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PubMed1983

Immunoreactive endorphin peptides in amniotic fluid during labour.

Immunoreactive endorphin peptides (irEP) were measured in term amniotic fluids at induction by amniotomy (n = 8), during early and late first stage of labour (n = 52), at vaginal delivery (n = 30) and at caesarean section (n = 10). Individual values ranged from 50 to 222 pg/ml, but mean values did not differ significantly, and serial determinations revealed that irEP in the amniotic fluid remained almost constant in each woman from the first stage of labour through to delivery. There was no correlation between pathological changes in the cardiotocogram or low umbilical artery pH and irEP levels in the amniotic fluid at vaginal delivery. We conclude that immunoreactive endorphin peptides in the amniotic fluid probably are of fetal or placental origin and do not reflect fetal wellbeing or distress.

Amniotic Fluid↗

PubMed1981

A comparison of meptazinol and pethidine for pain relief during the first stage of labour.

Meptazinol and pethidine were compared in a double-blind randomized trial with regard to analgesia during the first stage of labour. It was concluded that neither drug is effective for sustained pain relief, and that there is no advantage of one over the other. However, neither drug affected maternal condition as reflected by respiratory rate, pulse rate and blood pressure, nor was any detrimental effect noted on the condition of the newborn infant. The critical reassessment of traditional drugs for analgesia in labour is suggested.

Azepines↗

PubMed1966

[Paracervical block in obstetrics].

Local anesthesia can be very useful in the first stage of labour when a general anesthetic cannot be given during this stage, and it is associated with reduced respiratory depression in the fetus. Paracervical block anesthesia is one such method of local anesthesia. Its successful use depends upon a proper technique, knowledge of the indications and contraindications, appropriate equipment and use of a long-acting anesthetic agent of low toxicity. A series of 90 cases of paracervical block are described in which the success rate was 90 to 95%.

Anesthesia, Obstetrical↗

PubMed1983

Intrapartum paracervical block anesthesia with 2-chloroprocaine.

Most of the reports of fetal bradycardia and acidosis following paracervical block anesthesia have involved the use of amide-linked anesthetics, such as lidocaine and mepivacaine. The purposes of this study were (1) to determine placental transfer of an ester-linked local anesthetic, 2-chloroprocaine, and its inactive metabolite, 2-chloroaminobenzoic acid (CABA) following paracervical block and (2) to evaluate the clinical use of 2-chloroprocaine for paracervical block anesthesia. Accordingly, 2-chloroprocaine was administered to 16 normal pregnant women in labor at term. Following injection, the levels of 2-chloroprocaine or CABA in maternal and neonatal plasma or urine were quantitated. Multiple clinical parameters, including the presence or absence of fetal bradycardia, were monitored before and after the paracervical block. The pharmacologic data indicated that 2-chloroprocaine is rapidly hydrolyzed. At delivery only trace levels of 2-chloroprocaine were present in 6.3% of the maternal samples and 25% of the cord vein samples. Furthermore, only 0.24% of the total dose of 2-chloroprocaine administered was recovered in neonatal urine as CABA. The clinical data showed no adverse effects on the parturient or neonate. Therefore, the data suggest that paracervical block anesthesia with 2-chloroprocaine may offer safe analgesia during the first stage of labor. Larger clinical studies appear warranted.

Adolescent↗

PubMed1986

Effect of epidural analgesia on maximum and minimum blood pressures during the first stage of labour in primigravidae with mild/moderate gestational hypertension.

One of the arguments used in favour of epidural analgesia for hypertensive patients in labour is its effect on mean arterial blood pressure, although the fetal and maternal risk from hypertension is more closely linked to maximum recorded levels. We have therefore assessed the effect of epidural analgesia on maximum blood pressure. There was no change in the maximum systolic or diastolic blood pressure after epidural analgesia when compared to baseline values or levels in untreated hypertensive controls. We conclude that this form of analgesia should be offered to hypertensive patients purely for its analgesic effect and not as a method for blood pressure control.

Adult↗

PubMed1991

Influence of epidural anaesthesia on the course of labour in patients with antepartum fetal death.

The course of labour in 22 patients with antepartum fetal death who received epidural anaesthesia was evaluated as compared to 22 controls matched for parity and gestational age, who received narcotic pain relief. Both groups had similar preinduction cervical dilatation and the induction was performed by amniotomy and oxytocin infusion. The mean first stage of labour was 5.4 hours in the epidural group, and 8.7 hours in the controls (p = 0.0192). The mean cervical dilatation rate was 3.3 cm/hour and 1.0 cm/hour respectively (p = 0.0142). The second stage was similar in both groups. We conclude, that parturients receiving epidural anaesthesia may benefit both emotionally and physically from excellent pain relief and a shorter delivery process when going through the distressing experience of delivering a dead fetus.

