Course Of Labor In Women Research Articles

Retrospective study of the course of pregnancy, obstetric and perinatal outcomes in post-term pregnancy

Aim. To study the frequency, risk factors, and course of labor in women with post-term pregnancies in the city of Dushanbe.Material and methods. The study is based on the retrospective analysis of childbirth in the city maternity hospital No. 2, which is the clinical base of the Department of Obstetrics and Gynecology No. 2 of TSMU named after Avicenna for the period 2007 - 2011.Results and discussion. The frequency of post-term pregnancy among women in Dushanbe over 7 years ranges from 3.9 to 0.83% of cases. The study shows that after the introduction of national standards on the induction of labor, the number of post-term pregnancies and, along with it, the complications associated with it decreased. Among women with post-term pregnancy, each 2 had the first pregnancy. The course of pregnancy and childbirth with a post-term pregnancy is characterized by a high percentage of complications, which is 6.7 ± 2.09% and 70.8 ± 2.16%, respectively. 382 (72%) women delivered through the vaginal birth canal, and 77 (15%) women had a cesarean section.Conclusion. In spite of the declination tendency of post-term pregnancies frequency after the introduction of national standards on induction of labor, the obstetric and perinatal outcomes of postmature pregnancy deserve attention.

The course of labor in term patients with concomitant acute intestinal infections

BACKGROUND: Literature data on the course of labor in women with concomitant acute intestinal infections are very scarce. Individual works and articles are devoted to the coverage of this most important final stage of pregnancy. There are no developed specific tactics of labor management in patients with acute intestinal infections, therefore obstetricians and gynecologists have to use generally accepted standards of labor management in this group of patients, without having a clear idea of the frequency and nature of clinically relevant complications in childbirth. AIM: The aim of this study was to evaluate the course of labor in women with concomitant AIIs at full-term pregnancy. MATERIALS AND METHODS: We examined 120 patients aged 19 to 39 years, delivered in Clinical Infectious Disease Hospital named after S.P. Botkin, St. Petersburg in 2017-2019. The main group consisted of 60 women with concomitant acute intestinal infections who gave birth, and the comparison group comprised 60 conditionally healthy women. The spectrum of acute intestinal infection pathogens in pregnant women, the course of labor, complications during labor and the condition of newborns were evaluated. RESULTS: Women of the both study groups did not differ in the duration of labor and the anhydrous interval, the frequency of birth abnormalities, the volume of blood loss, and the frequency of maternal injury and complications in the postpartum period. The frequency of premature rupture of membranes, acute and chronic fetal hypoxia, and episiotomy was higher in patients of the main group. Asphyxia in the first minute after birth was also more common in newborns from women with concomitant acute intestinal infections. CONCLUSIONS: Acute intestinal infections may complicate the course of labor. Labor management in women with concomitant acute intestinal infections requires continuous monitoring of the condition of the fetus during labor and the provision of timely medical care to the newborn.

Course of labor and condition of the newborn in women affected by benign ovarian tumors

