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PubMed2004

The continuing effectiveness of active management of first labor, despite a doubling in overall nulliparous cesarean delivery.

OBJECTIVE: The purpose of this study was to determine the continuing effectiveness of active management of labor, a protocol that involves early detection and correction of dystocia with oxytocin in spontaneous cephalic nulliparous labor, by analysis of the contribution of this cohort to a doubled overall nulliparous cesarean delivery rate. STUDY DESIGN: This was a retrospective analysis of annually collated institutional data on cesarean delivery and perinatal outcome. RESULTS: From 1989 to 2000, 81,855 women were delivered at the National Maternity Hospital, of whom 34,201 women (42%) were nulliparous; the annual proportion of nulliparous women in spontaneous labor decreased progressively from 83% to 60%; the overall nulliparous cesarean rate increased from 8.1% to 16.6%. Cesarean birth rate among nulliparous women in spontaneous labor, although showing a significant upward trend between 1989 and 2000 (2.4%-4.8%; P = .001), was stable, averaging 5% for the last 8 years (P = .705); the peripartum death rate in this group fell significantly (P = .024). Comparing results for 1989 with results for 2000, nulliparous women in spontaneous labor accounted for 14% of the overall increase in cesarean deliveries (dystocia, 5%), compared with 51% for nulliparous women with induced labor. The perinatal mortality rate in term infants was unchanged. CONCLUSION: Active management of spontaneous first labors remains an effective protocol for the promotion of vaginal delivery with low peripartum mortality rates; factors other than dystocia in spontaneous labor account for the progressive increase in the nulliparous cesarean delivery rate.

Cesarean Section↗

PubMed1980

Fetal breathing in labor.

Fetal breathing during labor was investigated in a 3-part study of 42 normal singleton pregnancies. In the first part fetal breathing movements (FBM) were compared antenatally and during labor in 22 patients to determine whether FBM persisted during labor in fetuses in whom these movements had been demonstrated antenatally. In the second part a double-blind trial was conducted on the responsiveness of fetal breathing in labor to maternal glucose infusion in 12 patients. In the third part the influence of artificial rupture of the membranes (ARM) to induce labor was examined in 8 patients. Fetuses spent 36% of their time making breathing movements antenatally but this decreased to less than 1% during labor. Fetal trunk movements also decreased during labor but not significantly. Fetal breathing and trunk movements were not stimulated by maternal glucose infusion. Fetal breathing but not trunk movements were significantly inhibited by ARM prior to the onset of labor. Cessation of fetal breathing in labor is normal, but the cause of this change in behavior has not been positively identified.

Blood Glucose↗

PubMed2006

Comparison of labor progression between induced and noninduced multiparous women.

OBJECTIVE: The incidence of labor induction is rising rapidly in the United States. Among multiparas, labor is often followed with traditional labor curves derived from noninduced pregnancies. We sought to determine how labor progression of multiparous women who presented in spontaneous labor differed from those who were electively induced with and from those induced without preinduction cervical ripening. METHODS: We analyzed data on all low-risk multiparous women with an elective induction or spontaneous onset of labor between 37(+0) and 40(+6) weeks of gestation from January 2002 to March 2004 at a single institution. The median duration of labor by each centimeter of cervical dilatation and the risk of cesarean delivery were computed for 61 women with preinduction cervical ripening and oxytocin induction, 735 women with oxytocin induction, and 1,885 women with a spontaneous onset of labor. An intracervical Foley catheter was used to ripen the cervix. RESULTS: Those women who experienced electively induced labor without cervical ripening had a shorter active phase of labor than did those admitted in spontaneous labor (99 minutes in induced labor versus 161 minutes in spontaneous labor, P < .001). However, the cesarean delivery rate was elevated in the induction group (3.9% versus 2.3%, P < .05). Women who underwent preinduction cervical ripening also had a shorter active phase than those admitted in spontaneous labor (109 minutes versus 161 minutes, P = .01). CONCLUSION: The pattern of labor progression differs for women with an electively induced labor without cervical ripening compared with those who present with spontaneous onset of labor.

Adult↗

PubMedDate not supplied

[Unrecognized hemorrhages during delivery].

