Degree Of Cervical Dilatation Research Articles

Three methods of oxytocin-induced parturition and their effects on foals

Objective To compare effects of 3 oxytocin-based induction techniques on fetal and neonatal foals. Design Prospective randomized controlled trial. Animals 16 pregnant mares. Procedure Parturition was induced in mares by use of 3 treatments: group 1, 75 U of oxytocin, IM; group 2, 15 U of oxytocin, IM, q 15 minutes, for a maximum of 75 U; group 3, 75 U of oxytocin in 1 L of 0.9% NaCI solution, IV (1 U/min), for a maximum of 75 U. Blood gas values and indices of vitality were measured in foals, and variables describing parturition were measured in mares. Results Group-3 mares had a shorter interval from administration of oxytocin to rupture of the chorioallantois (OTCA) than group-2 mares. More foals were abnormal when the interval from oxytocin administration to delivery of the foal (OTDE) was ≥ 60 minutes, Arterial blood gas values, measurements of vitality, and plasma cortisol concentrations did not differ among foals in various treatment groups. Increased interval for OTCA and OTDE resulted in higher neonatal Paco2, and a longer interval for OTCA resulted in lower arterial pH. Time required for birth was shorter in mares with a dilated cervix. More abnormal foals than normal foals were delivered after premature placental separation or dystocia. Abnormal foals took longer to stand and suckle than normal foals. Interval from delivery to suckling was positively correlated with OTCA, OTDE, and Paco2. Clinical Implications Method of oxytocin-induced parturition did not impact neonatal outcome. Interval from induction until parturition, degree of cervical dilatation, and intrapartum complications influenced induction success. (J Am Vet Med Assoc 1997; 210:799–803

Pre-operative cervical preparation before first trimester missed abortion: A randomized controlled comparison between single or double intracervical administration of PGE 2 gel

The aim of this study was to evaluate whether a single intracervical application of prostaglandin E 2 (PGE 2) gel is as effective as a repeated administration with respect to the % of curettage for a missed abortion and to incidence of side effects. 32 consecutive patients with ultrasonographic diagnosis of missed abortion from 6th–13th week of gestation were randomly allocated to either single (group A) or repeated, 2 h apart (group B), intracervical application of PGE 2 gel. No differences were observed in cervical dilatation before the administration of the gel between the two groups. In group B, evaluation of cervical dilatation 2 h after the first administration of PGE 2 gel and before the second one did not show significant changes as compared to baseline values. The degree of cervical dilatation before surgery was significantly improved as compared to the initial dilatation in both groups; no significant difference was observed between the two study groups. A single administration of PGE 2 gel followed by surgery 5 h later has the same effectiveness on cervical dilatation but fewer side effects than repeated administration of the drug 2 h apart.

Effect of early amniotomy on the risk of dystocia in nulliparous women

Background Early amniotomy has been advocated as a means of preventing dystocia, but its efficacy has not been studied prospectively. The purpose of this multicenter study was to determine whether routine early amniotomy reduces the risk of dystocia for nulliparous women in spontaneous labor. Methods We studied 925 nulliparous women in labor, who were stratified according to the degree of cervical dilatation (<3 cm vs. ≥ 3 cm) and randomly assigned to either early rupture of the membranes (amniotomy group) or conservative management of labor (conservative-management group). Dystocia was defined as a period of at least four hours after dilatation of the cervix to 3 cm had been reached during which the mean rate of cervical dilatation was less than 0.5 cm per hour. Results Dystocia was significantly less frequent in the amniotomy group than in the conservative-management group (34 percent vs. 45 percent; relative risk, 0.8; 95 percent confidence interval, 0.6 to 0.9). The median length of time from randomiz...

C-reactive protein inpregnancy and labor

In order to evaluate the clinical usefulness of maternal serum C-reactive protein measurement in early detection of infectious morbidity at term laboring women, serum C-reactive protein levels were measured in 521 healthy pregnant women ; 64 who were not in labor before term, 55 who were in labor before term, 71 who were not in labor at term and 331 who were in labor at term. The frequencies of elevated serum C-reactive protein level were compared in relation to the gestational weeks, the presence or absence of labor, the status of amniotic membranes and the degree of cervical dilation. The obtained results were as follows. 1. The frequencies of women with elevated serum C-reactive protein, 0.8mg/dl or higher and 2.0mg/dl or higher, in 521 health pregnant women were 12% and 4%, respectively. 2. C-reactive pretein levels of 0.8mg/dl or higher were more frequent in the group of women in labor than those not in labor(5.93%, vs. 13.73%, p

A Response from the FDA

SACHS et al., in discussing the Food and Drug Administration's approval of marketing of the Genesis Home Uterine Activity Monitor (HUAM), raise issues that require clarification. The authors contend that because the Genesis HUAM has not been shown to prevent premature births, it has no clinical value. We disagree. The FDA approved the device on the basis of its demonstrated ability to detect uterine contractions indicative of the onset of preterm labor, as evidenced by the degree of cervical dilation at the time of diagnosis. (It should be noted that in the supporting clinical study, none of the study subjects . . .