Annotation. According to various estimations, the incidence of adnexal neoplasms during pregnancy makes up from 0.19% to 8.8%. Most of cases are diagnosed in the first trimester and their incidence gradually decreases as the period of pregnancy grows. Depending on their size and location, ovarian tumors may be related to an adverse obstetrical result caused by mechanical influence. They increase the risk of abortion (from 0 to 6%), preterm labor (from 5.8% to 10.4%) and mechanical impediment to labor. Aim – studying the peculiarities of the course of labor and the condition of the newborn of women affected by benign ovarian tumors. We have conducted a complex examination of 67 pregnant women with benign ovarian tumors and tumor-like growths found before pregnancy or in the first trimester of gestation (basic group) and 50 women presenting no ovarian neoplasms or any other severe gynecological or somatic pathology (reference group). To identify the risk factors, the basic group was divided into 2 subgroups. The condition of fetuses was assessed with the use of automated cardiotocography analysis based on the Dawes/Redman criteria, with the calculation of the short-term variability (STV). The mean and standard deviation (M ± m) were evaluated at a significance level of p <0.05. Categorical variables are presented as the absolute number of cases in the group and the frequency in percent – n (%). Tests for differences between independent samples in the case of quantitative variables were performed using Student’s t test, the Mann-Whitney rank test, and in the case of categorical variables using Fisher’s exact test. The obtained results suggest that the course of labor in women affected by benign ovarian neoplasms is characterized by an increased incidence of complications. A significant difference has been established in the incidence of cesarean sections (35.8% vs 8.0% in the reference group, р<0.05), preterm labor (28.4% vs. 6.0%, р<0.05), fetal distress (19.4% vs. 8.0%, р<0.05) and preterm rupture of membranes (17.9% vs. 6.0%, р<0.05). The incidence of almost all complications of labor in Subgroup 1 significantly exceeds the figures from the reference group and the incidence of preterm labor and fetal distress is also higher in comparison with Subgroup 2. The presence of extragenital pathology is a well-known risk factor for perinatal complications, which is also confirmed by our research. A high level of comorbidity of benign ovarian neoplasms with various extragenital diseases also accounts to a certain degree for gestational complications. Thus, pregnancy in women affected by ovarian tumors implies an increased risk of obstetrical and perinatal complications, in particular, threats of miscarriage and preterm labor. The studies of this issue lack systematization, are often controversial and fragmentary. There has been practically no research on the risk factors for such complications and the ways of their prognostication and prevention.

Features of childbirth and the condition of newborns in women with menstrual dysfunction in the puberty

The issue of preserving the reproductive health of women for many years does not lose its relevance. Fundamental studies of recent decades have made it possible to determine the basic mechanisms of functioning of the female reproductive system, but studies of the characteristics of pregnancy, complications in childbirth and the condition of newborn children in women with menstrual dysfunction in the puberty remain single.The objective: аccording to laboratory and instrumental methods of research, to study the characteristics of childbirth and the condition of newborns in women with menstrual dysfunction in the puberty.Materials and methods. According to the nature of the disorders, the main group of pregnant women (n=120) who had a menstrual pathology in the puberty were divided into 3 subgroups (n=40): the first – pregnant women with primary oligomenorrhea in the anamnesis, the second – with a late age menarche, the third – with puberty bleeding. The control group included pregnant women (n=40) with the correct rhythm of menstruation in puberty.Results. During the clinical study, significant differences in the biological readiness of the body for childbirth in all subgroups of the main group of pregnant women were noted compared with the control group. In 35 (29,2%) pregnant women with menstrual dysfunction during the puberty, an «unripe» or insufficiently «mature» cervix was observed in the expected period of labor, which was important in the violation of labor activity during spontaneous labor in the occipital presentation and an increase in the frequency of delivery using cesarean section (CS) operation. Caesarean section was performed in 51 (42,5%) pregnant women of the main group: planned CS in 39 (32,5%), urgent delivery in 12 (10,0%). In the group of pregnant women with the correct rhythm of menstruation, spontaneous delivery occurred in 37 (92,5%) women, planned CS due to the narrowed pelvis and large fetus in 2 (5,0%), emergency CS – 1 (2,5%) case. The frequency of complications during childbirth (violation of labor, premature rupture of the membranes, bleeding) in the main group is 4 times higher than in the control group (p<0,001), in a comparative aspect, the differences between the subgroups are not significant. 95,2% of newborns from mothers with menstrual dysfunction in the puberty were born in a satisfactory condition. The Apgar score is significantly higher in newborns from mothers receiving pregravid preparation. The frequency of individual conditions that occur in the perinatal period is the highest in newborns from mothers with a history of primary oligomenorrhea.Conclusion. The results of the studies confirm the presence of the biological unpreparedness of the body for the normal course of labor in women with menstrual dysfunction in the puberty, as evidenced by violations of labor, the main predictor of which is placental dysfunction. The frequency of individual conditions that occur in the perinatal period is significantly higher than in newborns from mothers who had the correct rhythm of menstruation. It is possible to reduce the frequency of obstetric and perinatal complications in women with reduced reproductive potential by optimizing the pregravid preparation program and introducing a scientifically based complex of treatment and preventive measures.

