Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “LABOR”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,603 records · Page 89Linked to original sources
PubMed1996

Local administration of prostaglandin E2 for cervical ripening and labor induction: the appropriate route and dose.

BACKGROUND: Although there are many comparative studies concerning the local administration of prostaglandin E2 gel for cervical ripening and labor induction, the safety, efficacy and the appropriate route and dose of the gel are still debated. PATIENTS AND METHODS: One hundred and ten women with high-risk pregnancy and unripe cervix received prostaglandin E2 gel 1 mg intravaginally (n=35), 2 mg intravaginally (n=36) and 0.5 mg intracervically (n=39), maximally three times at 6-hour intervals for cervical ripening prior to labor induction. The safety, efficacy and optimal dose were assessed. RESULTS: The 2 mg intravaginal gel and the 0.5 mg intracervical gel were equally effective and more effective than the 1 mg intravaginal gel in labor characteristics such as ripening time and cesarean section rate, but not in labor time. However, the failure rate (labor could not be induced) was highest in the intracervical group (10.3%) compared to the intravaginal groups (2.9% and 2.8%), although the differences were not statistically significant. In the two intravaginal groups three and five patients received the third gel application and one patient in both groups could not be induced. In the intracervical group the ripening of the cervix failed in all patients, who received the third gel. The neonatal outcome was uneventful in all groups. There were two cases of uterine hypertonus associated with fetal bradycardia, one in the intracervical and one in the 2 mg intravaginal group. Thus careful fetal monitoring is necessary. Furthermore, the vaginal route has the advantage of an easier technique of administration and obviously lower risk for inadvertent extraamnial instillation. CONCLUSION: We recommend the use of multiple applications of 2 mg intravaginal prostaglandin E2 gel as a safe, effective and easy method for preinduction cervical ripening in high-risk pregnancies. More than three gel applications hardly increase the efficacy.

Administration, Intravaginal↗
PubMed1996

Intraamniotic infection in patients with preterm labor and twin pregnancies.

BACKGROUND: Microbial invasion of the amniotic cavity plays a major role in the pathogenesis of preterm labor and delivery in singleton pregnancy. Nevertheless, this association is not well established among patients with multiple gestations. The purpose of our study was to explore the role of intraamniotic infection in the setting of twin pregnancies. METHODS: Consecutive women with twin gestations, intact membranes and preterm labor who underwent transabdominal amniocentesis under sonographic guidance. Amniotic fluid (AF) was retrieved from both sacs and cultured for aerobic and anaerobic microorganisms as well as for Mycoplasma species. Intraamniotic infection was defined as a positive AF culture for microorganisms. Mann Whitney U test or Student t-test or Fisher's exact test were utilized for analysis. RESULTS: Amniotic fluid was obtained from 74 patients. Sixty-eight women delivered prematurely (91.9%). Amniotic fluid culture results were positive for microorganisms in nine cases and all women with intraamniotic infection delivered prematurely as well as 59 (90.7%) patients with negative culture. Among the nine patients with intraamniotic infection, microorganisms were isolated from the presenting sac in five cases (55.6%), from both sacs in three patients (33.3%) and from the upper sac in the remaining case (11.1%). Patients with a positive AF culture had a more advanced cervical dilatation, a shorter interval amniocentesis-to-delivery and a higher incidence of clinical chorioamnionitis than those with a negative AF culture. CONCLUSIONS: The prevalence of intraamniotic infection and clinical and histological chorioamnionitis in twin pregnancies and preterm labor is similar to singleton pregnancies and preterm labor. Therefore, women with multiple gestations and preterm labor should be managed as singleton pregnancies.

Amniotic Fluid↗
PubMed1999

A randomized controlled trial of nonpharmacologic approaches for relief of low back pain during labor.

BACKGROUND: Low back pain is common during labor. Our randomized controlled trial compared the effectiveness of 3 nonpharmacologic approaches for relief of back pain. METHODS: A total of 34 women suffering from low back pain during labor were randomly assigned to receive 1 of 3 treatments: (1) intracutaneous sterile water injections (ISW); (2) transcutaneous electrical nerve stimulation (TENS); and (3) standard care, including back massage, whirlpool bath, and liberal mobilization. Women self-evaluated both intensity and affective dimensions of pain using visual analog scales. Their evaluations of control and satisfaction were assessed using adapted versions of the Labour Agentry Scale and the Labor and Delivery Satisfaction Index. RESULTS: Women in the ISW group rated the intensity and unpleasantness of pain during the experimental period significantly lower than women in the standard care group or the TENS group, (P = .001 and P = .003, respectively). Similar results were observed for intensity (P = .01) and unpleasantness (P = .03) of pain assessed just before delivery or request for an epidural. Mean pain intensity at 15 and 60 minutes after randomization was significantly reduced in the ISW group compared with the 2 other groups. There was no significant difference in the 3 groups in the level of control and satisfaction with labor and delivery, but less women in the ISW group indicated that they would like to receive the same treatment for back pain during another delivery. CONCLUSIONS: Intracutaneous sterile water injections are more effective than standard care (back massage, bath, and mobilization) or transcutaneous electrical nerve stimulation for relieving low back pain during labor.