Development of a vaginal gel containing 9-deoxo-16,16-dimethyl-9-methylene PGE 2 for cervical dilatation and pregnancy termination

A stable hydrophilic gel for vaginal administration containing 9-deoxo-16,16-dimethyl-9-methylene PGE 2 (9-methylene PGE 2) was developed and its clinical usefulness for preoperative cervical dilatation and for termination of first and second trimester pregnancy evaluated in 521 pregnant patients admitted to the hospital for therapeutic abortion. Following vaginal administration of 3 mg of 9-methylene PGE 2 gel a peak plasma level of between 3.5 and 10 ng/ml was found 3 to 6 hours following treatment. The “bioavailability” of the drug was in the order of 25–30%. 9-methylene PGE 2 was found to be equally effective as 1 mg Cervagem ® for preoperative cervical dilatation. With a pretreatment period of 3 hours side effects were rare with both compounds. If the pretreatment period was extended to 12 hours the degree of cervical dilatation, but also the frequency of side effects increased significantly. Repeated administration of 9-methylene PGE 2 was found to be effective (96% complete abortion) in terminating very early pregnancy provided the total dose was 10 mg or more. During second trimester the minimum effective dose was 4.5 mg of the compound repeated every fourth hour. The results of the present study have shown that with the new gel formulation the amount of 9-methylene PGE 2 needed to terminate first and second trimester pregnancy was approximately ten times less in comparison with the previously used lipid base suppositories. The treatment was also associated with a low frequency of side effects.

Abruptio placentae — risk factors and outcome of the newborn

A total of 180 (0.21%) out of 85.177 deliveries were complicated by abruptio placentae (AP) during the period 1962–1981. Of these the obstetric records of 130 deliveries were retrospectively studied in order to elucidate risk factors for the occurrence of abruptio placentae as well as to find out factors influencing the outcome of the newborn. The control group consisted of 120 randomly chosen contemporary parturients. Preterm contractions during pregnancy seemed to be most significantly associated with the occurrence of abruptio placentae. Also mothers with gestational hypertension or pre-eclampsia, smokers and unmarried mothers seemed to run a more than two-fold risk of premature separation of the placenta, while twin pregnancy and high parity seemed to increase the risk only slightly. However, a history of abruptio placentae revealed an 11-fold risk of premature separation of placentae in subsequent pregnancy. The factors most significantly associated with favourable prognosis of the newborn were: duration of gestation, birth weight and the degree of separation of the placenta. However, degree of cervical dilatation, presentation, mode of delivery or the time interval between diagnosis of AP and delivery seemed to have only weak discriminative power between newborns who survived and those who were lost.

Prediction of time to delivery from start of contractions in induced labor: A life table analysis approach

Labor was induced in a total of 200 patients. Outcome of treatment was compared with respect to time to delivery from start of contractions. Prognostic variables compared here were, e.g. dilatation, parity and Bishop score. All comparisons were performed with a life table technique, both bivariate and multivariate. Parity showed a strong relation to prognosis and so did cervical dilatation. The degree of cervical dilatation as in spontaneous labor is the factor in the Bishop index that correlated best to the outcome of treatment. With the two predictors parity and dilatation, a scoring system was constructed.

Pain Relief during Delivery

Abstract The study evaluates the effect of conventional obstetric analgesia on 544 parturients and their newborn infants. The parturients' pain situation was evaluated with respect to both the effect of pain relief given, and the total pain experience in the first and second stage. This gave a more correct view of the parturients' pain situation and effectiveness of the analgesic procedures that if one or the other estimation was used separately. Nearly 20% of all parturients experienced good effect on low-back or suprapubic pain in the first stage. Severe to almost unbearable pain was experienced by about 60% of all parturients in the first stage as well as in the second stage. The duration of labor showed a strong positive correlation (p less than 0.0001) to the pain intensity in the first stage and a strong negative correlation (p less than 0.0001) to the degree of cervical dilation at admission. No adverse effects on the newborn infants were seen, apart from the well-known association between the drug--delivery interval and the slightly depressant effects of pethidine.