Amnion↗

PubMed1977

Haematological indices of the mother and baby during labour.

Haematological indices were obtained by Coulter Counter analysis from 325 women in the first stage of labour, and from the cord blood of their newborn babies. The mean maternal haemoglobin concentration was 12.49 g/dl and the mean cord haemoglobin 16.18 g/dl. The mean corpuscular volume measured directly was 89.00 fl from maternal blood and 106.73 fl from the cord blood; the two ranges barely overlapped and it should be possible by automated analysis to differentiate between fetal and maternal blood obtained at amniocentesis or artificial rupture of the membranes at term.

Birth Weight↗

PubMed1997

Recombinant human relaxin as a cervical ripening agent.

OBJECTIVE: The aim of this study was to investigate the efficacy and safety of recombinant human relaxin (rhRIx) as a cervical ripening agent in women with an unfavourable cervix before induction of labour at term. DESIGN: A multi-centre, double-blind, placebo-controlled trial performed in Edinburgh, Glasgow and Oxford. Women were treated with 0, 1, 2 or 4 mg of rhRIx in a gel vehicle administered intravaginally. Analysis of variance tests were performed on all continuous variables, and Cochran Mantel-Haenszel tests employed for all discrete variables. PARTICIPANTS: Ninety-six women at 37 to 42 weeks of gestation with a singleton pregnancy and a modified Bishop score of < or = 4 were recruited. RESULTS: There was no significant difference in the change in modified Bishop score between the four treatment groups. The lengths of the first and second stages of labour were similar in all 4 groups. PGE2 and oxytocin requirements were similar in all groups, as was the mode of delivery. There was no evidence that relaxin was absorbed systemically when given in this way. CONCLUSION: Recombinant human relaxin 1 to 4 mg, administered as an intravaginal gel, has no effect as a cervical ripening agent before induction of labour at term.

Administration, Intravaginal↗

PubMed1992

Sweeping of the membranes is an effective method of induction of labour in prolonged pregnancy: a report of a randomized trial.

OBJECTIVE: To determine whether sweeping of the membranes is an effective method of induction of labour in women with prolonged pregnancy. DESIGN: Randomized controlled trial. SETTING: A district maternity hospital. SUBJECTS: 65 women attending an antenatal clinic; 33 randomized to sweeping of the membranes and 32 to a control group. MAIN OUTCOME MEASURE: Proportion of women achieving spontaneous labour. RESULTS: Spontaneous labour occurred more often in the sweeping of the membranes group than in the control group (25/33 (76%) vs 12/32 (38%); odds ratio (OR) 4.65; 95% confidence interval (CI) 1.75 to 12.31; P = 0.002). In addition a greater proportion of women in the sweeping group had a cervical dilatation of 4 cm or more at the first vaginal examination in the labour ward (16/33 (49%) vs 5/32 (16%); OR 4.39; 95% CI 1.56 to 12.32; P = 0.005). There were fewer maternal infections in the sweeping group (0/33 vs 4/32 (12%); OR 0.12; 95% CI 0.02 to 0.88; P = 0.04). There were no differences in the type of analgesia used in labour, the mode of delivery or neonatal outcome. CONCLUSIONS: Sweeping of the membranes is an effective method of induction of labour in women with prolonged pregnancy.

Adult↗

PubMed1990

Prostaglandin induced cervical ripening under tocolytic cover in primiparae: results of a double blind placebo controlled trial.

In a double blind trial, 60 nulliparae with a modified Bishop score of less than or equal to 5 requiring induction of labour, received either 8 mg of salbutamol or an identical placebo orally, 30 min before vaginal administration of 2 mg prostaglandin E2 gel. Women in the salbutamol group experienced less uterine activity over the subsequent 12 h compared with those given placebo, and fewer (35%) commenced labour compared with the placebo group (62%). However, the change in cervical score was significantly less in the salbutamol group (mean 3.0, SD 3.1) than that in the placebo group (mean 5.8, SD 3.2), and the prostaglandin treatment to delivery time in the salbutamol group (mean 26.1 h, SD 6.49) was significantly longer than that in the placebo group (mean 19.3 h, SD 7.95). The first stage of labour lasted greater than 10 h in 11 women in the salbutamol group compared with five in the placebo group. Side effects attributable to salbutamol occurred in 10% of the treated women but in none of their fetuses and fetal outcome was satisfactory and similar in both groups. Our findings show that salbutamol can suppress prostaglandin-induced uterine activity during cervical ripening, which could be an advantage in induction of labour where a planned delivery is preferred. However, the poorer outcome of labour in salbutamol-treated women mitigates against this approach.

