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PubMed1999

The duration of labor in healthy women.

OBJECTIVE: To measure the duration of active labor (first and second stages) in low-risk women whom received intrapartum care from certified nurse-midwives in nine hospital settings in the United States in 1996. Clinical factors and morbidity indicators associated with longer labors were also examined. DESIGN: An observational study was conducted with healthy women at term who did not receive oxytocin or epidurals (n = 2511). Descriptive statistics are reported for the duration of the active phase--first stage (4 cm to complete cervical dilatation) and second stage (complete to delivery)--by parity and for subgroups of women according to race/ethnicity, age, insurance, activity in labor, type of fetal heart monitoring, and narcotic analgesia. Logistic regression was also used to assess the contribution of each variable to longer labors with simultaneous adjustment of the other variables. RESULTS: The mean length of the active-phase, first stage was 7.7 hours for nulliparas and 5.6 hours for multiparas (statistical limits of 2 standard deviations from the mean were 17.5 and 13.8 hours, respectively). The mean length of second stage was 54 minutes for nulliparas and 18 minutes for multiparas (statistical limits 146 and 64 minutes, respectively). Variables associated with longer labors were electronic fetal monitoring, ambulation, maternal age over 30 years, and narcotic analgesia. Morbidity was not increased in longer labors. CONCLUSION: Normal labor in healthy women lasted longer than many clinicians expect. The criteria for distinguishing normal from abnormal labor, based on time, need revision.

Adult↗

PubMed1980

A one-year study of routine fetal heart rate monitoring during the first stage of labor.

At the Department of Obstetrics and Gynecology, University Hospital, Lund, Sweden 90 per cent of all deliveries are monitored with cardiotocography (CTG). The fetal heart rate recording (FHR) together with various pregnancy- and delivery data, are continuously analysed. The present paper is an account of FHR changes during the first stage of labor of all patients registered during 1977. FHR-changes occurred already during the 1st stage of labor in more than 90 per cent of all deliveries where the newborns' Apgar score was less than 7 at 1 minute. Tachycardia, silent pattern, and late and combined decelerations, rarely occurred in the material, but were dominant at deliveries where the newborns' Apgar score was less than 7 at 1 and 5 minutes. This relationship was even more pronounced when these changes occurred together.

Apgar Score↗

PubMed2005

Velamentous cord insertion and atypical variable decelerations with no accelerations.

OBJECTIVES: To examine intrapartum fetal heart rate (FHR) patterns in the presence of velamentous cord insertion (VCI). METHODS: The site of cord insertion was determined in 1460 women on antenatal ultrasonographic and postnatal examinations. Each of 24 women with pregnancies complicated with VCI was matched at the onset of labor with 10 women who had a normal pregnancy, and FHR patterns were analyzed for both cases and controls. RESULTS: Compared with controls, cases of variable decelerations with no accelerations (VDNA) during the first and second stages of labor were more frequent in women with VCI (first stage: 25% vs. 5.1%, second stage: 65.0% vs. 21.7%, P < 0.001). The adjusted odds ratio associated with VDNA occurrence in women with VCI was 3.83 (95% confidence interval [CI]: 1.51-9.72, P = 0.005). The mean odds ratio associated with length of aberrant vessels in women with VCI plus VDNA was 1.38 (95% CI: 1.04-1.83, P = 0.026). CONCLUSION: Pregnancies complicated with VCI are associated with a higher rate of VDNA.

Adult↗

PubMed1994

Maternal age and duration of labor.

The computerized records of a population of 7214 women who were delivered during the period 1987-1991 were analysed. We studied the possible relationship of the duration of the first and second stages of labor to maternal age. In para 0, para 1 and para 2+ mothers we found an independent positive correlation between the second stage duration and maternal age. By multiple stepwise regression analysis maternal age turns out to be one of the most influential maternal characteristics of the second stage of labor. No correlation was found between maternal age and the duration of the first stage.

Adult↗

PubMed1976

Dip area in fetal heart rate and its relationship to acid-base-observations of fetus and mother during labor.

