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PubMed1997

Smoking and preterm labor.

The aim of the present study was to investigate the role of maternal smoking during pregnancy in the occurrence of the premature rupture of the membranes (PROM) and premature labor . Our study consisted of 1,133 women of which 283 (group A) had premature labor (gestation < or = 37 weeks), while 850 (group B) had term labor (gestation > 37 weeks). The two groups did not differ in their socioeconomic status and did not include women with serious complications during pregnancy. There were no apparent effects of smoking on the length of gestation. However, our results showed that smoking had a marked effect on preterm labor of less than 32 weeks; we also found a statistically significant correlation between PROM in premature deliveries and smoking during pregnancy, but no gradient was observed between the number of cigarettes smoked per day and the risk for PROM, in cases of premature labor. We conclude that smoking during pregnancy raises the risk of delivery before the 32nd week, as well as the PROM in premature deliveries, independently of the number of cigarettes smoked per day.

Adult↗
PubMed1998

Reduction of serum citrulline levels in women at term toward the day of labor onset.

OBJECTIVE: To test the hypothesis that labor onset could be the result of a reduced release of nitric oxide (NO). STUDY DESIGN: Out of 91 consecutive healthy nulliparous women at term serum citrulline (Cit) and arginine (Arg) levels were measured at least twice in 37 subjects, by the means of HPLC with fluorometric detection. Twenty cases underwent a spontaneous onset of labor (group A) while in 17 cases labor was induced (group B) because of pregnancy prolongation or amniotic fluid reduction. RESULTS: Cit and Arg levels were unaffected by the gestational age. In group A, Cit levels undergo a progressive decrease toward the day of labor (from 32.9+/-4.7 microM/L the day - 18,-5 to 27.7+/-7.8 the day -4,0; p=0.012) whilst they remained stable in group B (from 33.3+/-7.7 to 34.2+/-9.2). No significant changes were observed in Arg levels. Cit/Arg ratio remained stable in group A whereas it showed a trend to increase in group B. CONCLUSION: These data indirectly suggest a reduced release of NO toward term. This phenomenon could play a permissive role in the spontaneous onset of labor of healthy nulliparous women.

Arginine↗
PubMed1998

Randomized comparison of rectal misoprostol with Syntometrine for management of third stage of labor.

BACKGROUND: The search for an effective, easily stored, affordable uterotonic agent in preventing postpartum hemorrhage is of importance, especially in the developing world. The objective of this study was to randomly compare the effectiveness of rectal misoprostol with Syntometrine in the management of the third stage of labor. METHODS: Four hundred and ninety-one low risk women in labor were randomly allocated to receive either misoprostol 400 microgram rectally or Syntometrine 1 ampuole intramuscularly, and postpartum blood loss was estimated as the principal end point. Comparisons were by the chi-square test or Fisher's test and relative risks with 95% confidence intervals for categorical data, and the Mann-Whitney test for ranked continuous variables. RESULTS: The baseline characteristics in terms of hemoglobin estimation in antenatal clinic, mean age, parity, and duration of labor in the 250 patients who received Syntometrine and 241 patients who received misoprostol were similar. However, there was a significant difference in the pre-delivery blood pressure of the two groups because of the non-protocol exclusion of women with elevated blood pressure allocated to receive Syntometrine. Duration of third stage of labor, blood loss postpartum and hemoglobin estimation post partum were all similar. Postpartum diastolic hypertension was more common in the Syntometrine group (p= 0.002). No other apparent side effect was noted in either group. CONCLUSION: Misoprostol rectally for management of the third stage of labor merits further investigation.

Administration, Rectal↗
PubMedDate not supplied

Strategies women engage in when managing preterm labor at home.

Despite widespread efforts to prevent preterm birth in the United States, greater than 10% of the more than 4 million births that occur each year are preterm. Up to 75% of morbidity and mortality in infants is linked to preterm labor and birth. Bed rest, which may have adverse physical and psychologic effects, is commonly prescribed to manage preterm labor. This study describes the experience of women in programs of home management for preterm labor. Interview data from 25 women treated at home for preterm labor were analyzed with the grounded theory method. Findings from this study indicate that the process of home management of preterm labor involves managing activity restriction. Women employed certain strategies when demands from relationships, households, and careers competed with the prescription of bed rest. These strategies included cheating, piggybacking, and testing the limits of their activity restriction. Implications for research and practice are suggested.

