Labor In Term Pregnancies Research Articles

C-Reactive Protein and the Mode of Onset of Labor in Term Pregnancies

Wiser, A.; Sivan, E.; Dulitzki, M.; Chayen, B.; Schiff, E.; Bar-Chaim, A.; Simchen, M. J. Author Information

Author response to: The effect of hyoscine butyl bromide on the first stage of labour in term pregnancies

BJOG: An International Journal of Obstetrics & GynaecologyVolume 115, Issue 8 p. 1064-1065 Author response to: The effect of hyoscine butyl bromide on the first stage of labour in term pregnancies L Samuels, L Samuels Department of Obstetrics and Gynaecology, University Hospital of the West Indies, Kingston, Jamaica, West IndiesSearch for more papers by this author L Samuels, L Samuels Department of Obstetrics and Gynaecology, University Hospital of the West Indies, Kingston, Jamaica, West IndiesSearch for more papers by this author First published: 28 June 2008 https://doi.org/10.1111/j.1471-0528.2008.01762.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume115, Issue8July 2008Pages 1064-1065 RelatedInformation

The effect of hyoscine butyl bromide on the first stage of labour in term pregnancies

The effect of hyoscine butyl bromide on the first stage of labour in term pregnancies

The Effect of Hyoscine Butylbromide on the First Stage of Labor in Term Pregnancies

An example of actively managing labor is intravenous administration of hyoscine (scopolamine) butylbromide, which has spasmolytic effects on smooth muscle of the genitourinary and gastrointestinal tracts. How this substance shortens the duration of labor is not understood. This randomized, double-blinded, controlled trial, undertaken in Jamaica, West Indies, compared IV hyoscine with a placebo, administered once active labor began. Sixty hyoscine-treated women were compared with 69 placebo recipients. All participants were 18 years of age or older, were at term, and had no chronic or pregnancy-induced disorders. The dose of hyoscine was 20 mg. The duration of the first stage of labor declined from 228 minutes in control women to 156 minutes in hyoscine-injected women, a reduction of 31.7%. There was no significant change in duration of either the second or third stage of labor. The treatment and control groups did not differ with regard to blood loss or Apgar scores. Cesarean deliveries were slightly but not significantly more frequent in women taking hyoscine (6.7% vs. 4.3%). The investigators conclude that hyoscine butylbromide (Buscopan) significantly shortens the first stage of labor without apparent adverse effects on either the mother or newborn infant.

C‐reactive protein and the mode of onset of labor in term pregnancies

To evaluate whether C-reactive protein (CRP) levels in maternal serum at post-date follow-up can predict the mode of onset of spontaneous delivery in term pregnancies and the interval to delivery. Women at 40 completed weeks of gestation were recruited. The interval from CRP sampling to delivery and mode of onset of delivery were noted. Sixty women were divided into 3 groups according to the mode of onset of labor. Group A presented with spontaneous onset of contractions, Group B presented with pre-labor ruptured membranes (PROM), and Group C completed 42 weeks without spontaneous initiation of labor. There was no association between CRP values and latency from time of sampling to delivery. Mean serum CRP in Group B (12.7 mg/l) was significantly higher than in either Group A(7.2 mg/l) or Group C (10.2 mg/l) (p=0.01). In addition, CRP values in the upper quartile (>12.2 mg/l) had a 37.5%positive predictive value for PROM, with a negative predictive value of 93%. Women whose labor will start with PROM have higher CRP values at post-date follow-up than women whose labor starts otherwise.

The effect of hyoscine butylbromide on the first stage of labour in term pregnancies

To determine whether hyoscine butylbromide shortens the first stage of labour, without an increase in maternal or neonatal complications. Randomised, double-blinded, controlled trial. The Antenatal clinics and Labour and Delivery ward of the University Hospital of the West Indies, Kingston, Jamaica. Women in spontaneous labour at term. Either drug or placebo was given intravenously once the women entered active labour. The duration of the first stage of labour. Secondary outcomes included comparisons of the duration of the second and third stages of labour, blood loss at delivery, rate of caesarean section, and APGAR scores in the neonates between the two groups. A total of 129 women yielded data for analysis. Of these, 69 women received the placebo and 60 received hyoscine butylbromide. The mean time for the first stage in the control group was 228 minutes, compared with 156 minutes in the drug group, representing a decrease of 31.7% (P = 0.001). There was no significant change in the duration of the second and third stages of labour, and no difference in blood loss or in APGAR scores. There was a slight (but statistically insignificant) increase in the caesarean section rate. Hyoscine butylbromide is effective in significantly reducing the duration of the first stage of labour, and it is not associated with any obvious adverse outcomes in mother or neonate.

