A 21-year-old woman was diagnosed with Fechtner syndrome at 15 weeks gestation. She had a familial history of this disorder; her mother, two siblings and maternal grandmother were also affected. She presented with neither bleeding from the genital tract nor symptoms suggestive of placental abruption. Labor progressed uneventfully and resulted ...

This article discusses the cooperative efforts of a team of physicians and veterinarians resulting in the successful assisted vaginal delivery of a Western lowland gorilla at the Woodland Park Zoo in Seattle, Washington. A 10-year-old, captive-born female gorilla, gravida 3, para 0, aborta 2, was observed to be in labor ...

Fetal tachycardia and signs of hydrops fetalis were diagnosed at 29 weeks of gestation. The heart rate normalized by combined treatment with digoxin and flecainide and was followed by improvement of the hydrops. Premature labor led to delivery at 33 weeks of gestation. The newborn infant showed mild respiratory distress ...

Preterm labor (PTL) is defined as uterine irritability accompanied by cervical dilation and/or effecement that occurs before 37 weeks gestation. In most cases, PTL becomes preterm delivery (PTD), accounting for 8% to 10% of births in the United States. Fetuses born before 37 weeks' gestation are at risk for a ...

PROBLEM: Clinically useful tests for the prediction and diagnosis of preterm labor and delivery remain to be established. We have hypothesized that soluble intercellular adhesion molecule-1 (sICAM-1) in the cervicovaginal fluid of women with preterm labor may be a useful diagnostic tool. METHOD OF STUDY: The cervicovaginal fluid of 103 ...

OBJECTIVE: This study was undertaken to compare the efficacy and safety of intravenous administration of atosiban versus ritodrine for the treatment of preterm labor. Study Design: Women with preterm labor and intact membranes diagnosed at 23 to 33 gestational weeks (n = 247) were randomly assigned to treatment arms and ...

Myometrial contractions of labor result from an increase in myometrial activation and stimulation. Activation develops through the expression of contraction associated proteins (CAPs), including oxytocin receptors (OTR), connexin-43 (Cx-43), and prostaglandin F2 alpha, receptors (FP). Stimulation involves increases in contractile agonists including prostaglandin E2 (PGE2) and prostaglandin F2 alpha. (PGF2 ...

OBJECTIVE: To determine whether gravidas with short cervical length on endovaginal ultrasound examination, not in preterm labor, who underwent cervical cerclage have better outcomes compared with those with no cerclage. METHODS: This is an observational study in which data were collected prospectively on women who had ultrasound endovaginal cervical length ...

OBJECTIVE: We compared nifedipine and ritodrine for treatment of preterm labor with respect to neonatal outcome. METHODS: We conducted an open randomized multicenter study of neonatal outcome in 185 women who received either oral nifedipine (n = 95) or intravenous (IV) ritodrine (n = 90) for treatment of preterm labor. ...

Methods to prevent perineal trauma during childbirth include avoiding episiotomy and forceps delivery and slowing delivery of the head to allow the perineum time to stretch. Each intervention can lengthen the second stage of labor and change the biophysical stresses on infants and the pelvic floor. Available evidence supports the ...

BACKGROUND: Misoprostol was reported to be an effective agent for cervical ripening and induction of labor. Our purpose was to evaluate whether vaginal pH affected the efficacy of misoprostol for induction of labor. METHODS: The vaginal pH of 103 women admitted for induction of labor were measured. According to the ...

OBJECTIVE: This study was undertaken to compare total medical costs of trial of labor after cesarean with those of elective repeat cesarean without labor, with both short- and long-term neonatal costs associated with such procedures taken into account. STUDY DESIGN: Costs associated with All Patient Refined diagnosis-related groups and Current ...

BACKGROUND: The use of enemas during labor usually depends on the preference of the attending physician and available resources. However enemas cause discomfort in women and increase the costs of delivery. OBJECTIVES: The objective of this review was to assess the effects of enemas during the first stage of labor ...

Renal tubular acidosis in pregnancy is a very rare disorder. Most cases are either inherited or secondary to maternal disease or ingestion of toxic chemicals. We report a 22-year-old woman, previously healthy, who presented at 27 weeks of gestation with preterm labor. Investigation revealed renal tubular acidosis with no obvious ...

The association between women's overall experience of labor and birth and a range of possible explanatory variables were studied in a group of 1111 women who participated in a birth center trial. Data were collected by a questionnaire in early pregnancy (demographic background, parity, personality traits, and expectations), hospital records ...

