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PubMed1997

Intrathecal opioids plus bupivacaine: an option to prolong analgesic efficacy when using the combined spinal-epidural technique--a case report.

Providing analgesia in the latent phase of labor can be challenging. Many obstetricians and nurse midwives believe that epidural analgesia initiated too early in the course of labor can prolong labor and result in fetal malpresentation, thus increasing the need for instrumentation. Many practitioners therefore use the combined spinal-epidural technique with intrathecal opioids during the early portion of first stage labor and initiate epidural analgesia only in the active phase of labor. However, the use of intrathecal opioids has been shown to be less than efficacious in meeting the analgesic needs in a large segment of the patient population, thus requiring initiation of epidural analgesia after only 1 to 2 hours. A case is reported in which the combined spinal-epidural technique was utilized in a primigravida patient. An intrathecal dose of 15 micrograms of sufentanil was given with a dilute concentration of bupivacaine at the initiation of analgesia. Analgesia was provided for approximately 5 hours before epidural analgesia was required. The patient delivered by spontaneous vaginal delivery without instrumentation or adverse sequelae to mother or infant.

Adult↗
PubMed2002

Effectiveness of intravenous meperidine for pain relief in the first stage of labour.

OBJECTIVE: To determine the effectiveness and side effects of intravenous meperidine in labour pain relief. MATERIAL AND METHOD: A double blind, randomized controlled trial was conducted in 84 parturients, using normal saline as control. Visual analogue scale, postpartum parturients' opinion of effectiveness, sedative scores, nausea/vomiting, dizziness, delivery method, Apgar scores, and naloxone prescription were assessed. RESULT: There were no statistically significant differences between the mean and median of visual analogue scale of meperidine and control group. In addition, the sedative scores, nausea/vomiting and dizziness in the meperidine group occurred more than those in the control group significantly. Even mean of the pain increment in the meperidine group was less than those in the control group (p < 0.05). The parturients' opinion on the effectiveness of pain relief during labor within 24 hours of the first postpartum day was only 23.80 per cent in the meperidine group, however, it was statistically significantly different when compared to 7.10 per cent in the control group. CONCLUSION: Intravenous meperidine exhibited the effectiveness of pain relief of only 23.80 per cent of the subjects, in addition, it may cause many side effects.

Adult↗
PubMed1990

Parturition pain treated by intracutaneous injections of sterile water.

Forty-five pregnant women in the first stage of labour presenting with lower back pain were randomized into 2 groups. One group received intracutaneous injections of sterile water in the lumbosacral region, while the other group was given corresponding subcutaneous injections of isotonic saline, regarded as a placebo treatment. In the group that received intracutaneous sterile water injections the mean VAS score was significantly more reduced compared to the placebo group at 10 min (P less than 0.001), 45 min (P less than 0.02), and at 90 min (P less than 0.05) after the treatment. The midwives' blind estimation of the effectiveness of treatment was consistent with the VAS assessment. However, the requirement of pethidine (meperidine) was similar in the 2 groups. The analgesic method presented was found to be an effective treatment against lower back pain during the first stage of labour and it is speculated that the mode of action resembles acupuncture.

Adult↗
PubMed1978

[Dynamics of the dilatation of as uteri during birth].

219 partogramms of primipares and 219 partogramms of multipares were analysed retrospectively. Only normal deliveries after normal pregnancies were taken into consideration. Graphs were plotted of time intervalls against the width of the cervix. The mean duration of dilation were 6 hours for multipares and 9 hours for primipares. All phases of first stage of labour were reduced in multipares. The results were compared with observations of other authors.

Cervix Uteri↗
PubMed2004

Epidural neostigmine combined with sufentanil provides balanced and selective analgesia in early labor.

