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PubMed1995

Management of labor and labor complications.

Obstetricians assume a dual role in the provision of health care for both mother and fetus during labor. Not only do they function as consultants for medical and surgical problems peculiar to labor, but they also assume a more broad-based role in the prevention of labor complications to achieve the best possible health maintenance for both patients. This includes the provision of continuous health care throughout pregnancy, delivery, and postpartum management. A summary of the common problems of management of labor and labor complications is provided, including fetal monitoring during labor, augmentation of labor, vaginal delivery after cesarean section, epidural analgesia and its effects on delivery, and fecal incontinence after delivery.

Anesthesia, Epidural↗
PubMed1999

The influence of prepregnancy body mass index on labor complications.

BACKGROUND: To investigate the influence of Body Mass Index on the incidence of labor complications in a population of women with a normal pregnancy. MATERIAL AND METHODS: From a local database, information on maternal weight and height was extracted concerning 4258 women who had an uncomplicated pregnancy. After calculation and stratification with respect to Body Mass Index, this was retrospectively related to labor interventions and complications. RESULTS: High Body Mass Index was related to more oxytocin infusion and early amniotomy, but not to vacuum extraction or cesarean section. Primary inertia and, to a minor degree, cephalopelvic disproportion and secondary inertia were seen more often in women with high Body Mass Index. CONCLUSIONS: Overweight (25.0<=BMI<30.0) and obesity (BMI>=30.0) are only weak predictors of labor complications, given a normal pregnancy. However, the heavy use of labor augmentation indicates that obese women should not be recommended to give birth in an ABC-clinic or at home.

Body Mass Index↗
PubMed2006

Obesity and gestational weight gain: cesarean delivery and labor complications.

OBJECTIVE: To assess the association between pre-gestational obesity and weight gain with cesarean delivery and labor complications. METHODS: A total of 4,486 women 20-28 weeks pregnant attending general prenatal care clinics of the national health system in Brazil from 1991 to 1995 were enrolled and followed up through birth. Body mass index categories based on prepregnancy weight and total weight gain were calculated. Associations between body mass index categories and labor complications were adjusted through logistic regression analysis. RESULTS: Obesity was present in 308 (6.9%) patients. Cesarean delivery was performed in 164 (53.2%) obese, 407 (43.1%) pre-obese, 1,045 (35.1%) normal weight and 64 (24.5%) underweight women. The relative risk for cesarean delivery in obese women was 1.8 (95% CI: 1.5-2.0) compared to normal weight women. Greater weight gain was particularly associated with cesarean among the obese (RR 4th vs 2nd weight gain quartile 2.2; 95% CI: 1.4-3.2). Increased weight at the beginning of pregnancy was associated with a significantly higher adjusted risk of meconium with vaginal delivery and perinatal death and infection in women submitted to cesarean section. Similarly, greater weight gain during pregnancy increased the risk for meconium and hemorrhage in women submitted to vaginal delivery and for prematurity with cesarean. CONCLUSIONS: Pre-gestational obesity and greater weight gain independently increase the risk of cesarean delivery, as well as of several adverse outcomes with vaginal delivery. These findings provide further evidence of the negative effects of prepregnancy obesity and greater gestational weight gain on pregnancy outcomes.

Body Mass Index↗
PubMedDate not supplied

Maternal age and labor complications in healthy primigravidas at term.

The objective of this study was to describe the association between maternal age and selected risk indicators (both recognized and potential) to determine whether any were predictive of labor complications in women having a first child. Low-risk primigravidas (n = 1,792) were selected from a large national probability sample of births for 1988 (the National Maternal and Infant Health Survey). Recognized and potential risk indicators were described according to categories of maternal age and the occurrence of labor problems. Stratified analysis and logistic regression were used to assess the association of various risk factors with labor complications adjusted for maternal age. Only cesarean delivery varied significantly across maternal age groups, the rate being 11.6% for those < 20, 15.9% for those age 20-29, and 28.3% for those > or = 30. Cesarean delivery was associated with several characteristics of social advantage. Independent risk factors for cesarean delivery were maternal age (particularly > or = 30), epidural anesthesia, and receipt of adequate prenatal care. We conclude that older primigravidas have significantly more cesarean deliveries, and this is partially explained by characteristics of social advantage. To address the high cesarean rate, care providers need a better understanding of the relationship between social circumstances and cesarean delivery.

