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PubMed2003

Effects of LI4 and BL 67 acupressure on labor pain and uterine contractions in the first stage of labor.

Acupressure is said to promote the circulation of blood and qi, the harmony of yin and yang, and the secretion of neurotransmitters, thus maintaining the normal functions of the human body and providing comfort. However, there has been little research-based evidence to support the positive effects of acupressure in the area of obstetric nursing. The purpose of this study is to determine the effect of LI4 and BL67 acupressure on labor pain and uterine contractions during the first stage of labor. An experimental study with a pretest and posttest control group design was utilized. A total of 127 parturient women were randomly assigned to three groups. Each group received only one of the following treatments, LI4 and BL67 acupressure, light skin stroking, or no treatment/conversation only. Data collected from the VAS and external fetal monitoring strips were used for analysis. Findings indicated that there was a significant difference in decreased labor pain during the active phase of the first stage of labor among the three groups. There was no significant difference in effectiveness of uterine contractions during the first stage of labor among the three groups. Results of the study confirmed the effect of LI4 and BL67 acupressure in lessening labor pain during the active phase of the first stage of labor. There were no verified effects on uterine contractions.

Acupressure↗
PubMed1975

Intrauterine pressure wave-form characteristics of spontaneous first stage labor.

Intrauterine pressure wave-form parameters were measured in 827 contractions obtained from 26 patients in spontaneous labor. The coefficients of correlation between the maximal and minimal rates of pressure change and the maximal pressure amplitude were 0.78 and 0.63, respectively, and greater than or equal to 0.70 in 22/26 patients. Contractions partitioned into decile statistical groups of the pressure amplitude and both maximal and minimal rates. A linear relationship between these parameters has therefore been established. Contractions of greater amplitude tend to be longer, but the relationship between duration and amplitude is nonlinear with a limiting maximum contraction time. The duration of the midportion of the pressure wave appears invariate with respect to wave amplitude and only start-up and termination times increase with increasing amplitude. Mean values and standard deviations of the maximal amplitude (40.4 +/- 16.9mmHg). the maximal (2.4 +/- 0.9 mmHg/s) and minimal (-2.1+/- 0.9 mmHg/s)rates of pressure change, and the total duration of contractions (68.6 +/- 17.8s) were determined.

Female↗
PubMed1977

Respiratory movements in the fetal guinea pig in utero.

Intrauterine respiratory movements in the fetal guinea pig were detected from about 0.6 of term by the use of chronically implanted tracheal and amniotic catheters. Three distinct patterns were seen: 1) "slow" breathing recurring at a rate of 1-8/min; 2) "rapid irregular" breathing in which episodes last a few seconds to 40 min and the frequency of breathing is high (greater than 0.5 HZ) (the respiratory movements are associated with negative tracheal pressures of of 0.5-20 Torr); and 3) "rapid regular" breathing which recurs in bursts lasting 0.6-6.8 min with a maximum incidence of 3/h. Inspiratory efforts in the range of 10-20 Torr were uniform during a single episode. All three types of respiratory activity were continued into first stage labor, both during and between contractions, but were absent during second stage labor.

Animals↗
PubMed1983

Insulin and glucose requirements during the first stage of labor in insulin-dependent diabetic women.

Studies utilizing glucose-controlled insulin infusion systems were undertaken to more accurately define the glucose and insulin requirements during the first stage of labor induced by oxytocin in 12 insulin-dependent diabetic women in whom normoglycemia had been maintained before delivery. Insulin requirements decreased to zero during active stage 1 labor, while the glucose infusion rate necessary to maintain a blood glucose level of 70 to 90 mg/dl (or 3.9 to 5.0 mmol/liter) was constant at 2.55 mg/kg per minute. The findings were confirmed in 40 additional studies of oxytocin-induced labor. Studies of six women undergoing spontaneous labor and one nonpregnant woman receiving oxytocin confirmed that the decrement in the insulin requirement during stage 1 labor was not influenced by oxytocin infusion. The changes occurred regardless of whether epidural anesthesia was employed. Insulin requirements returned during the second stage of labor. Active stage 1 labor in diabetic women thus appears to be associated with a predictable decrease in the need for insulin and a constant glucose requirement.