Analgesia, Obstetrical↗
PubMed1981

Health care labor relations law--understanding the issues.

The 1974 amendments to the Labor Management Relations Act have created new problems of statutory interpretation in the rapidly evolving area of health care labor law. By including nonprofit hospitals under the auspices of the Act, the amendments have opened up a new area for unionization and have given rise to questions concerning the types of bargaining units that are appropriate in health care facilities. In the following article, the authors discuss these questions and other current issues in health care labor relations law. The issues include the determination of relevant bargaining units, the status of state nursing associations as labor organizations, and the ten-day strike notice requirement of the Labor Management Relations Act.

Health Occupations↗
PubMedDate not supplied

Corporate reorganization in the health care industry: the labor law implications.

Health care mergers, acquisitions, or the creation of new subsidiaries or satellite facilities have significant labor law implications. The National Labor Relations Board may disregard the independent corporate status of two related entities. Such "single employer" status may make a health care organization more susceptible to union organizing, to labor disputes, or to monetary liability for unfair labor practices. The Board may also allow employees at independent facilities of a single employer to organize and bargain as a single unit. Such a multifacility unit may result in employees of small outlying facilities being organized against their wishes. Similarly, the unit accretion theory of the Board allows employees of a newly acquired or newly created small facility to be merged into a larger, existing bargaining unit without an opportunity for an election. Finally, a health institution that acquires or merges with another facility may be obligated to assume and honor an existing union contract. Alternatively, the "successor" may be required to bargain with the union, but not to assume the union's contract. With the proper planning, however, the employer may have no obligation either to bargain or to assume the contract. The successor employer must also be concerned with its liability for unfair labor practices of the seller.

Health Facilities↗
PubMed1998

Spinal and combined spinal epidural techniques for labor analgesia: clinical application in a small hospital.

Providing safe and effective analgesia to laboring parturients presents a challenge to anesthesia providers in small hospitals. The necessary time commitment and additional staff needed to provide coverage for the obstetrical area can strain resources. Offering the spinal opioid block as the first choice for labor analgesia and the combined spinal epidural block in selected cases permits a labor anesthesia service to address the needs of the community hospital. Sufentanil injected into cerebral spinal fluid provides effective analgesia for 124 minutes. Adding 2.5 mg of bupivacaine further increases effective analgesia time to 170 minutes. The combined spinal epidural block offers the advantages of spinal opioid analgesia but with the flexibility of having an epidural catheter in place. The epidural catheter can be dosed intermittently for parturients in whom labor is prolonged, who require surgical manipulation for vaginal delivery, or who require cesarean section for delivery. By offering both blocks to laboring parturients, the appropriate block can be applied in each situation.

Analgesia, Epidural↗
PubMed1999

Induction of labor with mifepristone--a randomized, double-blind study versus placebo.

OBJECTIVE: To evaluate the efficacy of mifepristone in inducing labor in women with an unripe cervix, its effect on the cervix and on the status of the newborn. METHODS: In a prospective double-blind study, 36 post-term pregnant women with a Bishop score of 5 or less received either 400 mg mifepristone (n=24) or placebo (n=12). If, 48 hours after the treatment was started, labor had not begun or the Bishop score was 5 or less, the women were given 0.5 mg prostaglandin E2 intracervically, a treatment which was repeated 12 hours later, if necessary. RESULTS: During the first 48 hours following treatment, 19 (79.2%) of the women treated with mifepristone and two of the women (16.7%) treated with placebo went into labor. In addition, one and three women, respectively, had a ripe cervix at the end of the 48h period. The overall success rate was thus 83.3% for mifepristone and 41.7% for placebo (p=0.008; OR 14.8; 95% CI 2.1-107.6). The median time from the start of treatment to delivery was also shorter (mifepristone 36h23' and placebo 53h17'). Treatment with intracervical PGE2 was needed more often after the placebo. The duration of labor, however, tended to be shorter after placebo than after mifepristone in the women who delivered vaginally. The frequencies of instrumental delivery were similar in both treatment groups. The median Apgar score was slightly lower at 1 minute (p<0.05) following mifepristone treatment, but did not differ at 5 and 10 minutes. There was no difference between the two treatment groups in the umbilical pH at delivery. CONCLUSION: The results of the present study show that mifepristone is a simple and effective treatment for inducing labor in post-term women with an unripe cervix.