The relationship between dip area (DA) of fetal heart rate (FHR) and the acid base status of fetus and mother during the first and second stage of labor were studied on 39 women at term. The observations reveal a significant correlation between the fall in fetal base excess (BE) and the measured DA: deltaBE = 0.01 - 0.143 DA (2alpha less than 0.01). There is no difference in the correlation of these parameters between the first and the second stage of labor despite the fact of a greater fall in BE and a greater DA per time compared to the first:BE meq/1/10min. 0.14 (SD 0.26) and 0.76 (SD 0.62); DA cm2/10 min. 0.99 (SD 1.19) and 4.28 (SD 3.06), respectively. With increasing DA the variance of the fall of fetal BE (S2BE) rose also: DA of 0-5 cm2: S2BE 0.66; DA greater than 15.1cm2:S2BE 3.76. With the fall in fetal BE there was also a fall in maternal BE, more pronounced during the second stage of labor:-BEF=0.38.DELTA BEM-0.70(2alphaless than 0.01). The fraction of the fall in fetal BE per DA increased with the fall in maternal BE (2alpha less than 0.05). This correlation reveals that there might be a slight influence of maternal BE on fetal BE. The present observation shows that measuring DA serves only as an approach to predict fetal condition during labor. It therefore should be combined with fetal scalp blood sampling. The influence of maternal BE on fetal BE seems to be only of less importance.

Acid-Base Equilibrium↗

PubMed1986

Clinical assessment of the pelvic cavity and outlet.

A clinical assessment of the pelvic midplane (or cavity) and the pelvic outlet was made in 1,286 singleton pregnancies with a cephalic presentation of the fetus. 43 cases (3.4%) of pelvic contraction were excluded. The mothers were divided into two groups: those with an adequate pelvis and those with a borderline pelvis (18.6%). Those with a borderline pelvis were further subdivided into three categories: those with a borderline outlet, those with a borderline midplane and those with a borderline midplane and outlet. With a funnel pelvis the incidence of occiput posterior positions and vacuum extractions was three times as high and the duration of the first and the second stages of labor slightly longer when compared with those who had a normal pelvis. A borderline midplane seemed least harmful type with lower incidences of caesarean section and vacuum extraction, and a first stage of normal duration. Although birthweight had an effect on the duration of the first stage of labor in women with an ample pelvis, this was not the case with a borderline pelvis. The assessment of fetal weight therefore seems unnecessary in with a borderline midplane or outlet. With a borderline midpelvis and outlet the course of labor seemed normal in most cases. Clinical assessment of the midpelvis and the pelvic outlet seems to be the best method of measuring pelvic capacity.

Adolescent↗

PubMed1994

Short labor: characteristics and outcome.

OBJECTIVE: To determine the characteristics and consequences of short labor. METHODS: Ninety-nine term pregnancies with singleton vertex presentation and labor lasting 3 hours or less were compared with controls with longer labor, matched to the index cases by maternal age, parity, and birth weight. RESULTS: Short labor occurred mostly in multiparas. Both the first and second stages of labor were found to be shortened in these cases. There was significantly more placental abruption, uterine tachysystole, and maternal cocaine use among short-labor cases. Major perineal lacerations, postpartum hemorrhage, birth trauma, and low Apgar scores were distributed approximately equally between cases and controls. A preponderance of the bad outcomes in the short labors occurred in the subgroup of those with rates of dilatation and descent that exceeded established 95th percentile limits. CONCLUSIONS: Labors of 3 hours or less in duration were strongly associated with placental abruption, but were otherwise not major contributors to maternal and fetal morbidity.

Abruptio Placentae↗

PubMed1999

Fetal heart rate patterns in term labor vary with sex, gestational age, epidural analgesia, and fetal weight.

OBJECTIVES: Our purpose was to analyze the previously unreported effect of fetal sex on the fetal heart rate in labor and to measure its magnitude in relation to the effects of other independent clinical variables. STUDY DESIGN: The last hour of the intrapartum heart rates of 1884 term singleton fetuses collected during routine clinical monitoring over 19 months in Oxford, United Kingdom, was analyzed by computerized techniques. The records were selected for completeness and continuity until within at least 30 minutes of delivery. A subset of records from earlier in labor and a separate archive of antepartum normal term records were also examined. RESULTS: Female fetuses had significantly faster heart rates than male fetuses (P <.0001). Epidural analgesia, weight percentile (adjusted for age and sex), parity, the duration of first and second stages of labor, and a fall in umbilical arterial blood pH at birth also independently modulated the fetal heart rate (all P <.0001). The effects of these independent variables on heart rate were additive, the most important being epidural analgesia as a cause of tachycardia. The effect of fetal sex was less in the first stage, 6 to 7 hours before delivery, and was not present before the onset of labor (in another 552 pregnancies at 37 to 38 weeks). CONCLUSIONS: The fetal heart rate response of female fetuses to normal labor differs from that of male fetuses. Computerized numeric analysis of intrapartum fetal heart rate patterns will need to take into account the multiple factors that influence the fetal heart rate to identify precisely which patterns predict clinical outcome.

