The remote effects of prolonged labor with forceps delivery, precipitate labor with spontaneous delivery and natural labor with spontaneous delivery on the child.
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Delivery, Obstetric↗
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The immediate effects of prolonged labor with forceps delivery, precipitate labor with spontaneous delivery, and natural labor with spontaneous delivery on the child.
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Delivery, Obstetric↗
[Psychophysical labor & directed labor: medical control of labor today].
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Female↗
[Psychoprophylactic labor and directed labor; medical direction of labor at the present time; personal experience].
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Female↗
[Seasonal and daily rhythms of labor in women. Relation of some complications in labor to the daily rhythm of labor activity].
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Female↗
[Inhibition of uterine contraction in labor by prostaglandin antagonists in threatened abortion, premature labor and normal labor].
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Abortion, Threatened↗
Clinical studies on the uterine contraction in labor. II. Multi-channel pattern of uterine contractility in normal labor and abnormal labor.
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Female↗
Effects of SP6 acupressure on labor pain and length of delivery time in women during labor.
OBJECTIVE: The purpose of this study was to evaluate the effects of SP6 acupressure on labor pain and delivery time in women in labor. DESIGN: Randomized clinical trial. SETTING/LOCATION: Delivery room in a university hospital. PARTICIPANTS: Seventy-five (75) women in labor were randomly assigned to either the SP6 acupressure (n = 36) or SP6 touch control (n = 39) group. The participants were matched according to parity, cervical dilation, labor stage, rupture of amniotic membrane, and husband's presence during labor. There were no additional oxytocin augmentation or administration of analgesics during the study period. INTERVENTION: The 30-minute acupressure or touch on SP6 acupoint was performed. OUTCOME MEASURES: Labor pain was measured four times using a structured questionnaire, a subjective labor pain scale (visual-analogue scale [VAS]): before intervention, immediately after the intervention, and 30 and 60 minutes after the intervention. Length of delivery time was calculated in two stages: from 3 cm cervical dilation to full cervical dilatation, and full cervical dilatation to the delivery. RESULTS: There were significant differences between the groups in subjective labor pain scores at all time points following the intervention: immediately after the intervention (p = 0.012); 30 minutes after the intervention (p = 0.021); and 60 minutes after the intervention (p = 0.012). The total labor time (3 cm dilatation to delivery) was significantly shorter in the SP6 acupressure intervention group than in the control group (p = 0.006). CONCLUSIONS: These findings showed that SP6 acupressure was effective for decreasing labor pain and shortening the length of delivery time. SP6 acupressure can be an effective nursing management for women in labor.
Acupressure↗
Duration of intrathecal labor analgesia: early versus advanced labor.
Early first-stage labor pain is primarily visceral in origin. Increasing pain intensity and transition to somatic nociceptive input characterizes late first- and second-stage labor pain. The effect of this change in nociceptive input on the duration of intrathecal labor analgesia has not been well studied. This prospective cohort observational study compares the duration of intrathecal labor analgesia after intrathecal injections made in early labor (3- to 5-cm cervical dilation) and those made in more advanced labor (7- to 10-cm cervical dilation). Forty-one parturients (18 in early labor and 23 in advanced labor) received intrathecal sufentanil (10 micrograms) and bupivacaine (2.5 mg) as part of a combined spinal-epidural technique. Patients rated their pain using a 0-10 verbal pain scale prior to intrathecal injection and every 20 min thereafter. Duration of analgesia was defined as the lesser of time until the pain score exceeded 5 or until a request for supplemental epidural analgesia was made. The duration of spinal analgesia was significantly less when intrathecal injection was made in advanced labor (120 +/- 26 min) compared with early labor (163 +/- 57 min, P < 0.01). We conclude that cervical dilation and stage of labor significantly impact the effective duration of intrathecal sufentanil/ bupivacaine labor analgesia.
Adult↗
Expression of bone morphogenetic protein 2 in normal spontaneous labor at term, preterm labor, and preterm premature rupture of membranes.