Adult↗
PubMed1999

Cervical ripening and labor induction with a controlled-release dinoprostone vaginal insert: a meta-analysis.

OBJECTIVE: To systematically review published randomized trials that compared efficacy of a 10-mg, controlled-release dinoprostone vaginal insert with other prostaglandins for cervical ripening and labor induction. DATA SOURCES: We supplemented a search of entries in electronic databases with references cited in original studies and review articles to identify randomized clinical trials of dinoprostone vaginal inserts for cervical ripening and labor induction. METHODS OF STUDY SELECTION: We evaluated, abstracted data, and assessed the quality of randomized clinical trials on the efficacy of dinoprostone vaginal inserts as cervical ripening and labor induction agents. Only published randomized trials were included in this meta-analysis. TABULATION, INTEGRATION, AND RESULTS: Seventeen studies were identified, eight of which met our criteria for metaanalysis. Those eight trials included 964 subjects, 490 of whom were allocated to dinoprostone vaginal inserts and 474 to other prostaglandin (PG) preparations. We calculated an estimate of the odds ratio (OR) and risk difference for dichotomous outcomes, using a random- and fixed-effects model. Continuous outcomes were pooled using a variance-weighted average of within-study difference in means. Compared with women who received other PG preparations, those who received dinoprostone vaginal inserts had lower incidence of vaginal delivery within 12 hours of PG application (OR 0.55, 95% confidence interval 0.39, 0.79). Vaginal inserts were associated with longer intervals to vaginal delivery and lower rates of active labor. There were no differences in cesarean delivery rates, incidence of hyperstimulation, or need for oxytocin augmentation between dinoprostone and other PGs. CONCLUSION: Dinoprostone vaginal insert was less effective than other prostaglandins for cervical ripening and labor induction.

Administration, Intravaginal↗
PubMedDate not supplied

Maternal intravenous administration of long chain n-3 polyunsaturates to the pregnant ewe in late gestation results in specific inhibition of prostaglandin h synthase (PGHS) 2, but not PGHS1 and oxytocin receptor mRNA in myometrium during betamethasone-induced labor.

OBJECTIVES: Both the onset of labor and time to delivery during betamethasone-induced delivery are delayed by omega-3 polyunsaturated fatty acid (PUFA) administration to pregnant sheep. That fatty acid also inhibits the labor-related increase in maternal plasma estradiol and maternal and fetal prostaglandin E(2). To evaluate the mechanism of inhibition of prostaglandin production and delay of onset of labor and time of delivery in PUFA-treated sheep, we determined the effect of PUFA on myometrial prostaglandin H synthase (PGHS) 1 and 2 and oxytocin receptor mRNA levels in betamethasone-induced labor. METHODS: At 124 days' gestation, a 20% emulsion of either intralipid (IL, n = 6) or PUFA (n = 6) was infused continuously (3 mL/kg per day) intravenously (IV) to the ewe. At 125 days' gestation, betamethasone was administered IV (10 microg/h over 48 hours) to fetuses of both intralipid- and PUFA-treated ewes. Myometrium was collected at necropsy either during betamethasone-induced labor as evaluated by myometrial electromyography or within 5 days of the termination of betamethasone infusion, if delivery did not occur after fetal betamethasone infusion. Total myometrial RNA was analyzed by Northern blot for oxytocin receptor and PGHS1 and 2 mRNA normalized for 18s. RESULTS: Treatment with PUFA decreased myometrial PGHS2 mRNA but did not alter myometrial PGHS1 and oxytocin receptor mRNA after betamethasone administration. CONCLUSIONS: This finding provides a mechanism whereby PUFA delays betamethasone-induced delivery in sheep and suggests a potential role of PUFA as an effective tocolytic agent in human pregnancy.

Animals↗
PubMed2000

[Premature labor with intact membranes: microbiology of the amniotic fluid and lower genital tract and its relation with maternal and neonatal outcome].