On the basis of a series of 600 deliveries between January 1 and May 1 1993, the authors analyze cases of unrecognized delivery-related hemorrhage. Hemorrhage of this type, defined retrospectively on the basis of a difference of at least 3g/100 ml in hemoglobin levels at the time of admission to the labor ward and on the 2nd day post-partum, were found in 3.83% of deliveries and were responsible for 51.11% of falls in hemoglobin of 3g/100 ml or more. Primiparity, induced labor (oxytocics), episiotomy, forceps extractions and cesarean section are their etiologic factors. Particular care should be taken in the presence of any of these factors and induced labor may be useful in the prophylaxis of these unrecognized hemorrhages.

Adult↗

PubMed2000

Routine ultrasound fetal examination in pregnancy: the 'Alesund' randomized controlled trial.

OBJECTIVE: To evaluate the possible benefits of the routine use of ultrasound screening in pregnancy. DESIGN: A randomized controlled trial was designed to detect a 50% difference in the incidence of induction for apparent post-term pregnancies between women who were screened with ultrasound and unscreened women. A total of 1628 pregnant women from the general population were included. Eight hundred and twenty-five were allocated to an ultrasound examination at the 18th and 32nd week of pregnancy in addition to receiving routine antenatal care. The remaining 803 women received standard antenatal care, but could only be referred for ultrasound examination on clinical indication. RESULTS: The incidence of induced labor due to apparent post-term pregnancies was approximately 70% lower in the ultrasound-screened group. Inductions from all causes were also less frequent among ultrasound-screened women. There were six perinatal deaths among the screened and seven among the controls after excluding three lethal malformations among the controls. There was no difference in Apgar score after 1 min, but the proportion with Apgar score less than 8 after 5 min was lower among the screened group (P = 0.04). The need for positive pressure ventilation for more than 1 min was lower among the screened group (P = 0.02). Birth weight was slightly higher in the screened group (39 g), but the difference was not statistically significant. Among the controls three pairs of twins remained undiagnosed until the mothers were admitted to the hospital in labor at between 36 and 38 weeks gestation. CONCLUSION: These results suggest that for women who were screened with ultrasound, obstetricians were less likely to induce labor due to apparent post-term pregnancy, than for women who were not screened. All 10 pairs of twins in the screened group were diagnosed at the routine examination. These data also suggest that perinatal morbidity might be slightly lower in the screened group.

Adult↗

PubMed1980

Duration of the second stage of labor.

The second stage of labor, defined as the time from full dilatation of the external os to delivery of the child, was recorded during a three-month period in 635 labors with vaginal delivery. The median duration in labors of spontaneous onset was 31.3 minutes in para 0 mothers, 14.3 minutes in para 1 mothers and 11.7 minutes in para 2 + mothers. In induced labors the second stage had approximately the same length as in labors with spontaneous onset. The time distribution showed that the second stage in para 0 mothers had a plateau in the 17.5--37.5 minute range, whereas para 1 + mothers had a sharper peak at 7.5 minutes. Forty and 45 minutes respectively seemed to be limits beyond which only very few second stages of labor lasted. Operative delivery terminated 18 per cent of para 0 labors and 6 per cent of the para 1 + labors entering the second stage. The operative interventions seemed to appear in two clusters for each parity group. It appeared that fetal asphyxia requiring intervention was discovered before 40 minutes of the second stage in para 0 and before 30 minutes in para 1 + mothers. Later operative termination was more often performed to relieve fatigued mothers.

Cesarean Section↗

PubMed1987

Labor induction for planned vaginal delivery in patients with previous cesarean section.

The role of labor induction in patients scheduled for vaginal delivery following a previous lower segment cesarean section has been controversial. In Hong Kong, we have managed these patients by induction when there were obstetric or medical indications. A review of 137 patients who had labor induced for a trial of scar showed that induction of labor was a safe procedure and the rate of repeat caesarean section in these patients (18.2%) was similar to that in other patients with a trial of scar who had spontaneous onset of labor (12.9%). There were no serious maternal or fetal complications. Although the use of oxytocin in addition to amniotomy produced no difference in the outcome, we felt that it was useful in preventing a long induction delivery interval as well as avoiding a high failure rate of induction. We conclude that in patients selected for a trial of scar, planned induction of labor should be attempted when an indication for delivery arises, as a high proportion (more than 80%) of these patients gave birth vaginally. If induction were ruled out, most of these patients would have to be delivered by repeat cesarean section, with its associated morbidity and expense.

