Change In Cervical Dilatation Research Articles

Does change in cervical dilation after anesthesia impact latency after cerclage placement?

Background: Pregnant individuals with early cervical dilation have a high risk for preterm birth. The authors encountered cases where cervical dilation increased after anesthesia administration for a cerclage. Objective: The primary objective was to assess if a change in cervical dilation after anesthesia administration for a cerclage was associated with a shorter latency to delivery. Study design: This was a retrospective chart review of pregnancies from January 1, 2011, to December 31, 2021, who had a cerclage and delivered at our institution. Maternal demographics, obstetrical history, operative details, and delivery information were collected. Multi-fetal gestations, un-indicated cerclages, and abdominal cerclages were excluded. The primary outcome was the difference in cervical dilation between the office and the operating room after spinal anesthesia administration. A multivariable regression was performed. Results: A total of 183 pregnancies were included. The mean gestational age at cerclage placement was 18 weeks (STDEV 3.6). Twenty-nine percent of patients (53/183) were more dilated in the operating room compared to the office The latency between cerclage and delivery was not different if there was a cervical change between these settings (p = 0.655). There was an increased risk for preterm delivery with dilation in the office (OR 1.01, CI 1.01 to 2.5), but not with dilation in the operating room (OR 1.4, CI 0.9 to 2.0). Conclusion: Cervical dilation between the office and the operating room is different. Pregnancies with more dilation delivered at earlier gestations. However, a change in dilation between the office and the operating room was not associated with a shorter latency.

Cervical opening during estrus in Aceh Local Cows based on camera-equipped artificial insemination endoscope

Twelve healthy and not pregnant local cows, aged 3-6 years, 1-3 parity. The cows were synchronized using the PGF2α of 5 ml/cow intramuscularly, twice at 11 days intervals. The Estrus detection based on the scoring of van Eerdenburg was conducted 24 hours after the second prostaglandin injection three times daily for three days. The changes in cervical dilatation were observed at 0, 6, and 12 hours from the onset of estrus. The result showed that 8 of 12 cows were estrus after twice PGF2α injection. All the estrus cows showed mild cervical dilatation with liquid and transparent mucus (opening cervix score 1) at 0-hour observation. Six hours later, 62.50% of cows remained at opening cervix score 1, and 37.50% changed to opening cervix score 2 (optimum cervical dilatation with thick and transparent mucus). At 12 hours after the onset of estrus, 25% of estrus cows had cervical closure (opening cervix score 0, closed cervical with thick and turbid mucus), and 75% changed to opening cervix score 2. In this study, 75% of the cows experienced an optimum open cervix at 12 hours from the onset of estrus. It could be concluded that opening the external cervical canal of local Aceh cows reaches optimum at 12 hours from the onset of estrus.

Cervical opening during estrus in Aceh Local Cows based on camera-equipped artificial insemination endoscope

Twelve healthy and not pregnant local cows, aged 3-6 years, 1-3 parity. The cows were synchronized using the PGF2α of 5 ml/cow intramuscularly, twice at 11 days intervals. The Estrus detection based on the scoring of van Eerdenburg was conducted 24 hours after the second prostaglandin injection three times daily for three days. The changes in cervical dilatation were observed at 0, 6, and 12 hours from the onset of estrus. The result showed that 8 of 12 cows were estrus after twice PGF2α injection. All the estrus cows showed mild cervical dilatation with liquid and transparent mucus (opening cervix score 1) at 0-hour observation. Six hours later, 62.50% of cows remained at opening cervix score 1, and 37.50% changed to opening cervix score 2 (optimum cervical dilatation with thick and transparent mucus). At 12 hours after the onset of estrus, 25% of estrus cows had cervical closure (opening cervix score 0, closed cervical with thick and turbid mucus), and 75% changed to opening cervix score 2. In this study, 75% of the cows experienced an optimum open cervix at 12 hours from the onset of estrus. It could be concluded that opening the external cervical canal of local Aceh cows reaches optimum at 12 hours from the onset of estrus.

Does a change in cervical dilation after anesthesia impact latency after cerclage placement?

Pregnant individuals with early cervical dilation are at risk for preterm birth. The authors had cases where women are more dilated in the operating room.The primary objective was to assess if a change in cervical dilation after anesthesia administration for a cerclage was associated with a shorter latency to delivery.

