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PubMedDate not supplied

[The effect of the presence of the husband during childbirth].

In the course of 1994 a particular number of deliveries were examined in the maternity ward of the Clinical Hospital "Sestre milosrdnice". Randomly a hundred pregnant women were chosen whose husbands were present at the childbirth. The same number of women delivered their babies without their husband's presence. The duration of labor was examined as well as APGAR score, threatening intrauterine asphyxia, uterine inertia, prolonged labor, induced labor, medical analgesia, and the frequency of cesarean section and vacuum extraction. In the group, in which the husband was present, the labor was shorter, the number of threatening intrauterine asphyxia cases and cesarean sections was smaller, but there were more induced deliveries. Contrary to all expectations, the uterine inertia with the administration of oxytocin was comparably present in both groups, the same as medical analgesia. Other above mentioned parameters were also comparably present in both groups. The level of labor analgesia was not examined in particular to avoid the subjective factor, and besides, the aim was to achieve the maximal possible analgesia. The results suggest the importance of husband's presence at childbirth. Apart from being a very important psychosocial factor, reducing the duration of labor as well as the frequency of threatening intrauterine asphyxia and cesarean section, it also directly affects the course and result of labor.

Delivery, Obstetric↗
PubMed1999

Fetal Doppler hemodynamic changes in spontaneous versus prostaglandin E1-induced active labor.

BACKGROUND: To assess fetal hemodynamic changes before and during active labor, either spontaneous or prostaglandin E1 (PGE1)-induced labor. MATERIALS AND METHODS: This is a prospective longitudinal study and a cohort of 49 healthy women at 37-41+ weeks gestation without signs of fetal distress was investigated until in labor. One group of 23 healthy women had spontaneous active labor, the second group of 26 women was in active labor induced by an intra-cervical administration of PGE1 for elective induction. Blood flow waveform indices (S/D ratio, RI, PI) were assessed by pulsed Doppler ultrasonography from the umbilical artery (UA) and fetal middle cerebral artery (MCA) before and in labor. Both groups were compared for the waveform indices and perinatal outcome including duration of labor, meconium stain, baby sex, birthweight, UA blood gas measurements at delivery, Apgar's scores, prolonged nursery stay (> or =5 days), and NICU admission. RESULTS: Demographic data of the two groups were comparable. During spontaneous active labor, the S/D ratio and RI became significantly decreased in the UA (p<0.05) and the three wave-form indices were decreased more in the MCA (p<0.01, 0.005, 0.05, respectively) compared with those measured before labor. During PGE1-induced active labor, all the waveform indices were not significantly decreased in either the UA or the MCA. The occurrence of abnormal UA blood gas values was significantly more in the PGE1-induced group than in the spontaneous labor group (23.1% v.s. 4.3%; p<0.05). No other adverse perinatal outcomes were observed in either group. CONCLUSIONS: Decreasing impedance in both the UA and MCA during spontaneous labor is a physiological fetal adaptation to labor to prevent fetal cerebral hypoxia by maintaining adequate brain blood flow during normal parturition. This fetal adaptation phenomenon was not observed in the group of PGE1-induced labor with the result of a high incidence of abnormal UA blood gas values.

Adult↗
PubMed2005

Pregnancy outcome following non-obstetric surgical intervention.

OBJECTIVE: To evaluate the effects of non-obstetric surgical procedures on maternal and fetal outcome. METHODS: A systematic review of all English language literature. RESULTS: Fifty-four papers met the inclusion criteria. The overall number of patients reported was 12,452. Reported maternal death was rare at .006%. The miscarriage rate was 5.8%; however, this number is difficult to interpret since matched controls were not available. The rate of elective termination of pregnancy following non-obstetric surgery was 1.3%. The rate of premature labor induced by non-obstetric surgical intervention was 3.5% and this was noted specifically following appendectomy versus other types of interventions (P<.001). A total of 2.5% of pregnancies resulted in fetal loss. The prematurity rate was 8.2%. The rate of major birth defects among women who underwent non-obstetric surgical intervention in the first trimester was 3.9%. Sub-analysis of papers reporting on appendectomy during pregnancy revealed a high rate (4.6%) of surgery-induced labor. Fetal loss associated with appendectomy was 2.6%; however, this rate was increased when peritonitis was present (10.9%). CONCLUSIONS: Modern surgical and anesthesia techniques appear to diminish the rate of maternal death. Surgery in the first trimester does not appear to increase major birth defects and should not be delayed when indicated. Acute appendicitis with peritonitis is associated with higher risk to the mother and fetus.

