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PubMed1996

Treatment of preterm cervical dilatation with glyceryl trinitrate, a nitric oxide donor.

We report an observational study on the use of transdermal glyceryl trinitrate as a treatment to delay delivery of women presenting in pregnancy with dilatation of the cervix. Ten women found to have cervical dilatation more than 2 cm (range 2 to 8 cm) at gestations between 16 and 32 weeks were studied. These women were treated with 50 mg glyceryl trinitrate patches. The mean prolongation of gestation from the time of admission was 46.2 days (range 1 to 130 days). There was 1 stillbirth in a 22.6-week fetus and 1 neonatal death secondary to prematurity. Vaginal delivery occurred in all but 3 cases. All babies were of size appropriate for gestational age at delivery. The only reported maternal side-effect was headache. No adverse fetal effects were noted. We conclude that glyceryl trinitrate may provide an effective and safe method of tocolysis, well suited for long-term use. The purpose of reporting this study is to highlight the mounting accumulation of data on glyceryl trinitrate and reinforce the need to evaluate its use in randomized controlled trials.

Administration, Cutaneous↗
PubMed1986

Sacral acupuncture for pain relief in labour: initial clinical experience in Nigerian women.

Sacral acupuncture was used for pain relief during labour in 30 pregnant Nigerian women. It produced clinically adequate analgesia in 19 women (63.3%). 6 women in this group (31.6%) reported that they had experienced no pain whatsoever throughout the period of labour and delivery (average duration - 8 hours). 11 women (36.7%) had no pain relief and required pethidine injection when sacral acupuncture proved ineffective. 24 women (80%), including 5 who did not obtain relief, indicated their wish to have sacral acupuncture during their next confinement. 2 women (6.7%) objected to needling, 3 considered acupuncture useless while another 2 did not believe in it. The patients' cardio-respiratory functions and uterine contractions were not adversely affected. There were no untoward effects on the mothers or their neonates. The procedure was technically simple, the equipment light and cheap. The needles did not interfere with nursing or obstetric manouvres. The procedure was however time consuming. The results were inconsistent and unpredictable. Despite these limitations, the simplicity, cheapness and absence of physiological complications associated with the procedure, make it a worthwhile medical armament for pain relief in the Nigerian environment, with limited resources and specialized manpower.

Acupuncture Therapy↗
PubMed2003

Impact of maximal cervical dilatation at primary caesarean delivery on mode of delivery in the following pregnancy.

The maximum cervical dilatation achieved by parturients who went through labour prior to their primary caesarean births were related to the mode of delivery in the subsequent birth to ascertain if there is a link between the two. The success rates of vaginal births after primary Caesarean sections (VBAC) for arrest and non-arrest disorders were also compared using information derived from the birth records of the hospital. The success rate for VBAC was significantly high in subjects whose primary caesarean sections were for non-arrest disorders compared to those who had arrest disorders (73.3% versus 55.6%; x2 = 5.25, p = 0.02). The maximum cervical dilatation reached before primary caesarean section did not significantly affect the success rate of VBAC in the subsequent delivery (x2 [trend] = 0.78, p = 0.68). Patients who had primary caesarean section for arrest disorder require full evaluation before being allowed to attempt vaginal birth in a subsequent pregnancy but the maximum cervical dilatation reached before primary caesarean section need not be factored into a decision for VBAC.

Adult↗
PubMed1990

Apheresis of low molecular weight protein fraction and the onset of labor.

In our study, we subjected six (6) pregnant goats of known gestational age to whole blood ultrapheresis using an extracorporeal circuit. The serum fraction removed was replaced with equal volume of the same material prepared from non-gravid goats. The serum fraction removed was identified as to content of clinically measurable parameters and plotted as permeability coefficient compared with molecular weight. The goats were observed to enter the first stage of labor as a consequence of this form of apheresis and to deliver normal products of conception. No clinically significant deleterious effects on the goats were observed. There was no evidence of complement activation, nonspecific heparin effect, or endotoxin effect. We consider the possibility that soluble mediators of immune suppression may play a role in the maintenance of pregnancy and that the onset of the first stage of labor may be an immunologic event.

Animals↗
PubMed2006

Relief of low back labor pain by using intracutaneous injections of sterile water: a randomized clinical trial.