Adolescent↗
PubMed1989

Prophylactic amnioinfusion during labor complicated by meconium: a preliminary report.

The purpose of this prospective and randomized study is to evaluate the safety and efficacy of prophylactic transcervical amnioinfusion in the management of labor complicated by meconium. A preexisting intrauterine pressure catheter was used for amnioinfusion. The incidence of thick meconium was significantly lower after amnioinfusion, compared with standard management (5% versus 62% p less than 0.0005). This was also demonstrated with spectrophotometry. Significant differences between the amnioinfusion group and the control group were found for the following: arterial cord pH less than 7.20 (16% versus 38%, p less than 0.05); meconium more than trace below the vocal cords at delivery (0% versus 29%, p less than 0.05) and need for positive pressure ventilation at birth (16% versus 48%, p less than 0.05). No complications related to amnioinfusion were observed. We conclude that (1) transcervical amnioinfusion during labor complicated by meconium is a simple and apparently safe procedure, and that (2) amnioinfusion effectively decreases the frequency of thick meconium, the frequency of neonatal acidemia, the frequency of more than trace meconium below the vocal cords, and the need for positive pressure ventilation.

Adult↗
PubMed1989

Subcutaneous emphysema and pneumomediastinum complicating labor in a twin pregnancy.

Although a rare complication of labor, subcutaneous emphysema and pneumomediastinum (Hamman's syndrome) must be considered in the parturient complaining of chest or neck pain, dysphagia, or shortness of breath. With conservative management, the prognosis is favorable. The case presented is the first of Hamman's syndrome complicating the labor of a twin gestation. The pathophysiology, symptoms, and management guidelines for the syndrome are reviewed.

Adult↗
PubMed1990

Complexing of tissue plasminogen activator with PAI-1, alpha 2-macroglobulin, and C1-inhibitor: studies in patients with defibrination and a fibrinolytic state after electroshock or complicated labor.

Release of tissue plasminogen activator (t-PA) and its interaction with plasma protease inhibitors were studied in two patients with massive defibrination, one after electroshock and soft tissue injury and the other after complicated labor; both had very severe hemorrhage. Large quantities of free t-PA were present in the circulation for several hours. Complexes of t-PA with plasminogen activator inhibitor 1 (PAI-1), alpha 2-macroglobulin and C1-inhibitor were also observed. PAI-1 antigen rose dramatically in both patients, and complexes of t-PA with PAI-1 rose rapidly during the period of observation. In contrast, the complexes of t-PA with alpha 2-macroglobulin and C1-inhibitor, present initially, persisted for short periods only and disappeared when free t-PA disappeared from the circulation. Plasmin was generated initially, as indicated by the presence of plasmin-alpha 2-antiplasmin complexes. Plasma concentrations of alpha 2-macroglobulin, C1-inhibitor, antithrombin III, and alpha 2-antiplasmin were severely depleted initially, but rapidly returned to normal. The observations demonstrate that there is a major release of t-PA in such defibrinating patients, that there is a role for protease inhibitors other than PAI-1 in the regulation of endogenous t-PA, and indicate the great rapidity with which such free t-PA is complexed and cleared.

Adult↗
PubMed1994

Amnioinfusion during labor complicated by particulate meconium-stained amniotic fluid decreases neonatal morbidity.