Adult↗

PubMed1991

Epidural anesthesia shortens duration of labor in singleton vertex presentation spontaneous delivery.

Influence of epidural anesthesia on the duration of labor was studied in 1,206 parturients having spontaneous singleton vaginal delivery. In primiparous women, the mean first stage was 3.52 hr in the epidural group, and 7.68 hr in the control group (p less than 0.001), the mean second stage was 25.78 min in the epidural group, and 43.58 min in the control group (p less than 0.001). In the multiparous women, the mean first stage was 2.06 hr in the epidural group, and 3.85 hr in the control group (p less than 0.001), the mean second stage was 17.06 min in the epidural group, and 25.42 min in the control group (p less than 0.0001). The conclusion is that epidural anesthesia shortens the duration of first and second stages of labor in singleton vaginal delivery.

Anesthesia, Epidural↗

PubMed1993

Pregnancy outcome after large loop excision of the cervical transformation zone.

OBJECTIVE: Our purpose was to determine whether large loop excision of the cervical transformation zone affects the outcome of pregnancy after 20 weeks' gestation. STUDY DESIGN: In a retrospective case control study 40 women who had undergone large loop excision of the cervical transformation zone and were subsequently delivered at Dudley Road Hospital were identified between January 1989 and January 1992. Eighty controls were identified and matched for age, parity, and ethnic group from women delivered immediately before and after index cases. Variables included maternal performance in labor and smoking habits and perinatal outcome. Maternal factors analyzed included pregnancy gestation, length of the first and second stages of labor, use of oxytocin, analgesia, mode of delivery, estimated blood loss, whether labor was spontaneous or induced, and if preterm spontaneous rupture of membranes occurred. Perinatal outcome measures included whether the infant was liveborn, fetal weight, the presence of fetal abnormalities, and admission to the neonatal unit. RESULTS: Women delivered after large loop excision of the cervical transformation zone had infants of significantly lower birth weight than did controls. They were also significantly more likely to have admitted to smoking on admission. CONCLUSION: Previous studies investigating pregnancy outcome after local destructive methods of treating cervical intraepithelial neoplasia have been generally reassuring. However, in this study women who were delivered after large loop excision of the cervical transformation zone had significantly smaller infants. Although this may be related to the characteristics of women who have cervical intraepithelial neoplasia (for example, their smoking habits), larger adequately controlled studies should be performed before colposcopists can be justified in adopting a liberal attitude to treating all women with abnormal smears.

Adult↗

PubMed1991

Oxytocin secretion and human parturition: pulse frequency and duration increase during spontaneous labor in women.

The secretory pattern of oxytocin was determined in blood samples taken at 1-minute intervals for 30 minutes from 32 parturient women. The samples were collected in a manner that minimized degradation by plasma oxytocinase, and a highly specific antibody was used for the radioimmunoassay. The results indicated that oxytocin is secreted in discrete pulses of short duration. The frequency of the pulses was significantly higher during spontaneous labor than before the onset of labor. The mean pulse frequencies per 30 minutes were 1.2 +/- 0.54 before labor, 4.2 +/- 0.45 during the first stage, and 6.7 +/- 0.49 during the second and third stages of labor. The mean pulse durations in these three groups were 1.2 +/- 0.20, 1.9 +/- 0.28, and 2.0 +/- 0.26 minutes, respectively. The amplitude of the pulses was variable with no significant differences between the groups, the majority being around 1.0 microU/ml. The spontaneous pulses were of similar magnitude as those measured in 18 women after intravenous injections of 4 to 16 mU of oxytocin, which doses stimulated uterine contractions. We therefore conclude that the pulses of oxytocin observed at increasing frequency during spontaneous labor are of physiologic significance and provide evidence for the participation of oxytocin in the onset and maintenance of spontaneous labor.

Analysis of Variance↗

PubMed1983

[Transcutaneously measured carbon dioxide partial pressure in non-hypoxic fetuses during labor].

