Active Stage Of Labor Research Articles

Maternal blood and amnionic oxytocin receptor gene expression and serum oxytocin levels in preterm birth: a case-control study

BACKGROUND: The oxytocin (OXT)-oxytocin receptor (OXTR) system provides promising candidate gene for studies of genetic contributions to prematurity. OBJECTIVE: Quantification and comparison of oxytocin receptor (OXTR) gene expression and serum OXT levels in the blood and amnion of women delivering preterm and evaluation of the correlation between OXTR gene expression in blood and amnion with serum OXT levels in them. METHODS: 70 pregnant women in spontaneous labor delivering vaginally preterm i.e < 37 weeks and equal number of matched controls delivering spontaneously at term (37-42 weeks) were recruited. Maternal serum OXT levels taken in active stage of labor (i.e 4 cm cervical dilatation) were quantified by ELISA. Gene expression studies in the maternal blood and amnion were done by using real time quantitative polymerase chain reaction (RT-qPCR). RESULTS: The mean serum OXT level in PTL was 48.56 +- 6.97 pg/ml; significantly higher than in controls (43.00 +- 3.96 pg/ml), p<0.001. OXTR gene expression both in maternal blood (2.5 times) and amnion (3.5 times) were significantly higher in PTL. A significant positive correlation was observed between serum OXT levels and OXTR gene expression in amnion (r = -0.190, p = 0.025). CONCLUSIONS: The serum OXT levels and OXTR gene expression in amnion surge significantly in active phase of PTL. Thus, amnion probably links OXT-PTGs autocrine paracrine circuit to facilitate PTL. Future studies are needed to devise better OXTR receptor antagonists preferably acting on amnionic OXTRs to prevent PTL. KEYWORDS: Preterm birth, Preterm labor, Oxytocin, Oxytocin receptor, Placenta, Amnion

Teknik Rebozo terhadap Intensitas Nyeri Kala I Fase Aktif dan Lamanya Persalinan pada Ibu Multigravida

This study aims to determine Rebozo Shake The Apples (RSTA) effectiveness and Rebozo Sifting While Lying Down (RSWLD) on the intensity of pain during the first stage of the active phase and the duration of labor in multigravida mothers. This research method is a quasi-experiment with two group pre and post design. This study indicates that there is a difference in the mean intensity of pain in the first stage of active labor in multigravida mothers before and after giving RSTA &amp; RSWLD (p-value = 0.007). Whereas in the length of work, there was no significant difference in the average size of labor between the RSTA and RSWLD technique interventions (p-value = 0.351), and the effectiveness of the two Rebozo techniques had the same variant, meaning they were equally effective in diverting labor pain during the active phase and duration of delivery (p-value = 0.118). In conclusion, they are giving RSTA, and RSWLD can delay labor pain intensity during the first stage of the active phase and the duration of labor in multigravida mothers.&#x0D; &#x0D; Keywords: Pain intensity, duration of labor, Multigravida, Rebozo technique

Impact of ultrasound guided training in the diagnosis of the fetal head position during labor: A prospective observational study

ObjectivesTo assess whether the additional training with transabdominal ultrasound may improve the accuracy of the transvaginal digital examination in the assessment of the fetal head position during the active stage of labor. MethodsProspective observational study involving 2 residents in their 1 st year of training in Obstetrics with no prior experience in neither transvaginal digital examination nor ultrasound. Women with term, cephalic presenting fetus and active labor with cervical dilation ≥ 8 cm and ruptured membranes were included. In the preliminary phase of the study, the resident A (“blinded”) was assigned to assess the fetal head position by transvaginal digital examination, while the resident B (“unmasked”) performed transvaginal digital examination following transabdominal ultrasound, which was considered to be the gold standard to determine the fetal head position. After 50 examinations independently performed by each resident in the training phase, a post-training phase of the study was carried out to compare the accuracy of each resident in the diagnosis of fetal head position by digital assessment. The occiput position was eventually confirmed by ultrasound performed by the main investigator. ResultsOver a 6 months period, 90 post-training vaginal examinations were performed by each resident. The number of incorrect diagnoses of head position was higher for the “blinded” resident compared with the “unmasked” resident subjected to the ultrasound training (28/90 or 31.1 % vs 15/90 or 16.7 % p = 0.02). For both residents a wrong diagnosis was more likely with non-OA vs OA fetuses but this difference was statistically significant for the “blinded” Resident (10/20 or 50 % vs 18/70 or 25.7 % p = 0.039) but not for the “unmasked” Resident (5/18 or 27.9 % vs 10/72 or 13.9 % p = 0.16). ConclusionThe addition of transabdominal ultrasound as a training tool in the determination of the fetal head position during labor seems to improve the accuracy of the transvaginal digital examination in unexperienced residents.

