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PubMed2003

[Prenatal ultrasonographic evaluation of fetal limbs anatomy and fetal limbs malformations using a systematic continuous sequence approach].

OBJECTIVE: To review the value of ultrasonographic evaluation on fetal limbs anatomy and malformations in prenatal diagnosis using a systematic continuous sequence approach (SCSA). METHODS: Successive 4,932 prenatal ultrasonographic evaluation during gestation aging 14 - 40 weeks from August 2000 to September 2002 entered the present review. SCSA was applied to scan each limb of the fetus respectively. RESULTS: The anatomic structures of the four limbs of the fetus were clearly displayed and correctly recognized on ultrasonic images using the SCSA in 4 750 cases (96.3%). Ninety eight limb malformations of 34 fetuses were correctly diagnosed (87.2%). Whereas 16 malformations of 5 fetuses were missed to recognize (12.8%). The diagnoses were confirmed after subsequent labor or induced labor. The sensitivity, specificity, accuracy, positive and negative predictive values were 87.2%, 99.8%, 99.2%, 81.0% and 99.9%, respectively. CONCLUSION: The majority of fetal limb structures and malformations can be clearly demonstrated on prenatal ultrasonic imaging using SCSA. SCSA for prenatal ultrasonographic evaluation of the fetal limbs is a reliable and accurate diagnostic modality so far as the skills become more sophisticated.

Adult↗
PubMed1975

Response of pituitary-adrenal axis on partal stress.

The circulating level of ACTH (by radioimmunoassay) and cortisol (by competitive protein binding) were determined at 1- to 2-hour intervals during spontaneous labor (N=8) and induced labor (N=28) and after delivery. There were no differences in ACTH levels between primiparous and multiparous women. The primiparous women displayed a higher level of cortisol throughout labor than the multiparous women, but not after delivery. After spontaneous onset of labor, ACTH levels were always lower than after elective induction of labor, while there were no differences in the levels of cortisol. The hypertensive complications of pregnancy did not affect the secretion of ACTH. In normal pregnancy the rise of cortisol during labor and after delivery was significant, but it was not significant in the group of patients with hypertensive complications.

Adrenocorticotropic Hormone↗
PubMedDate not supplied

[Administration of prostaglandin E2 in premature rupture of the membranes].

The imminent amnion infection syndrome with or without premature rupture of the membranes is regarded as one of the most severe perinatal complications, especially for the baby. Early treatment or better, prevention of manifest intrauterine infection syndrome is thus a priority task in obstetrics. In recent years, administration of prostaglandin has proven to be a good choice to stimulate cervix maturation and to induce labor. The present study wanted to investigate the effect of prostaglandin application in PRM. Prostaglandin E2 was intracervically applied in the form of gel, and intravaginally in the form of a tablet. Its action was compared with controls. Patients with immature cervix were evaluated versus patients with mature cervix. Duration of labor and fetal outcome were compared to a group of non-primed patients. After application of prostaglandin E2, approximately 80% of patients started to deliver within 24 hours. Concerning the duration of labor, the rate of cesareans, incipient chorio-amnionitis and fetal morbidity, independent of cervical maturation, results after prostaglandin E2 administration were better among the primi- and pluriparae. Adverse effects such as uterine overstimulation or pathologic FHF in the CTG were seen in 7% of the cases. The incidence of pH-shifting in the umbilical artery was nearly equal in all groups. Our study confirmed that prostaglandin E2-application constitutes a successful method to shorten aminon infection syndrome. In absence of spontaneous labor, priming should be done early, e.g. within six to seven hours.

Administration, Topical↗
PubMed1990

Intra/extra-amniotic administration of prostaglandin F2a in fetal death, missed and therapeutic abortions.

Prostaglandin F2a was used for termination of pregnancy in two groups of patients. The first included eighteen patients with either missed abortion or intrauterine fetal death, and were treated by intrauterine-extraamniotic infusion of 20 mg prostaglandin F2a. The treatment was successful in 14 patients (mean induction-abortion interval 6.7 hours). Four patients, where the above method failed to induce labor, were given intravenously prostaglandin F2a or oxytocin simultaneously or separately; the expulsion time ranged from 12 to 48 hours. The second group included twelve patients who underwent a therapeutic abortion following either a diagnosis of fetal congenital abnormality or because of a maternal indication. The therapeutic abortion was performed using prostaglandin F2a (25-40 mg) via amniocentesis. The treatment was successful in all patients (mean induction-delivery interval 10.6 hours).

Abortion, Missed↗
PubMed1987

Early gastric cancer and a concomitant pregnancy.