Cesarean Section↗

PubMed1977

Wave-form analysis of intrauterine pressure curves with methods and models developed in cardiac research.

With the Hill model of muscle dynamics and a modified cardiac model, a series of computer programs have been generated which permit the description of certain aspects of uterine contractility and uterine function in human parturition. Patterns of labor relating to delivery outcome, dysfunctional uterine activity, and use of drugs are discussed with reference to the parameters measured in the study. Central tendencies among 70 spontaneous and induced labors (6,302 contractions) are presented and discussed. (Am. J. Obstet. Gynecol.

Cardiology↗

PubMed1977

The cervical balloon method for induction of labor.

The cervical balloon (Embrey & Mollison) was used to induce labor in a study group of 87 patients. The control group included 97 patients, where induction of labor was performed using oxytocin-drip. In the study group oxytocin-drip was added in 34 patients. The cases of the study and control groups were classified as "favorable" cervix. The patients classified as "unfavorable" cervix showed a shorter mean induction-delivery interval in the study group, and a shorter mean duration of oxytocin-drip in the cases of the study group where it was needed. It was concluded that the cervical balloon is a convenient method for the induction of labor, for its effectivity, simplicity and innocuity, especially in the "unfavorable" cervix cases.

Adult↗

PubMed1995

Changes in estrogen receptor messenger ribonucleic acid in sheep fetal and maternal tissues during late gestation and labor.

OBJECTIVE: Our purpose was to investigate whether there is an increase in messenger ribonucleic acid for estrogen receptor in critical maternal or fetal tissues in the last third of pregnancy and during labor in sheep. STUDY DESIGN: Estrogen receptor messenger ribonucleic acid was measured by Northern hybridization analysis in fetal-placental and maternal uterine tissues during the last third of pregnancy and during spontaneous or cortisol-induced labor in sheep. Statistical differences were assessed with two-way analysis of variance. RESULTS: No estrogen receptor messenger ribonucleic acid was observed in amnion or chorion in any animal studied. There were no gestational age related changes in estrogen receptor messenger ribonucleic acid in any tissues between 100 and 145 days' gestation. During spontaneous and cortisol-induced labor estrogen receptor messenger ribonucleic acid increased significantly (p < 0.05) in myometrium, endometrium, and cervix. No increase was observed in the fetal placental cotyledon and mesometrium. Estrogen receptor messenger ribonucleic acid was markedly decreased (p < 0.05) in myometrium and endometrium after fetal adrenalectomy. CONCLUSION: An increase in estrogen receptor messenger ribonucleic acid in association with labor may contribute part of the mechanism by which estrogens exert their influence on the process of parturition.

Animals↗

PubMed2001

Acupuncture for cervical ripening and induction of labor at term--a randomized controlled trial.

OBJECTIVE: The aim of this study was to evaluate whether acupuncture at term can influence cervical ripening, induce labor and thus reduce the need for postdates induction. METHODS: On the estimated date of confinement (EDC) women were prospectively randomized to an acupuncture group (AG) or a control group (CG). Data of 45 women were evaluated (AG, n = 25; CG, n = 20). Inclusion criteria were as follows: confirmed EDC, uncomplicated course of pregnancy, singleton pregnancy in cephalic presentation. Exclusion criteria were as follows: cervical dilation > 3 cm, active labor, premature rupture of membranes, previous cesarean section, pathologies in mother or fetus. Women were examined at 2-day intervals. The cervical length was measured with vaginal ultrasonography, cervical mucus was obtained for a fetal Fibronectin test and the cervical status was assessed according to the Bishop score. In the AG, the points Hegu (Large Intestine 4) and Sanyinjiao (Spleen 6) were pierced on both sides every second day. If women were not delivered 10 days after EDC, labor was induced by administering vaginal prostaglandin tablets. RESULTS: The cervical length in the AG was shorter than that in the CG on day 6 and day 8 after EDC (P = 0.04 for both). In the AG the time period from the first positive Fibronectin test to delivery was 2.3 days, while that in the CG was 4.2 days (P = 0.08). The time period from EDC to delivery was on average 5.0 days in the AG and 7.9 days in the CG (P = 0.03). Labor was induced in 20% of women in the AG (n = 5) and in 35% in the CG (n = 7) (P = 0.3). Overall duration of labor, and first and second stage of labor were not different in the two groups. In 56% of women who underwent acupuncture (n = 14) and in 65% of controls (n = 13), Oxytocin was used to augment labor. (P = 0.54). CONCLUSION: Acupuncture at points LI4 and SP 6 supports cervical ripening at term and can shorten the time interval between the EDC and the actual time of delivery.