Using the newly developed Severinghaus electrode we performed measurements of the transcutaneous carbon dioxide partial pressure (tcPco2) in 81 non-hypoxic fetuses during labor. The calibration and measuring temperature was 39 degrees C. After a correction with a factor of 13% the transcutaneous Pco2 values corresponded well with the blood values of the Pco2 from FBA respectively the umbilical artery. While during the first stage of labor we found only a gradual rise in the tcPco2 level, we observed a rapid rise at the end of the second stage. Analysing the influence of clinical factors on the fetal tcPco2 level we found statistically significant higher levels during the first stage of labor in primipara compared with multipara. However there was no significant difference dependent on gestational age, the age of the mother and the birthweight.

Birth Weight↗

PubMedDate not supplied

Effect of epidural epinephrine infusion with bupivacaine on labor pain and mother-fetus outcome in humans.

BACKGROUND AND OBJECTIVES: Epinephrine is used with local anesthetics to prolong the duration of epidural analgesia and decrease the peak plasma concentrations of local anesthetics. In the practice of obstetric anesthesia, the utero-placental and fetal effects of epinephrine are controversial issues. We designed a prospective, randomized, and double-blind study to examine the effects of epinephrine infusion on the quality of analgesia and uterine or umbilical blood flows with Doppler ultrasound, as well as the duration of the first or the second stage of labor, and fetal outcome. METHODS: Twenty-eight parturients received continuous epidural bupivacaine 0.25% (4 mL/h) combined either with epinephrine (20 microg/h) (n = 13) or without epinephrine (n = 15) for analgesia during labor. If patients requested additional analgesia, an additional bolus of 1% or 1.5% lidocaine (6 to 10 mL) was administered. RESULTS: The total amount of additional lidocaine was greater in the plain bupivacaine group (130 [0, 280] mg; median [25th, 75th percentile] with P < .05) than in the epinephrine group (0 [0, 60] mg). Epinephrine infusion did not alter the resistance of the uterine and umbilical arteries as measured by resistance index. The duration of the first or second stages of labor did not significantly differ in the 2 groups. Epinephrine infusion did not change the fetal heart rate or the blood gas data in the umbilical artery. CONCLUSIONS: A low-dose epidural infusion of epinephrine decreased anesthetic requirements.

Adult↗

PubMed1994

'To bathe or not to bathe' during the first stage of labor.

OBJECTIVE: Does a warm tub bath relieve labor pain? How is it experienced by the parturient? METHODS DESIGN: prospective randomised trial. SETTING: labor ward of a teaching hospital with a uniform active labor management. PARTICIPANTS: one hundred and ten nulliparous low risk women, at term, in true spontaneous labor. Fifty-four women had a bath, 56 women served as controls. MEAN OUTCOME MEASURES: labor pain (assessed by means of a visual analogue scale) and post partum patients' bathing experience (by means of a self-made questionnaire). RESULTS: The study group and the control group were comparable with respect to maternal age, weight, length, duration of gestation, cervical status and labor pain sensation before randomisation. Absolute values of labor pain were not statistically different between the two groups, yet this latter progressed differently: in the bathing group the initial pain sensation (V.A.S.) was 6.8, and this remained stable during the first 25 minutes (V.A.S. = 6.7) and then rose to 8.2 after a mean of 53 minutes. In the control group, labor pain rose progressively from 6.3 to 7.3 after 25 min and to 8.7 after a mean of 52 min (p < 0.01, Student t-test). There was no difference in the use of epidural analgesia. There were no differences in labor duration nor in the frequencies of either operative deliveries or neonatal complications. Eighty percent of the bathers experienced soothing of the pain and all but one reported body relaxation. Ninety percent wanted to bathe again during a next labor. CONCLUSION: Bathing provided no objective pain relief. It had, however, a temporal pain stabilizing effect possibly mediated through the improved ability to relax in between contractions. No side effects were found. It gives great satisfaction to users. Bathing, in conjunction with other forms of analgesia, is recommended.

Adult↗

PubMed2002

A preliminary study of fetal ductus venosus blood flow during the first stage of labor.