Administration, Intravaginal↗

PubMed1995

Epidural analgesia and uterine function.

OBJECTIVE: To determine whether continuous epidural analgesia with bupivacaine and fentanyl affects the rate of cervical dilation and myometrial contractility. METHODS: In a 5-week period, 62 consecutive women who received standardized epidural analgesia were matched with the next two groups of 124 consecutive women of the same parity who did not receive epidural analgesia. The outcome variables were uterine activity, rate of cervical dilation, oxytocin therapy, and operative deliveries. RESULTS: Continuous epidural analgesia with bupivacaine and fentanyl did not result in a change in myometrial contractility in the first hour after the initiation of analgesia. However, despite more oxytocin therapy, the rate of cervical dilation was significantly lower in the epidural group than in the nonepidural group (1.9 versus 5.6 cm/hour, P < .001). Operative deliveries were more common in patients with epidural analgesia than in those without it (12 of 62 versus two of 124, P < .001). CONCLUSION: After epidural analgesia, myometrial contractility is maintained with oxytocin, but the ability of the uterus to dilate the cervix is reduced significantly.

Analgesia, Epidural↗

PubMed1989

Alteration of maternal posture and its immediate effect on epidural pressure.

A study was undertaken to investigate the changes in pressure inside the epidural space in parturients in the first stage of labour. The purpose was to see whether acute local pressure changes in the epidural space were consistent with the hypothesis that there is physical movement of cerebrospinal fluid with certain changes in maternal posture. Pressure changes were measured via the epidural catheter through which continuous infusion epidural analgesia was administered, using a pressure transducer kept at the level of the lumbar spine. The mothers moved through a series of postures that reflected those expected during the course of labour and delivery. The pressure within the catheter was recorded during these manoeuvres. The pressure changes which were found, taken in conjunction with the associated investigations of others, are consistent with the hypothesis.

Anesthesia, Conduction↗

PubMed1991

Induction of labour in nulliparas with poor cervical score: oxytocin or prostaglandin vaginal pessaries?

In a previous study nulliparas with poor cervical score (less than 5 out of 10) had a 43.5% Caesarean section (CS) rate of which 55% were for failed induction when labour was induced by artificial rupture of membranes and oxytocin infusion. In this study induction of labour by 2 doses of 3 mg prostaglandin E2 (PGE2) vaginal pessaries, 4 hours apart, and if necessary by artificial rupture of membranes and oxytocin infusion 24 hours later, resulted in a CS rate of 23.7% of which 38.9% were for failed induction. The latter regimen resulted in a significantly lower CS rate compared with labour induced by oxytocin infusion and rupture of membranes without the use of prostaglandins (p less than 0.001). In the prostaglandin group 53.3% were established in labour within 24 hours of inserting the pessary and in these patients the CS rate was 18.5%. In those who did not start labour and needed rupture of membranes and oxytocin infusion 24 hours after the first pessary, 34 (47.9%) had a good cervical score (greater than or equal to 6 out of 10) and 37 (52.1%) had a poor cervical score (less than or equal to 5 out of 10) at the time of amniotomy. The CS rates in these groups were 8.8% and 48.6% respectively (p less than 0.001). In nulliparas with poor cervical score induction is better performed with vaginal prostaglandin pessaries in order to reduce the high CS rate associated with artificial rupture of membranes and oxytocin infusion.

Adult↗

PubMed1998

Intrathecal catheter insertion during labour reduces the risk of post-dural puncture headache.

PURPOSE: To describe the anaesthetic management and report the incidence of PDPH in three parturients who had experienced accidental dural puncture during labour and the subsequent deliberate intrathecal insertion of an epidural catheter. CLINICAL FEATURES: Inadvertent dural puncture with a 16-gauge Tuohy needle occurred during the first stage of labour at 3-4 cm cervical dilatation in all three women. The 20-gauge epidural catheter was immediately inserted into the subarachnoid space after accidental dural penetration. Intermittent intrathecal injections of lidocaine or bupivacaine with fentanyl were administered to provide analgesia during labour and delivery. Two of the women had spontaneous vaginal deliveries, whereas Caesarean section was performed in one case due to acute fetal distress during the second stage of labour. The intrathecal catheter was left in-situ for 13-19 hr after delivery and the women were questioned daily for symptoms of PDPH. None of the three women developed PDPH after dural puncture and intrathecal catheterisation with the epidural catheter. CONCLUSION: Immediate intrathecal insertion of the epidural catheter after accidental dural puncture during labour proved to be an effective prophylactic technique to prevent PDPH in these three parturients.