BACKGROUND: This study evaluated the efficacy of an epidural single dose of neostigmine combined with sufentanil to provide selective and balanced analgesia at the beginning of labor. METHODS: After informed consent, 125 healthy parturients were randomly allocated to receive, after a test dose, a single injection of either epidural sufentanil 20 micrograms (minimal analgesic dose) or 10 micrograms or a combination of sufentanil 10 micrograms with neostigmine 250, 500, or 750 micrograms in a total volume of 12 ml. Pain scores were recorded at regular intervals to determine onset and duration of analgesia. Maternal and fetal vital parameters as well as side effects were closely monitored. RESULTS: Parturients did not differ concerning demographic data. Epidural neostigmine 500 micrograms with sufentanil 10 micrograms produced effective analgesia (visual analog scale <30 mm within 10 min in 72% parturients and within 15 min in 85% parturients; average duration of 119 min, confidence interval 96-142 min) that was as effective as epidural sufentanil 20 micrograms. Epidural combination with neostigmine 250 micrograms was ineffective, whereas 750 micrograms did not produce higher effect than 500 micrograms. No motor block was recorded. Maternal and fetal vital parameters remained stable during labor. CONCLUSIONS: Epidural combination of neostigmine 500 micrograms (e.g., 6-7 micrograms/kg) with sufentanil 10 micrograms provides similar duration of analgesia as epidural sufentanil 20 micrograms and allows effective and selective analgesia devoid of side effects in the first stage of labor.

Adult↗
PubMedDate not supplied

Natural eating behavior in latent labor and its effect on outcomes in active labor.

This study examined the effect of eating during the latent phase of labor on the hospital-estimated labor duration and birth outcomes for the mother and baby. A prospective, comparative trial with concurrent controls compared labor duration and outcomes of 176 low-risk, nulliparous women who birthed at four hospitals in Sydney, Australia. Food was voluntarily consumed by 82 women, whereas 94 consumed clear fluids only. Food intake during the latent phase of the first stage of labor was associated with a longer duration of labor (mean difference = 2.35 hours). No difference was found between eating and noneating groups for the rate of medical interventions, adverse birth outcomes, or vomiting. Results suggest that eating during the latent phase of labor may increase labor duration.

Adult↗
PubMed1996

Warm tub bath during labor. A study of 1385 women with prelabor rupture of the membranes after 34 weeks of gestation.

BACKGROUND: To evaluate the influence of a bath on infectious morbidity in mothers and neonates in women with prelabor rupture of the membranes after 34 weeks of gestation. METHODS: A nonrandomized study of 1385 healthy women. During the first stage of labor 538 women wanted a bath while 847 did not. The women awaited spontaneous contractions up to 24 or 72 hours after the membranes had ruptured before labor was induced with oxytocin. Digital examinations of the cervix were avoided until onset of active labor or until the time induction was planned. For statistical analysis Fisher's exact test was used. RESULTS: Chorioamnionitis during labor occurred in 1.1% of the women in the bath group and in 0.2% in the reference group (p = 0.06). Postpartum endometritis was found in three cases both in the bath group (0.6%) and in the reference group (0.4%) (p = 0.68). The frequency of neonates receiving antibiotics was 3.7% and 4.8% respectively (p = 0.43). CONCLUSION: A tub bath did not increase the risk of maternal or neonatal infection after premature rupture of the membranes and prolonged latency.

Apgar Score↗
PubMed2006

Labour management: an appraisal of the role of false labour and latent phase on the delivery mode.

Achieving normal vaginal delivery requires an orderly transition from early labour to an established active labour. We analysed retrospectively the outcome of labour and the delivery mode based on the diagnosis of labour from the first examination of 3,130 parturients. A total of 1,847 (59.1%) delivered mothers had the first vaginal examination performed by the senior house officer (SHO). The majority (74.4%) of the mothers presented in established labour (cervical dilatation > or =4 cm), 25.6% in early labour, while 11.3% in latent phase. Patients who presented in established labour had a statistically significant higher spontaneous vertex delivery (SVD) rate (Pearson chi2 = 29.74, p = 0.000). A total of 62 parturients (17.5%) who presented in the latent phase and 204 (29.1%) in early labour had an unfavourable delivery mode; 46 had a caesarean section. There was a significant correlation between delivery mode and prolonged latent phase (Pearson correlation coefficient R = -0.066, p = 0.000). Linear regression analysis showed that the total number of VEs was the most significant predictor of the delivery mode of SVD (Regression beta-coefficient = 0.278, t = 10.37, p = 0.000). Early admissions in labour and a prolonged (abnormal) latent phase are significant predictors of difficult mode of delivery (poor labour outcome). We suggest that the first vaginal examination should be undertaken by the most experienced medical personal present at admission.