Acupuncture Points↗

PubMed2001

[Epidural analgesia and the rate of cesarean delivery].

OBJECTIVES: To assess the influence of epidural analgesia on the increased rate of cesarean delivery and to analyze associated factors. PATIENTS AND METHOD: Prospective study enrolling 1,714 women in labor to whom epidural analgesia was offered; 719 received epidural analgesia and 995 did not. We recorded age, weight, height, parity, gestational age, duration of labor, manner of onset of labor, delivery, birth weight, Apgar score and pH in the umbilical artery and vein. Student t, Hotteling's t2 and chi-squared tests were used to compare the results. Multiple logical regression analysis was used to determine the variable or variables having the most effect on the rate of cesarean delivery. RESULTS: Labor lasted longer in the group of women who received epidural analgesia than in those who did not (234 +/- 90 versus 181 +/- 43 minutes) and the epidural group had significantly higher rates of induced labor (50% versus 15%), instrument-assisted delivery (19% versus 5%) and cesarean delivery (21% versus 8%). Cesarean sections were more frequent among women whose labor was induced and in nulliparous women in both groups. Logical regression analysis showed that epidural analgesia was the most significant variable affecting delivery by cesarean section. The next most influential variable was induction of labor. Parity was not significantly related to delivery by cesarean. CONCLUSIONS: Epidural analgesia increased the likelihood of cesarean delivery in our study. The same factors that most often encourage women to accept epidural analgesia (induced labor, greater pain, prolonged labor, etc.) may predict increased likelihood of cesarean delivery.

Adult↗

PubMed1975

Relationship of mammary blood flow to parturition in the ewe.

Mammary blood flow was measured in conscious, unanesthetized ewes with electromagnetic flow probes prior to spontaneous labor (four animals) or during the induction of premature labor (four animals) by administration of dexamethasone, 1 mg/24 h, to the fetus. In all animals an increase in mammary blood flow was noted prior to delivery. Dexamethasone administered to one mother in the same dose did not induce labor or produce an increase in mammary blood flow. These results suggest that the fetal adrenal gland influences maternal mammary blood flow prior to delivery.

Animals↗

PubMed1982

[Effects of 16,16-dimethyl-trans-delta 2-PGE1 methyl ester (ONO-802) on reproductive function (author's transl)].

Effects of ONO-802 on maintenance of pregnancy, luteal function and ovulation were investigated. In pregnant rats, ONO-802 given i.p. showed antinidatory, abortifacient and strong labor-inducing effects with treatment on day 2, after day 17 and on day 21 of gestation, respectively. The abortifacient effect was not apparent when treatment was given from day 4-15. PGE1 had an antinidatory effect, PGF2 alpha had an abortifacient and labor-inducing effects after implantation, and PGE2 had both these effects. PGF2 alpha and PGE2 showed a luteolytic effect in rats, while ONO-802, similarly to the findings with PGE1, had no such effect. In pregnant rabbits, intraperitoneal ONO-802, exhibited antinidatory and abortifacient effects after implantation. Abortifacient effects were more potent with the progression of pregnancy of pregnancy though relatively large doses of ONO-802 were required. A significant decrease in peripheral blood progesterone level was observed in the group on high doses but the abortifacient effect of ONO-802 did not always depend on the decreases in the levels of progesterone. In cycling, spontaneously ovulating rats, the high doses of ONO-802 suppressed spontaneous ovulation when these doses were given two at 14:30 and 15:30 on the day of proestrus. ONO-802 did not inhibit the HCG-induced ovulation and the ovulation suppressed by ONO-802 was recovered by PGE2 or HCG.