Appendectomy↗
PubMed1988

The regulation of ovine placental steroid 17 alpha-hydroxylase and aromatase by glucocorticoid.

Parturition in the pregnant sheep is preceded by an abrupt alteration in placental steroid metabolism causing a shift from progesterone to estrogen production. This change is believed to be a consequence of the prepartum rise in cortisol in the fetal circulation and involves increases in activities of the enzymes steroid 17 alpha-hydroxylase (cytochrome P-450(17)alpha), steroid C-17,20-lyase, and possibly aromatase. We have investigated the activity levels of aromatase and 17 alpha-hydroxylase in placental microsomes in late pregnancy and dexamethasone-induced labor. Over the gestational period of 118-140 days basal levels of placental aromatase were relatively constant [mean value (+/- SD) of 5.6 +/- 1.6 pmol min-1 mg microsomal protein-1 (n = 10)]. Steroid 17 alpha-hydroxylase activity was undetectable [less than 0.5 pmol min-1 mg microsomal protein-1 (n = 7)]. In six animals in labor induced with infusion of dexamethasone into the fetus, placental aromatase activity had a mean value of 14.0 +/- 2.5 pmol min-1 mg protein-1; placental steroid 17 alpha-hydroxylase, measured in four of the animals, had a mean (+/- SD) activity of 319 +/- 58 pmol min-1 mg microsomal protein-1. Immunoblotting of placental microsomal preparations with specific antibodies to cytochrome P-450(17)alpha and NADPH-cytochrome P-450-reductase indicated that the glucocorticoid-induced activity of 17 alpha-hydroxylase was associated with increased content of cytochrome P-450(17)alpha. Northern blotting with a cDNA probe for cytochrome P-450(17)alpha showed that glucocorticoid increased the levels of mRNA for the enzyme.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

[Prostaglandins: synthetic and pharmacological studies and development].

The therapeutic use of prostaglandins (PGs) which contain various biological activities and are unstable was successfully achieved. PGs were produced in a large scale according to the Corey method and could be stabilized by the formation of a clathrate compound with cyclodextrin, which enabled the production of marketable form of highly pure PGs. Diligence in the development of native PGs and their structural analogs for human therapy resulted in the following six drugs now being on the market in Japan: PGF2 alpha as the first drug of PGs in the world which induces labor; PGE2 as an orally active labor inducing drug; PGE1 for the treatment of peripheral vascular diseases; gemeprost for therapeutic abortion in the middle-term; ornoprostil, as an oral anti-ulcer agent; limaprost for the treatment of peripheral vascular diseases as an oral agent.

Humans↗
PubMed1983

Postdates pregnancy. Assessment of fetal risk and obstetric management.

Two hundred forty-eight well-dated pregnancies that exceeded their expected dates of confinement were followed with serial maternal urinary or plasma estriol determinations and weekly fetal heart rate tests. Most pregnancies (176) delivered after spontaneous labor, while 72 had labor induced for abnormal test results or electively. Perinatal mortality (8.1/1,000) was comparable to that of our term (37-40-week) population; the two deaths occurred in the 43rd week. Intrapartum fetal distress, meconium staining, postmaturity syndrome and primary cesarean section rates all increased with gestational age beyond the 40th week. Induced labors, irrespective of indication, were significantly longer than spontaneous ones and were associated with higher rates of fetal distress and primary cesarean section. In the study group, fetal distress often arose during labor and was not anticipated by the antenatal testing.

Female↗
PubMed1999

Uterine rupture during induced or augmented labor in gravid women with one prior cesarean delivery.

OBJECTIVE: Our purpose was to examine the risk of uterine rupture during induction or augmentation of labor in gravid women with 1 prior cesarean delivery. STUDY DESIGN: The medical records of all gravid women with history of cesarean delivery who attempted a trial of labor during a 12-year period at a single center were reviewed. The current analysis was limited to women at term with 1 prior cesarean delivery and no other deliveries. The rate of uterine rupture in gravid women within that group undergoing induction was compared with that in spontaneously laboring women. The association of oxytocin induction, oxytocin augmentation, and use of prostaglandin E(2) gel with uterine rupture was determined. Logistic regression analysis was used to examine these associations, with control for confounding factors. RESULTS: Of 2774 women in the analysis, 2214 had spontaneous onset of labor and 560 women had labor induced with oxytocin or prostaglandin E(2) gel. The overall rate of rupture among all patients with induction of labor was 2.3%, in comparison with 0.7% among women with spontaneous labor (P =.001). Among 1072 patients receiving oxytocin augmentation, the rate of uterine rupture was 1.0%, in comparison with 0.4% in nonaugmented, spontaneously laboring patients (P =.1). In a logistic regression model with control for birth weight, use of epidural, duration of labor, maternal age, year of delivery, and years since last birth, induction with oxytocin was associated with a 4.6-fold increased risk of uterine rupture compared with no oxytocin use (95% confidence interval, 1.5-14.1). In that model, augmentation with oxytocin was associated with an odds ratio of 2.3 (95% confidence interval, 0.8-7.0), and use of prostaglandin E(2) gel was associated with an odds ratio of 3.2 (95% confidence interval, 0.9-10.9). These differences were not statistically significant. CONCLUSION: Induction of labor with oxytocin is associated with an increased rate of uterine rupture in gravid women with 1 prior uterine scar in comparison with the rate in spontaneously laboring women. Although the rate of uterine rupture was not statistically increased during oxytocin augmentation, use of oxytocin in such cases should proceed with caution.