Cesarean Section↗
PubMedDate not supplied

Estrogen receptor alpha and progesterone receptor A and B concentration and localization in the lower uterine segment in term parturition.

OBJECTIVE: To determine the localization and concentrations of estrogen receptor alpha and progesterone receptors A and B in the lower uterine segment during term parturition. METHODS: Biopsies were taken from 70 patients during nonelective cesarean delivery. The patients were at different stages of cervical dilatation (<2 cm, 2-3.9 cm, 4-6 cm, >6 cm) and different duration of labor (< or =6 hours, >6-12 hours, >12 hours). The receptor concentrations were determined with solid phase immunoassays, and their localization was investigated immunohistochemically. RESULTS: Estrogen receptor alpha concentration decreased significantly from 2.12 fmol/mg protein at less than 2 cm dilatation to 1.08 fmol/mg (4-6 cm) but tended to increase at greater than 6 cm. Progesterone receptor A and B concentration was 84.7 fmol/mg at less than 2 cm dilatation, decreased significantly to 36.6 fmol/mg (2-3.9 cm), and increased again with further dilation. Concentrations of both receptors did not depend on duration of labor. By immunohistochemistry only progesterone receptor A and B was found to be expressed by endothelial and smooth muscle cells of the vessels, stromal fibroblasts, smooth muscle cells in the myometrium, and glandular epithelial cells. Regardless of the extent of cervical dilatation, expression of progesterone receptors A and B was marked. CONCLUSION: A decrease in estrogen receptor alpha and progesterone receptor A and B concentration in the early phase of first stage labor may play a role in cervical dilation at term.

Estrogen Receptor alpha↗
PubMed1998

Intrapartum vibratory acoustic stimulation after maternal meperidine administration.

OBJECTIVE: To examine the effectiveness of the acoustic stimulation test in the interpretation of suspicious cardiotocograms obtained after meperidine administration to the mother during the first stage of labor. SUBJECTS AND METHODS: We studied 45 unselected parturients who received 50 mg meperidine i.m. when cervical dilatation was 5 cm. In all cases a decreased beat-to-beat variability of the fetal heart rate and fetal movements was noted after the injection of meperidine. A vibratory acoustic stimulation was performed in 25 patients (group A) while the remaining 20 (group B) had no stimulation. RESULTS: After the meperidine injection, the acoustic-induced reactivity returned immediately in group A, while the spontaneous reactivity returned 30 minutes later. The mean number of fetal movements in all parturients was 8.71 +/- 2.18 before meperidine administration. Sixty minutes after the meperidine injection the mean number was 8.52 +/- 2.48 in group A and 1.65 +/- 1.81 in group B (p < 0.0001). CONCLUSION: The acoustic stimulation test is an effective method of interpreting suspicions CTG's obtained after meperidine administration to the mother during the first stage of labour.

Acoustic Stimulation↗
PubMed1962

[Preliminary clinical study on the use of dihexyverine in obstetrics].

This study attempted to evaluate the effect of dihexyverine HCl (Metaspas), an anticholinergic and direct smooth muscle relaxant (spasmolytic), in shortening the first stage of labour. One hundred and five patients constituted the series: 31 were primiparae, 27 secundiparae and 47 multiparae. The majority of these (95) received one intramuscular injection (10 mg.) of dihexyverine. Alphaprodine (Nisentil), 40 mg., was administered in all but 10 cases, since dihexyverine has no analgesic action. Seventy-five control patients were used: 25 were primiparae, 25 secundiparae and 25 multiparae. Alphaprodine alone was administered to these control patients. The length of time for dilatation from 4 cm. to 10 cm. was the selected criterion. In the control group, the average time for complete cervical dilatation was 4 hours, 10 minutes. In the group treated by dihexyverine, complete dilatation was achieved in 1 hour, 16 minutes. On the average, the first stage of labour was 2 hours and 54 minutes shorter with dihexyverine; the clinical effect begins 10-30 minutes after administration. The only side effect encountered was a skin rash in one patient.

