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PubMedDate not supplied

A randomized control trial of continuous support in labor by a lay doula.

OBJECTIVE: To compare labor outcomes in women accompanied by an additional support person (doula group) with outcomes in women who did not have this additional support person (control group). DESIGN: Randomized controlled trial. SETTING: A women's ambulatory care center at a tertiary perinatal care hospital in New Jersey. PATIENTS/PARTICIPANTS: Six hundred nulliparous women carrying a singleton pregnancy who had a low-risk pregnancy at the time of enrollment and were able to identify a female friend or family member willing to act as their lay doula. INTERVENTIONS: The doula group was taught traditional doula supportive techniques in two 2-hour sessions. MAIN OUTCOME MEASURES: Length of labor, type of delivery, type and timing of analgesia/anesthesia, and Apgar scores. RESULTS: Significantly shorter length of labor in the doula group, greater cervical dilation at the time of epidural anesthesia, and higher Apgar scores at both 1 and 5 minutes. Differences did not reach statistical significance in type of analgesia/anesthesia or cesarean delivery despite a trend toward lower cesarean delivery rates in the doula group. CONCLUSION: Providing low-income pregnant women with the option to choose a female friend who has received lay doula training and will act as doula during labor, along with other family members, shortens the labor process.

Adolescent↗
PubMed2004

Mode of delivery in pregnancies with suspected fetal growth restriction following induction of labor with vaginal prostaglandin E2.

BACKGROUND: Many fetuses below the 10th percentile for gestational age are uncompromised. We aimed to evaluate the mode of delivery and immediate neonatal outcome in pregnancies with suspected fetal growth restriction (FGR) and normal antenatal assessment following induction of labor with vaginal application of prostaglandin E2 (PGE2). METHODS: Ninety women with suspected FGR (sonographic estimated fetal weight < 10th percentile) with normal oxytocin contraction test (OCT), biophysical profile (BPP) and reassuring fetal heart rate underwent induction of labor with vaginal application of PGE2 tablets. The findings were compared with 115 women admitted for induction of labor because of decreased fetal movement (group 2) and with 510 women with normal spontaneous onset of labor (group 3). RESULTS: There were no between-group differences in mean maternal age, gravidity, parity, nulliparity rate, number of tablets used or rate of patients receiving more than one PGE2 application. The rate of cesarean section (CS) in the study group (8.9%) was similar to the rate in groups 2 and 3 (14.8% and 9.0%, respectively). The incidence of nonreassuring fetal heart rate pattern leading to cesarean delivery was higher in the study group, but the rate of low 5-min Apgar scores (< 7) was similar in all groups. A logistic regression model and forward likelihood analysis yielded no single significant variable associated with increased risk of cesarean delivery. CONCLUSIONS: In selected cases of suspected FGR with reassuring fetal heart rate and normal OCT and BPP, induction of labor with vaginal PGE2 may yield a similar immediate fetal outcome and CS rate as in uncomplicated, induced or spontaneous deliveries.

Administration, Intravaginal↗
PubMed1983

Umbilical cord cortisol and prolactin levels in preterm infants. Relation to labor and delivery.

The influence of labor and route of delivery upon the umbilical cord serum levels of cortisol and prolactin in ninety-nine preterm infants not exposed prenatally to corticosteroids was studied. Vaginally born infants (group A) presented a higher mean cord cortisol concentration than those delivered by cesarean section (group B); mean prolactin values, however, were not different between both groups. Although there was no difference in cortisol and prolactin levels between infants delivered by cesarean section after spontaneous onset of labor (group B-I) and those without labor (group B-II), the mean cortisol concentration was significantly higher in group A than in group B-I. The mean prolactin levels did not differ among all the studied groups. It is concluded that there is no association between presence of labor or route of delivery and cord serum levels of prolactin, there is no association between spontaneous preterm labor and cord cortisol values and there is an association between vaginal delivery and high cord cortisol levels in preterm infants. It is suggested that the increase in serum cortisol levels does not precede the initiation of preterm parturition but it is secondary to the stress caused by vaginal delivery.

Cesarean Section↗
PubMed2000

Increased apoptosis in human amnion is associated with labor at term.

