The short-acting opioid fentanyl has been shown to be a useful analgesic during labor. The purpose of this prospective, comparative investigation was to determine whether fentanyl influenced fetal biophysical parameters during labor. Twenty-four uncomplicated pregnancies at 37-41 weeks were studied during the early active phase of labor. Those patients who ...

Preterm birth accounts for the majority of neonatal morbidity and mortality not associated with congenital anomalies. Its incidence has remained relatively unchanged over the past 15 to 20 years. Tocolytic therapy has been shown to be ineffective in the prevention of preterm labor but can delay delivery by approximately 48 ...

In order to evaluate the neonatal outcomes of infants who had prolonged fetal heart rate (FHR) deceleration during the second stage of labor, the neonatal outcomes of 24 infants born after vaginal delivery at 37 to 42 weeks of gestation with prolonged FHR deceleration during the second stage of labor ...

BACKGROUND: Several randomized, controlled trials compared the policies of induction of labor and expectant management for women who reach 41 weeks' gestation, and although they suggest a better outcome for mothers and infants with such a policy in place, controversy continues as to which is the better form of care. ...

Diminished actin response to N-formyl-methionyl-leucyl-phenylalanine (FMLP) has been used to explain the impaired chemotaxis of neonatal neutrophils, but the effect of labor on this response has not been evaluated before. Therefore, we tested the hypothesis that labor stress may have an effect on actin response of cord blood neutrophils to ...

Maternal tachycardic responses to the intravenous injection of epinephrine 15 micrograms were compared with tachycardic responses induced by the pain of labor in a double-blind, prospective study of 15 women in active labor. After placement of an epidural catheter, maternal heart rate was continuously recorded. Each patient received, in uterine ...

Objective: We sought to determine if changing the surgeon's gloves after delivery of the infant and prior to manual placental removal decreases the incidence of postcesarean endometritis.Methods: Laboring women undergoing cesarean delivery between September 1, 1994, and August 31, 1995, were prospectively randomized into either a change or no-change glove ...

The management of patients with premature rupture of membranes has changed markedly in the past several years. The basis for this is a combination of a better understanding of newborn physiology, improved neonatal care, refinements in antibiotic therapy, and the widespread use of maternal and fetal monitoring. The best outcome ...

Previous studies suggest that women with asthma are at increased risk of preterm birth. Moreover, drugs (especially beta-agonists) used to treat asthma are also used to treat preterm labor. The authors carried out a case-control study of 555 women from three hospital centers with idiopathic preterm labor (< 37 weeks), ...

OBJECTIVE: We examined whether the presence of fetal fibronectin in cervicovaginal secretions can be used as a selection criterion for induction of labor at term. STUDY DESIGN: Cervicovaginal secretions of 64 women who were scheduled for induction of labor were examined for fetal fibronectin and divided into group A (positive ...

OBJECTIVE: Our purpose was to assess by metaanalysis the evidence from randomized clinical trials regarding home uterine activity monitoring. STUDY DESIGN: Six randomized controlled trials of home uterine activity monitoring, the same six trials reviewed by the U.S. Preventive Services Task Force on home uterine activity monitoring, were studied. Data ...

OBJECTIVE: Our objective was to determine the association between labor abnormalities and shoulder dystocia. STUDY DESIGN: All consecutive cases of shoulder dystocia from January 1986 to August 1994 were reviewed (n = 276). For purposes of comparison a control group of vaginally delivered patients was randomly selected in a 2:1 ...

OBJECTIVE: Our purpose was to determine the efficacy of a home uterine activity monitoring system for early detection of preterm labor and reduction of preterm birth. STUDY DESIGN: A randomized, controlled, double-blinded trial was performed in which pregnant women between 24 and 36 weeks' gestation and at high risk for ...

OBJECTIVE: Our purpose was to determine the incidence of adverse cardiovascular effects of terbutaline sulfate when administered as a continuous subcutaneous infusion in women with arrested preterm labor. STUDY DESIGN: Over a 6-year period records from 8709 women prescribed this therapy for preterm labor that had previously been arrested with ...

OBJECTIVE: The objective of this study was to determine if the discriminatory intrapartum amniotic fluid index can reliably predict respiratory or metabolic acidosis in the newborn. STUDY DESIGN: Among 256 parturients at 37 weeks' gestation or more, the intrapartum amniotic fluid index was obtained in early labor, and umbilical arterial ...

OBJECTIVE: The purpose of this study was to determine whether intrauterine sound pressure levels produced by vibroacoustic stimulation were associated with distance from an intrauterine hydrophone in human parturients and to evaluate the effects of distance on the spectrum of the stimulus. STUDY DESIGN: Measurements of intrauterine sound were taken ...