Early diagnosis of atypical rupture of scarred uterus: A case Report from Rural Nepal

A 28 years female from rural municipality of Dolakha was referred to our center diagnosis of G2P1 at 40 weeks of gestation in active stage of labor with previous CS. With the view of symptoms and history of previous CS, patient was shifted to Operation Theatre for delay in latent stage of labor, ruptured uterus identified at operating table and Caesarian Hysterectomy was done. Her post-operative hospital stay was uneventful. &#x0D; Spontaneous silent rupture can occur in women without any alarming symptom. Rapid recognition of potential uterine rupture and immediate laparotomy lower the rate of perinatal death.

Near-infrared spectroscopy of the placenta for monitoring fetal oxygenation during labour.

Although being the golden standard for intrapartum fetal surveillance, cardiotocography (CTG) has been shown to have poor specificity for detecting fetal acidosis. Non-invasive near-infrared-spectroscopy (NIRS) monitoring of placental oxygenation during labour has not been studied yet. The objective of the study was to determine whether changes in placental NIRS values during labour could identify intrapartum fetal hypoxia and resulting acidosis. We included 43 healthy women in active stage of labour at term. CTG and NIRS parameters in groups with vs. without neonatal umbilical artery pH ≤ 7.20 were compared using Mann-Whitney-U. Receiver-operating-characteristics (ROC) curves were used to estimate predictive value of CTG and NIRS parameters for neonatal pH ≤ 7.20. A computer-based statistical classification was also performed to further evaluate predictive values of CTG and NIRS for neonatal acidosis. Ten (23%) neonates were born with umbilical artery pH ≤ 7.20. Compared to group with pH > 7.20, fetal acidosis was associated with more episodes of placental NIRS deoxygenation (9 (range 2-37) vs. 2 (range 0-65); p<0.001), higher velocity of placental NIRS deoxygenation (2.31 (range 0-22) vs. 1 (range 0-49) %/s; p = 0.03), more decelerations on CTG (25 (range 3-91) vs. 10 (range 10-60); p = 0.02), and more prolonged decelerations on CTG (2 (range 0-4) vs. 1 (range 0-3); p = 0.04). Number of placental deoxygenations had the highest prognostic value for fetal/neonatal acidosis (area under the ROC curve 0.85 (95% confidence interval 0.70-0.99). Computer-based classification also identified number of placental deoxygenations as the most accurate classifier, with 25% false positive and 93% true positive rate in the training dataset, with 100% accuracy when applied to the testing dataset. Placental deoxygenations during labour measured by NIRS are associated with fetal/neonatal acidosis. Predictive value of placental NIRS for neonatal acidosis was superior to that of CTG.

PENGARUH PEMBERIAN ROSE EFFLEURAGE TERHADAP INTENSITAS NYERI PERSALINAN KALA I FASE AKTIF PADA PERSALINAN NORMAL PRIMIGRAVIDA DI BIDAN PRAKTIK MANDIRI ERNITA KOTA PEKANBARU

Birth pain can cause maternal discomfort such as fatigue, frustration, despair, and stress. The preliminary survey at PMB Ernita of Pekanbaru showed that there were 60% of the mothers that suffered moderate pain and 40% of them experienced severe pain. The intensity of labor pain can be reduced by giving a rose effleurage that can produce endorphin so that it stimulates a sense of relaxation. This pre-experimental research used a one group pre-test study post-test design carried out in March to June 2018. The population was primigravidae mothers in the first stage of labor taken using purposive sampling technique. The results showed that the average intensity of pain in parturient women before and after administration of rose effleurage was 6.00 and 4.60, respectively. The result of statistic test with Wilcoxon test on 95% confidence degree showed that there was the effect of rose effleurage stage on pain intensity in the active stage of labor (p value = 0.000). It is then suggested that rose effleurage can be applied as an alternative method which aims to reduce the intensity of labor pain at the time of active phase.