PROBLEM: To characterize whether increased apoptosis in human amnion was associated with labor at term. METHOD OF STUDY: Human amnion were obtained from term patients with vaginal delivery (n = 5) or who underwent elective Cesarean section (C/S) without labor (n = 5). Apoptosis was performed by the TUNEL (Terminal dUTP Nuclear End Labeling) assay. All nucleated cells stained with propidium iodide in the amnion epithelial cells were identified in red fluorescence. TUNEL positive apoptotic nuclei were identified in green fluorescence. Five random fields of each specimen were blindly counted by investigators. The percentage of apoptotic nuclei of total nuclei (apoptotic index) was calculated and compared between the two groups (25 microscopic fields for each group, respectively). RESULTS: Patients with term labor had a significantly higher mean apoptotic index in amnion epithelial cells than that with elective C/S without labor (27.3 +/- 4.1% versus 3.6 +/- 1.6%, P < 0.001). CONCLUSIONS: Our data indicate that apoptosis in human amnion is significantly increased and associated with labor at term.

Amnion↗
PubMed1994

Bacterial vaginosis and vaginal microorganisms in idiopathic premature labor and association with pregnancy outcome.

The vaginal microflora of 49 women in idiopathic preterm labor was compared with that of 38 term controls to determine whether the presence of bacterial vaginosis (BV) and/or specific microorganisms would influence the rate of preterm delivery. Demographic factors, pregnancy outcome, and reproductive history were also studied. BV, as defined by the presence of clue cells in a vaginal wet mount and characteristic microbial findings in a stained vaginal smear and vaginal culture, was more common in women with preterm labor and delivery than in controls (P < 0.01). The condition, diagnosed in 41% of women who had both preterm labor and delivery (n = 22) and in 11% each of women who had preterm labor but term delivery (n = 27) and controls, was associated with a 2.1-fold risk (95% confidence intervals, 1.2 to 3.7) for preterm birth prior to 37 weeks of gestation. BV was associated with low birth weight. Of 49 women with preterm labor, 67% (8 of 12) of women with BV were delivered of low-birth-weight neonates (< 2,500 g) compared with 22% (8 of 37) of women without the condition (P < 0.0005). The presence of hydrogen peroxide-producing facultative Lactobacillus spp. was strongly negatively associated with both preterm delivery and BV. BV-associated microorganisms, i.e., Mobiluncus, Prevotella, and Peptostreptococcus species, Porphyromonas asaccharolytica, Fusobacterium nucleatum, Mycoplasma hominis, and high numbers of Gardnerella vaginalis were significantly associated with preterm delivery; all species also strongly associated with BV (P = 0.0001 for each comparison). Mobiluncus curtisii and Fusobacterium nucleatum were recovered exclusively from women with preterm delivery. Our study clearly indicates that BV and its associated organisms are correlated with idiopathic premature delivery.

Adult↗
PubMed1991

Effects of inactivation of oxytocin receptor and inhibition of prostaglandin synthesis on uterine oxytocin receptor and gap junction formation and labor in the rat.

Normal term labor is associated with a surge in myometrial oxytocin receptor formation and gap junction development. We have previously shown that inhibition of prostaglandin synthesis by naproxen sodium, 2.0 mg/day, suppressed oxytocin receptor formation but not gap junction formation and prolonged gestation. In this study, we investigated the effects of a specific oxytocin antagonist on oxytocin receptor formation, gap junction formation, and labor in the rat. [Pen1,Phe(Me)2,Thr4,Orn8]oxytocin, a specific oxytocin antagonist, was infused subcutaneously during the last 3 days of pregnancy at 300 micrograms/day. Measurements of myometrial oxytocin receptor concentrations and gap junction formation on days 21 and 22 and days 22-23 (in labor) pregnant uteri showed no significant differences in the Bmax and Kd values between the control and the treated group. Gestation period was not prolonged by the oxytocin antagonist. However, in a separate group of day 23 pregnant rats, the uterine contractile response to 60 mU of oxytocin i.v. was found completely blocked by 10 micrograms of the oxytocin antagonist. These findings suggest that although functional oxytocin receptors did not appear to be essential for the initiation of labor, oxytocin antagonists may still be effective in the prevention of premature contractions. We also examined the effects of a higher dose of naproxen sodium, 5.0 mg/day, on gap junction formation. At this dose, naproxen sodium suppressed both oxytocin receptor and gap junction formation, prolonged gestation, and delayed parturition by 24 h or longer. Prostaglandin appears to be an important regulator or mediator of oxytocin receptor and gap junction formation and plays a critical role in the initiation of labor.