Blood Glucose↗
PubMed1997

"I gotta push. Please let me push!" Social interactions during the change from first to second stage labor.

BACKGROUND: Forms of social interaction may occur among the participants in medicalized births, in which a woman in labor is experiencing strong involuntary urges to push but has not yet been found to have a completely dilated cervix. This article examines the social events and communications that occur at the change between first and second stages of labor. METHOD: Three cases are described from videotapes of women in the second stage of labor and their caregivers. RESULTS: Several social and interactive features occurred, in which (1) the caregiver, usually a nurse, by invoking the "no pushing rule," insisted that the woman suppress her involuntary urges to push; (2) both the caregiver and the parturient displayed an orientation toward the future and the eventual certification of full cervical dilation by a designated authority, usually a physician, regardless of the actual state of the woman's cervix or her involuntary urges to push; and (3) the certification process marked a ritual transition to "official" second stage labor, in which the woman's involuntary urges were considered appropriate and actively encouraged. CONCLUSION: A discrepancy between a laboring woman's sensations and caregivers' ideas about how labor should be conducted has implications for clinical care of women, wherein the goal should be to facilitate the woman's accomplishment rather than to direct the "delivery."

Adult↗
PubMed1989

The effect of pH-adjusted 2-chloroprocaine on the onset of epidural analgesia in pregnant patients in the lying and sitting position during the first stage of labor.

The purpose of this prospective, randomized, double-blind study was to compare the epidural onset time of 2% 2-chloroprocaine with pH-adjusted 2-chloroprocaine administered in either the sitting or supine position in pregnant patients during the first stage of labor. Patients in Groups I and III received the control solution in the sitting and supine position, respectively. Patients in Groups II and IV received the buffered solution in the sitting and supine position, respectively. The pH and pCO2 of the control and buffered solutions differed significantly. The pH and pCO2 of the control and buffered solutions were 4.38 +/- 0.01, 18.4 +/- 2.2 mm Hg and 7.70 +/- 0.04, 114.9 +/- 3.0 mmHg, respectively. A statistically significant reduction in the time of onset of analgesia in the pH-adjusted groups was noted. Groups I and II had onset times of 4 +/- 1.2 and 4.3 +/- 1.0, whereas Groups II and IV had onset times of 2.6 +/- 0.9 and 2.7 +/- 0.6 min., respectively. There were no intergroup differences in the cephalad spread of analgesia or duration of analgesia. Position had no effect on the onset of analgesia at the S2-3 dermatomes nor on the bilateral cephalad spread of the epidural study solutions. Our results indicate that a pregnant patient may be dosed in the lateral supine position without adversely affecting the caudad or cephalad spread of plain or pH-adjusted 2% 2-chloroprocaine, which is clinically important because the incidence of aortocaval compression is increased in the supine position when compared with the lateral supine position.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1981

Distribution of observed patterns in fetal transcutaneous oxygen tension.

The interaction between intrauterine pressure, fetal heart rate, and fetal transcutaneous oxygen tension (tcPO2) may be classified into 10 pattern types. Eight of them indicate the reduction in fetal tcPO2 caused by uterine contractions and by fetal heart rate decelerations. Two pattern types show the effect of stasis and of pressure resulting in decreased fetal tcPO2. In 32 recordings from Uppsala, Sweden, and 11 from Zurich, Switzerland, 1,161 contractions were analyzed. A similar distribution of the patterns was found in the two hospitals in uncomplicated deliveries in the first stage of labor. In 15% of the contractions in the first stage of labor, fetal tcPO2 was affected by stasis or pressure, whereas this occurred in 48% of the 265 contractions in the second stage of labor. Thus, in most instances, fetal tcPO2 should be expected to give reliable information in the first stage, whereas the stasis and the pressure pattern must be recognized for the evaluation of fetal tcPO2 in the second stage of labor.

Female↗
PubMed2002

Obstetric risk factors for failure to progress in the first versus the second stage of labor.

