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PubMed2006

Induction of labor with oral misoprostol in nulliparous mothers of twins.

The efficacy and safety of oral misoprostol for labor induction of twins is unknown. We conducted a retrospective case-control study to evaluate the use of oral misoprostol in near term (> or =35 weeks) twin pregnancies in nulliparas. Eligible cases were given 100 mcg oral misoprostol, which was repeated after 6 h if labor did not start. Either a third dose or diluted oxytocin infusion were given in intractable cases. Diluted oxytocin infusion was used for augmentation. Controls were nulliparas delivered at > or =35 weeks by elective cesarean section. The two groups were comparable in most aspects, except for fetal malpresentation, which was the major reason for avoiding induction. Of the 69 patients in whom labor was induced, 53 (76.8%) had a vaginal birth, 3 (4.3%) had a combined twin delivery, and 13 (18.8%) had a cesarean during labor. The mean length of stay of the neonates was significantly shorter among study cases, without significant difference in the frequency of delayed discharges as an overall proxy for neonatal complications. Labor induction with oral misoprostol could be offered to patients in whom near term vaginal twin delivery is unequivocally permitted and wish to deliver by the vaginal route.

Administration, Oral↗
PubMed1984

Further study of the inhibition of premature labor by indomethacin. Part I.

Prematurity still remains one of the unsolved problems in obstetrics and is responsible for a majority of cases of perinatal morbidity and mortality. The use of indomethacin to stop uterine contractions and prevent premature delivery is based on the observation that indomethacin inhibits the release of prostaglandin which is assumed to play a role in the induction and continuation of labor. The effect of indomethacin as an antagonist to prostaglandin was evaluated in a series of 297 women in premature labor. The gestational age at admission varied between 24 and 34 weeks of pregnancy (120 primiparas and 177 multiparas). In 83% of cases there was complete cessation of labor for a period of 1 to 12 weeks, in 10% of cases from 2 to 7 days and in 7% there was no effect. The delay of premature labor for 2 to 7 days allowed the administration of betamethasone in an attempt to improve fetal lung maturity. The total daily dose needed for successful treatment was between 200-300 mg indomethacin. Dilation of cervix beyond 4 cm was associated with successful treatment in 58% compared to 90% if cervix was dilated 3 cm or less. In comparing women with intact membranes to women with ruptured, the success rate in suppressing premature labor was significant; 88% versus 53%. In 49 patients delivery was delayed 11-12 weeks. Fifty-one babies were born in spite of therapy, and of these 15 with birth weights of 700-1500 g suffered from respiratory distress syndrome and died. All the rest (36 premature and 246 mature infants) showed no ill effects related to the treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

An application of the Markov process for quantitative prediction of labor progress.

To quantitatively predict the progress of labor, we devised a mathematical model suitable for the Markov process. Included were 625 primiparas who went into spontaneous labor between 37 and 41 weeks of gestation with a cephalic presentation. When applying the Markov process, the sequence of labor was divided into eight categories from 4 cm cervical dilatation to delivery of the baby. Based on all data collected, a transition matrix was calculated, using a microcomputer system, in which the value in each element showed the percent of probability of progression in labor from one given state to another over a 30-minute period. This matrix was found to be available for evaluating the course of labor in clinical practise with a good predictive value and therefore the Markov process could be confirmed to be actually applicable as an analytical model.

Female↗
PubMed1990

Quantitative relationships between pain intensities during labor and beta-endorphin and cortisol concentrations in plasma. Decline of the hormone concentrations in the early postpartum period.

In 38 women with uncomplicated vaginal delivery at term, the different pain intensities during spontaneous labor were correlated to the plasma beta-endorphin and cortisol concentrations simultaneously examined. The pain intensities subjectively assessed were numerically categorized. The women in labor categorized to pain intensities 0 to III were in comparable stages of cervical dilatation. The hormone concentrations were measured by means of radioimmunoassay. The lowest hormone levels were found after abolition of pains of labor by epidural anesthesia: beta-endorphin 42 pg/ml, cortisol 318 ng/ml (mean values). The hormone concentrations rose progressively with increasing intensities of labor pain. The highest concentrations were observed in the first few minutes after delivery i.e. immediately after cessation of the extreme pains of expulsive labor: beta-endorphin 118 pg/ml, cortisol 449 ng/ml. Statistically significant, positive correlations were calculated between beta-endorphin and cortisol concentrations in plasma and the self-reported pain intensities (p less than 0.001 and p less than 0.01 resp.). Thus, highly elevated beta-endorphin levels in plasma do not abolish pain, probably they modulate it. Within the first four hours postpartum the concentrations of the two stress-stimulated hormones dropped rapidly. The endorphin level fell from 118 pg/ml immediately after delivery to 38 pg/ml in the above mentioned period, the cortisol level from 449 ng/ml to 302 ng/ml. One to three days after delivery the beta-endorphin and cortisol concentrations in maternal plasma were largely normalized, this means they then approximately corresponded to the values being found in nonpregnant women under normal conditions.