Gastric cancer associated with pregnancy is most often associated with a poor prognosis because the cancer stage is usually advanced at the time of diagnosis. The symptoms are frequently masked by factors related to the normal pregnancy and diagnostic approaches are restricted by physical and psychological clinical events. The authors treated a 30-year-old woman at 35 weeks of gestation. She had episodes of hematemesis and a prompt diagnosis of early gastric cancer was made following observations using a gastroduodenal fiberscope. A living normal child was delivered following oxytocin-induced labor and, 18 days later, curative resection for the gastric cancer was done. The patient has been doing well for over 16 months at this writing, with no evidence of recurrence. Based on the author's experience and a review of the literature, they conclude that early gastric cancer detected during pregnancy has a satisfactory prognosis and that use of the gastrofiberscope facilitates an early diagnosis in a pregnant subject with untoward symptoms of the GI tract.

Adenocarcinoma↗
PubMed1980

Placental concentrations of progesterone, estradiol-17 beta, and cyclic AMP at delivery.

In contrast to most mammals, human parturition is not preceded by a rise in the estradiol : progesterone ratio in peripheral plasma. Thus tissue concentrations of progesterone, estradiol-17 beta, and cyclic adenosine monophosphate (AMP) were measured in placentas obtained after spontaneous vaginal delivery (SVD, N = 11), after oxytocin-induced labor (OXIL, N = 5), and at elective cesarean section (ECS, N = 8). Both progesterone and estradiol were higher in placentas obtained from SVD compared with those from ECS (progesterone: 2.95 +/- 0.26 versus 1.96 +/- 0.29 ng/mg tissue, P < .025; estradiol: 33.6 +/- 5.2 versus 26.4 +/- 3.8 pg/mg). Placentas from OXIL had intermediate progesterone (2.50 +/- 0.47 ng/mg) but the highest estradiol concentration (41.4 +/- 3.2 pg/mg). Cyclic AMP was 29.8 +/- 1.5, 39.6 +/- 8.0, and 35.9 +/- 3.9 pmoles/100 mg tissue in SVD, OXIL, and ECS placentas, respectively. Thus no rise in the placental estradiol : progesterone ratio was found in association with spontaneous labor.

Cesarean Section↗
PubMed1977

Assessment of factors constituting an "inducibility profile".

A survey of 440 patients examined vaginally during the last month of pregnancy showed a correlation between quantitative assessment of the pelvic score features described by Bishop and the duration of induced labor. Cervical dilatation was as useful as the total Bishop score in this respect. Cervical dilatation and station of the head together were especially predictive for long labor and these two factors together with length of cervix were especially predictive for shorter labors. It was also apparent from this study that previous cervical surgery or vaginal termination of pregnancy was associated with a lower incidence of low Bishop scores. The changes in individual components of the Bishop score during the last month of pregnancy are described.

Cervix Uteri↗
PubMed2001

A comparison of spontaneous labor with induced vaginal tablets prostaglandin E2 in grand multiparae.

OBJECTIVE: To compare the outcome of labor in grandmultiparous patients (para >5) who had induction of labor with prostaglandin E2 vaginal tablets with grandmultiparous patients in spontaneous labor, and to observe the complications during induction of labor. METHODS: A retrospective case control study was carried out at King Faisal Military Hospital, Khamis Mushayt between January 1993 through until December 1994. This included 64 grandmultiparous patients that were induced with prostaglandin E2 vaginal tablets. Ninety grandmultiparous patients who went into labor spontaneously served as controls. Maternal and fetal data extracted from their hospital record files included age, parity, indication for induction, Bishop score at induction, total dose of prostaglandin used and complications of induction of labor. Other information were length of labor, need for syntocinon augmentation, blood loss during the 3rd stage of labor, mode of delivery, birth weight, sex and Apgar score at 10 minutes. RESULTS: No serious complication of induction of labor such as rupture of the uterus was noted in the subjects studied. There were no significant differences when the mean age and parity of patients in the 2 groups were compared (P>0.05) but there was difference in the gestational age at delivery (p=0.00). There was no significant difference in the mean length of first and 2nd stages of labor. The cesarean section rate was 11% and 8% in the cases and controls, while the need for syntocinon augmentation was twice in the cases than controls, 27% vs 14%. These were not statistically significant. CONCLUSION: We conclude that induction of labor with prostaglandin E2 vaginal tablets may not have adverse effect on the outcome of labor compared with patients in spontaneous labor. It may be safe to use prostaglandin E2 vaginal tablets for induction of labor in the grand- multiparae. We recommend a randomized prospective trial to validate these observations.