Is the 14% cesarean section rate in Gulu Regional Referral Hospital justifiable?

Worldwide, cesarean section (CS) rates have increased tremendously in recent years, especially among high-income countries, raising concerns about the over-utilization of CS without added benefits, and in the sub-Saharan African region, the rate is at its lowest (7.3%). In Uganda, the CS rate stands at 6% and is seen to be higher (11%) among first-order births indicating a high incidence of primary CS. Despite the low rate of CS in Uganda, there are massive gaps in the provision of obstetric procedure with some women receiving unnecessary surgeries, and the facility-based CS rate is projected to increase to 32% by end of 2021. Notwithstanding the increasing facility rates of CS, Gulu Regional Referral Hospital (GRRH) rate has remained low in the years 2017-2019, with lower levels maternal mortality ratio and fresh stillbirths´ rates compared to the national average. Prolonged labor is one of the commonest indications for primary CS accounting for more than 50% among nulliparous women and this is linked to progress of labor usually measured using cervical dilatation. World Health Organization (WHO) recommended a change in cervical dilatation from 4cm to 5cm as a threshold for the active phase of the first stage of labor, as a way to reduce unnecessary labor intervention including the CS. Lack of standard reporting tools such as the WHO Robson´s ten group classification in Uganda make comparisons of CS rate between/within facility/facilities worrisomely difficult.

Influence of Ambulation during the First Stage of Labor on Labor Progress of Primi Parturients

Background: The first labor stage is the longest. Progress of labor is usually assessed by changes in cervical dilatation, the descent of the fetal head, and uterine contractions. Normal labor progress might be attained by providing evidence-based practices. Ambulation during labor is one of the practices that may affect the progress of labor. Aim: This study aimed to assess the influence of ambulation during the first stage of labor on labor progress of primi parturients. Methods: A quasi-experimental research design was conducted at the Labor and Delivery unit, Mansoura University Hospital, Egypt. A purposive sample of 86 primi parturient mothers at the early active phase was allocated either to the control group who received the usual labor care or to the ambulation group who were ambulated during the active phase besides the usual care. Data were collected using a structured interview schedule and the modified Partograph sheet. Results: The labor progressed faster in the ambulation group compared to the control group giving a shorter active phase, second stage and third stage of labor with a mean difference of 2.3 hours, 20.1 minutes, and 3.0 minutes respectively; p < 0.001) and lower Cesarean Section deliveries (11.6% vs. 41.9% respectively; p = 0.002). Conclusion: The current study hypotheses were accepted; where the ambulation during the active phase of the first stage of labor was an effective intervention for enhancing the labor progress compared to the usual care only. Thus, it is recommended for the primi parturient mothers to ambulate at the early active phase of labor.

The Role of Hospital Specific Labor Curves in Promoting a Culture of Intended Vaginal Birth [37N

INTRODUCTION: To describe the labor curve in nulliparous women at term with a singleton fetus in the vertex presentation (NTSV) at a community hospital. METHODS: IRB approved, retrospective cohort study of NTSV presenting for labor management from January 1, 2016 – December 31, 2017 (N=1,638). Cervical examination upon admission and every cervical examination until delivery were extracted from the labor flow sheet and delivery summary in the electronic medical record. A linear mixed effect model with random intercept for each woman and random slope for time was used for modeling of cervical exam trajectories with time since first examination. Within-woman correlation and variability of trajectories across women were determined. RESULTS: 1,084 women delivered vaginally (VD) and 554 women delivered via cesarean section (CD). For the cohort, dilation increased 0.39 cm/hour in the first 12 hours, 0.46 cm/hour between 12–24 hours and 0.41 cm/hour after 24 hours. When comparing delivery type, rate of progression in the first 12 hours for the VD group was 0.45 cm/hour vs 0.26/hour (P&lt;.001) for the CD group. Rate of progression at 12–24 hours in the VD group was 0.53 cm/hours vs 0.34 cm/hour (P&lt;.001) in the CD group. CONCLUSION: The change in cervical dilation needed to achieve vaginal delivery in a nulliparous woman is slower than was previously suggested by the Friedman curve. Furthermore, the labor curve in women who delivered vaginally is markedly different from the curve of women who delivered via cesarean section as early as the first 12 hours of labor.

