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PubMed2006

Impact of abnormal results of outpatient fetal heart rate monitoring on maternal intervention in labor.

OBJECTIVE: To conduct a retrospective, cohort study to determine the impact of abnormal outpatient fetal heart rate (FHR) testing on maternal interventions in labor, including labor induction, operative vaginal delivery and unplanned cesarean section. STUDY DESIGN: Our cohort consisted of 1,386 women with singleton gestations who had outpatient fetal nonstress testing within 1 week prior to giving birth etween 1993 and 1998. Antepartum FHR records were interpreted as reassuring or nonreassuring, and pregnancy records were abstracted for background medical information, labor interventions and pregnancy outcomes. Logistic regression models were used to describe the association between abnormal outpatient monitoring results and maternal interventions in labor. RESULTS: After adjusting for potential confounders (maternal age, race, prior history of cesarean section, antepartum indications for monitoring, fetal presentation and abnormal fetal heart rate patterns in labor), women with nonreassuring monitoring were 90% more likely to undergo induction. The 2 groups were similar in operative vaginal delivery rates, but pregnancies with nonreassuring testing were more than twice as likely to end with an unplanned cesarean section. CONCLUSION: Abnormal outpatient antenatal FHR testing may be independently associated with an increased risk of unplanned cesarean section.

Adult↗
PubMed2006

[Analysis of premature labor and its causes in the Republic of Georgia].

The premature labor is the main index of perinatal morbidity and mortality of mother and newborn. The aim of our trial was, to study the real situation on premature labor in the Republic of Georgia, to determine the specific gravity of stress factors in epidemiology of this problem and to find optimal preventive measures. It is found that in those regions, which are close to military conflict areas, where people are under permanent "expectancy-stress", the rate of premature labor is significantly higher. We have found that the rate of premature labor in the Republic of Georgia is about 11.2%+/-2.1. 75% of still-born babies are premature. The rate of perinatal mortality for the last 3 years was 28.9, where about 75.3% is due to preterm labor. Stress endured by a pregnant woman affects psycho-emotional sphere of a newborn, which is revealed in its high neural reflex excitement. Chronic stress in a pregnant woman causes retention of the fetus development which later results in prenatal hypotrophy and morphofunctional immaturity.

Adult↗
PubMed2006

[Characteristics of uterine contraction and stages of labor under continuous epidural block anesthesia].

OBJECTIVE: To observe the characteristics of uterine contraction and stages of labor during delivery under continuous epidural block anesthesia. METHODS: Totaling 213 parturients in spontaneous labor under epidural block anesthesia with dilated cervical orifice of 3 cm were monitored for the contraction cycle, duration, intensity and curve types of uterine contraction, and recordings were made for 30 min before and 30, 60 and 120 min after the anesthesia took effect, respectively. The duration of the active phase in the first, second and third stages of labor was compared between 421 cases with anesthesia and 237 without anesthesia. RESULTS: Significant difference was noted in the objective indexes of uterine contraction recorded after anesthesia had taken effect (P<0.05) in comparison with those before anesthesia, suggesting significantly attenuated uterine contraction after anesthesia, whereas these indexes underwent no significant further variation as compared between different time points after anesthesia (P>0.05). The average active phase in the first stage was significantly shorter in anesthesia group than that in the control group (P<0.05), but the average duration of the second and third stages of labor differed little between the two groups with appropriate use of oxytocin under strict monitoring (P>0.05). The rates of obstetric forceps utilization and use of oxytocin were higher in anesthesia group than in the control group (P<0.05). CONCLUSION: Epidural block anesthesia produces certain influences on uterine contraction and stages of labor during delivery, for which appropriate treatment measures may prove beneficial.

Adult↗
PubMedDate not supplied

[Comparison of prostaglandin E2 and oxytocin infusions for induction of labor in primiparas at term with an unripe cervix and premature rupture of fetal membranes].

The study aimed at examining the effectiveness of labor induction in term pregnant nulliparas with the premature rupture of the membranes (PRM) and unriped cervix (Bishop less than 6). Each group contained 17 nulliparas. In the first group the labor was induced with the prostaglandin E2 (PgE2) infusion, in the second group the oxytocin infusion was used. The results of both groups were compared. PgE2 was found to be effective in labor induction; the rate of caesarean sections was 18.75% in the first group and 29.41% in the second group. The PgE2 drug was found to be safe for the fetus and also well tolerated by pregnant women. The effect of the drug on the ripening of the cervix has not been noticed. The time interval from the induction of labor to the delivery is equal in both groups. However, in the first group significantly less work was done by the uterus at the same interval. No incidence of uterine hyperactivity was recorded. All newborns in the first group were in good condition: in the second group two cases of fetal distress were recorded. The pregnancy outcome shows that the PgE2 drug is superior to oxytocin for labor induction in term pregnant nulliparas with the PRM and unriped cervix.