Administration, Intravaginal↗
PubMed2002

Effects of erythromycin on pregnancy duration and birth weight in lipopolysaccharide-induced preterm labor in pregnant rats.

OBJECTIVE: The aim of this study was to investigate the effects of erythromycin on pregnancy duration and on live birth weight in lipopolysaccharide (LPS)-induced preterm labor model in rats. STUDY DESIGN: Total of 60 pregnant rats on day 16 of gestation was intraperitoneally injected with 25 microg/kg LPS. Animals were randomly divided into six groups and 20mg/kg (n=10), 40 mg/kg (n=10), 60 mg/kg (n=10), 80 mg/kg (n=10), and 100mg/kg (n=10) erythromycin and equal volume of physiological saline (n=10) were given intraperitoneally. Injection of LPS-to-vaginal bleeding interval, vaginal bleeding-to-delivery interval, LPS injection-to-delivery interval was monitored and live birth weight of neonates was determined. Statistical analysis was performed using Kruskal-Wallis, Mann-Whitney U-test and Spearman correlation analysis. RESULTS: Intraperitoneal injection of erythromycin to LPS-administered rats caused significant increase in latent period, labor period, total period and live birth weight in a dose dependent manner. CONCLUSION: These data shows that erythromycin causes prolongation of pregnancy period and increases live birth weight in LPS-induced preterm labor of pregnant rats.

Animals↗
PubMed1982

Oxytocin in the fetal and maternal circulations during induced and spontaneous parturition in sheep.

Oxytocin has been measured in fetal and maternal plasma samples obtained serially from 6 sheep during late pregnancy, spontaneous labor and labor induced by intrafetal infusion of Synacthen (ACTH1-24). Fetal plasma contained significantly (P less than 0.001) greater concentrations of oxytocin than maternal plasma. Concentrations of oxytocin rose in maternal plasma during the later stages of spontaneous and induced labor, whereas concentrations in fetal plasma did not exhibit a consistent trend.

Animals↗
PubMed1997

Predictors of childbirth pain and maternal satisfaction.

There is little multivariate, multiphasic research on childbirth pain and satisfaction. We explored the relationship of demographic, medical, psychological, and environmental variables at different times to multiple indices of pain and satisfaction in 70 primiparae and multiparae. Induced labor, desirability of pregnancy, and coach's helpfulness predicted sensory pain. Duration of labor, depression, and outcome expectancy that childbirth education would facilitate medication-free childbirth predicted affective pain. Physician-anticipated complications, induced labor, and motivation to be medication-free predicted pain intensity. Grade level predicted-satisfaction. The results also demonstrated differences between primiparae and multiparae in the pattern of variables that explained pain and satisfaction as well as the temporal sensitivity of pain predictors. We discuss the implications of our findings for research and practice.

Depression, Postpartum↗
PubMed1990

[Exploration of the clinical management of prolonged pregnancy].

This study was designed to address the effect of induced labor using pitocin iv drip in decreasing the incidence of perinatal complications and perinatal mortality of prolonged pregnancy. Induced labor was used in a study group which included 126 prolonged pregnant nullipara without complication. One hundred and twenty-eight prolonged pregnant nullipara in natural labor were defined as the control group. The perinatal mortality was 0 in the study group and 3.125% in the control. Also, the asphyxia rate was 8.7% in the study group and 13.3% in the control. The percentage of caesarean deliveries was the same in the both groups. The results of this study suggest that induced labor is safe, effective and practical in the management of prolonged pregnancies.

Asphyxia Neonatorum↗
PubMed1976

Cortisol levels in umbilical cord plasma in relation to labor and delivery.

Cortisol was determined by a competitive protein-binding method in umbilical cord plasma from pregnancies of 37 or more weeks' gestation. In 162 cases of vaginal delivery following spontaneous labor the mean +/- S.E. of cortisol values was 7.43 +/- 0.29 mug per 100 ml. of plasma. This cortisol level was not significantly different from that observed in 51 cases of vaginal delivery after oxytocin-induced labor (6.53 +/- 0.49 mug per 100 ml.) or in 47 cases of delivery by emergency cesarean section following labor (6.21 +/- 0.66 mug per 100 ml.). The mean cortisol level in cases of elective cesarean section with no prior labor (4.67 +/- 0.60 mug per 100 ml.) was significantly less than the value for vaginal delivery after spontaneous or induced labor. The cord plasma and amniotic fluid concentrations of cortisol in a pregnancy complicated by fetal anencephaly and terminated at 44 weeks by induction were normal. It is concluded that labor and vaginal delivery resulted in a significant increase in cord plasma cortisol levels but there was no significant difference between spontaneous and induced labors. These findings do not support the hypothesis that a surge in fetal cortisol production immediately precedes and initiates spontaneous labor in human pregnancy.