OBJECTIVE: Our purpose was to evaluate the efficacy of prophylactic amnioinfusion in decreasing neonatal morbidity associated with labor complicated by particulate meconium-stained amniotic fluid and to assess potential complications of this procedure. STUDY DESIGN: One hundred five laboring pregnant women with particulate (moderate or thick) meconium by subjective clinical analysis were randomly assigned to receive amnioinfusion or to receive standard obstetric care without amnioinfusion. Patients with any antepartum complications, other than the presence of meconium, were excluded from the study. Statistical analyses consisted of the two-tailed and paired Student t tests, Pearson chi 2 test, and Wilcoxon nonparametric test. Significance was set at p < 0.05. RESULTS: The study included 47 patients in the study group and 58 patients in the control group. A significantly greater proportion of study patients demonstrated decreased meconium concentration between rupture of membranes and delivery (46 of 46 vs 15 of 58, p < 0.001). The relative dilution of meconium consistency by objective analysis was significantly different between the study group and the control group (77.1% decrease vs 9.3% increase, p < 0.001). The proportion of neonates with meconium below the vocal cords was reduced in the study group (two of 47 vs 36 of 58, p < 0.001). Umbilical artery pH was increased in the study group neonates (7.29 +/- 0.01 vs 7.25 +/- 0.009, p < 0.05). The rate of neonatal acidemia was reduced in the study group (4 of 45 vs 12 of 50, p < 0.05). The rate of meconium aspiration syndrome was reduced in the study group (1 of 47 vs 8 of 58, p < 0.05). Maternal and neonatal morbidity rates were similar. CONCLUSION: Prophylactic amnioinfusion should be considered a possible addition to the intrapartum management of patients with particulate meconium-stained amniotic fluid.

Acidosis↗
PubMed1980

Maternal-fetal pneumomediastinum complicating labor: report of a case and review of the literature.

Maternal pneumomediastinum and subcutaneous emphysema is a rare, alarming but relatively benign complication of labor. It usually manifests itself during the second stage. Once it is diagnosed, further bearing down should be avoided and labor shortened. Due to its rarity, a case is reported with a review of literature. In this case pneumomediastinum and pneumothorax occurred in the newborn, also. To our knowledge, this is the first reported case of simultaneous pneumomediastinum in mother and neonate.

Adult↗
PubMed2003

[Maternal serum and amniotic fluid IL-1 alpha, IL-1 beta, IL-6 and IL-8 levels in preterm and term labor complicated by PROM].

UNLABELLED: Cytokines may be implicated in the pathophysiologic mechanisms of preterm and term labor. Many studies indicate cytokines as predictors of preterm delivery and explain partially mechanism of preterm uterine contractions. Complicated relations between mediators in systemic fluids of a fetomaternal unit require further explorations. The right diagnosis and management require better understanding of these relationships. OBJECTIVES: The comparison of IL-1 alpha, IL-1 beta, IL-6 and IL-8 levels in maternal serum and amniotic fluid in term and preterm labor complicated by PROM. MATERIAL AND METHODS: In 44 patients in premature labor with PROM (group I) and 33 patients in labor at term with PROM (group II) cytokines levels were estimated one time in amniotic fluid: just after PROM, and two times in maternal serum: just after PROM and during labor. RESULTS: Amniotic fluid cytokines levels were significantly higher in group I than in group II. Maternal serum cytokines concentrations of IL-1 alpha and IL-1 beta in group I were significantly higher than in group II. IL-6 level was significantly higher in group II than in group I. In both groups maternal serum IL-6 levels during labor significantly increased in comparison to IL-6 levels just after PROM. No correlations between amniotic fluid and maternal serum cytokine levels at PROM were observed. CONCLUSIONS: Higher amniotic fluid cytokines levels in patients with preterm labor complicated by PROM than in labor at term with PROM indicate possible differences between PROM mechanisms in preterm and term labor. The increase of IL-6 level during labor can be related with the possible role of this cytokine in the immunological mechanism of the labor beginning. No relationships between amniotic fluid and maternal serum levels of investigated cytokines in PROM suggest the presence of the barrier stopped cytokines transfer by the placenta and the complete separation of these two compartments.

Adult↗