Angiotensin Receptor Antagonists↗
PubMed1997

Prostaglandin-endoperoxide H synthase-2 expression and activity increases with term labor in human chorion.

We investigated the changes in prostaglandin-endoperoxide H synthase (PGHS) specific activity and the levels and distribution of PGHS-1 and PGHS-2 mRNA in chorion collected at term before the onset of labor (CS) and after term labor and delivery (SL). PGHS specific activity and PGHS-2 mRNA abundance were higher in chorion collected after SL compared with that obtained at CS (P < 0.001); there was no difference in the levels of PGHS-1 mRNA between CS and SI, tissues. The increase in PGHS specific activity at SL was significantly correlated with PGHS-2 mRNA expression (P < 0.05) but not with PGHS-1 mRNA levels. In situ hybridization indicated that the pervasiveness of staining for PGHS-1 mRNA throughout full-thickness membranes did not change with labor onset; however, a greater number of cells expressed PGHS-2 in SL tissues. Our results demonstrate a selective increase in PGHS-2 expression and activity in chorion trophoblasts and mesenchymal cells with term labor onset. These observations are similar to those concerning amnion and imply that a concerted mechanism may exist in the fetal membranes to induce PGHS-2 expression at labor.

Chorion↗
PubMed2000

Prostaglandin dehydrogenase mRNA in baboon intrauterine tissues in late gestation and spontaneous labor.

The present study was designed to characterize prostaglandin dehydrogenase (PGDH) mRNA expression in critical intrauterine tissues of pregnant baboons in late gestation and at spontaneous labor. In addition, we determined regulatory effects of betamethasone in vivo on chorionic and placental PGDH mRNA expression. PGDH mRNA was present in chorion, decidua, lower uterine segment, fundal myometrium, and cervix in late gestation but undetectable in amnion. PGDH mRNA significantly decreased in decidua and cervix during late gestation and in chorion and fundus during spontaneous labor. PGDH mRNA in lower uterine segment, decidua, cervix, and placenta was unchanged during spontaneous labor from late gestation levels. Betamethasone had no effect on chorionic and placental PGDH mRNA expression. In summary, our data suggest that PGDH mRNA expression is tightly controlled in gestation- and tissue-specific manners. Decreased chorionic and fundal PGDH abundance during labor and decreased decidua and cervical PGDH mRNA in late gestation allow local uterine prostaglandin accumulation and assist prostaglandin transfer to myometrium. Local differences in PGDH function may regulate tissue- and region-specific requirements for prostaglandins to promote and complete labor.

Animals↗
PubMed1998

Role of serum ceruloplasmin and its ferroxidase activity on preterm labor.

The role of serum ceruloplasmin and its ferroxidase activity on preterm labor with or without rupture of the membranes was studied. Thirty-seven primigravid women between 31 and 35 weeks of gestation were investigated. Our material is divided into 3 groups. Group A consisted of 12 patients with premature rupture of the membranes; group B consisted of 10 patients with preterm labor but intact membranes, and group C consisted of 15 non-laboring patients. Patients with rupture of the membranes presented with statistically significantly higher serum ceruloplasmin levels compared to those with preterm labor but intact membranes (p < 0.05) as well as to non-laboring patients (p < 0.01). On the contrary, the mean ferroxidase activity level or ceruloplasmin was 518.2+/-183.42, 460.9+/-198.8 and 517.5+/-142.01 micromol/l/min in groups A, B and C, respectively. These values were not significantly different. Our results show a loss of ferroxidase activity of ceruloplasmin in patients with rupture of the membranes and probably suggest a defect in the maternal defense mechanisms.

Adult↗
PubMed2001

Labor pain effects on colostral milk beta-endorphin concentrations of lactating mothers.

beta-Endorphin (beta-EP) levels of colostral milk are approximately two-fold higher than in plasma of lactating women, in who concentrations peak at term, after the first and second stages of labor. We investigated the effect of labor pain and vaginal parturition on colostral beta-EP concentrations (beta-endorphin (125)I RIA, Incstar Corp., Stillwater, Minn., USA) of at-term nursing mother, in comparison to those having undergone elective cesarean section. Our results show that colostral milk beta-EP concentrations of mothers who delivered vaginally are significantly higher on the 4th postpartum day (6.0 +/- 0.5 vs. 4.3 +/- 0.4 pmol/l, respectively; p < 0.01) than colostral levels of mothers who underwent cesarean section. These data indicate the important influence of the labor process on the colostral opioid galactopoiesis. It is suggested that labor and parturition pain may increase colostral milk beta-EP concentrations of lactating mothers in order to help the newborn overcome the stressful perinatal events of natural labor and delivery.