Preterm birth (before 37 completed weeks of gestation) continues to account for the vast majority of neonatal morbidity and mortality. The incidence of preterm birth can be reduced by appropriate social interventions and antenatal care. Currently available tocolytic agents suffer from low uterospecificity and prolong pregnancy only marginally, although postponement ...

OBJECTIVE: Our purpose was to assess the utility of cervicovaginal expression of fetal fibronectin in the diagnosis of preterm labor. STUDY DESIGN: Women seen between 24 and 34 weeks' gestation with symptoms of preterm labor, intact membranes, and cervical dilatation < 3 cm were enrolled at five university medical centers. ...

Several authors of standard obstetric texts state that engagement occurs before the onset of labor in a majority of nulliparas at term, and failure of the fetal head to engage in early labor is a greater indicator for operative birth. A pilot clinical descriptive study was done at University Hospital, ...

OBJECTIVE: Our purpose was to determine the value of routine intrapartum amniotic fluid volume assessment on perinatal outcome. STUDY DESIGN: Patients admitted for labor and delivery who were ultimately delivered between January 1988 and June 1989 with a gestational age > or = 26 weeks and who had an intrapartum ...

Chart review of 73 patients with 3.5 cm or more dilation, intact membranes, and regular contractions at less than 36 weeks. Forty-four (group A) received tocolysis with magnesium sulfate, and 13 of the 44 also received indomethacin. Twenty-nine (group B) received no tocolysis. Obstetric and neonatal outcomes were compared. Demographic ...

OBJECTIVE: To assess the antecedents of shoulder dystocia, the risk of recurrence, and the perinatal morbidity associated with the different maneuvers used for its management. METHODS: We conducted a 10-year (1980-1989) retrospective case record review of all instances of shoulder dystocia in a teaching maternity hospital. RESULTS: There were 254 ...

Subclinical infection is suspected to be an important etiologic factor in the initiation of preterm labor in women with intact membranes. We present a case of acute clinical chorioamnionitis followed by preterm labor and fetal distress in a woman with intact membranes. The bacteriologic data on the mother and neonate ...

OBJECTIVE: Our purpose was to assess maternal and perinatal outcomes associated with a trial of labor and attempted vaginal birth after prior low-segment vertical cesarean delivery. STUDY DESIGN: During a 10-year period in a single tertiary hospital, all patients with a prior low-segment uterine incision (whether vertical or transverse) were ...

OBJECTIVE: Our purpose was to determine whether maternal preeclampsia per se has a beneficial effect on neonatal outcome after delivery before 35 weeks. STUDY DESIGN: A matched cohort study design was used. Two hundred twenty-three infants of strictly defined preeclamptic women were matched for gestational age, race, gender, and mode ...

A disciplined approach to labor management has resulted in a low cesarean rate (9%) in our population. We wondered if this management scheme was applicable and safe applied to women with previous cesareans. Women with a previous cesarean delivering in a 5-year period were included. Labor management included encouragement of ...

Premature rupture of the membranes (PROM) is the condition in which the chorioamnion is disrupted before the onset of labor. This condition creates a dilemma for the practicing obstetrician, because once the membranes have broken the risk of fetal or maternal infection, or both, increases. Preterm PROM adds to this ...

OBJECTIVE: This study was undertaken to determine whether peripartum cocaine use shortens labor. STUDY DESIGN: A total of 1220 gravidas delivering at an urban county hospital (November 1991 through April 1992) had urine specimens sent for toxicology studies. Cervical dilatation on admission and time intervals during the course of labor ...

OBJECTIVE: To analyze the available data on the efficacy of oral beta-agonist maintenance therapy in delaying delivery and in decreasing the incidence of preterm birth and its complications. DATA SOURCES: A computer search of English-language abstracts using MEDLINE (medical subject heading terms: labor, premature and beta-adrenergic receptor agonist, therapeutic use) ...

Creatine kinase-brain isoenzyme activity (CK-BB) was measured longitudinally in the serum of 31 pregnant women in the first stage of labor (early and advanced), at delivery, and 1, 6 and 24 h after delivery, in the umbilical cord and in the serum of their neonates on the first day of ...

The aims of this study were to examine data from an institution at which the goal has been to pursue vaginal delivery in patients with a preterm gestation and preeclampsia and to test the hypothesis that labor does not increase the risk of poor outcome for the preterm infant of ...

Recent experimental studies in a wide range of animal species have shown that the fetus determines the duration of pregnancy. The mechanism by which the birth process is initiated is closely linked to the normal maturation of vital fetal organs, such as the lungs. Thus, under normal circumstances, the fetus ...