Assessing the Effect of Patterned Breathing Techniques for Reducing Pain during Active Stage of Labour among Pregnant Women in Tertiary Care Hospital, Bhubaneswar

A study was undertaken to evaluate the effect of patterned breathing techniques in reducing pain during active stage of labour among pregnant women in tertiary care hospital, Bhubaneswar (Odisha). The conceptual framework adopted for this study was based on JW Kenny Open System Model. A randomised control trial design was used and consecutive sampling technique was used to select 50 pregnant mothers. Patterned breathing exercises were taught and practised individually to the mothers of experimental group during latent stage of labour and the mothers with 4 cm cervical dilatation were made to practice breathing exercise at each contraction for 1 hour. Pain intensity level was assessed in ve subsequent observations at an interval of 1 hour both in experimental and control group using modi ed numeric pain intensity scale. Five post-tests scores after intervention were recorded using numeric pain intensity scale for assessing pain level after pre-test during the contraction. Findings revealed that in experimental group 80 percent people experienced mild pain and 20 percent experienced moderate pain. As p value was&lt;0.005, so there was signi cant difference between the mean scores of two groups. Thus, patterned breathing techniques have signi cant effect in reducing of labour pain during active stage of labour. But demographic variables do not have signi cant association with the level of pain with patterned breathing exercises.

Evaluating the effectiveness of TENS for maternal satisfaction in laboring parturients - Comparison with epidural analgesia.

Background and Aims:Labor pain is one of the most severe pain that a woman experiences in her lifetime. Various methods are being used to relieve this pain and to achieve higher maternal satisfaction. One such technique is transcutaneous electrical nerve stimulation (TENS) that uses low-frequency electrotherapy. The aim of our study was to evaluate TENS by comparing it to an established labor analgesia technique, i.e., epidural analgesia in terms of maternal satisfaction.Material and Methods:This prospective study was conducted on 60 parturients in active stage of labor. The choice of analgesia was made by the parturient after informed consent. In group A (n = 30) TENS was used, while in group B (n = 30) epidural ropivacaine 0.125% + 2 μg/ml fentanyl was given. Continuous monitoring of maternal vitals, visual analogue score, and fetal heart rate (FHR) was done. Maternal satisfaction was scored considering pain relief, ability to move and experience of labor at the end of delivery and outcome was labeled as favorable and unfavorable.Results:TENS was found to be favorable in 90% of parturients as compared to 96.6% in epidural (P 0.301). The number of highly satisfied parturients was 4 (13.3%) in TENS group and 17 (56.6%) in the epidural group (P= 0.000). Three patients in the epidural group had assisted delivery and two had cesarean section whereas all patients in TENS group delivered normally (P= 0.065). No significant difference was found in the fetal outcome.Conclusions:TENS is a good alternate choice for providing labor analgesia and may have a major role in future.

264: Machine learning model for prediction of neonatal scalp hematomas using first stage of labor data