Adrenal Cortex↗
PubMed1997

External four channel tocography in preterm labor. First results.

In order to known more about preterm labor the objective of our investigation was to look for a correlation between the spatial and temporal pattern of uterine contractions and the duration of pregnancy. 50 patients with preterm labor between 21 and 35 weeks of gestation underwent repeated measurements using four-channel tocography in which the pressure of contractions was registered simultaneously on the left and right sides at the fundus and the lower segment of the uterus. Half of all recorded signals were locally restricted (typical labor pattern in only one or two registration tracks). The following two phenomena were significantly associated with a shorter duration of pregnancy: 1. the reproducibility of a center of dominance (defined as the locus of registration with the highest sum of amplitudes), and 2. a predominant origin of labor in the right fundal region of the uterus. Four-channel tocography indicates whether preterm labor is likely to lead to preterm delivery. It may therefore help the obstetrician in deciding whether to use tocolytic therapy.

Adolescent↗
PubMed1997

Fetal heart rate (FHR) pathology in labor related to preceeding Doppler sonographic results of the umbilical artery and fetal aorta in appropriate and small for gestational age babies. A longitudinal analysis.

The aim of this study was to ascertain the value of serially performed Doppler sonographic measurements of fetal vessels for the prediction of FHR alterations in labor a longitudinal analysis was conducted. 24 patients with SGA fetuses as the only risk factor and 38 patients without any risk factor were recruited for the study. Flow velocity waveforms of the fetal aorta and the umbilical artery were analyzed for systolic diastolic (S/D) ratio weekly at 20-39 weeks gestation and from 30 weeks gestation onwards twice weekly. Courses were related to complications during labor reflected by alterations of FHR tracings. The more numerous pathologie S/D ratios of both fetal vessels were recorded the more frequently complications in labor occurred (Chi Square test, p < 0.05). The mean value of the S/D ratios in fetuses with FHR pathology in labor differed significantly compared to the uncomplicated group (Wilcoxon rank sum test, p < 0.05). The fluctuation of S/D ratios was greater in the complicated than in the normal group (Wilcoxon rank sum test, p < 0.05). A combination of parameters describing S/D ratios showed a sensitivity of 86% and a specificity of 19% for the fetal aorta and a sensitivity of 71% and a specificity of 91% for the umbilical artery. Serial Doppler measurements of the fetal aorta and the umbilical artery aid in predicting pathologic FHR alterations in labor and may be of benefit in antenatal care to ensure fetal well being particularly in cases of IUGR.

Aorta↗
PubMed1998

Treatment of preterm labor with the oxytocin and vasopressin antagonist Atosiban.

Oxytocin is involved in the regulation of preterm and term labor but the exact effect mechanisms are not fully understood. A regulatory action by vasopressin may also exist. The concentrations of oxytocin and vasopressin V1a receptors in myometrium from pregnant women are high before and in the beginning of labor both preterm and at term. Atosiban has high affinity for both these receptors and is a competitive oxytocin and vasopressin antagonist. The inhibitory effect of Atosiban on oxytocin induced activity on isolated myometrium correlates significantly with the concentration of the oxytocin receptors. Inhibition of preterm contractions with Atosiban was first reported by Akerlund et al 1987. Goodwin et al compared the effect of Atosiban to placebo in threatening preterm labor and the antagonist was in this trial significantly more effective than placebo in reducing the frequency of contractions (55% vs. 23%, p < 0.001). The same authors also reported successful tocolysis with the drug in actual preterm labor. Atosiban is currently in phase III of clinical development and seems to have the same effectiveness but fewer side-effects compared to beta-mimetics. These properties suggests that Atosiban may offer advantages over existing therapies in acute treatment of preterm labor.