OBJECTIVE: To examine the effectiveness of any tocolytic compared with a placebo or no tocolytic for preterm labor. DATA SOURCES: We checked MEDLINE (1966-1998) and the Cochrane Controlled Trials Register for articles, using the search terms "randomized controlled trial" (RCT), "preterm labor," "tocolysis," "betamimetics," "ritodrine," "terbutaline," "hexaprenaline," "isoxuprine," "prostaglandin synthetase ...

BACKGROUND: Emergent cervical cerclage is often unsuccessful in patients with severely protruding fetal membranes for the following reasons: (1) difficulty in pushing the bulging membranes into the cervix; (2) risk of premature rupture of membranes during the operative procedures; and (3) displacement of the cerclage tape by the shortened cervix. ...

OBJECTIVE: To evaluate the correlation of amniotic fluid (AF) markers (AFMs) of intra-amniotic infection with histopathologic findings in cases of preterm labor with intact membranes, between 22 and 36 weeks' gestation. STUDY DESIGN: We reviewed the charts of patients admitted in preterm labor with intact membranes between January 1993 and ...

This article reviews a number of nonevidenced-based studies that have been conducted on the different physical positions of labor and delivery. A review of the literature disclosed that the traditional supine position appeared to be associated with a prolonged second stage of labor and persistence of occiput posterior presentations. However, ...

An infant born in a compound presentation had ischemic forearm necrosis requiring amputation. Bilateral renal vein thrombosis predating labor and delivery was also diagnosed. The possibility of congenital ischemic necrosis in an extremity should not affect the obstetrical management of compound presentation, but if this complication occurs a search for ...

OBJECTIVE: To assess the effects of clinical chorioamnionitis and labor complications on short-term neonatal morbidity, including seizures. METHODS: This was a retrospective cohort study of all live-born term infants who weighed more than 2500 g delivered between 1988 and 1997 at Parkland Memorial Hospital, Dallas, Texas. Infant outcomes were compared ...

OBJECTIVE: To determine the relevance of ischemia in the incidence of preterm labor. A second objective was to document perinatal outcomes for patients with preterm labor classified according to its clinical, functional, and pathologic characteristics (infectious, ischemic, mixed, or idiopathic). METHODS: Perinatal outcomes were evaluated for 145 consecutive patients with ...

OBJECTIVE: To examine and compare maternal and neonatal morbidity after use of two types of obstetric forceps used in the management of the second stage of labor. STUDY DESIGN: This retrospective investigation was conducted from January 1993 to December 1995 and included 55 infants delivered with Kielland forceps as compared ...

OBJECTIVE: To determine whether cervical dilatation at the time of placement of patient-requested epidural affects cesarean rates or lengths of labors in actively managed parturients. METHODS: The charts of 255 women randomized to active management of labor (n = 125) or control protocols (n = 130) were reviewed and stratified ...

OBJECTIVE: To determine whether delayed induction of labor in patients with premature rupture of membranes (PROM) at term has beneficial effects on the mother or the infant. STUDY DESIGN: Retrospective analysis of our database revealed 576 patients >37 weeks of gestation with PROM, who delivered live-born infants without major congenital ...

OBJECTIVE: To compare the effects of labor induction with the effects of cesarean delivery without labor on neonatal outcome in pregnancies complicated by severe preeclampsia and delivery of very low birth weight infants. METHODS: This was a retrospective study of 278 singleton, live-born infants who weighed 750-1500 g and were ...

OBJECTIVE: The aim of this study of transverse lie in labor of patients admitted to Korle Bu Hospital between 1 January 1996 and 30 June 1998, was to identify the methods of delivery, the perinatal and maternal morbidities and mortalities, and to provide recommendations to improve the outcome. METHODS: This ...

BACKGROUND: Two strategies have been recommended by the Centers for Disease Control and Prevention and approved by the American College of Obstetrics and Gynecology to help prevent group B streptococcal disease in the newborn. Both involve using penicillin in labor. However, the potential for allergic and even anaphylactic reactions to ...

BACKGROUND: To investigate the role of interleukin-1 related substances in amniotic fluid in normal term labor without intrauterine infection. METHODS: Amniotic fluid samples were collected from forty-one patients with various backgrounds. A novel pre-assay treatment using Frigen II was introduced to improve the recovery rates of cytokines, i.e., interleukin-1alpha, interleukin-1beta ...

OBJECTIVE: To determine if birth weights greater than 4000 g can be predicted by ultrasound measurements of abdominal circumferences. METHODS: In 1996, 254 newborns delivered at Tampa General Hospital weighed at least 4000 g, 84 of whom had ultrasound examinations within 2 weeks of delivery. Those were compared with 84 ...