Decision regarding the mode of delivery (either spontaneous, assisted or cesarean) during second stage of labor is one of the major challenges facing modern obstetrics. A model predicting maternal and fetal labor related outcomes, such as subgaleal hemorrhage (SGH), based on maternal and fetal variables collected during first stage of labor, may contribute substantially to the physician's decision-making process. Electronic medical records of labors during a 6-years period in a tertiary medical center were explored. Using gradient boosting, a model incorporating multiple maternal and neonatal variables was created to predict the risk for increased pressure on fetal head during delivery (SGH or cephalohematoma (SGH+CH)). This model can additionally allocate the deliveries with high risk for SGH at the beginning of second stage of labor. Elective repeated cesarean deliveries, multifetal gestations and preterm deliveries were excluded. We identified 659 (1.8%) deliveries with SGH+CH out of 36,607 parturients during a 6-years period. A machine learning based model to predict SGH+CH was developed. The area under the curve of the model was 0.89. Most importantly, the model was able to identify high risk births, using basic maternal, fetal and labor associated parameters, with increased odds ratio (OR) for several major neonatal complications; OR of 11.44 (95% Confidence Interval 7.5-17.5) for SGH, OR of 2.38 (95% CI 1.8-3.2) for neonatal intensive care admission and OR of 3.41 (95% CI 2.5-4.6) for lower than 7 APGAR score in 5 minutes after birth. Our machine learning-based model was able to accurately predict births with higher risk for SGH and CH. The same model was capable of early identification of deliveries with increased risk for several major obstetric and neonatal complications, making it an applicable tool, useful for personalized decision making during the active stage of labor.

EP23.04: To compare transvaginal digital examination with transabdominal ultrasound in determining the fetal head position in active stage of labour

EP23.04: To compare transvaginal digital examination with transabdominal ultrasound in determining the fetal head position in active stage of labour

Adverse Drug Reaction with Hyoscine and Valethamate for Cervical Dilation during Labour

Adverse drug reaction (ADR) is an injury caused by taking medication. ADR may occur following single dose or prolong administration of drug or combination of two or more drugs. While major advancements of discipline of pharmacovigilance have taken place in the West, not much has been achieved in Asian countries. Labour is characterised by forceful and painful uterine contraction that result in cervical dilation and foetus decent from the birth canal. Anti-spasmodic drugs like hyoscine butylbromide and valethamate bromide have been used to accelerate cervical dilation and thus reduce the labor duration. The objective was to observe ADR with hyoscine and valethamate for cervical dilation during labor. It was a hospital based cross sectional study. Investigation was carried out in the form of questionnaire. All the consecutive patients who were in active stage of labor were included in the study. They were given Intravenous (IV) valethamate bromide 8mg and hyoscine butylbromide 20mg, 3 doses half an hour apart. After administration of the drug, the progress of labor was monitored and management was done as per protocol in obstetrics and gynaecology department. ADR reported were blurred vision in 47.7% of the patients, followed by dry mouth (36.9%) and tachycardia (19.2%). Other ADRs were nausea (6.2%), dizziness (3.8%), flushing (2.3%), vomiting (1.5%), fever (1.5%) and constipation (1.5%). No statistical significance was found when ADR was compared between the age group of 18-25 years and 26-35 years. Therefore, ADR reported were irrespective of the age of the patients and no life threatening or severe forms of ADR were seen with hyoscine and valethamate during cervical dilation.

Effects of analgesia pain relief during entire labor on maternal and neonatal outcomes under new partogram