ОБОСНОВАНИЕ ЦЕЛЕСООБРАЗНОСТИ ПАРАВЕРТЕБРАЛЬНОЙ БЛОКАДЫ ДЛЯ АНАЛЬГЕЗИИ САМОПРОИЗВОЛЬНЫХ РОДОВ

The article presents the comparative assessment of efficiency and safety of neuraxial pain relief in labor. Subjects and methods . Four groups of 40 women in each group participated in the study: In Group 1, epidural analgesia was used for pain relief in labor, in Group 2, ultra-low-dose spinal analgesia was used, and paravertebral analgesia was used for pain relief in Group 3. And Control Group included 40 women with no pain relief in labor. The efficiency of analgesia in labor was monitored (scores by N.N. Rasstrigin and B.V. Shneider), as hemodynamic rates: heart rate, arterial tension, and median arterial tension (ATmed). Bromage scores were used for assessment of motor block. The changes in cervical dilatation and duration of the first and second period of the labor were assessed. All complications and negative effects of pain relief and impact of analgesia on the fetus were registered. Results. All methods of pain relief demonstrated statistically significant reduction of sensitivity to pain. Dilating pains were evaluated as 7.15 scores in Group 1; 6.88 scores in Group 2, and 7.43 in Group 3. In Control Group it made 3.87 scores (p < 0.001). During the second period of labor epidural and paravertebral analgesia was the most effective: 6.78 scores in Group 1 and 6.20 scores in Group 3 (p < 0.05). After pain relief in Groups 1, 2 and 3 there was a statistically significant reduction of specific peripheral vascular resistance, ATmed, reduction of cardiac index due to normalization of heart rate. In the groups with pain relief, the time from the development of analgesic effect until full dilation was statistically significantly shorter. The best result was achieved through paravertebral analgesia (27.5 minutes faster versus Control Group, p < 0.001). The statistically significant increase of active pushing phase was observed in Group 2, on the average for 6.1 minutes longer versus Control Group (p < 0.005). Conclusions. Neuraxial methods provide sufficient level of analgesia and are capable to manage labor abnormalities with no negative impact on the fetus. All represented methods of pain relief can be used for obstetric anesthesiology. In each specific obstetric situation, there is an option to choose the most appropriate method of pain relief.

The assessment of labor: a brief history.

In the 1930s, investigators in the US, Germany and Switzerland made the first attempts to quantify the course of labor in a clinically meaningful way. They emphasized the rupture of membranes as a pivotal event governing labor progress. Attention was also placed on the total number of contractions as a guide to normality. Beginning in the 1950s, Friedman determined that changes in cervical dilatation and fetal station over time were the most useful parameters for the assessment of labor progress. He showed all normal labors had similar patterns of dilatation and descent, differing only in the durations and slopes of their component parts. These observations led to the formulation of criteria that elevated the assessment of labor from a rather arbitrary exercise to one guided by scientific objectivity. Researchers worldwide confirmed the basic nature of labor curves and validated their functionality. This system allows us to quantify the effects of parity, analgesia, maternal obesity, prior cesarean, maternal age, and fetal presentation and position on labor. It permits analysis of outcomes associated with labor aberrations, quantifies the effectiveness of treatments and assesses the need for cesarean delivery. Also, dysfunctional labor patterns serve as indicators of short- and long-term risks to offspring. We still lack the necessary translational research to link the physiologic manifestations of uterine contractility with changes in dilatation and descent. Recent efforts to interpret electrohysterographic patterns hold promise in this regard, as does preliminary exploration into the molecular basis of dysfunctional labor. For now, the clinician is best served by a system of labor assessment proposed more than 60 years ago and embellished upon in considerable detail since.