Activities of Daily Living↗
PubMed1997

Induction of labor by intracervical prostaglandin gel and oxytocin infusion in primigravid women with unfavorable cervix.

The rate of Cesarean Section for failed induction of labor and maternal and fetal compilations are high when labor is induced in a nulliparas women with an unripe cervix by amniotomy and oxytocin infusion. Prostaglandins (PG) in different forms have been used for ripening the cervix with an aim of reducing these problems. A prospective randomized trial was performed on one hundred primigravid women between 37 and 42 weeks of gestation with singleton pregnancy, cephalic presentation and unfavorable cervix (Modified Bishop Score < or = 5) in the department of Obstetrics & Gynaecology of Institute of Postgraduate Medicine & Research from 1st May 1996 to 30th April 1997. In this study the efficiency of prostaglandin E2 intracervical (PGE2 IC) gel in induction of labor in a group of primigravid women with unripe cervix was assessed and compared with another group with similar characteristics using oxytocin infusion and artificial rupture of membrane (ARM). The Modified Bishop Score (MBS), interval between IOL and onset of labor and the duration of labor after insertion of PGE2 gel was significantly different from those of oxytocin infusion group. But the Apgar Score at 1 & 5 min had shown no statistically significant difference. Any significant difference could also not be detected in the mode of delivery between the two induction group. The proportion of emergency Cesarean Section (CS) was high in the oxytocin infusion group than that of in the prostaglandin group. There was also no significant difference regarding the acceptability of both the induction methods.

Adult↗
PubMed1997

[Comparison of misoprostol and ricinus oil meal for cervical ripening and labor induction].

OBJECTIVE: To compare the safety and efficacy of intravaginal prostaglandin E1, misoprostol with ricinus oil meal for labor induction. METHODS: Sixty patients with an indication for induction of labor were randomly assigned to two groups (30 cases each) induction with misoprotol, 50 micrograms intra-vaginally every 3 hours until active labor, or with that ricinus oil meal was taken. RESULTS: The time from start of induction to vaginal delivery was significantly shorter in the misoprostol group (12.2 vs 18.1, P < 0.05), and fewer patients in the misoprostol group required oxytocin augmentation (10.0% vs 40.0%, P < 0.05). The mean change in the Bishop score was significantly higher in those receiving misoprostol (5.5 vs 3.1, P < 0.05). Uterine tachysystole occurred more frequently in patients in the misoprostol group (16.7%) than in the ricinus oil meal group (3.0%). No significant differences were noted in the mode of delivery and patients of successful labor induction. CONCLUSIONS: Vaginally administered misoprostol is an effective agent for the cervical ripening and induction of labor.

Abortifacient Agents, Nonsteroidal↗
PubMed1998

[Vaginal birth after cesarean delivery: can the trial of labor be extended].

Based on a retrospective analysis of 1000 cases of scared uteri following cesarean section(s) (one cesarean, n = 857, 85.7%); two n = 129, 12.9%; three n = 14, 1.4%), we tried to answer two questions. Is trial of labor in case of low segment uterine-scar (excepting pelvic abnormalities, corporeal scar and more than two scars) free of risk for the mother and child? Can trial of labor be extended to cases of breech presentation, two previous cesarean sections, twin pregnancy and suspected macrosomia? In this series, the cesarean was indicated before labor in 138 cases (13.8%). Trial of labor was conducted in 862 cases (86.2%), and led to vaginal birth in 728 (84.5%). Successful trial of labor was observed in 75% of twin pregnancies, in 100% of breech presentations and in 69.6% of macrosomic infants. Uterine rupture occurred in 23 cases (2.7%), especially in cases with unknown corporeal scars (15 cases). No case of perinatal death related to uterine rupture was observed in this series.

Breech Presentation↗
PubMed1998

Women's evaluation of the labor and delivery experience.