Objective To explore the effects of whole-stage labor analgesia on maternal and neonatal outcomes after the implementation of the new partogram. Methods A retrospective cohort study was performed in Peking University First Hospital. From June to December 2016, 907 nulliparae with full-term singleton cephalic pregnancies that were expected to deliver vaginally and adhered to the new partogram were selected as the study group, and 982 cases that adhered to the old partogram (Friedman standard) from June to December 2012 were selected as the control group. Maternal basic characteristics and analgesic, obstetric and neonatal data were collected. Maternal and neonatal outcomes between the two groups were analyzed with independent sample t-test, rank sum test or Chi-square test (Fisher's exact test). Results (1) Maternal age and the proportion of gravidas of advanced maternal age in the study group were both higher than those in the control group [(30.2±3.0) vs (29.6±2.9) years, t=3.823; 8.2% (74/907) vs 4.2% (41/982), χ2=13.087; both P<0.001]. No statistically significant difference in the other basic characteristics was found between the two groups. (2) Women in the study group had significantly smaller cervical dilatation [M(P25-P75)] than that in the control group when analgesia was commenced [2(1-2) vs 2(1-3) cm, Z=-3.752]. The intensity of pain quantified with numerical rating scale (NRS) before analgesia, and during the second stage of labor in the study group were less than that in the control group [8(8-9) vs 8(8-10) points, Z=-14.441; 5(4-5) vs 6(5-7) points, Z=-16.495]. The study group had longer median duration of analgesia than the control group [520(340-750) vs 300(200-453) min, Z=-17.801, P<0.001]. The overall dose of analgesics in injection pump in the study group was significantly higher compared with that used in the control group [68 (35-84) vs 30 (18-48) ml, Z=-18.004, P<0.001]. However, there was no significant difference in the incidence of analgesia-related complications (hypotension, accidental dura puncture, lower extremity numbness, pruritus and urinary retention) between the two groups. (3) The study group showed a higher percentage of spontaneous vaginal delivery, and a lower rate of converted cesarean section compared with the control group [71.8% (651/907) vs 63.2% (621/982), χ2=15.623; 13.6% (123/907) vs 20.5% (201/982), χ2=18.831; both P<0.001]. The study group had lower forceps-assisted vaginal delivery rate than the control group without statistically significant difference [14.8% (133/907) vs 15.3% (150/982), χ2=0.093, P=0.797]. The duration of the first, second and third stage of labor in the study group were all significantly longer than that of the control group [680 (470-900) vs 480 (360-660) min, Z=-12.490; 56 (31-89) vs 37 (24-58) min, Z=-9.964; 7 (5-10) vs 6 (5-8) min, Z=-6.673; all P<0.001]. Women in the study group had a lower rate of artificial rupture of membranes when comparing with the control group [55.2% (501/907) vs 63.2% (621/982), χ2=12.516, P<0.001]. The incidence of fever, pathologically confirmed infection and postpartum hemorrhage were significantly higher in the study group than that in the control group [10.8% (98/907) vs 6.4% (63/982), χ2=11.652; 9.6% (87/907) vs 3.7% (36/982), χ2=27.201; 12.6% (114/907) vs 5.7% (56/982), χ2=27.144; all P<0.05]. There was no significant difference in the rate of oxytocin use during labor or blood transfusion between the two groups. (4) Compared with the control group, the proportion of cesarean section due to arrested active stage of labor in the study group was significantly lower [5.7% (7/123) vs 50.2% (101/201), χ2=68.173, P<0.05], but the incidences of cesarean section due to intrauterine infection and relative cephalopelvic disproportion were higher in the study group [61.0% (75/123) vs 30.8% (62/201), χ2=2.680; 20.3% (25/123) vs 8.0% (16/201), χ2=10.555; both P<0.05]. There was no significant difference in the proportion of fetal distress or other indications for cesarean section between the two groups. (5) There was no significant difference between the two groups in birth weight, macrosomia, fetal distress, neonatal asphyxia, or the proportion of neonatal intensive care unit admission. Conclusions After the implementation of the new partogram, analgesic pain relief covering the whole labor prolongs the average analgesic time and reduces the rate of cesarean section due to arrested active stage of labor. Although the risk of postpartum hemorrhage is slightly increased, analgesia itself does not pose additional risks on forceps-assisted delivery, maternal blood transfusion and neonatal asphyxia. Key words: Labor, obstetric; Analgesia, epidural; Labor stage, second; Analgesia, obstetrical; Cesarean section

EFEKTIVITAS PEMBERIAN TEKNIK MASSAGE EFFLEURAGE DAN TEKNIK MASSAGE CONTERPRESSURE TERHADAP RASA NYERI PERSALINAN NORMAL PADA PRIMIGRAVIDA DI LANGSA TAHUN 2017