OBJECTIVE: To study the effectiveness of intracutaneous injections of sterile water in relieving low back pain during labor in Thai women. STUDY DESIGN: Randomized controlled trial. SETTING: Department of Obstetrics and Gynecology, Taksin Hospital, Bangkok. MATERIAL AND METHOD: Fifty pregnant women at term, requiring pain relief for severe low back pain during the first stage of labor. The women were randomized to receive either 4 intracutaneous injections of 0.1 mL sterile water (n = 25) or isotonic saline as placebo (n = 25). MAIN OUTCOME MEASURES: Pain scores measured by visual analogue scale. RESULTS: Mean pain scores were significantly lower among the treatment group compared to the placebo group at 30 minutes, 1 and 2 hours after injections (p = 0.018, 0.046, and 0.027 respectively). Mean pain reduction were significantly greater in the treatment group compared to the placebo group at 30 minutes, 1 and 2 hours after injections (p < 0.001). There was no difference between the two groups with regard to time to delivery and rate of instrumental and cesarean delivery. CONCLUSION: The intracutaneous injections of sterile water was found to be an effective treatment against lower back pain during the first stage of labor.

Adult↗
PubMed2003

Uterine contractility in women whose fetus is delivered in the occipitoposterior position.

OBJECTIVE: Most fetuses in the occipitoposterior position rotate spontaneously after striking the pelvic floor. The increased prevalence of prolonged labor, operative delivery, and oxytocin augmentation in women with an occipitoposterior fetal position seems consistent with decreased uterine contractility. We sought to test the hypothesis that women with a persistent occipitoposterior fetal position have inadequate intrauterine pressure. STUDY DESIGN: Intrauterine pressure was measured prospectively electronically in 94 women whose labor pain was controlled by patient-requested epidural analgesia. Eleven women (12%) were delivered as a persistent occipitoposterior fetal position. In a nested case-control study, these women were compared with 22 women who were delivered as an occipitoanterior fetal position who were matched for age, parity, gestational age, cervical examination at study enrollment, and body mass index. The intrauterine pressure measurements were initiated during the first stage of labor and continued throughout the entire labor process. Women were encouraged in the second stage of labor, after a period of recording baseline contractility, to push using a standardized Valsalva maneuver once the vertex reached the +2 station. The area under the intrauterine pressure curve (integral) was used to estimate uterine contractility and expulsive performances. RESULTS: Five women (45%) in the occipitoposterior group required operative delivery. The average duration of the second stage of labor in the occipitoposterior group was 91.4 +/- 23.2 minutes compared with 51.7 +/- 6.6 minutes in the occipitoanterior fetal position (P =.04). Ninety percent of women in the occipitoposterior group required oxytocin, compared with 59% of the women in the occipitoanterior group (P =.11). There were no differences in uterine contractility between occipitoposterior and occipitoanterior groups during either the first stage of labor (integral mean +/- SEM: occipitoposterior [1685.3 +/- 194.6 mm Hg. s] vs occipitoanterior fetal position [1700.8 +/- 128.9 mm Hg. s, P =.98]) or second stages of labor (occipitoposterior [1952.6 +/- 186.5 mm Hg. s] vs occipitoanterior fetal position [1740.8 +/- 104.3 mm Hg. s, P =.46]). Further, there were no significant differences in pushing performances between the occipitoposterior and occipitoanterior groups (Valsalva maneuver: occipitoposterior 2864.9 +/- 328.8 mm Hg. s] vs occipitoanterior [2898.6 +/- 222.2 mm Hg. s, P =.90]). CONCLUSION: Women who were delivered as a persistent occipitoposterior fetal position do not have lower intrauterine pressure levels immediately before or during the second stage of labor.

Adult↗
PubMed2005

Review of 1600 water births. Does water birth increase the risk of neonatal infection?