We investigated whether opiate analgesics as commonly administered to women during labor would affect later response to maternal separation in infant guinea pigs. Meperidine hydrochloride (10-15 mg/kg i.m.) was administered to late-pregnant guinea pigs 5 min prior to labor induction with oxytocin. On Day 11 or 12 postnatal, pup distress ...

We elucidated several controversial problems surrounding the vaginal trial in patients with prior abdominal delivery under the diagnosis of failure to progress or cephalopelvic disproportion, by conducting a prospective 6-year survey on the basis of patients who underwent prior operation for arrest disorders of labor (ADL). Of 45 full-term women ...

Superoxide anion (.O2-) production was investigated in whole blood of mothers in the peripartal period and in neonates. Blood samples from 14 mothers undergoing vaginal delivery (VD) were tested at the beginning of labor, during labor, after delivery, and 4 d after delivery. Nine mothers undergoing elective cesarean section (ECS) ...

The purpose of this study was to explore the relationship between religious affiliation and obstetric outcome. We reviewed 1,919 records of patients whose infants were born at a university medical center. Data obtained from maternal and newborn records included demographic information, prenatal history, labor and delivery records, and religious affiliation. ...

The objective of this study was to determine the usefulness of the peripheral white blood count (WBC) drawn during labor as a predictor of postpartum morbidity. Hospital charts on 309 consecutive obstetrical deliveries performed by residents of the Cox Family Practice Residency were reviewed for evidence of maternal or neonatal ...

Ninety-four patients in documented preterm labor received three intramuscular injections of ritodrine hydrochloride over an interval of 6 hours. They subsequently received the tocolytic agent intravenously for a minimum of 6 hours. The effects of ritodrine on uterine activity and the cardiovascular system were determined. Intramuscular ritodrine hydrochloride elicited a ...

OBJECTIVE: To describe the time relation between symptoms, contractions, and the clinical diagnosis of preterm labor. METHODS: We analyzed the records from 57 women who were enrolled in a previously reported trial of home uterine monitoring and who developed preterm labor while using the monitor. In a post hoc descriptive ...

BACKGROUND: Although several investigators have attempted to define the normal values of umbilical cord blood pH and gases, there is considerable controversy about the optimal cutoff values to diagnosis intrauterine asphyxia. A possible reason for this might be that several studies have included data from fetuses born after different duration ...

OBJECTIVE: To improve the accuracy of the diagnosis of preterm labor by comparing transvaginal sonography to digital examination of the cervix. METHODS: We performed transvaginal sonography in women with preterm labor who had completed a course of parenteral tocolysis. Cervical length was measured according to criteria reported previously. Cervical sonographic ...

OBJECTIVE: To examine whether there is a relationship between the uro-genital microbial colonization and threatening preterm delivery. STUDY DESIGN: The microflora in the urine and endocervix was studied in 43 women with preterm labor, 45 women with preterm premature rupture of the membranes (PPROM) and 80 normal pregnant women at ...

Hypnotic preparation for labor and delivery is enjoying renewed interest. This interest lies in the mother's psychological comfort and sense of involvement in the birth process. In this paper I present a model of psychological preparation, illustrated with case examples, that appears to be superior to Lamaze. This model offers ...

OBJECTIVE: To report a prospective multicenter comparison of outcomes of patients who attempted trial of labor and those who underwent elective repeat cesarean. METHODS: During the study interval, all pregnant women with previous cesarean delivery cared for at Kaiser Permanente Hospitals in Southern California were studied regardless of whether trial ...

OBJECTIVES: To examine whether continuous lumbar epidural analgesia administered in the early phase of labor leads to an increased incidence of instrumental vaginal deliveries. METHODS: In a retrospective analysis we have studied 563 consecutive term cephalic vaginal deliveries where an epidural was given for pain relief in labor. The type ...

Published studies assessing the effect of epidural analgesia in nulliparous labor on the frequency of cesarean delivery for dystocia are reviewed. There are at least four retrospective studies and two prospective studies that suggest that epidural analgesia may increase the risk of cesarean delivery for dystocia in first labors. The ...

OBJECTIVE: To determine which factors influence a trial of labor after previous cesarean delivery. METHODS: Among 8829 deliveries at five participating hospitals, the charts of 1001 women who had a previous cesarean delivery were reviewed to determine whether a trial of labor or elective cesarean had been performed. Bivariate analysis ...

Twelve infants born to mothers who received i.v. magnesium sulfate for > 6 weeks for the cessation of preterm labor were evaluated radiographically shortly after birth. All infants were born at > 33 weeks gestational age. All twelve infants demonstrated consistent and unique radiographic abnormalities in the metaphyses of their ...