Adult↗
PubMed2001

Serum nitric oxide and glutathione levels in preeclamptic and normotensive women during labor.

This study was performed on 38 preeclamptic women, including 26 severely preeclamptic and eclamptic cases, as well as 50 normotensive pregnant controls. Twenty cases in the preeclamptic group and 34 cases in the control group were in labor. Serum nitric oxide levels were measured as total nitrites after reduction of nitrates to nitrites. Among the control subjects, nitric oxide levels were significantly lower in the cases in labor when compared to those not in labor (p < 0.05), but glutathione levels were not significantly different (p >0.05). Among the preeclamptic patients, although nitric oxide levels were not significantly different between the cases in and not in labor (p > 0.05), glutathione levels were significantly higher in the latter group (p < 0.05). Thus, in preeclamptic patients there might be a compensatory increase in nitric oxide production during labor in order to maintain the systemic circulation. Glutathione levels might also be increased to compensate for the marked oxidative stress.

Adult↗
PubMedDate not supplied

Severe variable decelerations and fetal pulse oximetry during the second stage of labor.

OBJECTIVES: The aim of the study was to investigate the usefulness of fetal pulse oximetry in cases of severe variable decelerations in the second stage of labor. METHODS: It is a prospective study including 58 patients. Thirty-eight patients (group A) had a normal uncomplicated labor and 20 patients (group B) developed severe variable decelerations during the second stage of labor. All patients were primiparous with normal pregnancies and had electronic fetal monitoring of labor in conjunction with fetal pulse oximetry. An estimation of fetal pH and base deficit was performed at delivery in all patients. RESULTS: There was no statistically significant difference in relation to maternal age and gestational age between the two groups. Group A patients did not delivered neonates with metabolic acidosis. Six out of 20 (group B) patients delivered neonates with a pH <7.10 despite a fetal pulse oximetry reading of >30%. CONCLUSIONS: It appears that fetal pulse oximetry is not capable of detecting pre-acidotic or acidotic fetuses during the second stage of labor in patients with severe variable decelerations and the management of such patients should be supported by fetal scalp pH when indicated or otherwise the obstetrician should expedite delivery either with assisted operative delivery or cesarean section. Fetal heart rate monitoring was introduced into clinical practice over 30 years ago. It continues to be the predominant method of intrapartum fetal surveillance despite worries about its accuracy and efficacy.

Acidosis↗
PubMed1984

Retrograde time-scale analysis of human placental lactogen, beta human chorionic gonadotropin, and unconjugated estriol levels in human maternal serum from the onset of spontaneous labor.

We analyzed on a retrograde time scale which calculated in maternal serum, from the onset of spontaneous labor, human placental lactogen (hPL), beta human chorionic gonadotropin (beta-hCG), unconjugated estriol (E3) levels, and the ratios among these hormones in the normal late pregnancy. Maternal serum hPL, beta-hCG, and unconjugated E3 levels were measured simultaneously and serially in regular menstrual sera from 27 women in late pregnancy (total 155 samples) by radioimmunoassay. The peak level of hPL was found at 2 weeks before labor, and the peak of beta-hCG was found during 2-4 weeks before the onset of spontaneous labor. On the other hand, the mean level of E3 rose slightly with advancing gestational age. The hormonal ratios of hPL to E3 and beta-hCG to E3 decreased gradually toward the onset of labor, but the ratios of hPL to beta-hCG did not change. From these data, it is possible to conclude that the onset of spontaneous labor can be predicted by measuring the levels of hPL and unconjugated E3 in maternal peripheral serum.

Chorionic Gonadotropin↗
PubMed1989

Cachectin/tumor necrosis factor-alpha formation in human decidua. Potential role of cytokines in infection-induced preterm labor.