Abortifacient Agents↗

PubMed2006

Barusiban, an effective long-term treatment of oxytocin-induced preterm labor in nonhuman primates.

Preterm labor (PTL) affects up to 25% of human pregnancies in developing countries, but there are few therapeutic options. Based on the key role of oxytocin (OXT) in labor and parturition, OXT antagonists are a potentially useful class of drugs for PTL. Barusiban is a new selective, potent, and long-acting OXT receptor antagonist. In this study barusiban was given by continuous i.v. infusion to monkeys during the last 3 wk of pregnancy; the monkeys were also given daily doses of OXT to induce uterine contractions and simulate PTL. Barusiban effectively suppressed OXT-induced PTL-like contractions and prevented early delivery. In contrast, fenoterol (a beta2-adrenoceptor [beta2-AR] agonist used as a comparative control) did not inhibit uterine contractions in this model. Barusiban was particularly effective in maintaining low intrauterine pressure (IUP) near the end of pregnancy, which is when IUP in both OXT controls and fenoterol-treated females increased substantially. Although barusiban delayed the onset of labor, it did not prevent normal delivery. These data demonstrate the safety and efficacy of barusiban in reducing uterine contractility in response to repeated OXT challenge, and suggest that barusiban may be therapeutically effective in long-term treatment of PTL.

Adrenergic beta-Agonists↗

PubMed2002

Induction of labor versus conservative management of pregnant diabetic women.

Reasons for inducing labor at term in pregnancies complicated by diabetes include the avoidance of fetal demise and the prevention of excessive fetal growth and its concomitant conditions, shoulder dystocia and Cesarean delivery. Objectively evaluating the risks and benefits of labor induction is potentially confounded by the status of the cervix at the time of initiation of induction, early determination of an arrest disorder and physician bias toward Cesarean delivery for women who have diabetes. In non-diabetic women, incorporating estimates of fetal weight in deciding the route of delivery has not diminished the incidence of shoulder dystocia, and may have increased the incidence of Cesarean deliveries. Currently available evidence suggests that, while induction of labor for women who have diabetes may not carry much maternal or fetal risk, the benefit of this procedure is unclear.

Birth Injuries↗

PubMed1995

Induction of labor.

Several mechanical and biochemical methods have been used to induce labor throughout modern obstetrics. We review and compare mechanical and medical methods of labor induction, along with several new uterotonic agents such as mifepristone (RU 486) and misoprostol, which can be conveniently administered orally and managed in the outpatient clinic.

Female↗

PubMed1993

Labor induction with the prostaglandin E1 methyl analogue misoprostol versus oxytocin: a randomized trial.

OBJECTIVE: To compare the safety and efficacy of intravaginal misoprostol versus intravenous (IV) oxytocin infusion for labor induction. METHODS: One hundred thirty patients were randomly assigned to one of two induction groups: 1) intravaginal misoprostol or 2) IV oxytocin by continuous infusion, with prior cervical ripening using prostaglandin (PG) E2 gel if necessary. RESULTS: Among 129 patients evaluated, 64 were allocated to the misoprostol group and 65 to the oxytocin group. Prostaglandin E2 gel was administered to 29 patients (45%) in the oxytocin group with unripe cervices. Uterine tachysystole occurred more frequently in patients in the misoprostol group (34.4%) than in the oxytocin group (13.8%) (P < .05). Nevertheless, no statistically significant differences were noted between the groups in intrapartum complications including uterine hyperstimulation syndrome, mode of delivery, and neonatal or maternal adverse outcomes. The interval from induction to vaginal delivery was significantly shorter in the misoprostol group (11 versus 18 hours; P = .004). In 74% of patients in the misoprostol group, only one intravaginal dose was required for successful labor induction. CONCLUSIONS: Intravaginal administration of misoprostol safely and effectively induces labor while minimizing the expense associated with IV oxytocin infusion. The higher frequency of uterine tachysystole associated with the use of misoprostol did not increase the risk of adverse intrapartum or perinatal outcomes. The use of PGE2 gel for cervical ripening contributed to the longer induction-to-vaginal delivery interval noted in the oxytocin group. Clinical trials appear warranted to detail misoprostol's optimal route, dose, and schedule for labor induction and its safety.

Administration, Intravaginal↗