A rise in pain threshold during labor: A prospective clinical trial

To evaluate changes in pain threshold before, during and after labor in a prospective clinical trial. Forty pregnant women at term were included. Pain threshold in 18 specific pressure points was evaluated using a dolorimeter. Woman underwent pain threshold assessment at term before labor, during the active phase of labor and postpartum. Subjective pain intensity was assessed by the parturient using the Verbal Rating Scale (VRS). Pain threshold was significantly higher during active phase of labor. There was a significant decline in pain threshold after labor as compared to pain threshold during labor (2.507 ± 0.947 and 2.608 ± 1.023, respectively, p = 0.01). Pain intensity using the VRS score was higher during labor than before labor (4.8 ± 2.7 and 2.4 ± 2.6 p < 0.001). We found a significant rise in pain threshold during labor in term pregnancies. This rise may have an intended protective effect during the intense labor pain experience.

Use of mifepristone to ripen the cervix and induce labor in term pregnancies

This study was undertaken to determine the efficacy of mifepristone for ripening the cervix and inducing labor in term pregnancies. In a double-blind placebo-controlled dose-finding study, 346 women received 50, 100, 200, 400, or 600 mg of mifepristone or placebo. The main endpoint for efficacy was the number of patients in whom labor occurred between 12 and 45 and 54 hours after treatment or who had a Bishop score 6 or greater. Maternal and fetal tolerability was also studied. No significant efficacy was observed whatever the dose of mifepristone. Mifepristone was well tolerated by the mother and fetus. Mifepristone, at doses up to 600 mg, does not induce labor within 54 hours in patients with unfavourable cervical status.

A rise in pain threshold during labor: A prospective clinical trial

To evaluate changes in pain threshold before, during and after labor in a prospective clinical trial. Forty pregnant women at term were included. Pain threshold in 18 specific pressure points was evaluated using a dolorimeter. Woman underwent pain threshold assessment at term before labor, during the active phase of labor and postpartum. Subjective pain intensity was assessed by the parturient using the Verbal Rating Scale (VRS). Pain threshold was significantly higher during active phase of labor. There was a significant decline in pain threshold after labor as compared to pain threshold during labor (2.507+/-0.947 and 2.608+/-1.023, respectively, p=0.01). Pain intensity using the VRS score was higher during labor than before labor (4.8+/-2.7 and 2.4+/-2.6 p<0.001). We found a significant rise in pain threshold during labor in term pregnancies. This rise may have an intended protective effect during the intense labor pain experience.

Macrophage colony-stimulating factor levels in amniotic fluid before and after the onset of labor do not differ in normal pregnancies.

Macrophage colony-stimulating factor (M-CSF) promotes placental growth and maintenance. M-CSF also regulates trophoblast invasion into the placental bed. We evaluated whether M-CSF levels in amniotic fluid during labor contributing to subsequent delivery differed from those before the onset of labor in normal pregnancies. This study enrolled 48 Japanese women experiencing normal pregnancies with single fetuses who had no infection. Of these pregnancies, 24 were women during labor: 22 led to subsequent term delivery (labors); two had premature delivery. The other 24 were women without labor underwent cesarean section (controls). These two groups (22 labors and 24 controls) were compared. The average gestational age at entry was 38 weeks of gestation. The women's ages and gestational ages did not differ significantly between the two groups. Amniotic fluid was collected and the M-CSF levels were compared between two groups. The M-CSF level was determined by the sandwich enzyme-linked immunosorbent assay (ELISA) method. The levels of M-CSF in amniotic fluid did not differ significantly between the women during labor and those without labor. M-CSF in amniotic fluid may not contribute to the onset of labor in term pregnancy and/or labor resulting in subsequent delivery may not induce the production and secretion of M-CSF into amniotic cavity.