Cervix Uteri↗
PubMed1991

Retrospective study of fetal effects of prolonged labor before cesarean delivery.

Rising cesarean rates call for review of the indications for this procedure. Suspicion that subtle operatives, not reflected in morbidity and mortality rates, might be present inspired the study presented here. Three hundred fifty-two cesarean operations were done at Huron Road Hospital in the years 1952-1954. Examination of family records identified 97 probands delivered by cesarean after prolonged active labor before or during that period. Research efforts yielded 54 cases that were free of complications and had full historic data for both proband and sibling(s) of the same parentage, totaling 122 children. The intelligence quotient (IQ) scores of these families compared with that of the proband undergoing successive hours of labor suggested a detrimental effect of increasing length of trial labor. Statistical analyses of the 30 families in which the probands' trial labors exceeded 12 hours support that notion, as the probands had significantly lower IQ scores than their siblings born by elective cesarean with no labor (P = .006 to P less than .001). Probands had the lowest IQ scores in their families significantly more often (P less than .025) than could be expected to occur randomly. A similar pattern of school success occurred within the families.

Cesarean Section↗
PubMed1990

Objective tocodynamometry identifies labor onset earlier than subjective maternal perception.

The ability of women instructed in self-detection of uterine contractions to identify the abrupt rise in uterine activity known to precede the onset of labor has not been evaluated. This study was designed to assess the temporal relationship between objective uterine activity monitoring, subjective maternal perception of uterine activity above a commonly used threshold value (four or more contractions per hour), and progressive cervical change. Daily tocodynamometry (7-9 AM) was recorded in 79 women with preterm premature rupture of the membranes from admission until the onset of spontaneous labor (5.3 +/- 6.3 days). The subjects were at bed rest, received no tocolytic therapy, and were instructed in the signs of labor and uterine self-palpation. Patients simultaneously provided a subjective assessment of uterine activity (four or more contractions per hour). The majority of uterine activity recordings (78%) revealed fewer than four contractions per hour, and the patients' subjective reports agreed in almost all instances (97.6%). On 91 days, four or more contractions per hour were recorded objectively, but the patients' subjective reports agreed in only 25 instances (27%). On the day of labor onset, significantly more women had an objective assessment (32%) (P less than or equal to .01). Patients subjectively identified labor onset 10.6 +/- 6.7 hours after objective monitoring indicated increased uterine activity, and when subjectively identified, both cervical dilatation (4.9 +/- 2.5 cm) and effacement (85 +/- 30%) were significantly advanced (P less than or equal to .001) compared with the admission examination (1.1 +/- 1.2 cm; 20 +/- 30%).(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiotocography↗
PubMed1990

[The prostaglandin E content of the blood serum in mother and fetus during the reflex regulation of premature labor].

Prostaglandin (PG) biosynthesis is promoted by enzyme activation induced by neurohormonal regulation, an important determinant of labor. However, contribution of PG to premature labor is largely uncertain. Maternal and fetal blood PGE levels have been determined during the reflex regulation of premature labor in 39 women and in 20 patients with spontaneous labor. The reflex regulation was performed as transcutaneous suprapubic and sacral electric stimulation. Comparison of PGE levels in the women and their newborns led to the conclusion that the reflex regulation of premature labour has modulating effects on PGE biosynthesis both in the mother and fetus, thereby modifying progress of labor.

Adolescent↗
PubMed1990

A prospective comparison of hourly and quarter-hourly oxytocin dose increase intervals for the induction of labor at term.

Fifty-two women undergoing labor induction and vaginal delivery at term were randomized between two oxytocin infusion protocols, involving hourly versus quarter-hourly increases in dose. Potential differences were sought of duration of labor, amount of uterine activity generated, and amount of oxytocin required. Starting at 0.5 mU/minute, oxytocin infusion was increased regularly in small increments every hour or every 15 minutes, according to group assignment. No differences were observed in potentially confounding clinical and demographic factors between the groups, including time to ruptured membranes. There were no clinically or statistically significant differences found for the duration of any phase or stage of labor, quantitative assessment of uterine activity, incidence of hyperstimulation, or neonatal outcome. The average dose of oxytocin used was lower in the hourly than in the quarter-hourly, protocol (4.4 versus 6.7 mU/minute; P less than .005). Significantly fewer patients on the hourly protocol required a maximum infusion rate exceeding 8 mU/minute (P less than .05). More patients on the hourly protocol either had oxytocin discontinued completely or were maintained at 4 mU/minute or less during the active phase of labor (P less than .05 and P less than .001, respectively). We conclude that a slower rate of increase in oxytocin administration via continuous infusion results in no prolongation of any phase of induced labor, while permitting lower infusion rates of the drug.