OBJECTIVE: Genome-wide screening studies of the chorioamniotic membranes unexpectedly identified an increase in the expression of bone morphogenetic protein 2 in spontaneous labor at term. The objective of this study was to determine whether bone morphogenetic protein 2 messenger RNA and protein expression are altered in the chorioamniotic membranes of patients with term labor, preterm labor, and preterm premature rupture of membranes. STUDY DESIGN: Chorioamniotic membranes were obtained from patients at term (with and without labor), with preterm labor (with and without histologic chorioamnionitis), and with preterm premature rupture of membranes (with and without histologic chorioamnionitis). The expression of bone morphogenetic protein 2 was studied by real-time quantitative reverse transcriptase-polymerase chain reaction (n = 88) and immunohistochemistry (n = 124). Nonparametric statistics were used for analysis. Primary amnion cells obtained from women at term not in labor were treated with bone morphogenetic protein 2 to examine whether there was increased prostaglandin E2 expression. RESULTS: The median bone morphogenetic protein 2 messenger RNA and protein expression were significantly higher in the membranes of patients with spontaneous labor at term than in those of patients not in labor at term (P < .001 for both). Bone morphogenetic protein 2 messenger RNA and protein expression were increased in patients with preterm labor with histologic chorioamnionitis than in those without histologic chorioamnionitis (P < .05 and P < .001, respectively). There was no difference in bone morphogenetic protein 2 messenger RNA and protein expression in patients with preterm premature rupture of membranes, regardless of chorioamnionitis (P = .13 and P = .08, respectively). There was a correlation between bone morphogenetic protein 2 and cyclooxygenase 2 protein expression in chorioamniotic membranes (R = .34; P < .001). CONCLUSION: Bone morphogenetic protein 2 messenger RNA and protein expression are increased in the chorioamniotic membranes of patients with spontaneous labor at term and patients with preterm labor associated with histologic chorioamnionitis. Its expression pattern and biologic effects strongly suggest that bone morphogenetic protein 2 is involved in human parturition.
Amnion↗
Changes in plasma cyclic AMP and cyclic GMP during spontaneous labor and labor induced by oxytocin, prostaglandin F2 alpha and prostaglandin E2.
To investigate the response of cyclic nucleotides to the oxytocic agents administered for induction of labor, plasma concentrations of cyclic AMP (cAMP) and cyclic GMP (cGMP) were determined by radioimmunoassay during spontaneous labor and labor induced by oxytocin (OT), prostaglandin F2 alpha (PGF2 alpha), or PGE2 (PGE2). Subjects were 7 Japanese women in each labor group. Plasma cAMP levels significantly rose at the time of crowning of the fetal head in all 4 groups. They did not increase until that time in the 3 labor groups (spontaneous, OT-induced, and PGF2 alpha-induced labor groups). In the PGE2-induced labor group, plasma cAMP levels were significantly higher at labor onset (mean +/- SEM = 16.5 +/- 1.3 pg/ml) when compared to the pretreatment values (13.7 +/- 1.0 pg/ml), and increased thereafter gradually toward the time of crowning of the head (26.3 +/- 2.0 pg/ml). Plasma cGMP levels in the OT-induced group significantly rose after the onset of labor and remained at a high level until expulsion of the fetus. Plasma cGMP levels in the other groups did not change significantly throughout labor. These results suggest that cAMP may be involved in the labor process induced by PGE2, and that cGMP may be in that induced by OT.
Cyclic AMP↗
The use of cDNA microarray to identify differentially expressed labor-associated genes within the human myometrium during labor.