This study was conducted as part of an investigation to evaluate the hypothesis that bacterial toxins (LPS or lipoteichoic acid), acting on macrophage-like uterine decidua to cause increased formation of cytokines, may be involved in the pathogenesis of infection-associated preterm labor. We found that cachectin/tumor necrosis factor-alpha (TNF-alpha) was synthesized and secreted into the culture medium by human decidual cells and explants in response to treatment with LPS. LPS treatment also caused an increase in PGF2 alpha production by decidual cells and explants. In amnion cells in monolayer culture, TNF-alpha stimulated PGE2 formation, and TNF-alpha was cytostatic (inhibited [3H]thymidine incorporation into DNA) but not cytolytic in amnion cells. TNF-alpha was not detectable (less than 0.34 ng/ml) in the amniotic fluid of normal pregnancies at midtrimester or at term before or after the onset of labor (n = 44); but TNF-alpha was present at concentrations between 2.8 and 22.3 ng/ml in amniotic fluids of 4 of 20 pregnancies with intact membranes complicated by preterm labor (less than 34 wk gestational age). LPS was present in 10 of the 20 amniotic fluids of preterm labor pregnancies, including all four in which TNF-alpha was present. Bacteria were identified in only one of the four LPS-positive, TNF-alpha-positive fluids. Cytokine formation in macrophage-like decidua may serve a fundamental role in the pathogenesis of preterm labor, including increased prostaglandin formation and premature rupture of the membranes.

Amniotic Fluid↗
PubMed1997

A decline in myometrial nitric oxide synthase expression is associated with labor and delivery.

The mechanisms that maintain relative uterine quiescence during pregnancy remain largely unknown. A possible role for nitric oxide has recently emerged, however, the expression of nitric oxide synthase within human myometrium at midgestation, a time when the uterus is normally quiescent, has not been investigated. The purpose of this study was to identify cell types in human myometrium that contain inducible nitric oxide synthase (iNOS), and to examine changes in its expression during pregnancy and labor. We found that iNOS is expressed in smooth muscle cells of pregnant myometrium. Expression of iNOS was highest in myometrium of preterm not-in-labor patients. At term, iNOS expression fell by 75%, and was barely detectable in preterm in-labor or term in-labor specimens. There was no staining in the myocytes of nonpregnant myometrium. Western blotting also revealed a similar pattern of changes in iNOS expression. In summary, iNOS expression in the myocytes of human myometrium is increased greatly during pregnancy, and declines towards term or with labor. Significantly, preterm inlabor patients also had a large decline in iNOS expression. These data suggest that changes in myometrial iNOS expression may participate in the regulation of uterine activity during human pregnancy.

Adult↗
PubMed1988

Psychological factors in preterm labor: critical review and theoretical synthesis.

Cumulative or chronic environmental stress and high scores on psychopathology scales have been consistently linked to preterm labor. In the laboratory, psychological stimuli have also been shown to affect uterine activity. Clinical studies suggest that interventions which reduce tension and anxiety can prevent or inhibit preterm labor. A model is proposed that links preterm labor to a disorder of arousal manifested physiologically as a hyperreactivity of the limbic circuitry and its efferent components. Autonomic hyperreactivity has been found repeatedly in women who experience preterm labor. This central hyperreactivity could unleash a cascade of psychophysiological reactions that could cause uterine excitation and facilitate preterm labor.

Arousal↗
PubMed1994

International labor movements, trade flows and migration transitions: a theoretical perspective.

"This article presents a theoretical analysis of how the processes of industrialization and development interact with international trade in goods or services to influence a country's turning point from labor exporter to labor importer. It is concluded that trade in goods complements capital movements but substitutes for labor movements, whereas trade in services and labor movements complement each other. The proposed analytical framework suggests that both international trade and migration may contribute to, but cannot lead to, a development process that brings about a migration transition in surplus labor economies."

Commerce↗
PubMed1994

Turning points in international labor migration: a case study of Thailand.

"This article describes the dynamics of the structural transformation of the Thai economy, labor migration and direct foreign investment and proposes an econometric model to explain the migration phenomenon. Though migration shifts have been significantly influenced by political factors such as the Gulf crisis and tensions with Saudi Arabia, economic factors such as the Thai government's liberalization of markets and the expansion of trade and direct foreign investment have contributed to changes in labor market needs. The economic conditions of a shift from net exporter to net importer for labor are posited in the model. The empirical results reveal a turning point in labor migration from Thailand and also confirm the contribution of commodity export in place of labor export in creating employment and income."

Asia↗