Labor pain is a manifestation of contractions of the uterine muscles. Pain in childbirth if left untreated will increase anxiety, tensionand stress. Increased consumption of body glucose in maternity mothers who experience stress causes fatigue and catecholamine secretion that inhibits uterine contractions, which causes prolonged labor which ultimately causes anxiety in the mother, increased pain and prolonged stress. Massage can be used during labor and may be an effective pain reliever. The common massage technique is effleurage and Conterpressure. The aim this studyto determine the effectiveness of providing Effleurage Massage and Conterpressure Massage techniques in Active Phase Pain Reduction during normal labor in Primigravida mother at Eva Repelitamidwifery practice and Rusmalanitamidwifery practice Langsa City. Design of this study was quasi experimental design with posttest only control group design in the form of pain scaling in the first stage of active labor, conducted at Eva Repelita, Am.Keb midwifery practice and Rusmalanita Am.Keb midwifery practice in February to April 2017 Langsa City. The sample in this study were mothers, whom divided into two groups numbered 16 people, thus the total sample was 32 people. Data analysis techniques used are Univariate and Bivariate analysis using Paired T-Test The result of this study the mean pain scale in active phase of normal labor in Primigravida mothers, with Effleurage Massage Technique was 2 with SD 2.44 deviation, while the mean pain scale with Massage Conterpressure technique is 6 with SD 6.36 deviation. While the results of the Statistical Test using Paired T-test obtained P value of 0,000, that the Effleurage Massage technique was more effective than the Conterpressure Massage technique in reducing labor pain during active phase. Conclusions: It can be concluded that Effleurage Massage technique was more effective than Conterpressure Massage technique in reducing labor pain during the active phase.

Equipotent dose of levobupivacaine reduce the incidence of instrumental vaginal delivery when compared to ropivacaine during epidural labour analgesia

Background : Instrumental vaginal delivery is a major concern during epidural labour analgesia. In previous studies levobupivacaine 0.1% was associated with increase in instrumental vaginal delivery when compared to 0.1% ropivacaine. Reducing the concentration of levobupivacaine may decrease the incidence of instrumental delivery. Hence, we compared 0.08% levobupivacaine and 0.1% ropivacaine with fentanyl as adjuvant for epidural labour analgesia in terms of mode of delivery. M ethods: This prospective randomised controlled trial was conducted on 70 nulliparous parturients with singleton uncomplicated pregnancy. They were randomized into two groups to receive 0.08% levobupivacaine or 0.1% ropivacaine with 2mg/ml fentanyl as intermittent epidural boluses. The epidural analgesia was initiated with 12ml of study drug solution in active stage of labour and was maintained by repeated demand boluses whenever the Visual Analogue Scale (VAS) score was > 3. Onset, duration and quality of analgesia, degree of motor blockade was analysed. Primary outcome measure was the mode of delivery. Onset and duration of analgesia and Apgar score of baby were the secondary outcomes. Results: Instrumental vaginal delivery was 6.45% in levobupivacaine(L) and 4.54%in ropivacaine(R) group. However,11.4% and 37.1% parturients underwent caesarean section in group L and group R respectively (p=0.012**). Mean onset of analgesia and duration of analgesia was comparable. More than 80% of parturients had excellent pain relief in both the groups with good baby APGAR score. Conclusion: We conclude that 12ml of intermittent epidural boluses of 0.08% levobupivacaine and 0.1% ropivacaine with 2mg/ml fentanyl (equipotent dose) provided equal and effective analgesia during labour with comparable incidence of instrumental vaginal delivery.

The impact of nuchal cord on umbilical cord blood gas analysis and ischaemia-modified albumin levels in elective C-section