Female↗
PubMed2006

[The effect of immersion baths on the length of childbirth labor].

The objectives of this experimental, randomized, controlled trial study were to evaluate the effect of immersion baths on the length of the first stage of childbirth labor and on the frequency and length of the uterine contractions. Data were collected in a philanthropic public maternity hospital of the city of São Paulo whose month average is 1,100 births. The sample was comprised of 108 women in labor--54 in the control group and 54 in the experimental group that had immersion baths. The results showed that immersion baths did not have any influence on the length of labor and on the frequency of uterine contractions. However, the length of contractions was statistically shorter in the experimental group (experimental 41.9 versus control 44.6 min). The conclusion was that immersion baths are an alternative for the woman's comfort during labor, since it provides relief to her without interfering on the labor progression or jeopardizing the baby.

Baths↗
PubMedDate not supplied

[New formulation of sublingual misoprostol (25 mcg) for induction of labor].

OBJECTIVES: To determine effectiveness and safety of sublingual misoprostol in tablets of 25 mcg, given every 6 hours for induction of labor in high-risk pregnant women hospitalized in two teaching hospitals in the Northeast of Brazil. METHODS: An open, non-randomized clinical trial was conducted, including 40 women with high-risk pregnancies hospitalized at "Maternidade-Escola Assis Chateaubriand" and "Instituto Materno-Infantil de Pernambuco". All of them had gestational age >or= 37 weeks, alive fetus with good vitality and Bishop scores <or= 7. A tablet of 25 mcg of misoprostol was administered every 6 hours, up to a maximum of 4, until active labor. Statistical analysis was performed using the public domain software Epi-Info 3.2.2. RESULTS: Active labor occurred in 100% of cases after misoprostol administration. The mean (+/-SD) induction-to-labor interval was 4.8(+/-3.8 hours. Interval from induction-to-delivery varied from 8 to 31 hours with 95% of the deliveries occurring in the first 24 hours with 75% of vaginal deliveries. The frequency of tachysystole was 12.5%. The women did not present relevant side effects neither were there any neonatal complications. CONCLUSIONS: The sublingual tablet of misoprostol of 25 mcg was shown to be effective for induction of labor in high-risk pregnant women. The efficacy and acceptability of this new route should be compared to vaginal administration of misoprostol in future prospective randomized clinical trials.

Administration, Sublingual↗
PubMed2003

Misoprostol versus oxytocin for labor induction in term and post-term pregnancy: randomized controlled trial.

CONTEXT: Misoprostol, a synthetic E1 methyl analog prostaglandin, is at present receiving attention as a cervical modifier and labor induction agent. However, there is still a need for better determination of its safety and effectiveness. OBJECTIVE: To compare intravaginal misoprostol versus intravenous oxytocin for cervical ripening and labor induction in pregnant women with unripe cervices. DESIGN: Randomized controlled trial. SETTING: The study was performed at the Leonor Mendes de Barros Maternity Hospital between November 1998 and December 2000. PARTICIPANTS: 210 pregnant women with intact membranes and indication for labor induction were selected. PROCEDURES: The women randomly received 25 g of vaginal misoprostol every 4 hours, not exceeding 8 doses (105 women), or oxytocin in a continuous infusion (105 women). MAIN MEASUREMENTS: The main parameters measured were: latent period, time from induction to vaginal delivery, delivery route, occurrence of vaginal delivery with time, occurrence of uterine tonus alterations, hypoxia and neonatal morbidity. To verify the statistical significance of the differences between the groups, the chi-squared, Student t and log-rank tests were used. RESULTS: There were no significant differences between the groups concerning conditions for labor induction, age, parity, race, marital status, family income, initial Bishop Index and number of prenatal visits. The cesarean section rate, latent period and period from induction to vaginal delivery were significantly lower for the misoprostol group. With regard to uterine tonus alterations, tachysystole was significantly more common in the misoprostol group. However, there was no difference in hypoxia and neonatal morbidity between the groups. CONCLUSION: 25 g of misoprostol used vaginally every 4 hours is safer and more efficient for cervical ripening and labor induction than oxytocin.