The purpose of this study was to identify how women described and evaluated their labor and delivery experience and what factors were related to their responses. Sixty Lamaze-prepared, married multigravidae, aged 21 to 37 years, participated in this qualitative field study. Detailed, open-ended tape-recorded interviews were conducted on the postpartum unit of a community hospital or in the women's homes early during the postpartum period. Women evaluated their labor and delivery experience according to how well they perceived they had managed their own childbirth performance. Women who managed well viewed childbirth as positive, whereas women who had difficulty or managed poorly viewed it as both positive and negative. Women who managed well thought their own performance and the nature of labor and delivery (physical aspects) went well; women who had difficulty thought labor and delivery and the performance of others went well, but women who managed poorly had problems identifying anything that went well. There was overall agreement that the baby was the best part of the experience and that pain and pushing were the worst parts. Since women's evaluation of their labor and delivery experience may be related to the quality of their subsequent mothering, it is important to enhance their perceptions of their own performance, and thus their evaluation of the childbirth experience.

Adaptation, Psychological↗
PubMed2006

Labor pain and its management with the combined spinal-epidural analgesia: what does an obstetrician need to know?

Most women rate pain of childbirth as the most painful experience of their lives. Lumbar epidural analgesia is widely considered as the most effective method of providing pain relief in labor. However, lumbar epidural analgesia for labor is not a standard (generic) procedure and many technical modifications have been developed and introduced into clinical practice over time. The combined spinal-epidural labor analgesia technique (CSEA) has attained widespread popularity in obstetric anesthesia worldwide. The onset of analgesia is rapid and reliable, and maternal satisfaction is very high. While there still remains some concern about dural puncture, and while the pros and cons of using the CSEA as opposed to traditional epidural for labor pain are still being debated, it appears certain that the CSEA technique offers many unique advantages to the pregnant woman.

Analgesia, Obstetrical↗
PubMed1977

Epidural analgesia and its effects on the "normal" progress of labor.

The effects of epidural analgesia on the duration of labor have been a controversal subject since its increased use in recent years. A total of 598 patients receiving this form of analgesia were studied as to progress in labor and eventual outcome. The mean cervical changes during epidural analgesia with a single drug, bupivacaine, 0.125%, with epinephrine, 1:200,000, have been calculated. The labor curves are characterized by constant acceleration in dilatation without deceleration at approximately the same rate for nulliparous and multiparous patients after dilatation of 5 cm. has been reached. Examination of maternal and fetal profiles failed to demonstrate any consistent variables that produce abnormal labor.

Anesthesia, Epidural↗
PubMed1990

Increasing quantity of maternal immunoglobulin G in trophoblastic tissue before the onset of normal labor.

While levels of maternal immunoglobulin G (IgG) increase in the fetal circulation during the third trimester, actual trophoblastic concentrations have not been extensively studied. To investigate this process, placentas from 71 patients with gestational ages between 26 and 42 weeks were examined by means of a peroxidase-antiperoxidase immunostaining technique specific for IgG. Linear regression revealed a significant increase in antibody with advancing gestational age (r = 0.36, p less than 0.01). In addition, placentas from patients in spontaneous term labor revealed a significantly higher antibody level when compared with those of patients at term delivered electively before the onset of labor (mean +/- SEM 2.6 +/- 0.2 vs 1.7 +/- 0.3, p less than 0.02). Patients in premature labor failed to demonstrate this increase in antibody staining. One possible explanation for these findings is an enhanced recognition of the fetal trophoblastic tissue by the maternal immune system at term. It also suggests immunologic factors may play an important role in the initiation of normal labor.

Female↗
PubMedDate not supplied

Station in early labor in nulliparous women at term.

Several authors of standard obstetric texts state that engagement occurs before the onset of labor in a majority of nulliparas at term, and failure of the fetal head to engage in early labor is a greater indicator for operative birth. A pilot clinical descriptive study was done at University Hospital, University of Medicine and Dentistry of New Jersey, in Newark to examine the birth outcomes of nulliparous women who arrived in early labor with an unengaged vertex presentation at term. For the study, 146 births were reviewed, and data from 101 vertex deliveries that met the study's criteria were compiled to test this hypothesis. The study results showed that in approximately 31% of the nulliparas, the fetal head was engaged. The incidence of the unengaged vertex in early labor in nulliparous women who met the study's criteria was found to be 69%. This factor alone did not predict birth outcome.