Anencephaly↗
PubMed1976

Plasma cortisol levels in human fetus during parturition.

In several mammalian species, the fetal adrenal cortex plays an important role in the spontaneous onset of labor. No conclusive evidence has yet been presented that a similar mechanism is active in humans. Although in some previous studies the cortisol concentration in human cord blood has been found higher after spontaneous labor than after induced labor, it has not been possible to determine whether this rise in the fetal cortisol level precedes the onset of parturition or is a consequence of labor. In the present study, starting at the earliest possible stage of labor, fetal scalp blood samples were taken sequentially during 16 spontaneous and 13 induced vaginal deliveries. Cortisol levels in these 2 goups of samples were compared with each other and also with cord blood cortisol levels in 11 patients undergoing elective cesarean section. The initial fetal cortisol levels did not differ between groups with different modes of labor onset. A pronounced rise of plasma cortisol levels occurred during labor in simultaneously sampled maternal and fetal blood. These results do not support the concept of a role for the fetal adrenal cortex in the initiation of labor in humans; they invalidate the use of cortisol concentration in cord blood for the estimation of prelabor fetal cortisol level. The origin of the cortisol surge in fetal plasma during labor and also whether the fetal adrenocortical function responds to the stress of labor are discussed. It is concluded that the rise of fetal cortisol levels during labor might mainly be a reflection of the maternal response to stress.

Amniotic Fluid↗
PubMed2006

Outcomes of pregnancy beyond 37 weeks of gestation.

OBJECTIVE: The aim of the study was to evaluate pregnancy outcomes by weeks of gestation. A second aim was to assess the outcomes in groups with spontaneous or induced labor. METHODS: This was a prospective cohort study of singleton pregnancies delivered after 37 weeks of pregnancy covering a well defined region in Norway from 1990 to 2001 (N = 27,514). Linear regression, chi 2 tests, and multivariable logistic regression analysis were used. RESULTS: Maternal complications varied with gestational age, and were lowest at 39 weeks and highest postterm (cesarean delivery 12.3-21.6%, operative vaginal delivery 10.7-15.4%, maternal hemorrhage 9.7-14.6%). Poor neonatal outcome varied with gestational age only for spontaneous labors (Apgar at 5 minutes less than 7 1.0-2.3%, pH less than 7.10 3.4-5.2%), whereas induction of labor was a risk factor for delivery complications (odds ratio 1.3-2.8), independent of gestational weeks. CONCLUSION: Poor pregnancy outcomes vary with gestational age. Postterm pregnancy and induced labor are prognostic factors for poor outcome.

Adult↗
PubMed2003

Bacterially-induced preterm labor and regulation of prostaglandin-metabolizing enzyme expression in mice: the role of toll-like receptor 4.

Toll-like receptor 4 (TLR-4) is a critical mediator of the cellular response to lipopolysaccharide. Our purpose was to examine the role of TLR-4 in parturition and in the regulation of expression of prostaglandin synthase (cyclooxygenase [COX]-1 and COX-2) and 15-hydroxyprostaglandin dehydrogenase (PGDH) following exposure to heat-killed Escherichia coli (HKE) in pregnant mice. Inbred TLR-4-mutant C3H/HeJ mice and inbred normal C3HeB/FeJ mice on Day 14.5 of a 19- to 20-day gestation received intrauterine injection of either HKE or sterile vehicle (PBS). Preterm or term delivery was recorded for these animals. Tissues (myometrium, decidual caps, placentas, fetal membranes, and fetuses) were collected after injection of sterile vehicle or 5 x 109 HKE bacteria (n = 5 mice per strain per treatment per time point). The COX-1, COX-2, and PGDH gene expression was determined by semiquantitative reverse transcription-polymerase chain reaction. We found that 5 x 109 HKE induced preterm delivery in 100% of TLR-4-normal mice but in 0% of TLR-4-mutant mice. The HKE exposure up-regulated expression of COX-2, but not of COX-1, in maternal tissues in both mouse strains. The prostaglandin-catabolizing enzyme PGDH was down-regulated in myometrium, fetal membranes, and fetuses in control mice, but no change was observed in TLR-4-mutant mice after HKE treatment. These results demonstrate that a functional TLR-4 is essential for HKE-induced preterm labor and PGDH down-regulation but is not essential for HKE-induced COX-2 gene up-regulation. The TLR-4 may mediate bacterially induced preterm labor via regulation of prostaglandin degradation rather than prostaglandin synthesis.

Animals↗