BACKGROUND: The prevalence of idiopathic spontaneous premature labor or without an evident clinical cause, has not been reduced with tocolytic treatments, suggesting that premature labor has multiple causes and infections play a not well-defined role. AIM: To perform microbiological studies of the amniotic fluid and of the lower genital tract in women with idiopathic premature labor and intact membranes, relating these findings with maternal and neonatal outcomes. PATIENTS AND METHODS: Women with pregnancies between 24 and 34 weeks, with premature labor and without an evident clinical cause were enrolled. Amniotic fluid and genital tract samples were obtained for traditional microbiological cultures. This information was related with delivery events and neonatal outcome. RESULTS: Sixty-three patients were included. The overall frequency of microbial invasion of amniotic cavity was 23.8% and of cervical or vaginal infection was 63.5% (in 39.7% there was only cervical or vaginal infection without involvement of the amniotic sac). Absence of infection was documented in 36.5% of women. Compared to patients without infection, women with microbial invasion of amniotic cavity had a higher rate of prematurity (73.3% p < 0.05), a higher rate of prematurity of less than 34 weeks (60% p < 0.01), a higher frequency of preterm rupture of membranes (40% p < 0.001), a shorter admission-to-delivery interval (median 3.0 days p < 0.01) and lower gestational age at delivery (median 33 weeks p < 0.01). Clinical chorioamnionitis and endometritis (20% p < 0.01) was observed only in patients with amniotic cavity infections. Severe asphyxia (26.7% p < 0.05) and neonatal admission to Intensive Care Units (46.7% p < 0.05) were more frequent and neonatal weight was less in the offspring of women with microbial invasion of amniotic cavity (2020 g median p < 0.01). CONCLUSIONS: In preterm labor with intact membranes, intraamniotic infection is the most frequent cause of prematurity and is associated with a higher prevalence of maternal and neonatal problems.

Adolescent↗
PubMedDate not supplied

Brain nitric oxide synthase expression is enhanced in the human cervix in labor.

OBJECTIVES: To determine whether brain nitric oxide synthase (bNOS) is expressed in human cervix, define its localization, and examine the possibility that it contributes to the nitric oxide (NO) pool and has a role in human cervical ripening. METHODS: Human cervical biopsy tissues were collected from four groups: (1) nonpregnant patients, (2) term nonlabor (cesarean delivery) patients, (3) term labor patients with cesarean deliveries, and (4) term labor patients (vaginal delivery). The mRNA expression was assessed using reverse-transcribed polymerase chain reaction and in situ hybridization. The protein expression was determined using Western blot and its localization was shown using immunostaining. RESULTS: Both bNOS mRNA and protein are present in human cervical tissue. They were localized to stroma cells and epithelial cells by in situ hybridization and immunostaining. bNOS protein expression in the labor group was significantly higher than in the nonlabor group (P <.05). CONCLUSION: bNOS is expressed in the human cervix and enhanced expression is observed in labor, suggesting its possible role in contributing to the NO pool in the human cervix, in cervical ripening, and in labor.

Blotting, Western↗
PubMed2001

[Usefulness of ultrasonography of the cervical canal in the screening of pregnant women at risk of premature labor].

BACKGROUND: Goal of the study is to evaluate the utility of cervical sonography in the second quarter as screening of pregnancies with risk of preterm labor. METHODS: A.A. evaluate, by transvaginal sonography (TVS) of the uterine cervix, 75 pregnancies with history of preterm labor and 25 with risk of preterm labor between XXIV and XXXIII week of pregnancy. The uterine cervix length < 40 mm and width > 5 mm, funneling were pathological and predictive factors of preterm labor. RESULTS: Eighty-five percent of pregnancies that have, at sonography TVG, abnormal values of length and width of uterine cervix, delivered before XXXVI week. CONCLUSIONS: These results confirm the importance of the high frequency ultrasonography transvaginal, TVS, for its predictive value and for treatment in pregnancies with risk of preterm labor.

Cervix Uteri↗
PubMed1998

[Effect of castor oil-diet on the initiation of labor of pregnant rat].

OBJECTIVE: This study was designed to explor the effect of castor oil-diet, on the intiation of labor of preganant rat and determine what the active component of castor oil-diet was. METHODS: The time of the intiation of labor and course of delivery were observed by gavaged rats castor oil-diet at 18, 19 and 20 days of gestation. The compositions of fat acid of castor oil-diet and castor oil were analyzed by HPLC. RESULTS: The castor oil-diet could induce the initiation of labor and shorte the course of the delivery in pregnant rats. Ricinoleic acid was the active component of castor oil-diet in this study. CONCLUSIONS: Pregnant rats by gavaged castor oil-diet could serve as the animal model for induction of labor. Ricinoleic acid is likely the chief component to the induction of labor.