OBJECTIVE: The measurement of fetal ductus venosus blood flow during labor by means of color Doppler sonography. METHODS: 26 women between 37 and 41 weeks of gestation were included in the study. At various stages of cervical dilation (<2 cm, 2-4 cm, 6- 8 cm, and fully dilated) blood flow velocity waveforms of the fetal ductus venosus during and between contractions were studied in fetuses with a negative non-stress test. The Pulsatility index for veins (PIV) and the Peak velocity index for veins (PVIV), respectively were calculated off-line. The mean+/-standard deviation between and during contractions were determined for descriptive analysis. RESULTS: Waveforms were visualized during 139 contractions and 159 episodes of uterine relaxation in 24 of 26 fetuses (92.3%) in normal labor. Three and more waveforms were recorded, in 59.0% during contractions (82/139) and in 57.9% between contractions (92/159), respectively. The mean PIV and PVIV values during contractions were 1.68+/-1.02 and 1.46+/-0.72, respectively. Between contractions the values were 0.49+/-0.21 for the PIV and 0.44+/-0.18 for the PVIV, respectively. CONCLUSION: Ductus venosus blood flow can be visualized in labor. Further studies are needed to establish normal values.

Adult↗

PubMed1991

Spurious labor: a high risk factor for dysfunctional labor and fetal distress.

This is a retrospective case controlled study comparing the outcome of labor and neonates in pregnancies complicated by spurious labor at term. The first stage of labor was significantly longer and the proportion of cases requiring oxytocin augmentation was higher in the study group when compared to the controls. More infants in the study group displayed intrapartum CTG abnormalities and five had a depressed Apgar score at 5 min, compared to none in the controls. Of these five neonates, three were admitted to the neonatal intensive care unit and one died from meconium aspiration syndrome and asphyxia. The findings in this study support the view that spurious labor at term constitutes a high risk factor for the ensuing labor.

Adult↗

PubMed2004

The quality of intrapartum fetal heart rate monitoring.

OBJECTIVE: To determine the quality of fetal heart rate (FHR) recordings during the first and second stage of labor by quantifying the amount of fetal signal loss in relation to the method of monitoring: external ultrasound or directly via a scalp electrode. STUDY DESIGN: Analysis of 239 intrapartum recordings stored between 1 January 2001 and 1 July 2001 from consecutive deliveries at the Vrije Universiteit Medical Center in Amsterdam. Singletons delivered via the vaginal route were included in the study. FHR recordings had duration of at least 1h prior to birth of the infant. Subdivision in three groups took place on the basis of the recording technique which had been used; i.e. ultrasound, scalp electrode or a combination of both methods. FHR data was obtained using HP-M1350 cardiotocographs. The status (pen on, pen off, maternal signal) and the mode of the signals were acquired. The duration of pen lifts and maternal signals was divided by the total duration of the recording. Statistical analyses were performed with the Mann-Whitney U-test and the Wilcoxon signed ranks test. RESULTS: Recordings obtained via ultrasound demonstrated significantly more fetal signal loss than those obtained via the direct mode, particularly in the second stage. The FIGO criteria for fetal signal loss with external ultrasound were not fulfilled during this stage for about half the cases. CONCLUSION: Intrapartum FHR monitoring via a scalp electrode provides far better quality FHR signals than external ultrasound and deserves a more prominent position in fetal surveillance than it currently has.

Cardiotocography↗

PubMed2006

Maternal and neonatal infections and obstetrical outcome in water birth.

OBJECTIVES: The goal of our study was to assess the effect of water birth on obstetrical outcome, the maternal and neonatal infection rate in a selected low risk collective. STUDY DESIGN: In this prospective observational study (1998-2002) 513 women, wished to have a water birth. The study was approved by the local ethical committee, informed consent was obtained. According to the course of delivery, we compared three groups: woman who had a water birth, a normal vaginal delivery after immersion and a normal vaginal delivery without immersion. Outcome measurements were maternal and fetal infection rate, obstetrical outcome parameters and relevant laboratory parameters. RESULTS: The groups were comparable in terms of demographic and obstetric data. The maternal and neonatal infection rate and laboratory parameters showed no significant difference among the groups. There was no maternal infection related to water birth. There were five water born neonates and three neonates after normal vaginal delivery preceded by immersion with conjunctivitis. Significant differences were observed in obstetrical outcome parameters: less use of analgesia, shorter duration of first and second stage of labor, smaller episiotomy rate in water birth. In contrast no differences were seen in all observed fetal outcome parameters: APGAR score, arterial and venous pH, admission rate to neonatal intensive care unit. CONCLUSIONS: Water birth is a valuable alternative to traditional delivery. The maternal and fetal infection rate was comparable to traditional deliveries. A careful selection of a low risk collective is essential to minimize potential risks.

Adult↗