OBJECTIVE: Microarray technology was used to comprehensively analyze gene expression during human labor in the myometrium. STUDY DESIGN: cDNA micro-array was used to compare the transcriptomes of myometrium obtained from patients in spontaneous labor and those not in labor. Expression of four labor-specific genes was confirmed in the myometrium obtained from patients in spontaneous labor using RT-PCR, Northern blot analysis, and in-situ hybridization. RESULTS: Of the >6000 cDNAs evaluated, 56 were found to be differentially expressed during labor. The labor-specific expression of 4 genes was confirmed using RT-PCR and Northern blot analysis. The relative increased expression of thrombospondin-1 in myometrium obtained from patients in spontaneous labor was also confirmed using in-situ hybridization. CONCLUSION: cDNA microarray was used to identify 56 differentially expressed genes in myometrium obtained from patients in spontaneous labor. The up-regulation of four genes was confirmed by multiple methods. Elucidation of the role(s) of the genes identified by microarray should improve our understanding of normal labor physiology and may ultimately lead to more effective treatments for abnormal labor.
Blotting, Northern↗
Granulocyte-macrophage colony-stimulating factor levels in amniotic fluid before the onset of labor and during labor do not differ in normal pregnancies.
PROBLEM: Granulocyte-macrophage colony-stimulating factor (GM-CSF) at the implantation site may regulate invasion and differentiation of placental trophoblast. We evaluated whether GM-CSF levels in amniotic fluid during labor contributing to subsequent delivery differed from those before the onset of labor in normal pregnancies. METHOD OF STUDY: This study enrolled 36 Japanese women experiencing normal pregnancies with single fetuses who had no infection. Of these pregnancies, 18 were women during labor that led to subsequent term delivery (labors). The other 18 were women without labor underwent cesarean section (controls). These two groups (18 labors and 18 controls) were compared. The average gestational age at entry was 38-39 weeks of gestation. The women's ages and gestational ages did not differ significantly between the two groups. Amniotic fluid was collected and the GM-CSF levels were compared between two groups. The GM-CSF level was determined by the enzyme-linked immunosorbent assay method. RESULTS: There was no significant increase in GM-CSF levels in amniotic fluid during labor compared with that before the onset of labor. CONCLUSIONS: The GM-CSF in amniotic fluid may not promote the onset of labor at term and/or term labor contributing to subsequent delivery may not induce the production and secretion of GM-CSF into amniotic cavity.
Amniotic Fluid↗
Normal labor and the induction and augmentation of labor.
The management of labor is based on a sound understanding of labor's biochemistry and physiology. The interaction between prostaglandin synthesis and other mechanisms postulated to control the initiation of labor shows promise, but the definitive explanation for the initiation of labor awaits further research. The procedures associated with the management of routine labor, including perineal preparation and the use of enemas, intravenous fluids, and analgesics and anesthetics, are generally best applied on the basis of individual need rather than protocol. The Friedman labor curve and intrapartum risk scoring have proved to be useful indices in the evaluation of the course of labor. Oxytocin and prostaglandin are two clinically useful agents in the induction and augmentation of labor. Currently, prostaglandin is used generally in the induction of preterm labors with oxytocin reserved for the induction of labor at term. The effects and side effects of the medications may be controlled by careful use and monitoring. A protocol for the successful use of oxytocin includes careful fetal monitoring and control of intravenous infusion with careful incremental increases in the dose of oxytocin based on uterine response.
Delivery, Obstetric↗
[Uterine activity in primiparous and multiparous women in spontaneous labor and induced labor with oxytocin].
An analysis was performed of 5187 intra-amniotically measured labor pressure curves in 40 births with spontaneous labour (20 primiparae and 20 multiparae) and 40 births births in which labor was induced with oxytocin (20 primiparae and 20 multiparae). The dilatation of the os uteri was divided into three phases--Phase 1, dilatation of the cervix to 2 cm; Phase 2, dilatation of the cervix from 2 to 4 cm, and Phase 3, dilatation from 4 cm onwards until complete. During the active phase, from 2 cm until dilatation of the os uteri was complete, no differences were observed between induced and spontaneous labor with regard to frequency and amplitude of contractions. In the induced-labor cases, the parameters for uterine activity, maximum contraction and dilatation speed were higher in all three phases of labor, and those for total duration of labor lower than in the spontaneous labor cases. The contraction/dilatation speed is an important parameter for monitoring the effect of drug-induced stimulation of labor. In the latency phase in spontaneous labor, more contractions were observed in multiparae than in primiparae. This fact which should be reason enough to intensify monitoring of both mother and fetus during this phase. In light of these results it would appear advisable, in the absence of progress in labor, to make a clear distinction between the goals of cervical maturity and promotion of uterine activity, and to institute different drug therapy accordingly.