Abortifacient Agents, Nonsteroidal↗
PubMed1981

Possible role of prekallikrein in the mechanism of labor.

From the standpoint of labor mechanism, behavior of prekallikrein, a kinin-forming enzyme, during pregnancy and labor has been of great importance. Plasma prekallikrein determined by synthetic chromogenic tripeptide substrate was increased with advancing gestational ages, reaching approximately 200% of normal. When labor started, it decreased rapidly to 70%, then returned gradually to the normal level after delivery. Prekallikrein and kininogen are only two plasma proteins which change so markedly during labor among many plasma proteins. Role of prekallikrein in the mechanism of labor is presumptively as follows: (1) Prekallikrein is converted to kallikrein resulting in its consumption and decrease. (2) Kallikrein contributes to uterine contraction by liberating kinin from kininogen.

Female↗
PubMed1982

Pain relief in labor by transcutaneous electrical nerve stimulation. Testing of a modified stimulation technique and evaluation of the neurological and biochemical condition of the newborn infant.

In this prospective randomized study of pain relief in labor, the effect of transcutaneous electrical nerve stimulation (TNS) performed over both the low-back and suprapubic region was evaluated and compared with a control group not receiving TNS. Both high frequency and pulse train TNS were used. The study included 24 induced labors. In the TNS group, conventional methods were added when needed, while in the control group only conventional methods were used. Assessment of low-back and suprapubic pain was performed by the parturient each hour during the first stage. In the TNS group most of the parturients reported minimal or moderate low-back pain throughout labor, while parturients in the control group reported an increased intensity of low-back pain as labor progressed. The effect of suprapubic pain was insignificant in both groups. Neither TNS nor nitrous oxide-oxygen mixture and pethidine could reduce this pain component. Course of labor, uterine activity and fetal heart patterns were similar in the two groups. The neonates were evaluated with Apgar score, assays of blood samples from the umbilical vein including blood lactate, plasma hypoxanthine and blood gas, and neurobehavioral assessment on two occasions. All newborn infants were in good condition and no significant differences between the two groups could be demonstrated.

Anesthesia, Obstetrical↗
PubMed1983

Serial plasma oxytocin levels during pregnancy and labor.

Maternal plasma oxytocin levels during pregnancy and labor were measured by a sensitive and specific radio-immunoassay. The mean plasma oxytocin concentration in maternal peripheral plasma showed a gradual rise towards term, reaching 12.5 microU/ml in term subjects without labor contractions. This level was not significantly different from the mean value in the 1st stage of normal spontaneous labor (12.6 microU/ml). Brief fluctuations in plasma oxytocin levels of considerable degree, and sometimes spurt release, were observed in labor and at term, but not in the mid-trimester, in serial samples collected at short intervals (about 10 sec). In normal spontaneous labor, no obvious relation was observed between the plasma oxytocin level and the uterine contraction period, and no significant difference was found between the mean value in uterine contraction periods (12.1 microU/ml) and that in relaxation periods (11.5 microU/ml).

Female↗
PubMed1988

Decrease in serum concentration of 5 alpha-pregnane-3,20-dione prior to spontaneous labor.

Serum 5 alpha-pregnane-3,20-dione (5 alpha DHP) and progesterone (P) concentrations before spontaneous labor were studied in 13 women whose pregnancy and delivery were uncomplicated. Blood samples were drawn twice weekly from the 36th week of gestation up to the onset of spontaneous labor. P and 5 alpha DHP values were analysed by applying RIA methods. Mean serum 5 alpha DHP concentrations declined significantly during the last week of pregnancy, from 135 +/- 12 nmol/l 5 days prior to spontaneous labor, to 111 +/- 10 nmol/l on the day spontaneous labor started (p less than 0.005). No significant changes in progesterone concentration occurred during the observation period. These results suggest a change in 5 alpha DHP production preceding the onset of spontaneous labor.

5-alpha-Dihydroprogesterone↗
PubMed1990

The effect of delayed pushing in the second stage of labor with continuous lumbar epidural analgesia.

