 42 weeks of gestation in the expectant group (E group, N = 96). Perinatal events were compared between the 2 groups. RESULTS: A significantly higher incidence of meconium-stained amnios (19.4% vs 3.2%) and fetal resuscitation (16.7% vs 4.8%) was found in the E group than in the I group. Also, although a significantly higher incidence of epidural analgesia was noted in the I group (89%) than in the E group (54%) (labor onset > or = 39 weeks, N = 72), the duration of the 1st stage was shorter in I group and the duration of the 2nd stage was not significantly different. No other significant difference was noted between the 2 groups in terms of the rate of C-section, blood loss, incidence of pathological FHR, birth weight, Apgar score, umbilical arterial pH, or admission to NICU. CONCLUSION: Active management of labor at 39 weeks could be made as safely as expectant management with modified biophysical profile monitoring.

Adult↗
PubMed1993

Electronic fetal monitoring in the United States in the 1980s.

OBJECTIVE: To measure the frequency with which electronic fetal monitoring was used for childbirth in United States hospitals in the 1980s and to examine variation in use according to risk factors at labor onset. METHODS: Two data sets from the National Center for Health Statistics (the 1980 National Natality Survey and the 1988 National Maternal and Infant Health Survey) were used to generate proportional frequencies for electronic fetal monitoring use. These data files are based on representative samples of live births (9941 and 9953, respectively) drawn by probability methods from the entire country during a calendar year. Consistency in the sampling methods and questionnaire procedures, and use of sampling weights, permitted national estimates to be generated. RESULTS: Use of electronic fetal monitoring increased from 44.6% of live births in 1980 to 62.2% in 1988. In both time periods, low-risk women received monitoring more frequently than did women with risk indicators. Use grew by 64% in low-risk women (from 46.5% in 1980 to 76.3% in 1988) but only by 32% in women with risk conditions at labor onset (from 42.6% in 1980 to 56.2% in 1988). CONCLUSIONS: Use of electronic fetal monitoring increased during the 1980s, disproportionately so for low-risk women. This trend raises questions about the efficacy of monitoring for improving pregnancy outcomes.

Female↗
PubMed2006

Phorbol ester treatment of human myometrial cells suppresses expression of oxytocin receptor through a mechanism that does not involve activator protein-1.

Oxytocin (OT) is a potent uterine agonist. Its receptor (OTR) is a G protein-coupled receptor that is downregulated by prolonged exposure to OT. We hypothesized that activation of PKC mediated this OT-induced decrease in OTR expression. Diminished PKC activity in late pregnancy could underlie the increased expression of uterine OTR preceding labor onset. Using cell cultures of transformed human uterine myocytes, we determined the effects of PKC agonists and antagonists on the expression of OTR. We also explored the effects of overexpression of activator protein-1 (AP-1, a mediator of many PKC- and phorbol ester-induced effects) using adenoviral expression vectors for the AP-1 subunits c-Jun and c-Fos. Stimulation of PKC using the phorbol ester 12-O-tetradecanoylphorbol 13-acetate caused a rapid, significant (P < or = 0.05) increase in c-Jun and c-Fos concentrations but a significant decrease in mRNA for OTR within 6 h followed by a significant decrease in OT binding by 24 h. Adenoviral infection of the cells with expression vectors for c-Jun and c-Fos increased the AP-1 subunits but had no effect on OTR expression. Furthermore, there were no changes in c-Fos or c-Jun levels in human intrauterine tissues around the time of labor onset, as measured by Western analyses. We conclude that phorbol ester treatment decreases OTR expression, likely through a mechanism that does not involve AP-1.

Blood Proteins↗
PubMed2003

Hofbauer cell activation and its increased glucose-6-phosphate dehydrogenase activity in second trimester-spontaneous abortion: an ultrastructural dual staining enzyme-cytochemical study.

PROBLEM: While activated/phagocytosing phagocytes infiltrating to the chorioamnion are considered to be one of the causal agents of preterm labor onset, whether placental villous macrophages (Hofbauer cells) are activated/phagocytosing in this condition is not known. METHOD OF STUDY: We concomitantly localized two important phagocytosis-related enzymes, acid phosphatase (ACP) and glucose-6-phosphate dehydrogenase (G6PD), in Hofbauer cells in second trimester placental villi, and compared them with those from infection-related second trimester-spontaneous abortion (miscarriage) placentas. RESULTS: There were two types of Hofbauer cells. The first cells exhibited ACP stainings confined to the lysosomes, suggesting that they are dormant/non-activated cells. Approximately two-thirds of these cells showed weak G6PD labeling on the cytosolic side of endoplasmic reticula, and G6PD labeling was hardly recognizable in the remaining one-third. The second cells, possessing large phagosomes, showed marked ACP labeling in the phagosomes, suggesting that they are activated/phagocytosing cells. All these cells exhibited G6PD labeling, and in 'bursting cells' (possibly hyperactivated cells) G6PD deposits were marked. The percentage of activated cells in miscarriage placentas was significantly higher (44.8 +/- 6.0%) than that in gestational age-matched controls (17.4 +/- 5.3%). CONCLUSIONS: These observations indicated that (1) G6PD activity increased in activated/phagocytosing Hofbauer cells, and (2) the percentage of phagocytosing cells increased in infection-related miscarriage placentas. Hofbauer activation and G6PD may play an role in the pathogenesis/pathophysiology of preterm labor onset.

Abortion, Spontaneous↗
PubMed2004

Mode of delivery in pregnancies with premature rupture of membranes at or before term following induction of labor with vaginal prostaglandin E2.

Our aim was to evaluate the mode of delivery in pregnancies complicated with premature rupture of the membranes (PROM) at or before term following induction of labor with vaginal application of prostaglandin E2 (PGE2), and to identify possible predictors leading to cesarean section (CS). The study sample consisted of 220 women with term-PROM who did not enter spontaneous labor after 24 hours of expectant management and 42 with preterm (P)-PROM, who underwent labor induction with vaginal PGE2. Findings were compared with 115 women admitted for elective induction of labor, and 510 women with normal spontaneous-onset labor. There were no between-group differences in gravidity, parity, nulliparity rate, or number of PGE2 tablets used. Women with P-PROM were admitted at 34.6 +/- 2.4 weeks gestation, and delivered at 36.1 +/- 1.6 weeks (mean interval, 5.0 +/- 7.9 days; range, 0.5 to 40 days). The rate of CS was different only between the term-PROM (18.6%) and spontaneous onset of labor (9%) groups (odds ratio, 2.08; 95% confidence interval, 1.4 to 3.4). The rate of low 5-minute Apgar score (< 7) was similar in all groups, but the incidence of nonreassuring fetal heart rate pattern leading to CS was significantly lower in the PROM groups. A logistic regression model and forward likelihood analysis in the PROM groups yielded parity, higher number of PGE2 tablets used, and higher birth weight as independent and significant variables associated with increased risk of CS. Using our management protocol, 36.4% and 20.4% of women with term-PROM and P-PROM, respectively, required labor induction with PGE2, which was successful in more than 80% of cases, with no apparent serious maternal or fetal complications.

Administration, Intravaginal↗