Drug Administration Schedule↗
PubMed1990

The influence of birth weight on labor in nulliparas.

The purpose of this study was to examine the hypothesis that dystocia in nulliparas is directly related to birth weight. The study was confined to the first 1000 nulliparas delivered in 1988 who went into labor after 37 weeks' gestation with a single live fetus and cephalic presentation. The management of labor was standardized. As birth weight increased, there was an increase in the mean duration of labor and of the second stage of labor, in the incidence of oxytocin augmentation, and in the incidence of both cesarean and forceps delivery for dystocia. The direct relationship between birth weight and the mean duration of labor was independent of gestation and oxytocin augmentation. These findings suggest that birth weight is an important factor in the development of dystocia in nulliparas.

Birth Weight↗
PubMed1990

Changes in amniotic fluid concentrations of prostaglandins E2 and F2 alpha in women with preterm labor.

There is a paucity of data regarding the concentration of prostaglandins (PGs) in the amniotic fluid of women with preterm labor. The purpose of this study was to determine if preterm labor is associated with changes in amniotic fluid concentration of prostaglandins E2 and F2 alpha. Amniotic fluid was retrieved by transabdominal amniocentesis from women with preterm labor and intact membranes. Patients were classified into three groups according to the response to tocolysis and the presence or absence of intra-amniotic infection. PGE2 and PGF2 alpha were measured using specific and sensitive RIA kits. Amniotic fluid concentrations of PGE2 and PGF2 alpha were significantly higher in women with preterm labor and intra-amniotic infection than in women without infection, regardless of the response to tocolysis. These data suggest that both PGs are involved in the mechanism of preterm labor and may have prognostic value.

Amniotic Fluid↗
PubMed1990

A randomized trial of amniotomy in active labor.

The role of amniotomy in active labor is controversial because of contradictory data and a paucity of randomized studies. A randomized trial was conducted on the role of amniotomy in spontaneous labor. Fifty-three women who were admitted to the Family Medicine Service in active labor were randomly assigned to receive amniotomy (n = 26) or no amniotomy (n = 27). Amniotomy shortened the time from randomization to delivery by 143 minutes (t = 2.3, P less than .05, 95% confidence interval [CI] = 19-265). After adjusting for possible confounders, the effect of amniotomy was to shorten labor by 155 minutes (CI = 9-301). The effect of amniotomy on labor was not found to be related to parity or cervical dilatation. Amniotomy had no apparent effect on Apgar scores or use of analgesia.

Adult↗
PubMed1989

[Incidence of premature labor, characteristics of its course and optimization of management in areas with high birth rates].

Based on retrospective study of 9671 labor histories and prospective investigation of 90 females whose pregnancy ended in preterm labor, the authors concluded that in their region the incidence rate of premature delivery was 4.37 per cent (5.02 per cent in the rural and 3.78 in urban areas). In case of high parity, this value was twofold higher. Premature labors were not infrequently complicated by an early rupture of amniotic fluid sac (36.6 per cent), continuous waterless period (20.0 per cent), fetal asphyxia, etc. If indicated, perineotomy is to be applied to multiparous females and those with short inter partum periods. Intensive handling of preterm labor should be a method of choice in case of uterine inertia, infections, signs of fetal well-being risk, extragenital pathology. Rationalized management of premature labor reduces the incidence of hemorrhages, pathologic parturition and the rate of perinatal mortality.

Adult↗
PubMed1988

Oxytocin-induced labor characteristics and uterine activity after preinduction cervical priming with prostaglandin E2 intracervical gel.

Labor characteristics and quantitation of uterine activity resulting from oxytocin induction of labor after intracervical prostaglandin E2 (PGE2) gel priming have not been previously reported. Forty-seven women with modified Bishop scores of 5 or less received preinduction priming with 0.5 mg of intracervical PGE2 gel. Oxytocin was used to induce labor after priming, and uterine activity was quantitated. A matched group of control patients was managed identically but did not receive PGE2 gel. In the gel group, modified Bishop scores improved significantly and in two patients (4%), priming alone induced labor. No uterine hyperstimulation or fetal heart rate abnormalities occurred during priming. Cesarean sections for all indications and those for failed induction were less common in the gel group. The length of the active phase and the second stage of labor were significantly shorter in the gel group. Uterine activity was similar in both groups. The data suggest a primary cervical action of the gel.

Adult↗
PubMed1988

Intermittent weekly contraction monitoring to predict preterm labor in low-risk women: a blinded study.