Duration of labor by gestational week in nulliparous women

Objectives: To assess whether labor length differs by week of gestation.Methods: In this observational cross-sectional study, we compared duration of labor by gestational age (36 + 0 through 40 + 6 weeks) in primiparous singleton parturients with vertex presentation. Data were acquired for a period of 24 months (2010–2011).Results: In general, the rate of change in cervical dilatation decreased as gestational week at delivery advanced: 1.8 ± 1.0 cm/h, 1.5 ± 0.9 cm/h, 1.3 ± 0.8 cm/h, 1.6 ± 1.5, and 1.3 ± 1.0 cm/h at 36th, 37th, 38th, 39th and 40th gestational week, respectively (p = 0.040). Concurrently, the total labor duration (1st + 2nd + 3rd stages) increased as gestational age advanced: 423.6 ± 180.9 min, 496.5 ± 212.6 min, 545.9 ± 247.1 min, 483.8 ± 256.3 min, and 568.2 ± 273.8 min at 36th, 37th, 38th, 39th and 40th gestational week, respectively (p = 0.013).Conclusions: Gestational week of pregnancy may alter the duration of labor, specifically, the length of labor increases as gestational week at delivery advances.

Activity Level During a One-Hour Labor Check Evaluation

Determine if bed rest or walking during a 1-hour labor check evaluation affects progression to delivery. Randomized controlled trial. Convenience sample of nulliparous full-term, low-risk women with an initial negative exam for active labor (cervical dilatation < 4 cm; intact membranes) were randomly assigned to bed rest or walking for 1 hour prior to reassessment. Cervical dilatation and comfort level were evaluated before and after 1 hour of bed rest or walking. For patients who delivered within 24 hours, time to delivery was documented. Data were analyzed with Student's t-test and c-test. Positive and negative predictive values were calculated for the 1-hour labor check evaluation as a screen for delivery within 24 hours (negative screen = no change in cervical dilatation after 1 hour; positive screen = ≥1 cm change in cervical dilatation after 1 hour). Sixty-three participants were studied before and after a 1-hour period of bed rest (n = 32) or walking (n = 31). No differences were found between the groups in changes of cervical dilatation, time to delivery, number of women delivering within 24 hours, or maternal comfort after the 1-hour labor check evaluation. Predictive values of the 1-hour labor check evaluation to determine delivery within 24 hours were 88.2% (positive predictive value) and 54.3% (negative predictive value). Cervical dilatation and time to delivery were similar for nulliparous, full-term, low-risk women regardless of activity level during a 1-hour, in-hospital labor check evaluation. The woman's preference can be used to determine activity level during a labor check evaluation. Positive 1-hour labor check evaluations were highly predictive of delivery within 24 hours. A negative 1-hour labor check evaluation, however, was not a good predictor of delivery within 24 hours.

Contemporary Patterns of Spontaneous Labor With Normal Neonatal Outcomes

Concepts developed several decades ago established criteria that defined labor arrest as no appreciable change in cervical dilation in the presence of adequate uterine contractions for more than 2 hours. However, these criteria may no longer be applicable to contemporary obstetric populations. The aim of this study was to examine contemporary labor patterns and estimate duration of labor in a large number of parturients with spontaneous onset of labor. Information on contemporary labor and delivery data in the United States was abstracted for the Consortium on Safe Labor, a multicenter, retrospective, observational study. The information was obtained from electronic medical records in 12 clinical centers. The study subjects were 62,415 parturients with a singleton term pregnancy who had spontaneous onset of labor, a vertex presentation, vaginal delivery, and normal neonatal outcomes. Average labor curves stratified by parity were constructed using a repeated-measures analysis. The duration of labor was estimated by an interval-censored regression stratified by cervical dilation at admission; the median and 95th percentiles were calculated to assess labor progression from 1 centimeter of dilation to the next. The data showed that at 4 cm, it may take more than 6 hours to progress to 5 cm, whereas it may take more than 3 hours to progress from 5 to 6 cm. The medians and 95th percentiles of duration of labor showed similar progression among nulliparous and multiparous women before 6 cm. After this point, however, multiparous women showed much faster acceleration of labor than nulliparous women. The 95th percentiles for the second stage of labor in nulliparous women with and without epidural analgesia were 3.6 and 2.8 hours, respectively. The investigators produced a partogram from the data for contemporary nulliparous women. These findings suggest that the use of 6 cm rather than 4 cm of cervical dilation as the start of the active phase may be more appropriate in the contemporary population. On the basis of these data, the investigators believe that the long-established definitions of normal and abnormal labor should be re-evaluated.