Adolescent↗
PubMed1986

The preterm cervix and preterm labor: relative risks, predictive values, and change over time.

The accurate prediction and diagnosis of preterm labor continue to frustrate the clinician. This is partly due to a scarcity of cervical data from the early third trimester. A total of 760 prospective, serial, paired, and blinded pelvic examinations were done at 28 to 34 weeks of gestation for 191 patients without a history of preterm labor. If the cervix was dilated greater than or equal to 1 cm (internal os) or effaced greater than 30%, the relative risk of preterm labor was increased to 1.8 to 4.2. Negative predictive values for cervical status were greater than 92%, but positive predictive values were less than or equal to 18%. Change over time was unusual (dilatation increase greater than or equal to 1 cm or effacement increase greater than or equal to 40%), suggesting that a baseline late second-trimester examination could assist in the early but accurate diagnosis of preterm labor should it be suspected later in gestation. These data suggest that even in the low-risk patient, an early cervical examination could be beneficial.

Cervix Uteri↗
PubMed1999

Evaluation of cerebral perfusion pressure changes in laboring women: effects of epidural anesthesia.

OBJECTIVE: To compare the effect of epidural anesthesia on cerebral perfusion pressure in laboring women. STUDY DESIGN: Maternal cerebral blood flow velocity was assessed in seven laboring patients with continuous epidural anesthesia and 15 without, using transcranial Doppler. Maternal cerebral blood flow velocity was assessed during the first stage at the trough of a contraction, at the peak of a contraction and at the second stage during pushing over the course of four contractions. Calculated estimated cerebral perfusion pressure: eCPP = Vmean/(Vmean - Vdiastolic) x (mean BP - diastolic BP), where V is velocity and BP is blood pressure; modified from Aaslid and colleagues. An index of cerebrovascular resistance, the resistance area product, was calculated: RAP = mean BP/mean velocity. We calculated an index of cerebral blood flow (cerebral blood flow index): CBF index = eCPP/RAP. RESULTS: In non-epidural patients, the eCPP fell significantly at the peak of a contraction and during pushing. Cerebrovascular resistance, RAP, rose significantly during the peak of a contraction, although cerebral blood flow did not change. In patients undergoing epidural anesthesia, the stages of labor had no significant effect on eCPP or RAP; however, these values were lower than those in patients without epidural anesthesia. CONCLUSIONS: The epidural group had a lower eCPP and RAP and cerebral blood flow index compared to the non-epidural group. In the non-epidural group, the mean arterial pressure was higher in all stages of labor with a trend towards an increase in eCPP and cerebral blood flow index.

Adult↗
PubMedDate not supplied

The context & clinical evidence for common nursing practices during labor.

The purpose of this article is to review the context and current evidence for common nursing care practices during labor and birth. Although many nursing interventions during labor and birth are based on physician orders, there are a number of care processes that are mainly within the realm of nursing practice. In many cases, particularly in community hospitals, routine physician orders for intrapartum care provide wide latitude for nurses in how they ultimately carry out those orders. An important consideration of common nursing practices during labor is the context or practice model in which those practices occur. Nursing practice is not the same in all clinical environments. Intrapartum nursing practice consists of an assortment of different roles depending on the circumstances, hospital setting, and context in which it takes place. A variety of intrapartum nursing practice models have evolved as a result and in response to the range of sizes, locations, and provider practice styles found in hospitals providing obstetric services. A summary of intrapartum nursing models is presented. The evidence is reviewed for the three most common clinical practices for which nurses have primary responsibility in most settings and that comprise the majority of their time in caring for women during labor: (1) maternal-fetal assessment, (2) management of oxytocin infusions, and (3) second-stage care. Evidence exists for these nursing interventions that can be used to promote maternal-fetal well-being, minimize risk, and enhance patient safety.

Clinical Nursing Research↗
PubMed2005

Changes in fetal position during labor and their association with epidural analgesia.