Animals↗
PubMed2001

Review on prostaglandin and oxytocin activity in preterm labor.

The principal difference between term and preterm labor is how they are activated. It has been proposed that term labor results from physiological activation of the common terminal pathway, whereas preterm labor is a pathological condition caused by multiple etiologies that activate one or more of the components of this pathway. Increased uterine contractility at preterm labor results from activation and stimulation of the myometrium. Myometrium is stimulated by increased concentrations ofprostaglandins and oxytocin. Increased production of stimulatory prostaglandins by intrauterine tissues is generally considered a central component of the cascade of events leading to preterm parturition. Prostaglandins act to mediate cervical ripening and to stimulate uterine contractions and indirectly to increase fundally dominant myometrial contractility by up regulation of gap junctions, oxytocin and arginine vasopressin receptors and synchronizations of contractions. The authors tried to explain the role and influence of oxytocin in human parturition, as well as the novel therapy in inhibiting the contractions in preterm labor. The selective oxytocin inhibitor was tested in vitro on human myometrium and decidua by the author of this article among the first in the world.

Adult↗
PubMedDate not supplied

Advances in labor analgesia.

Approximately two-thirds of all women in the United States receive analgesia for labor and delivery. The ideal labor analgesic technique would confer complete pain relief without side effects to either the mother or the neonate. The analgesic technique would not cause any lower extremity motor blockade nor interfere with the progress or course of labor and would be sufficiently flexible to produce anesthesia for forceps or cesarean deliveries. Modern obstetric analgesia techniques and medications come close to achieving these goals. The following article will review current labor analgesia techniques and medications used during labor and delivery.

Analgesia, Epidural↗
PubMed2002

U.S. national trends in labor induction, 1989-1998.

OBJECTIVE: To examine the epidemiology of labor induction in the United States. STUDY DESIGN: We used U.S. natality data from 1989 to 1998 and examined the rate of labor induction by year, geographic region, maternal characteristics and pregnancy complications. RESULTS: Between 1990 and 1998, the rate of labor induction increased from 9.5% to 19.4% of all births nationwide. However, the induction rate varied widely by state. White race, higher education and early initiation of prenatal care were associated with a higher rate of induction. For all gestational ages, a significantly increased induction rate occurred during the study period. The increase for clinically indicated induction was significantly slower than the overall increase, suggesting that elective induction has risen much more rapidly. CONCLUSION: The rate of induction of labor more than doubled in the U.S. nationwide in the decade from 1989 to 1998. The increased use of labor induction may be attributable to both clinically indicated and elective induction.

Adolescent↗
PubMed2001

[Oxytocic use and duration of labor under peridural ambulatory analgesia].

OBJECTIVE: Extradural analgesia is associated with an increase duration of labor and oxytocin use. MATERIAL AND METHODS: We conducted a study of walking during active labor under extradural analgesia among 41 women. This group, with uncomplicated pregnancies, was similar to associate with a usual-care group according to the following criteria: maternal age, parity, gestational age, Bishop's score at the admission, and labor entrance mode. Analgesia was performed by using combined spinal-epidural analgesia and patient controlled extradural analgesia. Fetal heart and uterine contractions were continuously monitored using Telemetry. Anesthetic and obstetrical parameters were noted every hour. The main criteria were length of labor and oxytocin consumption. Statistical analysis was performed using Student's t-test and Fischer's exact test. RESULTS: Duration of the 1st and 2nd stage of labor, and oxytocin consumption were not statistically different in the two groups, neither was mode of delivery. No neonates had an Apgar score less than 5 at one minute. Parturients walked about 2 h 30 for about 2,000 m. CONCLUSION: Obstetrical parameters and oxytocin consumption are not modified during walking extradural analgesia. No maternal or neonatal adverse effects were noted in our study.

Analgesia, Epidural↗
PubMed2002

[Evaluation of fetal oxygen saturation (FSpO2) during the course of underwater labor].

During controlled, randomized prospective trials, fetal arterial hemoglobin saturation (FSpO2) was estimated during 25 underwater labors and compared to results obtained from 34 classical deliveries. Mean fetal hemoglobin saturation during the first stage of labor was similar in both groups while a gradual decreasing trend in fetal FSpO2 was noticed throughout the progress of labor. In the second stage of labor higher mean FSpO2 values were observed in the group of fetuses born underwater. The author emphasized in discussion that underwater labor constitutes delicate and mild procedure particularly for the fetus.

Delivery, Obstetric↗