This study was designed to evaluate umbilical cord ischaemia-modified albumin (IMA) levels and the cord blood gas parameters of foetuses with or without nuchal cords, at the time of elective C-section. The cross-sectional study population consisted of the patients who were admitted to the Tertiary Care Center between February and June 2015. Women with uncomplicated single term gestations between 37 and 40 completed weeks and scheduled for elective C-sections were included in the study. Fifty cases with a nuchal cord and 50 cases without a nuchal cord were recruited. Nuchal cord blood gas analysis and the IMA levels were evaluated. The IMA levels in umbilical artery of foetuses both in the study and control groups were similar (0.714 ± 0.150 vs. 0.689 ± 0.107 ABSU, p = .340, respectively). The umbilical artery pH values of the study group were significantly lower than that in the control group (7.31 ± 0.04 vs. 7.32 ± 0.03, p = .042; respectively). The results of the current study indicate that the nuchal cord has an impact on the foetal cord blood gas parameters to some extent before the initiation of labour. Fortunately, this impact does not end up with foetal tissue ischaemia, as confirmed by the IMA levels.Impact statementWhat is already known on this subject? The impact of nuchal cord on perinatal outcomes has been the subject of research for many years. Although the accumulated data has pointed out some unfavourable perinatal effects, the heterogeneity of the study groups both including a vaginal delivery and C-section and the inability to adjust the interfering factors ended up with some controversies. This is why there is not much known about the effects of the nuchal cord in women who are not in the labour process.What do the results of this study add? The current study aimed to exclude the interfering effects such as the active stage of labour. In this study, elective caesarean sections were selected as the study population to evaluate the effects of the nuchal cord on cord blood gas parameters and the IMA values. pH analysis in cord blood is used to detect hypoxia and the IMA is a new ischaemia marker. The results revealed that the in utero nuchal cord is associated with a significantly higher pCO2 and lower pH values and similar IMA values.What are the implications of these findings for clinical practice and/or further research? The final outcome supports that the nuchal cord causes alterations in cord blood gas analysis but this does not reach critical levels. Therefore, the results show that there is no need to change clinical practice when the nuchal cord is detected by ultrasound in a term gestation.

Risk factors for nonreassuring fetal heart rate tracings after artificial rupture of membranes in spontaneous labor.

We aimed to characterize factors associated with nonreassuring fetal heart (FHR) tracings after artificial rupture of membranes (AROM), during the active phase of labor. Delivery charts of patients who presented in spontaneous labor, at term, between 2015 and 2016 were reviewed. We identified cases in which AROM was performed during the active stage of labor. We compared deliveries with a normal FHR and those who developed nonreassuring FHR. Nonreassuring FHR was defined as fetal tracing that necessitated intrauterine resuscitation, which included: oxytocin withheld, amnioinfusion, or immediate instrumental or cesarean birth. Of 664 deliveries, nonreassuring FHR occurred in 141 (21.2%) and normal FHR in 523 (78.7%). Both groups were notable for similar maternal characteristics and a similar gestational age. Epidural block was significantly more common in the nonreassuring FHR group (P<.001), as was meconium during delivery (P=.01). Deliveries in the nonreassuring FHR group were characterized by significantly lower Bishop scores at AROM. Mean birthweight was significantly lower in the nonreassuring FHR group (3201±418 vs 3342±376g, P<.001), yet, neonatal outcome did not differ between the groups. In a multivariate logistic regression model, nulliparity, AROM at a station lower than -2, and increased birthweight were all significantly associated with a decreased rate of nonreassuring FHR, while prolonged duration from AROM to delivery and oxytocin augmentation significantly increased the risk for nonreassuring FHR. Nonreassuring FHR after AROM during delivery is associated with parity, fetal station at AROM, birthweight, and oxytocin augmentation.

Quality of Labor Epidural Analgesia and Maternal Outcome With Levobupivacaine and Ropivacaine: A Double-Blinded Randomized Trial.