Clinical and psychological aspects of pregnancy and features of the course of labor in women with different types of psychological component of gestational dominant

The aim of the work is to study and analyze the clinical and psychological aspects of pregnancy and features of the course of labor in women with different types of psychological component of gestational dominant (PCGD).Materials and methods. The study involved 126 pregnant women. At the first stage of the study (27–28 weeks’ gestation), a clinical and psychological study was conducted using specially selected psychodiagnostic methods and techniques. At the second stage (postpartum period), a retrospective analysis of the relevant medical documentation was carried out.Results. It was found that the vast majority of pregnant women with optimal, euphoric and mixed types of PCGD had a moderate level of anxiety, low level of psycho-emotional stress with well-being, increased activity and positive mood (Р ˂ 0.01) in comparison to pregnant women with anxious, depressive and hypogestognostic types of PCGD. Women with anxiety, depressive and hypogestognostic types of PCGD were dominated by destructive motivations towards pregnancy maintenance and the situation of impending motherhood, which can be a major impediment to the process of further formation of adequate maternal dominance.An analysis of the clinical course of labor showed the most favorable conditions for its course in women with optimal and mixed types PCGD; the greatest number of complications was identified in women with hypogestognostic, depressive and anxious types PCGD that can be regarded as a decrease in the functional capacity of relevant systems and an organism as a whole amid unstable psycho-emotional state. A similar correlation was found when assessing the condition of newborns on the Apgar scale since the highest indicators and the best dynamics occurred in newborns whose mothers were diagnosed with optimal and mixed types of PCGD during pregnancy.Conclusions. The results obtained indicate the need to organize a comprehensive medical and psychological support for pregnant women, during which a diagnosis of the psycho-emotional state in pregnant women with the detection of PCGD type is binding. This approach would not only help to prevent a number of clinical and psychological problems that may occur in women during pregnancy, but also to allow for the harmonious growth of an intrauterine fetus, effective women’s adaptation to the situation of impending motherhood and the birth of a healthy child.

Особливості перебігу пологів у жінок з перинатальними втратами в анамнезі

The objective: was to determine the features of the course of labor in women with a history of perinatal lesions. Materials and methods. A prospective, concurrent, controlled, randomized study was conducted involving 68 women aged 26.8 ±0.5 years, with a gestation period of 28.1 ±0.56 weeks, 41 of whom had perinatal history lesions (main group) and comparable for anthropodemographic indicators and terms of gestation of 27 women with a repeat pregnancy without abortion or unsuccessful childbirth (child death) in the history (comparison group). Results. In the anamnestic aspect, the characteristics of pregnant women with a history of perinatal losses are a relatively shorter interval between repeated pregnancies, a more frequent development of extragenital pathology - the respiratory, nervous, endocrine, cardiovascular and orthopedic disorders, and a higher incidence of gynecological anamnesis. In the context of complications of delivery, women with perinatal losses are characterized by premature birth, anomalies of labor, early discharge of amniotic fluid, ruptures of soft tissues. Conclusion. It is necessary to make a comparative analysis of the course of pregnancy, childbirth and the state of health of newborns in women with a history of obstetrical anamnesis in connection with violations of neurovegetative regulation. Key words: perinatal losses, anamnesis, childbirth, current.