To assess the predictive value of uterine activity as a marker for subsequent preterm labor, 139 black, inner city women were monitored at least three times for 1 hour between 28-32 weeks' gestation using a portable tocodynamometer. All had singleton gestations and gave no previous history of preterm labor or delivery. They were monitored between 8 and 10 AM while sitting in the clinic waiting area. Uterine activity records, numbered randomly, were transmitted by telephone to a site remote from the hospital. No one having any clinical contact with the participants saw or received feedback regarding the contraction data. Tocodynamometry records were then mailed to another center where they were read by one investigator blinded to all clinical information. The mean contraction frequency during the single hour of weekly testing was significantly greater for the 16 women who developed preterm labor than for women who delivered at term at each point between weeks 28-32. Using greater than six contractions per hour on at least one occasion between 28-32 weeks' gestation as a predictor would have identified 12 of 16 women (sensitivity 75%) who subsequently developed preterm labor. This contraction frequency was noted in 26 of 123 women (21%) who labored at term (specificity 79%; P = .0003).

Female↗
PubMed1988

Breast electrostimulation for the induction of labor.

The use of breast stimulation to promote cervical ripening and initiate labor has been studied frequently. However, the various mechanical methods that have been suggested cannot be adequately controlled by the physician. We studied breast electrostimulation as a controllable method of initiating labor in 21 women. This technique successfully induced labor in 15 women, including all nine with premature rupture of membranes. The six (of 12) women without premature rupture of membranes who failed to go into labor each had a Bishop score of 4 or less. All of the successfully induced women delivered vaginally. The time interval from the start of stimulation to birth ranged from 2-13.5 hours, and all infants were born in good condition. Uterine hyperactivity occurred in five cases, but was controlled easily by adjusting the electrical variables of the stimulation. Further work will be needed to establish clearly the indications and safety of breast electrostimulation for induction of labor.

Breast↗
PubMed1988

Microorganisms and premature labor.

A number of organisms, including Mycoplasma, group B Streptococcus, Bacteroides, Neisseria gonorrhoeae and Chlamydia trachomatis, have been isolated more frequently from patients in premature labor than from controls. Prophylactic antibiotic treatment in some studies lowered the incidence of prematurity. Silent chorioamnionitis has been noted in 15% of patients in premature labor. Untreated pyelonephritis is clearly associated with premature labor; however, the association of asymptomatic bacteriuria, appropriately treated pyelonephritis and premature labor is less clear. Some microorganisms have been demonstrated to produce phospholipase A2 and possibly prostaglandins, which might be the mechanism for some of the associations between premature labor and bacteria.

Anti-Bacterial Agents↗
PubMed1988

High spontaneous premature labor rate in insulin-dependent diabetic pregnant women: an association with poor glycemic control and urogenital infection.

The incidence of spontaneously occurring premature labor in insulin-dependent diabetic pregnancies is unclear, because previous studies have been confounded by a high rate of iatrogenic prematurity. The purpose of this study was to determine, in a large population of insulin-dependent diabetic pregnant women, the rate of spontaneous occurrence of premature labor and the various factors that may affect it. We hypothesized a priori that spontaneously occurring premature labor occurs at a high rate in insulin-dependent diabetic pregnant women, mainly because of poor control of diabetes during pregnancy, and is related to the presence of polyhydramnios and hypomagnesemia. One hundred forty-five insulin-dependent diabetic women undergoing 181 pregnancies were recruited since 1978 in an interdisciplinary prospective study. The goals of glucose control were a fasting blood glucose less than 100 mg/dL and a 90-minute postprandial glucose less than 140 mg/dL. The rate of spontaneous premature labor, 31.1%, was significantly higher (P less than .01) than that in a control population managed by the same obstetricians in similar clinical settings (20.2%). The following variables were not significantly associated with the onset of premature labor: maternal age, parity, gravidity, diabetic class according to White, presence of renal disease or retinopathy, previous elective abortion, chronic hypertension or pregnancy-induced hypertension, cigarette smoking, first-trimester or post-20 weeks' gestation vaginal bleeding, maternal serum magnesium concentration, or polyhydramnios.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Trial of labor in previous cesarean section patients, excluding classical cesarean sections.

The American College of Obstetricians and Gynecologists has supported the concept of a trial of labor in patients with a previous lower uterine transverse cesarean section, and its safety is generally accepted. The purpose of this report was to present the results of a year-long, prospective study in which the indications for trial of labor were liberalized. Only patients with a previous classical incision or "T" incision on the uterus were excluded. Two hundred seventy-two patients elected to undergo a trial of labor. Vaginal delivery occurred in 216 patients (76.5%). Oxytocin was used as needed, and epidural anesthesia was used in all patients who requested it. One uterine rupture occurred in a patient with a single lower transverse scar. The results of this study suggest that a trial of labor is a safe alternative for patients with a previous single or multiple lower uterine transverse incision or a lower uterine vertical incision. In addition, the use of epidural anesthesia and oxytocin appears safe in patients undergoing a trial of labor.

Anesthesia, Epidural↗