Prostaglandin E2 vaginal gel to treat dystocia in spontaneous labour: a multicentre randomised placebo‐controlled trial

To test the safety and efficacy of prostaglandin E(2) (PgE(2)) as a treatment for dystocia in spontaneous labour. Randomised, double-blind, placebo-controlled trial. Multicentre study in nine university-affiliated hospitals in Canada. Population Three hundred and thiry-two nulliparous women with spontaneous labour at term. Women who had progressed < 2 cm of cervical dilation in the 4 hours following the diagnosis of labour were randomly assigned to receive a single dose of either 1 mg (n= 112) or 2 mg (n= 111) PgE(2) vaginal gel or placebo gel (n= 109). The primary outcome was resolution of dystocia, defined as a change in cervical dilatation of >0.5 cm per hour in the 6 hours following gel administration. Secondary outcomes were progress of labour, uterine hyperstimulation (more than five contractions in 10 minutes or a contraction lasting more than 2 minutes), use of oxytocin, method of delivery, maternal and neonatal morbidity. Dystocia resolved more often after PgE(2) 1 mg (49%), RR 1.53 (95% CI 1.1, 2.1) and PgE(2) 2 mg (49%), RR 1.5 (CI 1.1, 2.1), compared with placebo (32%). Hyperstimulation was increased after PgE(2) 2 mg treatment (15%), RR 5.6 (95% CI 1.7, 18), but not after PgE(2) 1 mg (5.4%), RR 1.9 (CI 0.50, 7.6) when compared with placebo (2.8%). There was an increase in caesarean sections performed in the second stage of labour in the PgE(2) groups versus placebo. There were no differences in measures of maternal or neonatal morbidity. A single 1-mg dose of PgE(2) vaginal gel is more effective than placebo in resolving dystocia, without increasing uterine hyperstimulation, but may be associated with an increase in the incidence of second stage caesarean section.

Risk Factors for Cesarean Delivery at Presentation of Nulliparous Patients in Labor

In Brief OBJECTIVE To identify risk factors that place a term nulliparous patient in labor at risk for cesarean delivery. METHODS This was a case-control, chart review study of 325 nulliparous patients presenting in labor at term with singleton vertex fetuses with either cesarean (patients) or vaginal (controls) delivery. Dichotomous variables were analyzed by χ2 or Fisher exact tests; continuous variables were assessed by the Wilcoxon two-sample test. Multiple logistic regression was used to identify independent risk factors for cesarean delivery, and a model for predicting risk was built and evaluated. RESULTS In univariate analysis, 22 variables were significantly different between patients and controls. Of 11 that were known within 2 hours of admission, five (change in cervical dilatation, maternal weight, gestational age, fetal station at 2 hours, and preeclampsia) remained independently significant in a multiple logistic regression model for cesarean delivery. The multiple regression model could divide our study population into quintiles in which the lowest risk group had a 5% incidence and the highest risk group had an 88% incidence of cesarean delivery. CONCLUSION It may be possible to offer early cesarean delivery to patients at highest risk, reducing the potential morbidity of long labor or failed operative vaginal delivery followed by a later cesarean delivery. Determining a nulliparous patient's risk for cesarean delivery within 2 hours of presenting in labor may avoid unnecessary complications.

Risk factors for cesarean delivery at presentation of nulliparous patients in labor

Objective To identify risk factors that place a term nulliparous patient in labor at risk for cesarean delivery. Methods This was a case-control, chart review study of 325 nulliparous patients presenting in labor at term with singleton vertex fetuses with either cesarean (patients) or vaginal (controls) delivery. Dichotomous variables were analyzed by χ 2 or Fisher exact tests; continuous variables were assessed by the Wilcoxon two-sample test. Multiple logistic regression was used to identify independent risk factors for cesarean delivery, and a model for predicting risk was built and evaluated. Results In univariate analysis, 22 variables were significantly different between patients and controls. Of 11 that were known within 2 hours of admission, five (change in cervical dilatation, maternal weight, gestational age, fetal station at 2 hours, and preeclampsia) remained independently significant in a multiple logistic regression model for cesarean delivery. The multiple regression model could divide our study population into quintiles in which the lowest risk group had a 5% incidence and the highest risk group had an 88% incidence of cesarean delivery. Conclusion It may be possible to offer early cesarean delivery to patients at highest risk, reducing the potential morbidity of long labor or failed operative vaginal delivery followed by a later cesarean delivery.