Prediction of Adverse Outcome Associated With Vaginal Misoprostol for Labor Induction

Obstetrical & Gynecological Survey: April 2004 - Volume 59 - Issue 4 - p 247-248 doi: 10.1097/01.OGX.0000119176.81707.2D

Non-invasive magnetomyographic recordings of the uterus to predict labor in term pregnancies

Non-invasive magnetomyographic recordings of the uterus to predict labor in term pregnancies

Utilità e costo/efficacia del dinoprostone in ostetricia

Pregnancy-related hypertension, intrauterine growth retardation, post-maturity and unfavorable local conditions are among the most frequent indications for labor induction. There are two competing strategies for the induction of labor in term pregnancies: formal induction with artificial rupture of the membranes and/or intravenous oxytocin on one side, and cervical ripening and induction with exogenous prostaglandins on the other. The use of prostaglandins in obstetrics relies on two pharmacological properties: the capacity of inducing the biochemical changes in the connective tissue of the cervix that lead to its maturation and the stimulation of the uterine smooth musculature. While the latter property is shared with oxytocin, the former offers great clinical advantages, in particular in those women that present an indication for labor induction but whose cervix, normally assessed with the use of the Bishop score, does not show “ripeness”, i.e. does not permit vaginal delivery. Since the acquisition cost of the prostaglandins is quite high, but the clinical benefit appears evident, several studies have analyzed the overall economical impact of their use, both as pre-induction cervical ripening agents and as induction drugs. When compared to a strategy of expectant management in term pregnancies without cervical ripeness, exogenous prostaglandin administration has proven to be more cost-effective and better accepted by the patients. Prostaglandins have also proven to be more cost-effective than oxytocin and/or amniotomy in women with an indication to labor induction and unripe cervix, due to the reduced number of induction failures and cesarean sections required with this strategy. The economical analyses that have compared oxytocin and prostaglandins in women with ripe cervices deliver more ambiguous data, but it appears that their cost-effectiveness is comparable. Furthermore, none of the reviewed studies has considered intangible costs, but it is a wide-spread opinion that induction with prostaglandins results in a more “natural” and less painful labor.

Influence of maternal‐fetal medicine subspecialization on the frequency of trial of labor in term pregnancies with breech presentation

Objective To investigate the role of subspecialization in maternal-fetal medicine (MFM) on the frequency of a trial of labor in term pregnancies with breech presentation. Methods We conducted a retrospective study of 332 singleton pregnancies ≥37 weeks with nonfootling breech presentation that delivered over a 6-year period (1994–1998) at a university-based, tertiary care hospital. Patients were divided into two groups based on whether the delivery was attended by an MFM or non-MFM obstetrician-gynecologist. Demographic and clinical data were compared between groups and outcome variables included whether the patient had an attempt at vaginal delivery, cesarean delivery after a labor attempt, or vaginal breech delivery. Results The frequency of labor attempt (OR 1.4, 95% CI 0.9–2.3), vaginal breech success rate (OR 0.6, 95% CI 0.3–1.5), and overall cesarean rates (OR 0.9, 95% CI 0.5–1.7) were similar between groups. Using discriminant function analysis, only nulliparity (R2 = 1.6%, F = 6.0, P = 0.005) and birthweight (R2 = 2.0% F = 6.4, P = 0.01) were associated with trial of vaginal delivery. Conclusions Subspecialization in MFM had no impact on the frequency of trial of labor in the term pregnancy with a breech presentation. J. Matern.-Fetal Med. 9:229–232, 2000. © 2000 Wiley-Liss, Inc.

Influence of maternal-fetal medicine subspecialization on the frequency of trial of labor in term pregnancies with breech presentation