We studied primigravid women in spontaneous labor at term and given epidural analgesia. Two hundred such women giving birth in 1983 were compared with similar groups who gave birth in 1985 and 1987 after the introduction of 'delayed pushing' into our labor ward protocol. Four hundred controls were obtained in 1983 and 1985 by selecting from the labor ward register the next normal primigravid woman in spontaneous labor without epidural analgesia. The assisted delivery rate was significantly higher in all three epidural groups than in the controls (p less than 0.001). Among epidural labors, there was no significant difference between 1983 and 1987 in the incidence of rotational or non-rotational forceps, or of cesarean section. In each epidural group, women who waited more than 60 min were less likely to experience a normal spontaneous delivery than were those who did not (p less than 0.001 in 1983; p = 0.006 in 1985 p = 0.035 in 1987). We conclude that to delay pushing beyond 60 min confers no benefit regarding mode of delivery.

Adult↗
PubMed1991

A circadian variation in the observed duration of labor. Possible causes and implications.

UNLABELLED: The distribution of the duration of labor during the day was analyzed. MATERIAL: A one-year material consisting of 1,881 deliveries at the Department of Obstetrics, Regional Hospital of Trondheim, Norway. Only singleton pregnancies with spontaneous onset of contractions and intended vaginal delivery were included. Duration of labor was routinely recorded by the midwife. METHODS: Stepwise multiple regression. Logarithmic transformation of the dependent variable (duration measured in hours) was applied. Parity (0/1+) and hour of birth were the independent variables. RESULTS: The variable indicating delivery during the night (0 to 08) contributed significantly to explain the variation in the duration of labor, in terms of a decrease in the median duration. The effect is substantial, median duration of labor 1.2 h shorter than for deliveries during the day. The variable indicating delivery during the evening (16-24) did not reach the required level of significance (0.05). This reflects a clustering of cases with longer duration of labor, unfavourable progress and less good prognosis during the latter half of the day, which has practical implications for the obstetrical staff. This may explain the similar circadian pattern in perinatal mortality which has been repeatedly documented, the etiology of which has remained enigmatic.

Circadian Rhythm↗
PubMed1991

Open randomized comparison of prostaglandin E2 given by intracervical gel or vagitory for preinduction cervical ripening and induction of labor.

Intracervical application of prostaglandin E2 (PGE2) in a viscous gel was compared with conventional wax-based PGE2 vagitories (pessaries) for ripening of the cervix prior to induction of labor. A total of 226 healthy pregnant women at term were randomly allocated to receive intracervical gel with an effective dose of 0.5 mg (n = 116) or vagitories containing 2.5 mg PGE2 (n = 110). All women had a modified cervical score of less than or equal to 4. The numbers of cases contributed by each of the three centers were similar. There was no significant difference in parity, gestational length, maternal characteristics, indications for induction or preinduction cervical scores between the treatment groups. The rate of spontaneous birth was 71% in the gel group, compared with 69% in the vagitory group. Successful treatment was defined as active labor within 24 h or a change in cervical dilatation allowing artificial rupture of the membranes with subsequent progressive labor. The success rate was not significantly different in the gel group (82%) compared with the vagitory group (80%). There were no differences in the frequency of fetal distress, outcome of labor, assisted delivery rates or maternal side effects. The cervical scores were not different at 12 and 24 h after application. Intracervical gel and intravaginal application of PGE2 were similar in their efficacy and safety for ripening of the cervix and inducing labor at term.

Administration, Intravaginal↗
PubMed1993

Pushing method in the expulsive phase of labor. A randomized trial.

BACKGROUND: Pushing in the second stage of labor can be forced or follow the spontaneous urge to bear down. Recent studies have shown that spontaneous pushing results in a longer second stage, fewer CTG changes, higher arterial pH and less damage to the birth canal. METHOD: Randomized trial of spontaneous vs. forced pushing in 350 primiparous women. RESULTS: There was no difference between the randomized groups in duration of second stage of labor, umbilical arterial pH or damage to the birth canal. Of the women allotted to spontaneous pushing, 65.6% used the closed glottis technique for more than half the expulsive phase. When dividing the women into two groups according to the actual pushing technique used most, open or closed glottis, it turned out that women who used the open glottis technique had a shorter second stage of labor and gave birth to infants with lower birth weight. CONCLUSION: Recommending of spontaneous bearing down during the expulsive phase of labor did not result in a significant difference in duration of the second stage of labor, fetal arterial pH or less damage to the birth canal. Women who chose the open glottis technique had a shorter expulsive phase and gave birth to smaller infants than those who used the closed glottis technique.

Adult↗