Cervical dilatation related to uterine electromyographic activity and endocrinological changes during prostaglandin F(2alpha)-induced parturition in cows.

The temporal relationship between changes in cervical dilatation, uterine electromyographic (EMG) activity, and maternal plasma concentrations of estradiol 17beta (E(2)), progesterone (P(4)), and 13,14-dihydro-15-keto-prostaglandin-F(2alpha) (PGFM), was investigated in six parturient cows. Calving was induced with a single injection of a synthetic analogue of prostaglandin F(2alpha) (PG) on Day 274 of gestation. Cervical dilatation was measured continuously by measuring the transit time between two implanted ultrasound crystals while at the same time uterine EMG activity was measured through two silver electrodes sutured on the myometrial surface until the expulsive stage of calving had been reached. In blood samples collected at 4-h intervals, starting at the moment of PG injection, the mean plasma E(2) concentration gradually increased and was significantly elevated at 28 h after PG injection. At 4 h after PG treatment, the mean P(4) concentration had dropped significantly and continued to decrease until a value of around 1 ng/ml was reached, where it stayed until the onset of expulsion. Mean plasma PGFM concentrations increased steadily after PG injection, reaching significantly elevated concentrations at 20 h after treatment. In the five cows that delivered calves in anterior positions, uterine EMG activity, expressed as root mean square (RMS in microV), started to increase at a mean interval (+/- SD) of 13.1 +/- 3.7 h following PG treatment. The increase in EMG activity was significantly correlated with changes in plasma PGFM concentrations. In these cows, dilatation of the caudal cervix started after a mean (+/- SD) interval of 28.5 +/- 1.5 h following PG treatment and dilatation progressed at a mean (+/- SD) rate of 2.25 +/- 0.24 cm/h. In one cow with a calf in the posterior position, uterine EMG activity and dilatation started at 15.8 h and 31.8 h, respectively, after induction of calving. We conclude that a predictable sequence of physiological changes occurs around induction of calving, which allows specific timing of future studies on cellular and biochemical changes within the cervix during parturition.

Reassessing the labor curve in nulliparous women

Objectives: Our purpose was to examine the pattern of labor progression in nulliparous parturients in contemporary obstetric practice. Study Design: We extracted detailed labor data from 1329 nulliparous parturients with a term, singleton, vertex fetus of normal birth weight after spontaneous onset of labor. Cesarean deliveries were excluded. We used a repeated-measures regression with a 10th-order polynomial function to discover the average labor curve under contemporary practice. With use of an interval-censored regression with a log normal distribution, we also computed the expected time interval of the cervix to reach the next centimeter, the expected rate of cervical dilation at each phase of labor, and the duration of labor for fetal descent at various stations. Results: Our average labor curve differs markedly from the Friedman curve. The cervix dilated substantially slower in the active phase. It took approximately 5.5 hours from 4 cm to 10 cm, compared with 2.5 hours under the Friedman curve. We observed no deceleration phase. Before 7 cm, no perceivable change in cervical dilation for more than 2 hour was not uncommon. The 5th percentiles of rate of cervical dilation were all below 1 cm per hour. The 95th percentile of time interval for fetal descent from station +1/3 to +2/3 was 3 hours at the second stage. Conclusion: Our results suggest that the pattern of labor progression in contemporary practice differs significantly from the Friedman curve. The diagnostic criteria for protraction and arrest disorders of labor may be too stringent in nulliparous women. (Am J Obstet Gynecol 2002;187:824-8.)