OBJECTIVE: To evaluate whether epidural analgesia is associated with a higher rate of abnormal fetal head position at delivery. METHODS: We conducted a prospective cohort study of 1,562 women to evaluate changes in fetal position during labor by using serial ultrasound examinations. Ultrasound examinations were performed at enrollment, epidural administration, 4 hours after the initial ultrasonography if epidural had not been administered, and late in labor (> 8 cm). Information about fetal head position at delivery was obtained from the provider. RESULTS: Regardless of fetal head position at enrollment (occiput transverse, occiput posterior, or occiput anterior), most fetuses were occiput anterior at delivery (enrollment position: occiput transverse 78%, occiput posterior 80%, occiput anterior 83%, P = .1). Final fetal position was established close to delivery. Of fetuses that were occiput posterior late in labor, only 20.7% were occiput posterior at delivery. Changes in fetal head position were common, and 36% of women had an occiput posterior fetus on at least one ultrasound examination. Women receiving epidural did not have more occiput posterior fetuses at the enrollment (23.4% epidural versus 26.0 no epidural, P = .9) or the epidural/4-hour ultrasound examination (24.9% epidural, 28.3% no epidural), but did have more occiput posterior fetuses at delivery (12.9% epidural versus 3.3% no epidural, P = .002); the association remained in a multivariate model (adjusted odds ratio 4.0, 95% confidence interval 1.4-11.1). CONCLUSION: Fetal position changes are common during labor, with the final fetal position established close to delivery. Our demonstration of a strong association of epidural with fetal occiput posterior position at delivery represents a mechanism that may contribute to the lower rate of spontaneous vaginal delivery consistently observed with epidural.

Adult↗
PubMed1976

Dip area in fetal heart rate and its relationship to acid-base-observations of fetus and mother during labor.

The relationship between dip area (DA) of fetal heart rate (FHR) and the acid base status of fetus and mother during the first and second stage of labor were studied on 39 women at term. The observations reveal a significant correlation between the fall in fetal base excess (BE) and the measured DA: deltaBE = 0.01 - 0.143 DA (2alpha less than 0.01). There is no difference in the correlation of these parameters between the first and the second stage of labor despite the fact of a greater fall in BE and a greater DA per time compared to the first:BE meq/1/10min. 0.14 (SD 0.26) and 0.76 (SD 0.62); DA cm2/10 min. 0.99 (SD 1.19) and 4.28 (SD 3.06), respectively. With increasing DA the variance of the fall of fetal BE (S2BE) rose also: DA of 0-5 cm2: S2BE 0.66; DA greater than 15.1cm2:S2BE 3.76. With the fall in fetal BE there was also a fall in maternal BE, more pronounced during the second stage of labor:-BEF=0.38.DELTA BEM-0.70(2alphaless than 0.01). The fraction of the fall in fetal BE per DA increased with the fall in maternal BE (2alpha less than 0.05). This correlation reveals that there might be a slight influence of maternal BE on fetal BE. The present observation shows that measuring DA serves only as an approach to predict fetal condition during labor. It therefore should be combined with fetal scalp blood sampling. The influence of maternal BE on fetal BE seems to be only of less importance.

Acid-Base Equilibrium↗
PubMed2003

[Current practice and results of labor induction].

INTRODUCTION: The role of labor induction has been gradually increasing in the last decade all over Europe due to the early detection of fetal jeopardy, improvement of neonatal therapy and availability of cervical ripening agents. Success rate of vaginal delivery depends on maternal, fetal condition and cervical status. PATIENTS: Authors report the outcome of 795 labor inductions during the period from 1996 to 2000 at the Department of Obstetrics and Gynecology at the University of Debrecen, Hungary. Preinduction cervical ripening and induction method was based on Bishop score and clinical situation. RESULTS: The rate of induced labor was 5.97% out of 13312 consecutive deliveries. The outcome of induction is discussed in details. The caesarean section rate after induction of vaginal delivery was 25% in this high risk group, and 33.3% among the total number of inductions. CONCLUSIONS: The clinical application of prostaglandins for cervical ripening among high risk pregnant women facilitates the decision of labor induction and provides a favourable rate of vaginal deliveries.

Adult↗