[Maternal-fetal exchange of glucocorticoid hormones in rheumatic heart disease].
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11-Hydroxycorticosteroids↗
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Labor experience, maternal mood and cortisol and catecholamine levels in low-risk primiparous women.
This exploratory, prospective study was set up to determine the relationship between cortisol and catecholamine levels and labor experience and postpartum maternal mood. It was performed at the Coronation Hospital, which serves a low-income urban population in Johannesburg. Blood samples were taken from 189 low-risk primiparous women in active first stage of labor and analyzed for cortisol, norepinephrine, epinephrine and dopamine. The stress hormone levels were then correlated with maternal anxiety, depression and self-esteem scores, and changes associated with mothers' labor experience and pain. Patients who were distressed and required analgesia had higher cortisol levels. Those who described a more positive labor experience at 24 hours also had higher cortisol levels. There were no significant correlations between psychological test scores and stress hormone levels. Both labor pain at the time and a more positive recollected labor experience were associated with high cortisol levels. Cortisol and catecholamine levels in labor did not correlate with postpartum psychological test scores.
Adolescent↗
Effects of morphine administration on the fetal production of oxytocin in labour.
1. Animal and human work has indicated that maternal oxytocin secretion is under the control of endogenous opiates. Previous workers have described the fetal production of oxytocin in addition to maternal production. The study of the interaction between exogenously administered opiates and oxytocin secretion may give insight into the activity of any opiate-mediated regulatory mechanism of oxytocin secretion in the fetus. This study was designed to investigate the effect of an opiate (5 mg of morphine) given to the mother on the fetal production of oxytocin in labour. 2. Morphine was given by the attending clinicians for analgesic purposes to women in the first stage of labour. After delivery umbilical artery vein and maternal vein specimens were taken. 3. Four groups of patients were studied: women after normal vaginal delivery without analgesia in labour (n=10); women after normal vaginal delivery who had morphine administration in the first stage of labour (n=12); women who had an emergency Caesarean section in the first stage of labour (n=11); women who had an elective Caesarean section at term who were not in labour (n=11). 4. Oxytocin levels were measured by radioimmunoassay in the maternal vein, umbilical artery and umbilical vein specimens. Morphine was measured by radioimmunoassay in the umbilical vein specimens. 5. The umbilical artery minus vein concentration of oxytocin was calculated for each patient (A-V). There was no change in the umbilical (A-V) concentration of oxytocin if morphine had been given to the mother in labour; this applied to fetuses delivered vaginally or by Caesarean section. When the fetuses who were exposed to morphine were analysed separately, there was no correlation between the umbilical vein morphine concentration and the umbilical (A-V) oxytocin concentration either in Caesarean or vaginal deliveries. 6. Fetal oxytocin production was not affected by the maternal administration of morphine in the first stage of labour. This applies to the oxytocin production in the first and second stage of labour.
Analgesia, Obstetrical↗
Perineovulvovaginal preparation in labor.
Seventy-four patients who received antenatal care and whose deliveries were supervised in our hospital were studied. Most of them were from the low socioeconomic class. Forty patients were shaved and all patients had the same routine perineal, vulval and vaginal swabbing during the first stage of labor. Puerperal morbidity was low. Even in developing countries where patients often have poor personal hygiene, shaving the vulval, pubic and perineal hair is unnecessary for patients whose pregnancies and deliveries are supervised in hospital. We suggest that the procedure should be reserved for patients who have complications of pregnancies which may necessitate instrumental or abdominal deliveries.
Adult↗
The analysis of continuous fetal heart rate traces in the first and second stages of labour.
In the search for a simplified method of fetal heart rate trace assessment 50 traces recorded during the first stage of labour and those recorded in the last hour of each of a further 50 labours have been analysed intensively. The importance of baseline variability in predicting possible fetal distress in both the first stage and the last hour of labour is shown and the possible use of an objective measurement of baseline variability in the further screening for fetal acidosis is described. The importance of lag time measurement in the first stage of labour is demonstrated and the relationships between fetal scalp blood pH and other heart rate parameters is discussed. Significant inverse correlations between one-minute Apgar score and maximum amplitude of deceleration and total deceleration area in the last hour of labour are also shown. Temporal relationships between intrauterine pressure rises and transient changes of fetal heart rate failed to give significant correlations in the last hour. These findings in the last hour of labour are compared with those obtained in the first stage of labour and the differences are discussed.
Acidosis↗
The influence of pressure upon the fetal head during labour.