Use of prostaglandin E 2 to ripen the cervix of the mare prior to induction of parturition

Eleven light-breed pregnant mares (335 to 347 d gestaton) were used to evaluate the use of prostaglandin E 2 as a cervical ripening agent prior to induction of parturition during the months of April and May. Six hours prior to induction, each mare's cervix was examined per vagina for softness and dilation. Each mare was then assigned to 1 of 2 treatment groups: Group PGE mares (n=7) received 2.0 to 2.5 mg prostaglandin E 2 deposited intracervically; Group SAL mares (n=4) received 0.5 mL of sterile NaCl deposited intracervically. Six hours later, the mares were readied for parturition by wrapping the tail, scrubbing and rinsing the perineum and udder, and examining the cervix as previously described. Each mare was then administered 15 U, iv oxytocin at 15-min intervals until the chorioallantois ruptured. Intervals from initial oxytocin injection until rupture of the chorioallantois, from initial oxytocin injection until delivery of the foal, from delivery of the foal until the foal stood unassisted, and from delivery of the foal until the foal suckled were recorded. Mean cervical dilation immediately prior to induction of parturition tended to be greater in Group PGE mares (3.9 ± 1.7 cm) than in Group SAL mares (1.9 ± 1.9 cm; P = 0.10). Mean change in cervical dilation over the 6-h period prior to induction (3.4 ± 1.9 cm vs 1.5 ± 2.1 cm), mean number of injections of oxytocin required until the chorioallantois ruptured (1.9 ± 0.7 vs 2.5 ± 1.0), and mean intervals from initial injection of oxytocin to rupture of the chorioallantois (20 ± 10 min vs 28 ± 19 min) and delivery of the foal (28 ± 7 min vs 34 ± 22 min) were not different between Group PGE and SAL mares, respectively (P > 0.10). The proportion of foals that stood within 1 h of birth also did not differ between Group PGE foals ( 6 7 ; 86%) and Group SAL foals ( 3 4 ; 75%; Chi-square = 0.17; P > 0.10). The proportion of foals that nursed within 2 h of birth was higher in Group PGE foals ( 6 7 ; 86%) than in Group SAL foals ( 1 4 ; 25%; Chi-square = 4.02; P < 0.05). Premature separation requiring manual rupture of the chorioallantois at the vulvar labia occurred in 1 Group PGE mare (cervical dilation of 1.5 cm at time of induction) and 1 Group SAL mare (cervix closed and firm at time of induction). Foals born from the 2 mares with premature placental separation had the longest intervals from initial oxytocin injection to delivery, delivery to ability to stand unassisted, and delivery to suckling within their respective treatment groups. In summary, it appears that cervical ripening prior to induction of parturition favors shorter deliveries and foal vigor. Intracervical administration of prostaglandin E 2 may prove useful for ripening the cervix of the mare prior to induction of parturition. Further studies are indicated to determine optimal dosage and method of administration of prostaglandin E 2.

Randomized trial of oxytocin alone and with propranolol in the management of dysfunctional labor

To compare oxytocin infusion alone and with intravenous (i.v.) propranolol in the management of dysfunctional labor. Ninety-six parturients with abnormalities of the active phase of labor were randomly assigned to either propranolol 2 mg IV or an identical placebo, in addition to continuous infusion of oxytocin. Administration of propranolol or placebo was repeated in 1 hour if there was no change in cervical dilation. Patients not responding to this second administration of propranolol or placebo were delivered by cesarean. Among 96 subjects enrolled, 49 were allocated to the propranolol group and 47 to the placebo group; 13 (26.5%) of the former were delivered by cesarean, compared with 24 (51.1%) of the latter (relative risk 0.58, 95% confidence interval 0.35-0.93; P = .02). Between the two groups, no differences were observed in low Apgar scores, cord arterial pH, or incidence of admissions to the neonatal intensive care nursery. Maternal morbidity was similar in both groups. After logistic regression analysis controlling for nulliparity, birth weight, and epidural anesthetic use, the significant reduction in the cesarean rate associated with use of propranolol persisted. Propranolol administration was associated with a markedly reduced cesarean rate among patients with inadequate uterine contractility. Low-dose administration of IV propranolol in patients with dysfunctional labor augmented with oxytocin safely reduced the need for cesarean delivery, particularly among patients with inadequate uterine contractility.

Open Randomized Comparison of Prostaglandin E2 Given by Intracervical Gel or Vagitory for Preinduction Cervical Ripening and Induction of Labor

POULSEN, HENNING KVIST; MÖLLER, LARS KRAG; WESTERGAARD, JES G.; THOMSEN, STEN GROVE; GEIRSSON, REYNIR T.; ARNGRIMSSON, REYNIR Author Information