Alphaprodine↗
PubMed2004

Risk factors and outcomes associated with a short umbilical cord.

OBJECTIVE: To identify risk factors and outcomes associated with a short umbilical cord. METHODS: We conducted a population-based case-control study using linked Washington State birth certificate-hospital discharge data for singleton live births from 1987 to 1998 to assess the association between maternal, pregnancy, delivery, and infant characteristics and short umbilical cord. Cases (n = 3565) were infants diagnosed with a short umbilical cord. Controls (n = 14260) were randomly selected from among births without a diagnosis of short umbilical cord. RESULTS: Case mothers were less likely to be overweight (body mass index 25 or more, odds ratio [OR] 0.7; 95% confidence interval [CI] 0.6, 0.8) and more likely to be primiparous (OR 1.4; 95% CI 1.3, 1.6). Case infants were more likely to be female (OR 1.3; 95% CI 1.2, 1.4), have a congenital malformation (OR 1.6; 95% CI 1.4, 1.8), and be small for their gestational age (risk ratio [RR] 1.6; 95% CI 1.4, 1.9). A short cord was associated with increased risk for maternal labor and delivery complications, including retained placenta (RR 1.6; 95% CI 1.2, 2.3) and operative vaginal delivery (RR 1.4; 95% CI 1.3, 1.5). Adverse fetal and infant outcomes in cases included fetal distress (RR 1.8; 95% CI 1.6, 2.1) and death within the first year of life among term infants (RR 2.4; 95% CI 1.2, 4.6). CONCLUSION: Modifiable risk factors associated with the development of a short cord were not identified. Case mothers and infants are more likely to experience labor and delivery complications. Term case infants had a 2-fold increased risk of death, which suggests closer postpartum monitoring of these infants.

Adult↗
PubMed2006

[Transvaginal ultrasound assessment of the cervix and digital examination before labor induction].

OBJECTIVE: To examine the relationship between sonographic measurement of cervical length and Bishop score with duration of labour induction. METHODS: A prospective, blinded, observational study was performed in 191 pregnant women undergoing labor induction. Ultrasound measurement of cervical length and determination of Bishop score were performed. Induction was based exclusively on the Bishop score according to Obstetric Unit protocol. The criteria for considering the cervix unripe were either Bishop score < 6 or a cervical length = 26 mm. Duration of induction is defined like the induction-to-delivery interval. The main outcomes assessed were the duration of induction, the delivery within 24 h of induction and type of delivery. RESULTS: The duration of induction was between 2 h 27 min and 61 h 30 min. We found an association between cervical length and Bishop score with duration of induction. The duration of induction was significantly increased in nulliparous (median 18 h 38 min vs. 9 h 18 min). There was no correlation of age or weight of pregnant women with the duration of induction. Comparison between Bishop score and cervical length in predicting delivery within the first 24 hours showed that the pregnant women with low Bishop score had a higher risk of deliver after 24 hours of induction (OR = 21.16), as the ones with cervical length longer than 26 mm (OR = 5.06). Analyzing the relation of these two parameters with type of delivery we realize that low Bishop score has a higher risk of cesarean section (OR = 2.67) and that there wasn't any relation between type of delivery and cervical length. DISCUSSION: In this study we verified a statistically significant relation between Bishop score, US cervical length and previous vaginal birth with induction duration. Pregnant woman's age and weight didn't have influence on the duration of induction. The study showed that both Bishop score and US cervical length are useful in predicting delivery within the first 24 hours. Bishop score was also related with type of delivery.

Adolescent↗
PubMed2000

Graphic analysis of actively managed labor: prospective computation of labor progress in 500 consecutive nulliparous women in spontaneous labor at term.