Features during labor in women with chronic hepatitis B

Aim. To examine the course of labor in women with chronic hepatitis B.Methods. The course of labor was studied in 391 female patients with chronic viral hepatitis B, included in the study group (mean age 22.7±2.5 years), who delivered off in the National Maternity Hospital (Bishkek). The control group included 59 healthy women in labor (mean age 22.5±1.3 years).Results. The vast majority of patients - 53 (89.8%) of the control group and 328 (83.9%) of the study group - had delivered off at term. Post-term births were registered in both groups. Operative delivery by cesarean section was performed in 13.0% of chronic viral hepatitis B cases - by 4.5% higher compared to control group. In the study group, planned cesarean section was performed in 21 (5.4%) patients, the main indication was burdened obstetric history - in 8 (2.0%) patients; 5 (1.3%) patients had multiple indications. Emergency operations were conducted in 30 (7.7%) patients. Indications were premature rupture of membranes - 15 (3.8%) of cases, fetal hypoxia during labor and multiple indications - 10 (2.6%) cases each. The average blood loss at cesarean section in the group of patients with chronic viral hepatitis B was 870±15.2 ml, compared to 700±10.2 ml in the control group, which can be associated with low coagulation seen in hepatitis. Comparative analysis of the complications rate in the control group revealed that delayed rupture of membranes was the most frequent - 11 (18.6%) cases, followed by intrauterine fetal hypoxia - 5 (8.5%) cases, early postpartum bleeding - 4 (6.8%) cases, hypertensive disorders at labor and retained placenta - 3 (5.1%) cases each. In the group with chronic viral hepatitis B, premature rupture of membranes occurred in 51.5% of cases, (relative risk 2.8). Early postpartum bleedings were seen in 38.9% of the cases at the main group (relative risk 5.7).Conclusion. The above data gives us every reason to include women with chronic viral hepatitis B at high-risk group for possible bad pregnancy and childbirth outcomes both for the mother and the fetus.

Impact of Analgesia on the Course of Spontaneous Labor in Women with Diabetes Mellitus

Objective: to improve the results of spontaneous labor in female patients with diabetes mellitus (DM). Subjects and methods. The results of physiological labor analgesia were analyzed in 140 patients. The parturients were divided into 3 groups: 1) 40 parturients in whom analgesia was performed by the intravenous administration of promedol; 2) 40 parturients in whom analgesia was done by the fractional administration of 0.2% ropivacaine hydrochloride into the epidural space; 3) 40 parturients in whom analgesia was carried out with intravenous paracetamol 2000—3000 mg. In all the patients, the investigators estimated central hemodynamic parameters by echocardiography, the efficiency of labor analgesia according to the scale described by N. N. Rasstrigina and B. V. Shnaider, as well as blood glucose levels, fetal status by a cardiotocographic technique, and neonatal status by Apgar scores at 1 and 5 minutes of life. Results. Analgesia quality assessment established that the best analgesic effect was achieved in the patients in Group 2 where 75.0% of the parturients had 8—10 scores. A comparative analysis of carbohydrate metabolic parameters also ascertained that the most steady-state and physiological glycemic level was recorded in Group 2 patients throughout the study. In addition, epidural analgesia versus other analgesic techniques provides the most steady-state hemodynamic parameters during labor, which promotes improved labor and has a beneficial effect on fetal and neonatal states. Conclusion. Glycemic levels during labor and delivery can be optimized in patients with DM only if adequate analgesia is achieved. By ensuring adequate labor analgesia, epidural analgesia normalizes glycemic and central hemodynamic parameters, favors elimination of delivery abnormalities, and has a beneficial effect on fetal and neonatal states. Key words: epidural analgesia, diabetes mellitus, spontaneous labor.

Comparison of labor course and women's sexuality in planned and unplanned pregnancy

Objective. This study compares several parameters of sexual life and course of labor in women with planned and unplanned pregnancy.Methods. 339 primiparas participated in our study; they filled in a questionnaire concerning their sexual life during pregnancy on the second or third day after the delivery. One question also stressed planning of pregnancy. 246 women (i.e., 72.6%) indicated planned pregnancy, 93 pregnancies (i.e., 27.4%) were not planned.Results. Significant decrease of coital activity and number of orgasms and increase of sexual dysfunctions were observed in the whole study group during pregnancy. Significant differences between women with planned and unplanned pregnancy were observed only in frequency of vaginal dryness and pelvic pain.Conclusions. According to the results of this study, unplanned pregnancy has no adverse effect on parameters of the labor. The equal rate of partner's presence at delivery shows a high involvement of the partners of unmarried women.