OBJECTIVES: We reviewed 1600 water births at a single institution over an 8-year period. METHODS: We compared 737 primiparae deliveries in water with 407 primiparae deliveries in bed, and 142 primiparae on the delivery stool. We also evaluated the duration of labor, perineal trauma, arterial cord blood pH, postpartum maternal hemoglobin levels, and rates of neonatal infection. In 250 water deliveries we performed bacterial cultures of water samples obtained from the bath after filling and after delivery. RESULTS: The duration of the first stage of labor was significantly shorter with a water birth than with a land delivery (380 vs. 468 minutes, P<0.01). The episiotomy rate in all water births was lower with a water birth than with a delivery in bed or a delivery on the birthing stool (0.38%, 23%, and 8.4%, respectively). The rate of perineal tears was similar (23%, respectively). There were no differences in the duration of the second stage (34 vs. 37 minutes), arterial cord blood pH, or postpartum maternal hemoglobin levels. No woman using the water birth method required analgesics. The rate of neonatal infection was also not increased with a water birth (1.22% vs. 2.64%, respectively). CONCLUSION: Water birth appears to be associated with a significantly shorter first stage of labor, lower episiotomy rate and reduced analgesic requirements when compared with other delivery positions. If women are selected appropriately and hygiene rules are respected, water birth appears to be safe for both the mother and neonate.

Baths↗
PubMed2002

Influence of abnormal cervical pap smear undertaken during pregnancy to the outcome of the pregnancy.

OBJECTIVE: To investigate the influence of abnormal cervical pap smear undertaken in pregnancy to the outcome of the pregnancy. METHODS: A total of 1 069 primipara deliveried in Beijing Chaoyang hospital from Jan 1999 to May 2001 were reviewed, furthermore we compared the group of normal pap smear (group A) with the group of abnormal pap smear (group B), and analysed the difference of the complications during pregnancy, methods of delivery, the first stage of labor, fetal distress and the outcome of the cervical pap smear postpartum. RESULTS: The incidence of premature rupture of the membranes and fetal distress in group B, which were 39.39% and 30.30%, respectively, were significantly higher than that of group A, which were 5.21% and 15.25%, respectively (P < 0.01). There was no statistical difference in premature delivery, the ratio of cesarean section and the first stage of labor which were 3.38% and 3.03%, 44.11% and 30.30%, 7.3 h and 7.7 h, respectively (P > 0.05). The regression rate for patients with abnormal cervical pap smear postpartum was 62%. CONCLUSIONS: The outcomes of the pregnancy such as premature rupture of the membranes and fetal distress were affected by the abnormal cervical pap smear undertaken during pregnancy. It is important to undergo routine cervical pap smear examination during pregnancy.

Female↗
PubMed1975

A labour-saving manoeuvre.

Slow progress in the first stage of labour was treated in 792 mothers by digital dilatation. This manoeuvre is described. Partial dilatation was converted to complete dilatation in 94.4 per cent of all cases, the incidence of success being 90.0 per cent in primiparae and 96.0 per cent in multiparae. Difficulties are described, but serious complications were conspicuously absent.The manoeuvre was helpful with mothers unable to resist premature bearing down, and especially valuable for reducing delay before applying forceps for fetal distress. The early perinatal loss of 20 (in the first 200 cases) was reduced to 3.3 (in the last 599 births) after a change of technique.

Dilatation↗
PubMed1992

Does the addition of tris(hydroxymethyl) aminomethane to 0.5% bupivacaine delay epidural onset in parturients?

A rapid onset of epidural anesthesia may predispose a pregnant patient to hypotension during the first stage of labor. Sodium bicarbonate has been reported to hasten epidural onset of chloroprocaine, lidocaine and bupivacaine while tris(hydroxymethyl) aminomethane (THAM) has been shown to delay the onset of epidurally administered chloroprocaine in parturients. The purpose of this study was to determine whether the addition of THAM to bupivacaine affected the onset, cephalad spread and incidence of hypotension following epidural administration in healthy pregnant patients during the first stage of labor. Three groups each consisting of 20 ASA I or II patients were studied. Group I received 0.5% bupivacaine with saline (0.06 ml/10 ml). Group II received bupivacaine buffered with THAM (0.06 ml/10 ml) to a pH of 6.8. Group III received bupivacaine buffered to a pH of 6.8 with sodium bicarbonate (0.05 ml+0.01 ml saline/10 ml). Statistical analysis used one-way analysis of variance and the appropriate post hoc test for multiple comparisons. A [Formula: see text] value less than 0.05 was considered significant. The onset of analgesia, the cephalad spread, and the incidence of hypotension did not differ between the groups. It is concluded that THAM does not affect the pharmacodynamics of 0.5% bupivacaine administered epidurally.