OBJECTIVE: Active management has been shown to shorten the length of labor and reduce the incidence of prolonged labor. We examined the influence of this protocol on the rate of cervical dilatation by calculating a mean partogram to explain how this acceleration is achieved. STUDY DESIGN: We retrospectively analyzed partograms of cervical dilation in 500 consecutive nulliparous women in spontaneous labor at term with a singleton fetus in a cephalic presentation; cesarean deliveries were not excluded. Mean cervical dilations at admission and mean time intervals to reach 2, 3, 4, 6, 8, and 10 cm of dilatation and delivery were calculated, with 95% confidence intervals, both for the whole cohort and specifically in women with cervical dilatations <3 cm at admission. These data were used to construct mean partograms. RESULTS: The mean duration of labor was 6.1 hours. The mean cervical dilatation at admission was 1. 7 cm; all but 2.8% were delivered within 12 hours. The cesarean rate was 5.4%. The mean partogram, with narrow 95% confidence intervals, shows a rapid active phase after a much shorter latent phase than reported in other analyses of labor. CONCLUSION: Active management reduces the duration of first labor mainly by shortening the latent phase in association with amniotomy at very early cervical dilatations and does not delay the diagnosis of labor until the active phase has begun.

Adolescent↗
PubMed1976

Uterine contractility in spontaneous and induced labour.

Contractility parameters (uterine activity, contraction interval, amplitude, and frequency of contractions) were analyzed quantitatively during the active phase of first-stage of labour in 60 clinically normal term nulliparae with spontaneous or induced labour. Inductions were surgical (amniotomy alone) or by amniotomy combined with either intravenous oxytocin or prostaglandin administered intravenously (PGF 2alpha or PGE 2) or orally (PGE 2).

Administration, Oral↗
PubMed1997

Fetal oxygen saturation during labour.

OBJECTIVE: To derive oxygen saturation by pulse oximetry (SpO2) values at each cervical dilation in labour in fetuses with normal neonatal outcome. PARTICIPANTS: One hundred and forty-five women at term in established labour with ruptured membranes and cervical dilation at least 2 cm who had normal delivery outcome. The infants had 5 minute Apgar scores > or = 7, birthweight > or = 2500 g, umbilical cord artery pH > or = 7.15 and did not require assisted ventilation or admission to neonatal intensive care. METHODS: Women were monitored continuously with cardiotocography and fetal pulse oximetry using the Nellcor N-400 fetal pulse oximeter and FS-14 fetal oxisensor till delivery. Labour was managed according to established protocol without recourse to SpO2 readings. RESULTS: There was a wide range of SpO2 values during labour in fetuses with normal outcome. Mean values averaged 50% +/- 10% throughout the first stage of labour, with lower ranges of SpO2 values above 30%. There was no significant difference in SpO2 readings at different cervical dilatations in the first stage of labour. Mean SpO2 values in the last 10 minutes before delivery were also not significantly different from those in the first stage of labour. CONCLUSION: The range of SpO2 in 115 healthy fetuses during normal labour was wide, but always above 30%. There was no trend of SpO2 values in this study of 115 fetuses with normal neonatal outcome.

Apgar Score↗
PubMed1987

Augmentation of labour--mode of delivery related to cervimetric progress.

This study was designed to investigate the possible benefits, in terms of obstetric and neonatal outcome, of a prolonged augmentation period with oxytocin in patients with dysfunctional first stage of labour. The majority of patients (65.5% of nulliparas and 83.8% of multiparas) responded with satisfactory progress within the first 4 hours of augmentation and the Caesarean section rate was low in this group (1.3%). In those with unsatisfactory progress during the first 4 hours of augmentation a further 4 hour period of augmentation resulted in vaginal delivery for 50.7% of nulliparas with primary dysfunctional labour and 33.3% of those with secondary arrest in labour. Corresponding figures for multiparas were 41.7% and 25.0%, respectively. The neonatal outcome was uniformly good. It is concluded that the management protocol presented for augmentation of labour seems to be a safe procedure and might reduce the rising Caesarean section rate for dystocia.

Female↗