OBJECTIVE: To compare obstetric risk factors for failure of labor to progress in the first versus the second stage. STUDY DESIGN: A comparison was performed of all singleton, vertex and term deliveries with an unscarred uterus, complicated with non-progressive labor during the first and the second stages. Deliveries occurred between the years 1988 and 1999 in a tertiary university medical center. RESULTS: Patients with non-progressive labor in the first stage (n = 1197) were significantly older, of higher birth order, and were more likely to have complications such as gestational diabetes, hypertensive disorders, premature rupture of membranes, meconium-stained amniotic fluid, hydramnios and oligohydramnios (p < 0.001 for all variables) as compared to patients with non-progressive labor in the second stage (n = 1545). In addition, pregnancies complicated with non-progressive labor in the first stage had a significantly higher rate of fetal macrosomia as compared to patients with non-progressive labor in the second stage (11.6% vs. 8.8%; p < 0.001). CONCLUSIONS: Higher rates of fetal macrosomia and high-risk pregnancies were noted among pregnancies complicated with non-progressive labor during the first vs. the second stage. The significant increase in Cesarean deliveries during the first stage of labor among high-risk pregnancies might reflect exaggerated concern of caregivers. This concern may influence an overall conservative attitude leading to the seemingly simpler mode of direct intervention by Cesarean delivery.

Adolescent↗
PubMed1998

Influence of acupuncture on duration of labor.

The aim of this case control study was to evaluate the thus far controversially discussed influence of acupuncture (AP) on the duration of labor. Fifty-seven women with AP treatment (group A) were included in our study after spontaneous vaginal full-term delivery. The control group included 63 women (group B). Median duration of the first stage of labor was 196 min in group A and 321 min in group B (Wilcoxon 2-sample test, p < 0.0001). Median duration of the second stage of labor was 57 min in group A and 57 min in group B (Wilcoxon 2-sample test, p = 0.82). Thirty women had a premature rupture of the membranes (PROM), in group A 66.7% and in group B 33.3% (chi2 test, p = 0.02). Women without AP (group B) received significantly more often oxytocin during the first stage of labor compared with group A women (85 and 15%, respectively, chi2 test, p = 0.01) as well as during the second stage of labor (72 and 28%, respectively, chi2 test, p = 0.03). Our study suggests that AP treatment is a recommendable form of childbirth preparation due to its positive effect on the duration of labor, namely by shortening the first stage of labor.

Acupuncture Analgesia↗
PubMed1987

The management of functional dystocia in the first stage of labor.

To summarize: Functional dystocia is easily diagnosed in laboring patients by lack of cervical dilatation for 2 hours in association with weak uterine contractions. If the membranes are intact, amniotomy should be performed. If cervical dilatation at a rate of at least 1 cm/h does not occur promptly, oxytocin should be begun. Efficient and safe use of oxytocin requires knowledge of its clinical pharmacologic characteristics: that the maximum level of a dose is not reached for approximately 40 minutes, that the blood level needed is a reflection of the sensitivity of the myometrium, and the blood level produced by a specific dose is a manifestation of the plasma clearance rate. While it has never been demonstrated that continuous electronic monitoring of the uterus and fetus with intermittent visits from professional personnel is better than palpation and auscultation performed by an educated attendant present continuously, the former practice is more common in the United States than the latter. If maximum use is to be made of the information provided by the uterine monitor, the data must be quantitated. When the patient's inadequate contractility fails to improve in response to the initial dose of 1 mU/m, the dose must be increased until some improvement is noted. Geometric incrementation should be limited to nulliparas in whom each dose of oxytocin is evaluated after a 40-minute infusion period.(ABSTRACT TRUNCATED AT 250 WORDS)

Amnion↗
PubMed1986

[Prognostic significance of heart rate accelerations of the fetus in the first stage of labor].

The clinical data and the cardiotocograms of 232 low-risk-deliveries and that of 344 cases of high risk deliveries (98 premature deliveries, 102 cases with meconium stained amniotic fluid, 86 cases with EPH gestosis and 58 cases of fetal distress necessitating emergency cesarean section) have been studied. It is concluded that the fetal heart rate accelerations even in cases of high risk pregnancies and deliveries indicate a good fetal state and a good neonatal outcome. In the presence of both of decelerations and accelerations the fetal state is still good. In the presence of accelerations the low- and high risk deliveries (except the premature deliveries) have a similarly good prognosis. In the lack of accelerations the neonatal mortality, the frequency of resuscitations is higher, and the low Apgar-scores are commoner.

Asphyxia Neonatorum↗