Adult↗
International labor migration and domestic labor supply.
"This paper constructs a dynamic, general equilibrium framework to study the relationship between international labor migration and domestic labor supply. The general equilibrium nature of the model enables us to endogenize the pattern of labor migration. The effect of labor migration on domestic wage rates and labor supply is shown to depend on the pattern of labor migration. If the substitution effect dominates the income effect in labor supply, the domestic supply of labor necessarily decreases in response to an inflow of migrants....Similarly, if the dominant effect is the income effect, the immigration of labor necessarily increases the domestic supply of labor."
Demography↗
Prolonged labor in nulliparas: lessons from the active management of labor.
OBJECTIVE: To define factors causing prolonged labor in nulliparous women undergoing active management of labor. METHODS: We included all nulliparas delivered during 1990-1994 with spontaneous onset of labor lasting more than 12 hours, singleton gestation, cephalic presentation, and labor at greater than 37 weeks. Each patient was matched with the next nulliparous woman who delivered with a labor lasting less than 12 hours and who fulfilled the same inclusion criteria. Subjects were managed according to the previously described active management of labor protocol from The National Maternity Hospital, Dublin. RESULTS: In the 5-year period, 9018 nulliparas met inclusion criteria, with 147 (1.6%) having prolonged labor. Prolonged labor was due to inefficient uterine action in 65%, persistent occipitoposterior position in 24%, and cephalopelvic disproportion in 11% of cases. Univariate analysis showed statistically significant (P < .05) differences in maternal body mass index, cervical dilation on admission, oxytocin use, epidural use, placement of epidural at less than 2 cm of dilation, and birth weight between these study groups. On multivariate conditional logistic regression analysis, the following were significant independent predictors for having a prolonged labor (odds ratios with 95% confidence intervals presented): 3.1 (1.3-7.3) for cervical dilation less than 2 cm on admission, 42.7 (7.5-242.0) for early epidural placement, 5.1 (1.9-13.7) for epidural placement at greater than or equal to 2 cm, and 10.2 (3.6-29.4) for birth weight greater than 4000 g. CONCLUSION: Less-advanced cervical dilation on admission and epidural use, especially when placed early, are strongly associated with prolonged labor.
Adult↗
Minimum analgesic dose of epidural sufentanil for first-stage labor analgesia: a comparison between spontaneous and prostaglandin-induced labors in nulliparous women.
BACKGROUND: The aim of this prospective, double-blind, sequential allocation study was to compare the effects of spontaneous and prostaglandin-induced labor on the minimum analgesic dose of epidural sufentanil in the first stage of labor. METHODS: Seventy healthy, nulliparous women, at more than 37 weeks' gestation with cervical dilatation from 2 to 4 cm, requesting epidural pain relief in labor were enrolled. The subjects were assigned to two different groups according to whether labor was spontaneous or induced with dinoprostone 0.5 mg. Parturients received 10 ml of the study solution through a lumbar epidural catheter. The initial dose was sufentanil 25 microg, and subsequent doses were determined by the response of the previous patient in the same group using up-down sequential allocation. The analgesic effectiveness was assessed using 100-mm visual analog pain scores. The up-down sequences were analyzed using the method of independent paired reversals and probit regression. RESULTS: The minimum analgesic dose of sufentanil in spontaneous labor was 22.2 microg (95% CI: 19.6, 22.8) and 27.3 microg (95% CI: 23.8, 30.9) in induced labor. The minimum analgesic dose of sufentanil in induced labor was significantly greater (P = 0.0014) than that in spontaneous labor (95% CI difference: 2.9, 9.3) by a factor of 1.3 (95% CI: 1.1, 1.5). CONCLUSION: Prostaglandin induction of labor produces a significantly greater analgesic requirement than does spontaneous labor.
Adult↗