Pre-Abortion Treatment with a Singel Vaginal Suppository: Containing 9-Deoxo-16,16-Dimethyl-Pmethylene PGE2in Late First and Early Second Trimester Pregnancies

In the present study the efficacy of a new stable prostaglandin E analogue, 9-deoxo-16,16-dimethyl-9-methylene-PGE2 (9-methylene-PGE2), administered as a single vaginal suppository for preoperative dilatation of the cervical canal was evaluated in 382 mainly nulliparous patients. Late first trimester patients received either 20 mg 3 hours prior to or 30 mg 12 hours prior to vacuum aspiration. Early second-trimester patients received 40 mg of the analogue and vacuum aspiration was performed 12 hours later. The degree of cervical dilatation was related to the pretreatment time and the dose of 9-methylene-PGE2. However, even with 20 mg of the analogue and 3 hours pretreatment time, cervical dilatation was adequate in almost 40% of the patients and in the remaining women further mechanical dilatation was regularly performed with ease. The frequency of gastro-intestinal side effects was significantly lower than that found for comparable doses of 15-methyl-PGF2 alpha methyl ester administered by the same route. With 20 mg 9-methylene PGE2, side effects were very rare; only 9% of the patients experienced occasional episodes of vomiting. Three hours' pretreatment with 20 mg of the analogue seems suitable for late first trimester pregnant women in whom the abortion is performed on an outpatient basis. For early second trimester patients pretreatment with 40 mg 9-methylene-PGE2 for 12 hours followed by vacuum aspiration seems to be a better alternative than the two-stage procedures in current use.

Association of Induced Abortion With Subsequent Pregnancy Loss

We compared prior pregnancy histories of two groups of multigravidas--240 women having a pregnancy loss up to 28 weeks' gestation and 1,072 women having a term delivery. Women who had had two or more prior induced abortions had a twofold to threefold increase in risk of first-trimester spontaneous abortion, loss between 14 to 19 and 20 to 27 weeks. The increased risk was present for women who had legal induced abortions since 1973. It was not explained by smoking status, history of prior spontaneous loss, prior abortion method, or degree of cervical dilatation. No increase in risk of pregnancy loss was detected among women with a single prior induced abortion. We conclude that multiple induced abortions do increase the risk of subsequent pregnancy losses up to 28 weeks' gestation.

Thromboxane B2 in amniotic fluid before and during labour.

Concentrations of thromboxane B2 (TXB2) have been measured in amniotic fluid obtained during late pregnancy and labour. Samples taken at amniocentesis contained significantly lower levels of TXB2 than samples taken by amniotomy for the induction of labour which in turn contained significantly less than when the same procedure was performed during labour. In the latter group there was no correlation between the degree of cervical dilatation and the concentration of TXB2. There was no correlation between gestational age and the concentration of TXB2 in amniotic fluid obtained at amniocentesis whereas there was a significant correlation (P less than 0.025) between these parameters when fluid was taken by amniotomy before labour. It is suggested that the relative activities of the enzymes responsible for the conversion of prostaglandin endoperoxides to prostaglandins, thromboxane A2 and prostacyclin may be of great importance during parturition.

The effect of indomethacin in labour at term.

The effect of indomethacin as an antagonist to prostaglandin was evaluated on a series of 16 women during spontaneous labour in the ninth month of pregnancy. The evaluation of the effect of indomethacin on the progression of labour was determined by the deviation from the normal curve of Friedman. In 8 cases there was complete cessation of labour from 3 to 192 hours and in 8 additional cases there was protraction of the active phase from 3 to 17 hours. In 2 cases there was no effect. Seven births terminated spontaneously and in 9 cases it was necessary to administer pitocin intravenously to strengthen or renew contractions in order to terminate the pregnancy. There is no correlation between the obstetric state (the degree of cervical dilation, or effacement or rupture of membranes) at the time of indomethacin administration and the uterine response, or the speed of return to the normal curve of Friedman. The effect of indomethacin, as an antagonist to prostaglandin, at the time of labour was studied.

Cervical dilatation with prostaglandin analogues prior to vaginal termination of first trimester pregnancy in nulliparous patients

Dilatation of the cervix with prostaglandin analogues prior to vaginal termination of pregnancy was attempted in 125 nulliparous women in the first trimester of pregnancy. The patients were divided into five groups (25 in each group) and given a single extra-amniotic dose of one of the following prostaglandin analogues 14–16 hours prior to the evacuation of the uterus by vacuum aspiration. (Group A) 15 (S) 15 methyl PGE 2 (free acid); (Group B) 15 (S) 15 methyl PGE 2 methyl ester; (Group C) 15 (S) 15 methyl PGF 2α (free acid); (Group D) 15 (S) 15 methyl PGF 2α methyl ester and(Group E) a mixture of 15 (S) 15 methyl PGE 2 methyl ester and 15 (S) 15 methyl PGF 2α methyl ester. Evacuation of the uterus without mechanical dilatation of the cervix was possible in 111 (90%) of the patients. In an additional 10 patients (8%) there was some degree of cervical dilatation and further mechanical dilatation could be performed easily. With the combination of 15 (S) 15 methyl PGE 2 methyl ester and 15 (S) 15 methyl PGF 2α methyl ester the incidence of gastrointestinal side effects and pyrexia were considerably reduced.