Background:Quality of labor analgesia plays a vital role in the maternal outcome. Very few literature are available analyzing the quality of epidural labor analgesia.Aim:The aim of this study was to compare the effectiveness of 0.1% levobupivacaine and 0.1% ropivacaine with fentanyl as an adjuvant for epidural labor analgesia in terms of onset, duration, quality of analgesia, and degree of motor blockade.Methodology:Sixty nulliparous parturients, with singleton uncomplicated pregnancy, were recruited by continuous sampling. Parturients were randomized to receive either levobupivacaine 0.1% or ropivacaine 0.1% with 2 μg/ml fentanyl as an intermittent epidural bolus. The epidural analgesia was initiated with 12 ml of study drug solution in the active stage of labor (cervix 3 cm dilated). Demand bolus was given whenever the visual analog scale (VAS) score >3. Onset, duration, and quality of analgesia and degree of motor blockade were analyzed. Maternal outcome was evaluated in terms of mode of delivery, duration of labor, and assisted vaginal delivery.Statistical Analysis:All the data were recorded in Microsoft Office Excel. Statistical analysis was carried out using SPSS version 19.0 (IBM SPSS, USA) software with Regression Modules installed. Descriptive analyses were reported as mean and standard deviation of continuous variables.Results:The mean onset of analgesia was shorter in ropivacaine (21.43 ± 2 min) than in levobupivacaine group (23.57 ± 1.71 min) (P = 0.000). Duration of analgesia was shorter in ropivacaine (60 ± 14 min) than levobupivacaine (68 ± 11 min) (P = 0.027). Levobupivacaine produced a better quality of analgesia in terms of not perceiving pain and uterine contraction during labor analgesia but was associated with 37% incidence of instrumental delivery. Duration of labor and rate of cesarean section were comparable between the groups.Conclusion:Quality of analgesia in labor epidural was superior to levobupivacaine but was associated with higher incidence of instrumental vaginal delivery.

Uterine electrical activity at labor: is there a correlation between labor stages?

Objective: To determine the association between the myometrial electrical activity in the active and second stages of labor at term using electrical uterine myography (EUM).Methods: A prospective observational study of 47 singleton deliveries at term in a tertiary hospital. All women were assessed using noninvasive 9-channel surface electrodes of the EUM during labor. EUM index (EUMi) was calculated as the mean electrical activity during a 30 min monitoring period and expressed as microjouls (MJ). Mean EUMi of the active and second stages of labor were compared accordingly.Results: Mean EUMi during the active phase was 3.53 ± 0.43 MJ, whereas mean EUMi in the second stage was 3.66 ± 0.48 MJ (p = 0.02). Correlation analysis between mean EUMi of the active and second stages of labor produced r2 = 0.68 (p < 0.01). In a regression analysis model EUMi of the active stage of labor remained strongly correlated with the duration of the second stage (r2 = 0.73, p < 0.001). No correlation was found between EUMi and the duration of the second stage.Conclusion: A positive correlation of myometrial electrical activity exists between active phase and second stage of labor. However, while EUMi was associated with the duration of the active phase, no correlation was found between EUMi and the duration of the second stage.

Duration of the active stage of labour in spontaneous and induced labours: a prospective cohort study

Duration of the active stage of labour in spontaneous and induced labours: a prospective cohort study

Levobupivacaine for labor analgesia.

Background:Combined spinal-epidural analgesia has become the preferred technique for labor analgesia as it combines the benefits of both spinal analgesia and flexibility of epidural catheter. Study was carried out with the primary aim to compare levobupivacaine and ropivacaine with fentanyl in terms of onset and duration of sensory block and to know maternal and fetal outcome.Materials and Methods:In a prospective randomized double-blind study, 60 primipara of the American Society of Anesthesiologists health status Class I and II with singleton pregnancy in active stage of labor were randomly allocated into two groups of 30 each. Group A received 3 mg intrathecal levobupivacaine with 25 μg fentanyl followed by epidural top-ups of 14 ml of levobupivacaine 0.125% with fentanyl 30 μg whereas Group B received 4 mg intrathecal ropivacaine with 25 μg fentanyl followed by epidural top-ups of 14 ml of ropivacaine 0.2% with fentanyl 30 μg. Patients were monitored for sensory and motor block characteristics, hemodynamics, maternal and fetal outcome, side effects, and complications. These characteristics were analyzed using the “Chi-square tests” and “unpaired t-test.”Results:Onset of analgesia was rapid in Group A (4.72 ± 0.54 min) as compared to Group B (5.58 ± 0.49 min). Duration of analgesia was also prolonged in Group A (117.00 ± 11.86 min) as compared to Group B (90.17 ± 8.85 min). Patients remained hemodynamically stable and side effects, and complications were comparable in both groups.Conclusion:Levobupivacaine with fentanyl leads to early onset and prolonged duration of analgesia as compared to ropivacaine with fentanyl during labor analgesia.