To investigate the role of subspecialization in maternal-fetal medicine (MFM) on the frequency of a trial of labor in term pregnancies with breech presentation. We conducted a retrospective study of 332 singleton pregnancies > or =37 weeks with nonfootling breech presentation that delivered over a 6-year period (1994-1998) at a university-based, tertiary care hospital. Patients were divided into two groups based on whether the delivery was attended by an MFM or non-MFM obstetrician-gynecologist. Demographic and clinical data were compared between groups and outcome variables included whether the patient had an attempt at vaginal delivery, cesarean delivery after a labor attempt, or vaginal breech delivery. The frequency of labor attempt (OR 1.4, 95% CI 0.9-2.3), vaginal breech success rate (OR 0.6, 95% CI 0.3-1.5), and overall cesarean rates (OR 0.9, 95% CI 0.5-1.7) were similar between groups. Using discriminant function analysis, only nulliparity (R2 = 1.6%, F = 6.0, P = 0.005) and birthweight (R2 = 2.0% F = 6.4, P = 0.01) were associated with trial of vaginal delivery. Subspecialization in MFM had no impact on the frequency of trial of labor in the term pregnancy with a breech presentation.

Influence of maternal-fetal medicine subspecialization on the frequency of trial of labor in term pregnancies with breech presentation

Influence of maternal-fetal medicine subspecialization on the frequency of trial of labor in term pregnancies with breech presentation

The effect of changes in atmospheric pressure on the occurrence of the spontaneous onset of labor in term pregnancies

OBJECTIVE: Our purpose was to determine whether there is a relationship between changes in atmospheric pressure and spontaneous onset of labor in term pregnancy. STUDY DESIGN: All women admitted to Medical Center of Central Massachusetts - Memorial Hospital with spontaneous onset of labor at term and who were delivered on the service during a 12-month period represent the cohort for this study. Each maternal chart was abstracted to ensure that each member of the cohort met the inclusion criteria. Hourly recordings of atmospheric pressure made at the Worcester Station of the National Weather Service, Department of Commerce, were used as the meteorologic data points of interest. Least-squares regression was used to determine an equation that expresses the probability of the onset of labor in this cohort as a function of gestational age, which was used to calculate expected numbers for the statistical analyses. Two relationships were studied: (1) the ratio of the observed to the expected number of onsets of labor and (2) the initiation of labor and atmospheric pressure changes in the preceding 3 hours. RESULTS: Three-hour periods of falling atmospheric pressure were less often followed by initiation of labor than were the periods with other types of pressure sequences. No association was observed between the onset of labor and days of low mean pressure. CONCLUSION: Although there was an observed statistically significant association between falling barometric pressure and onset of labor, the magnitude of the difference is not of clinical significance. (A M J O BSTET G YNECOL 1996;174:1192-9.)

Changes in the Connective Tissue of Corpus and Cervix Uteri during Ripening and Labour in Term Pregnancy

Departments of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital, Stockholm; and Uppsala University, Akademiska Sjukhuset, Uppsala; and Department of Physiological Chemistry, University of Lund, Lund, Sweden

Initiation of labor with a moderately favorable cervix: a comparison between prostaglandin E 2 gel and oxytocin

This study compares prostaglandin E 2 (PGE 2) gel and oxytocin for the initiation of labor in term pregnancies with a moderately favorable cervix (Bishop score 5–8). Compared with a matched group, 48 cases treated with PGE 2 gel (2.5 mg intravaginally) required significantly less or no oxytocin, had shorter first stages of active labor, and had no increased risk of uterine hyperstimulation or cesarean section. Initiation of labor with low dose PGE 2 when the cervix is moderately favorable is less labor intensive and meets with more patient satisfaction.

Changes in the connective tissue of corpus and cervix uteri during ripening and labour in term pregnancy.

The composition of the connective tissue of human cervix and corpus uteri was studied in tissue specimens from seven nonpregnant women and 14 pregnant women, delivered at term by section, to examine spontaneous cervical ripening and labour-induced changes in both the uterine and the cervical connective tissue. The main finding in both the cervix and the corpus was a large (40-60%) decrease of the collagen concentration. The collagen extractability, obtained by pepsin digestion, was increased twofold, suggesting a change of the organization of the collagen fibrils. This reorganization process could also be demonstrated by a large increase of the collagenolytic activity demonstrated with an artificial DNP-peptide substrate. The concentrations of sulphated glycosaminoglycans was lower in pregnant women than in non-pregnant women. The results show that both the cervix and the corpus uteri contain substantial amounts of connective tissue components (collagen, sulphated glycosaminoglycans and hyaluronic acid) and that during ripening, reconstruction of the connective tissue components occurs in both sites. This indicates that the cervical state reflects that of the myometrium.