In contracted pelvis, moulding of the skull bones is caused by the force of the amniotic fluid pressure and the resistance of the pelvis. In normal labour and abnormal uterine action the moulding of the skull bones is caused by the head to cervix pressure, as has been demonstrated by intra-uterine tokometry. By contrast, in the contracted pelvis there are no mouldings between the two parietal bones. In breech presentation during the first stage of labour the moulding of the skull bones is explained, by the differing resistance of the various skull bones against the amniotic fluid pressure.
Amniotic Fluid↗
An analysis of uterine activity in spontaneous labour using a microcomputer.
A microcomputer was used to analyse uterine activity during spontaneous labour in 30 nulliparous and 30 parous patients. The intrauterine mean active pressure (MAP) in the nulliparous group was 1.51 kPa (SD 0.45) in the first stage and 2.71 kPa (SD 0.77) in the second stage. For the parous group, the MAP in the first stage was 1.22 kPa (SD 0.37) and in the second stage was 2.92 kPa (SD 0.98). A significant parity difference in MAP and contraction frequency was observed in the first stage but not in the second stage. Epidural analgesia did not appear to influence uterine activity in the first stage but was associated with a lower MAP, contraction frequency and intensity in the second stage. During the first stage, MAP increased by 21% in nulliparas and by 39% in multiparas. The rise in MAP was mainly due to an increase in contraction frequency.
Analgesics↗
Lumbar epidural analgesia in labour. A clinical analysis.
Lumbar epidural block was given for pain relief to 296 women in labour. Bupivacaine was used as the analgesic agent and the technique is described in detail. Satisfactory analgesia was obtained in 92% of the cases during the first stage of labour and in 84% during the second stage of labour. The frequency of instrumental deliveries and of occipitio-posterior position increased but the clinical condition of the newborn seemed to be unaffected.
Anesthesia, Epidural↗
Pupillary constriction and ptosis following caudal epidural analgesia.
This study reports pupillary changes occurring in seventeen of twenty pregnant women at term who received caudal analgesia for the relief of pain in the first and second stages of labour. It is suggested that 10 ml or more of analgesic solution, injected into the sacral epidural space, reaches high enough (probably to T1) to cause meiosis and/or ptosis.
Anesthesia, Caudal↗
Lactate in fetal scalp blood and umbilical artery blood measured during normal labor with a test strip method.
A new test strip method was used to determine the lactate concentration in fetal scalp blood during normal labor. Sixty-six fetal scalp blood samples were collected at cervical dilatations between 4 cm and 10 cm. The mean lactate value was 1.7 +/- 0.8 mmol/l simultaneously (IS.D.) and the mean pH sampled simultaneously was 7.36 +/- 0.04 (IS.D.). The corresponding values for base deficit was 2.1 (+/- 1.9) and for pCO2 5.8 (+/- 0.8). No difference was seen in lactate concentrations or pH values in early compared to late first stage of labor. The mean lactate concentration in the umbilical artery immediately after delivery was 3.7 mmol/l +/- 1.2 (IS.D.). The method was easy to handle and gave the result within 60 seconds.
Female↗
[Fetal pulse oximetry: a clinical methodological study].
The aim of the study is to provide preliminary assessment of the possibilities of fetal pulse oximetry as a method for monitoring of fetal pulse rate and oxygen saturation during labour. The study includes 65 pregnant women during active labour at term--all with one fetus and ruptured membranes. A system for fetal pulse oximetry is used, consisting of monitor Nellcor-N 400; oxygen sensor FS-14 and printer P-400 (Nellcor Puritan Bennett incorporation). Sensor is applied by mean dilatation of cervical channel 6.5 +/- 1.9 cm. Mean duration of monitoring of the pregnant woman is 104 +/- 68 minutes, range 30 to 180 min. The time of reliable signal quality is 83% for first stage of labour and 70% for second stage of labour. Mean SpO2 values are 47.1 +/- 9.8%. The conclusion is made that fetal pulse oximetry is an easy method to use, without side effects for mother and fetus. Mean SpO2 values are tower than in adults and vary inside wider range 35-55%.
Adult↗
A study of the benefits and acceptability of ambulation in spontaneous labour.
A prospective study of 300 consecutive deliveries has been made to assess the benefits and acceptability of ambulation during spontaneous labour. Ambulation during the first stage occurred in 48 patients with 55 non-ambulant patients acting as controls. No difference in the length of first or second stage, incidence of fetal distress or mode of delivery was observed. In spite of the lack of apparent advantage to the fetal condition, ambulation was acceptable to both patients and nursing staff and should not be discouraged.
Adolescent↗
Why deliver in the supine position?