Prediction of labor and delivery by transperineal ultrasound in pregnancies with prelabor rupture of membranes at term

To evaluate whether engagement of the fetal head or cervical length in women with premature rupture of membranes (PROM) at term, are associated with time from PROM to delivery or need for operative delivery. A transperineal ultrasound examination was performed in 152 women with a single live fetus in cephalic presentation after PROM (at > 37 gestational weeks). The shortest distance from the outer bony limit of the fetal skull to the skin surface of the perineum was measured in a transverse view, and the cervical length was measured in a sagittal view. The time from PROM to delivery was tested in a Cox regression analysis with ultrasound measurements, parity, maternal age, body mass index and birth weight as possible predictive factors. The head-perineal distance was associated with the time from PROM to delivery (log rank test, P < 0.001). Thirty-six hours after PROM, 32% (95% CI, 15-49) of women with a short head-perineal distance (< 45 mm) and 43% (95% CI, 24-62) of women with a long distance (> or = 45 mm) were still in labor. Women with a short head-perineal distance had fewer Cesarean sections, less use of epidural analgesia and a shorter time in active labor, and their babies had a higher pH in the umbilical artery. The measured cervical length was not associated independently with time to delivery. Transperineal ultrasound measurements of fetal head engagement may help clinicians to predict the course of labor in women with PROM.

Balloon Cervical Ripening With Extra-Amniotic Infusion of Saline or Prostaglandin E2

In Brief Objective To compare extra-amniotic infusion of diluted prostaglandin (PG) E2 solution with saline infusion in balloon cervical ripening and labor induction. Methods Women with pregnancy complications and Bishop scores of 3 or lower (n = 116) were assigned randomly to receive extra-amniotic infusion (1 mL/minute) of normal saline or PGE2 in saline (0.5 μg/mL) through a Foley catheter with a 30-mL inflated balloon. We induced labor using intravenous oxytocin only when labor had not developed by 6 hours after balloon expulsion. Analysis was by intent-to-treat. We assessed ripening efficiency and course of labor in women who had spontaneous balloon expulsion (n = 110) and trial of labor (n = 107), respectively. Results Ripening with PGE2 was associated with significantly shorter mean (± standard error of the mean [SEM]) time for balloon expulsion (4.7 ± 0.4 versus 6.5 ± 0.6 hours) and with significantly higher Bishop scores (P < .002), compared with ripening with saline. In the PGE2 group, rates of labor induction (15%) and oxytocin use (37%) were significantly lower than in the saline group (51% and 72%, respectively). The groups did not differ significantly in other labor abnormalities, labor duration, mode of delivery, birth weight, Apgar scores, and puerperal morbidity. Conclusion Cervical ripening by extra-amniotic balloon and PGE2 infusion is faster and more effective than by balloon and saline infusion, resulting in a higher rate of spontaneous labor and a lower rate of oxytocin use. Extra-amniotic prostaglandin E2 infusion is more rapid and effective than saline infusion for balloon cervical ripening, and has a higher rate of spontaneous, unaugmented labor.

Balloon cervical ripening with extra-amniotic infusion of saline or prostaglandin e 2: a double-blind, randomized controlled study

Objective: To compare extra-amniotic infusion of diluted prostaglandin (PG) E 2 solution with saline infusion in balloon cervical ripening and labor induction. Methods: Women with pregnancy complications and Bishop scores of 3 or lower ( n = 116) were assigned randomly to receive extra-amniotic infusion (1 mL/minute) of normal saline or PGE 2 in saline (0.5 μg/mL) through a Foley catheter with a 30-mL inflated balloon. We induced labor using intravenous oxytocin only when labor had not developed by 6 hours after balloon expulsion. Analysis was by intent-to-treat. We assessed ripening efficiency and course of labor in women who had spontaneous balloon expulsion ( n = 110) and trial of labor ( n = 107), respectively. Results: Ripening with PGE 2 was associated with significantly shorter mean (± standard error of the mean [SEM]) time for balloon expulsion (4.7 ± 0.4 versus 6.5 ± 0.6 hours) and with significantly higher Bishop scores ( P < .002), compared with ripening with saline. In the PGE 2 group, rates of labor induction (15%) and oxytocin use (37%) were significantly lower than in the saline group (51% and 72%, respectively). The groups did not differ significantly in other labor abnormalities, labor duration, mode of delivery, birth weight, Apgar scores, and puerperal morbidity. Conclusion: Cervical ripening by extra-amniotic balloon and PGE 2 infusion is faster and more effective than by balloon and saline infusion, resulting in a higher rate of spontaneous labor and a lower rate of oxytocin use.