Adult↗

PubMed2006

Does the way that women experience the onset of labour influence the duration of labour?

OBJECTIVE: To assess whether the way in which women experience the onset of their labour influences the duration of their labour. DESIGN: Longitudinal study on a convenient sample of women in spontaneous labour with a singleton pregnancy in cephalic presentation at term. SETTING: University hospital in Germany. POPULATION/SAMPLE: Six hundred and fifty-one women (347 primiparae and 304 parae). METHODS: Women recorded how and when labour had started. Responses were subjected to structured content analysis. Two investigators independently subdivided women's reported signs and symptoms into eight predefined categories. These data were related to maternal characteristics and to the course and outcome of labour as documented in the perinatal record. MAIN OUTCOME MEASURES: Women's perception of how labour had started, interval between onset of labour and rupture of the membranes and duration of first stage labour and overall duration of labour. RESULTS: Only 60% of women reported contractions as a sign of the onset of their labour. These women had a longer interval between the onset of labour and rupture of the membranes but a similar duration of labour when compared with women who did not report contractions as a sign of the onset of labour. Self-reported loss of amniotic fluid was the only sign that showed a consistent relationship with the duration of labour. Other patterns of labour onset had no effect on the duration of labour. CONCLUSION: Irrespective of whether they have given birth before, women experience their onset of labour in a variety of ways. A large proportion of these experiences bear no resemblance to the classical diagnosis of labour and most are unrelated to the duration of labour.

Adult↗

PubMed1980

[Residual slowing of the heart in the first stage of labour. The interpretation and the prognostic value of this sign (author's transl)].

117 deliveries in which fetal heart slowing was accompanied by residual bradycardia where at least one measure of the fetal pH was undertaken (212 measures were carried out in the whole series) allowed the authors to analyse the maximum and residual amplitudes, the regular or irregular morphology. The frequency of the slowing and its relationship to uterine contractions (regular or variable) and the number of episodes of slowing were recorded before any measures of the fetal pH in utero were undertaken. The regular morphology and the size of the residual degree of bradycardia beyond 30 Bpm are of great diagnostic importance. In fact, while slowing with residual bradycardia below 30 Bpm is tolerable, beyond this 19% of cases show fetal acidosis when slowing is irregular or variable, and 76% when slowing is regular (53 of these had severe acidosis with a pH of less than 7.20). In this last group, which is by far the most dangerous, acidosis appeared after 5 episodes of slowing and became constant after more than 10 episodes. Because of this, measuring pH in the presence of residual slowing would seem to be only useful in irregular types of slowing.

Acidosis↗

PubMed1977

A comparative study of uterine activity in labour induced with prostaglandin F2alpha or oxytocin and in spontaneous labour. II. Characteristics of uterine activity and their effect on the progress of labour.

In 76 women with spontaneous labour or labour induced with oxytocin or PGF2alpha, intra-uterine pressure was recorded during the first stage of labour. A statistical analysis was performed of the intensity and frequency of contractions, the total uterine activity and the variability of peak-to-peak intervals and amplitudes of contractions. The duration of the latent phase was shortened by 50% in induced labour compared with spontaneous, while the active phase was less affected. However, the intensity and frequency of contractions and the uterine activity in Montevideo Units were of the same magnitude in spontaneous as in induced labour, apart from two cases of hyperactivity found in the induction groups. The variability of intervals between contractions and amplitudes of contractions were also of the same degree in all groups and no overall tendency towards greater regularity was seen during progress of labour. If irregular intervals between contractions were noted, when active cervical dilatation had begun, the progress of labour was slower and more uterine work was needed for dilatation than when the uterine activity was more regular.

Female↗

PubMed1983

Fetal plasma catecholamine concentrations and fetal heart-rate variability during first stage of labour.

Fetal heart-rate (FHR) variability was studied in 50 term fetuses during the first stage of labour. The variability was computed as an arbitrary index during a 20-min period preceding a fetal scalp blood sample which was used for the measurement of pH, adrenaline and noradrenaline. None of the fetuses was found to have a scalp blood pH less than 7.2. The short-term variability index was significantly correlated with the noradrenaline concentration in fetal blood, but the adrenaline levels which were generally very low showed no correlation with the variability values. There was no correlation between variability index and cervical dilatation or blood pH. We have shown previously high plasma catecholamine concentrations in the asphyxiated fetus with a decreased pH. In this study where fetal pH was normal a correlation between FHR variability and fetal scalp plasma noradrenaline levels was found. Thus an increased FHR variability might be an early sign of fetal distress when fetal pH is still normal.

Analgesics↗