This study was conducted at the Lokmanya Tilak Municipal General Hospital, Bombay, India during the year 1990. The aim was to compare the routinely used supine position versus ambulation in the first stage and squatting position during the second stage of labour. Our study was comprised of 200 patients both primigravidas and multigravidas; 100 were kept in the supine position throughout labour and 100 were kept ambulatory in the first stage and adopted the squatting position during the second stage. The study showed a shortening of both stages of labour in the squatting group but the incidence of complications was less in the control group. It was concluded that without proper birthing chairs which can give excellent perineal support, the usual supine position is preferable in our setup.
Adult↗
Prolonged labour attributed to large fetus.
The aim of this study is to assess the interactive dynamics of power, passenger and passage in relation to an adverse course of labour. The design was a community-based follow-up of all women with singleton pregnancies experiencing spontaneous term labour. Median of first stage was 2.6 h for multiparas and 3.7 h for primiparas. Median of second stage was 20 min for multiparas and 91 min for primiparas. Heavy birth weight significantly influenced a prolonged late first stage OR 6.6 (CI 2.1-21) and second stage of labour OR 4. 5 (CI 1.5-14) among primiparas. The attributable proportions of heavy birth weight for prolonged labour were 19-21%. Large paediatric head circumference showed a positive correlation to prolonged late first stage OR 3.2 (CI 1.2-9) and intervention OR 7.2 (CI 1.8-35), with an attributable proportion of 22%. For multiparas no significant association were found. To conclude, this study indicates that heavy birth weight and large head circumference contribute to 1/5th of the prolongation of labour and interventions among primiparas.
Body Height↗
Communication of pain: vocalization as an indicator of the stage of labour.
The sounds made by women in the first and second stages of labour were recorded. One minute segments were replayed to 40 medical staff with at least 6 months labour ward experience who were asked to determine whether the sounds played were made by a woman in the first or second stage of labour. The stage of labour associated with each of the sound segments was correctly identified at much greater than chance frequency. It is suggested that further research into the nature and significance of these sounds may have the potential to allow them to be used more systematically by midwifery staff as an unobtrusive aid in monitoring the labour process.
Adult↗
[For and against non-obstetrical indications for cesarean section].
The authors have made a retrospective study on the nonobstetrical indications for SC from 1996-2000 year, with the help of special documents belonging to VMI, Obstetric Clinic, Pleven. There have been 10,465 deliveries in the same period, 1096 with SC (10.47%). The main indications in 56 cases (5.11%) were non-obstetrical complications of pregnancy and delivery. The most frequent non-obstetrical indications were: ophthalmological in 18 (32.14%), orthopedical in 10 (17.86%), cases CNS diseases in 5 (8.93%) and cancer in 3 (5.36%). We have included: Condylomata accuminata--5 (8.93%), acute thrombophlebitis and thromboembolic diseases--5 (8.93%), a condition after plastic repairs of the perineum, virgin and vulvae--3 (5.36%). Special interest was taken on another group of patients with some rare diseases about the other specialist recommended SC. The ovarian age of the patients was 20-29 years--in 36 (64.28%). The SC has been performed in 30 cases (53.57%) in the first stage, in 14 (25.00%) in the second stage of delivery and in 12 (21.43%) cases was emergency. The conclusions of the authors is that the Obstetricians, who manage the delivery, may not always been comparted with that of the other specialist. This comes from the fact that the responsibility is mainly for him.
Adult↗
Segmental epidural analgesia and urinary excretion of catecholamines during labour.
Urinary excretion of catecholamines was determined separately during the first stage of labour and during the period from the beginning of the second stage until 1/2 h after delivery in 16 healthy mothers, whose labours were induced at term. Seven mothers were given segmental epidural analgesia, at the height of TH10-12, to achieve complete pain relief during the first stages of labour. The remaining parturients served as controls. During the first stage of labour the urinary excretion rate of catecholamines was at the normal nongravid rest level in both groups. During the second stage, and 1/2 h after the delivery, the amount of urinary catecholamines increased significantly in both groups. The latter values corresponded to the amounts of catecholamines excreted during heavy physicial work.
Adult↗
Normal labor: mechanism and duration.
Labor is refers to the chain of physiologic events that allows a fetus to undertake its journey from the uterus to the outside world. The mean duration of a singleton preganancy is 40.0 weeks (280 days), which is dated from the first day of the last normal menstrual period. The period from 37.0 weeks (259 days) to 42.0 weeks (294 days) of gestation is regarded as "term". This article focuses on the onset progress, and mechanics of normal labor term. Topics such as preterm labor (labor before 37 weeks), postterm labor (labor after 42 weeks), and abnormal labor and delivery have not been addressed and are discussed in detail elsewhere in this issue.
Female↗