Journal Article↗
PubMed2005

Reducing cesarean delivery rates: an active management labor program in a setting with limited resources.

OBJECTIVE: To determine the effect of an active management of a labor program on the rate of cesarean section and labor outcomes in low-risk nulliparous pregnancies in a setting with limited resources. MATERIAL AND METHOD: Nine hundred and seventy-five low risk nulliparous pregnant women were randomized to receive either active management of a labor program (n = 325) or conventional management (n = 650). The rate of cesarean section and labor outcomes were compared between the two groups using Chi-square and t-tests. RESULTS: The subjects in the active management program had significantly shortened first stage of labor and total duration of labor compared with the conventional group (538.0 +/- 242.9 min vs 589.4 +/- 263.8 min, p < 0.05, 539.3 +/- 261.4 min vs 610.3 +/- 264.4 min, p < 0.001, respectively). There was no statistical difference found in the rate of cesarean section and other labor outcomes. CONCLUSION: The active management program shortened the first stage and duration of labor in low-risk nulliparous pregnant women.

Adult↗
PubMed2006

Performance of acupuncture as labor analgesia in the clinical setting.

BACKGROUND: Three randomized controlled trials have shown that acupuncture during labor can reduce the use of epidural analgesia and meperidine. To supplement these trials, we have designed an observational study to answer the research question: "Do laboring women in a normal hospital setting who receive acupuncture require less epidural analgesia than those who do not receive acupuncture?" METHODS SETTING: Delivery ward of a tertiary care University hospital in Norway. SUBJECTS: All attempted vaginal labors during the period 01.12.99-31.12.03 (n = 17,741). STATISTICAL ANALYSIS: Multivariate logistic regression analysis. RESULTS: The dependent variable in the regression analysis was use of epidural analgesia. The independent variables were: use of acupuncture, use of nitrous oxide, use of meperidine, parity, ethnicity, age, duration of pregnancy, type of labor (induced or not), and duration of first stage of labor. In the multivariate analysis the odds ratio for having an epidural was 0.6 (95% CI 0.5-0.7) for the patients having acupuncture compared to those not having acupuncture. CONCLUSIONS: Women having acupuncture as labor analgesia in the clinical setting have a reduced use of epidural analgesia.

Acupuncture Analgesia↗
PubMed2006

Risk factors for forceps delivery in nulliparous patients.

OBJECTIVE: To identify risk factors for forceps delivery during first pregnancy. MATERIALS AND METHODS: A retrospective case-control study was carried out in a tertiary maternity ward between January 2001 and December 2003. A total of 582 nulliparous women, with full-term (>37 weeks gestation), singleton, cephalic pregnancies, who delivered by the vaginal route with or without instrumental assistance were evaluated. RESULTS: The strongest risk factors for forceps delivery were birth weight greater than 4000 g (OR: 6.5; 95% CI: 1.6, 26.9), the occiput posterior position of the fetal head (OR: 5.8; 95% CI: 2.5, 13.8), and epidural analgesia (OR: 7.7; 95% CI: 4.1, 14.7). Other significant risk factors for forceps delivery were age over 35 years (OR: 2.4; 95% CI: 1.1, 5.1), induction of labor (OR: 2.1; 95% CI: 1.4, 3.1), first stage of labor longer than 420 min (OR: 2.3, 95% CI: 1.3,4.2), and a prolonged second stage of labor (OR: 1.6, 95% CI: 1.1, 2.4). CONCLUSION: Age over 35 years and induction of labor are risk factors for forceps delivery at admission. Epidural use, fetal head in occiput posterior position, and birth weight >4000 g are strong intrapartum risk factors for instrumental delivery in nulliparous women.

Adult↗
PubMedDate not supplied

Management of the first stage of labour.

The management of delay in labour has been dominated by the use of oxytocin to augment the 'powers' of labour. However, this empirical approach has not been rigorously tested and 'failure to progress' remains a major clinical problem. A return to an analysis of the underlying pathophysiology is advocated.

Adult↗