Cesarean Section↗
PubMed1999

Efficacy of the selective prostaglandin synthase type 2 inhibitor nimesulide in blocking basal prostaglandin production and delaying glucocorticoid-induced premature labor in sheep.

OBJECTIVE: The purpose of the study was to determine the effects of selective prostaglandin synthase type 2 inhibitors on basal prostaglandin concentrations in the fetal and maternal circulations and on the labor-associated increase in prostaglandin production in sheep. STUDY DESIGN: The effects of maternal nimesulide (0.01, 0.1, and 1 mg/kg) and 6-methoxy-2-naphthylacetic acid (1, 5, and 10 mg/kg) administration were examined (n = 5) at 134 +/- 1 days' gestation. At 138 days' gestation premature labor was induced by fetal dexamethasone infusion (1 mg/d). Ewes were treated with either vehicle or nimesulide infusion (20 mg. d-1. kg-1, n = 5 per group). RESULTS: Nimesulide and 6-methoxy-2-naphthylacetic acid decreased basal prostaglandin production in a concentration-dependent manner. Delivery of nimesulide-treated ewes was delayed by >/=17 hours with respect to that of control ewes (53.9 +/- 2.6 hours). In 2 nimesulide-treated ewes labor did not progress to delivery despite membrane rupture. The increase in prostaglandin concentrations usually seen during dexamethasone-induced labor was abolished in nimesulide-treated ewes and also in their fetuses. CONCLUSIONS: Highly selective inhibitors of prostaglandin endoperoxidase H synthase 2 may be required to spare fetal prostaglandin production and limit potential side effects during the suppression of preterm labor.

Animals↗
PubMed1984

Plasma concentration of 13,14-dihydro-15-keto-PGE2 (PGEM) after various ways of cervix ripening with PGE2.

PGEM concentration was determined radioimmunologically in a non-pregnant woman, in whom PGE2 was infused intravenously at increasing rates and in women, in whom labor was induced by various methods for local application of PGE2. There was excellent correlation between the amount of PGE2 infused intravenously and the levels of PGEM determined in the peripheral plasma. The following methods of local application of PGE2 were included in the study: 0.4 mg PGE2 gel placed retroamnially by means of a balloon catheter, 0.4 and 0.5 mg PGE2 applied endocervically and 3 mg PGE2 placed intravaginally in form of a single vaginal tablet; also included was a control-group, where only vaginal examination was performed. Bloods were drawn before, 30 minutes, 1, 2 and 3 hours after PGE2 administration. Mean levels of PGEM in the maternal peripheral plasma did not change neither within nor between the various groups. It is concluded from the present study, that local application of doses currently used to soften the cervix and/or induce labor at term do not lead to the same PGEM-concentration in the maternal blood as after intravenous infusion of PGE2 in doses normally used to induce labor.

Cervix Uteri↗
PubMed1987

Amniotic fluid prostaglandin D2 in spontaneous and augmented labor.

Prostaglandin D2 (PGD2) was quantified in human amniotic fluid obtained from women in various phases of the first stage of spontaneous labor, augmented labor, and induced labor. PGD2 increased significantly only in late labor in the spontaneous and augmented labor groups.

Amniotic Fluid↗
PubMed1984

Composition of free fatty acids at the end of pregnancy and inducibility of labor.

The concentrations of free fatty acids which included prostaglandin precursors were investigated in a group of 54 healthy women coming to elective induction of labor. There were no differences between the concentrations of the fatty acids when the mothers were divided in two groups according to whether induction was successful or not. There were slightly more mothers with successful induction, who had the total prostaglandin precursor level above average than among mothers with unsuccessful induction (p less than 0.05). The rates of false positives or false negatives were so high, however, that this determination can not be clinically used in predicting the outcome of labor induction.

Arachidonic Acids↗