Maternal adrenocorticotrophic hormone and cortisol during labour and vaginal delivery.

SummaryPlasma concentrations of ACTH (by radioimmunoassay) and cortisol (by competitive protein binding) were measured in eight healthy parturients during labour and vaginal delivery. The concentration of both ACTH and cortisol increased during labour; the maximum values were recorded immediately prior to delivery. The changes correlated well with the degree of cervical dilatation. Both the mean (±SEM) ACTH (275.3±39.5 pg./ml.) and cortisol (2.33±0.49 μmol./l.) recorded before delivery were significantly elevated compared with the initial values (ACTH: 89.3±39.5 pg./ml.; cortisol: 0.86±0.20 μmol./l.).

Alterations of plasma free fatty acids and glucose during labor

Comparisons were made between the maternal blood sugar and FFA levels during the first stage of labor and at delivery. In all patients studied of various parities both blood sugar and FFA levels are higher at delivery than during the first stage of labor. The increments of rise of blood sugar and FFA concentrations are not correlated with the length of labor between the labor sample collection and delivery, the degree of cervical dilatation at the time of labor sample collection, or the length of fast prior to labor sample collection. It appears that the rise in blood sugar and FFA occurs late in labor, possibly exclusively during the second stage of labor, and may possibly be related to catecholamine release during this period.

Elective induction of labor

This is a report of 1,000 clective inductions of labor performed in healthy multipara or near term with a vertex presentation which was at least partially engaged and a cervix that was at least 2 cm. dilated at the internal os. The maternal and fetal results obtained in these cases are compared with those of an equal number of multiparas who went into labor spontaneously. These matched cases were similar in every detail to the induced group except for the fact that the degree of cervical dilatation at the onset of their labors was of necessity unknown. There were no essential differences between the two groups in the more obvious fetal and maternal morbidity factors. However, the induced patients showed more rapid labors and what are interpreted to be the effect of such labors which include cervical lacerations, postpartum hemorrhage, and depressed infants. It is believed that the rapid labors of the induced group were related to the ripe cervix rather than the induction itself. Since there is evidence that the rapid labor may be harmful to the child there is justification to electively induce labor in women who show prelabor cervical dilatation so that a controled labor may be obtained. In these cases elective induction has been shown to have prophylactic value.

Prolapse of the Umbilical Cord: A Report of 50 Cases

Summary A review of 50 cases of prolapse of the umbilical cord is presented. The important aetiological factors are: malpresentations, prematurity, multiple pregnancy, hydramnios and placenta praevia. Parity is a relatively unimportant aetiological factor. The degree of cervical dilatation is of prime importance in determining the method of treatment. The foetal mortality in this series was 50%. When the foetal heart was present on admission the mortality was 35.9%. There were no maternal deaths. Proper antenatal care, early diagnosis and the more liberal use of Caesarean section will help in the reduction of foetal loss.

The frequency of contractions during normal labour.

The frequency and strength of contractions are the most important factors in a clinical estimation of the intensity of labour. The effect of labour, however, is determined by the degree of cervical dilatation and the position of the presenting part of the fetus. By uterine activity is meant the product of the intensity (amniotic pressure minus amniotic tone) and the frequency of contractions. The uterine activity is usually expressed in Mootevideo-units [M. U.), i. e. the product of intensity and frequency of contractions for 10 minutes. Good progress in labour is associated with a high frequency of contractions whereas a low frequency is found with hypotonic inertia. A high frequency, however, occurs often with hypertonic inertia as uterine fibrillation. In most textbooks (Williams, 1956; Baird, 1957; Martius, 1959; Greenhill, 1960, and others) it is reported that the frequency of contractions is low in the beginning of labour (one contraction every 10th to 30th minute) and successively increases to one contraction every 2nd to 3rd minute at delivery. Westermark (1893) arrived at the same results by using intra-uterine tocography. In distinction to this S chaffer (I 896) found about the same frequency during the whole labour about one contraction every 3rd minute. In an investigation with intra-uterine tocography (Li n d g r e n, I 959) has been observed