OBJECTIVE: The purpose of our study was to determine the folate status of pregnant women at labor, and to detect probable relationships with the gestational age at delivery, the birth weight of the newborns, as well as the mode of the delivery, taking into account any changes in the fetal ...

OBJECTIVE: To identify the presence of residual blood and organic matter on "clean" stethoscopes in maternal-infant units. DESIGN: In this retrospective, nonexperimental study, stethoscopes were tested using qualitative measurements. SETTING: Using a nonprobability sampling technique, 11 acute care hospitals in a three-state area of the southwestern United States were studied. ...

Preterm labor is the leading cause of perinatal morbidity and mortality in the United States. It is characterized by cervical effacement and/or dilatation and increased uterine irritability before 37 weeks of gestation. Women with a history of preterm labor are at greatest risk. Strategies for reducing the incidence of preterm ...

OBJECTIVE: To determine the predictive value of each fetal heart rate (FHR) variable and of patterns of FHR variables for fetal asphyxia during labor. METHODS: This matched case-control study included an asphyxia group of 71 term infants with umbilical artery base deficit greater than 16 mmol/L and a control group ...

Hydrotherapy is an effective, alternative intervention that can be used by care providers to provide a nonpharmacological method to assist low risk, laboring women cope with labor. This article provides a synthesis of the state of the science on the effects of hydrotherapy with labor and delivery. The indications, physiologic ...

There is a pressing need to develop accurate methods of diagnosing true preterm labor because of the availability of potent tocolytic drugs and the known beneficial effects of antenatal glucocorticoid administration on neonatal outcomes of premature infants. Maternal plasma corticotropin-releasing hormone concentrations are elevated in women with threatened preterm labor ...

OBJECTIVE: To examine the effect of insurance status on method of delivery while controlling for clinical and sociodemographic characteristics of women delivering at a single medical center. STUDY DESIGN: Sociodemographic and clinical characteristics of 878 women, who delivered their infants between 1985 and 1991 at a university hospital, were analyzed. ...

Advances in the understanding of the endocrine and hormonal mechanisms involved in normal and abnormal labor have led to clinical research into the roles of hormones and cytokines in preterm labor. This article reviews the current status of assays for estriol, activin, corticotropin-releasing hormone, interleukin-6, and relaxin as predictors of ...

To understand better the development of the neonatal immune system, we evaluated the role of labor length, gestational age, and mode of delivery on the expression of the neonatal neutrophil cell surface antigens CD11b, CD11c, CD15, CD33, and CD66b in premature newborns. Peripheral blood samples from 68 apparently healthy preterm ...

OBJECTIVE: This study was conducted to document the prevalence of maternal genital tract colonization by Ureaplasma urealyticum and Mycoplasma hominis, and to assess its association with low birth weight (LBW) and prematurity. METHODS: The high vaginal swabs of pregnant women in spontaneous labor after 26 weeks of gestation were cultured ...

The following recommendations are based on good and consistent scientific evidence (Level A): With term PROM, labor may be induced at the time of presentation or patients may be observed for up to 24-72 hours for the onset of spontaneous labor. Antibiotics prolong the latency period and improve perinatal outcome ...

OBJECTIVE: Our objective was to determine significant predictors for the development of neonatal infection in infants born to patients with premature rupture of membranes at term. STUDY DESIGN: Multivariate analysis was used to determine the significant predictors of neonatal infection in infants born to women with premature rupture of the ...

BACKGROUND: There has been some controversy regarding the effect that a long labor can have on fetal well-being. This study was undertaken to evaluate the effect of duration of labor both the first and second stage on the acid-base variables in the umbilical artery of the newborn. METHODS: Bloodsampling was ...

OBJECTIVE: To describe the outcomes of intended home birth in the practices of certified nurse-midwives. METHODS: Twenty-nine US nurse-midwifery practices were recruited for the study in 1994. Women presenting for intended home birth in these practices were enrolled in the study from late 1994 to late 1995. Outcomes for all ...

A major route of tryptophan metabolism is via the hepatic and cerebral synthesis of kynurenine, a substance subsequently used by astrocytes in the brain for the production of the neuroactive substances kynurenic acid and quinolinic acid. Both kynurenic and quinolinic acids have been implicated in modulating the activity of excitatory ...

It is often believed that the frequency of clinical chorioamnionitis in preterm premature rupture of membranes (PROM) increases with the duration of the interval between membrane rupture and delivery. We tested the hypothesis that the prevalence of histologic evidence of intrauterine infection increases proportionally to the duration of the latency ...

The Magnesium and Neurologic Endpoints Trial was a randomized controlled trial (RCT) done to learn whether or not receiving magnesium sulfate during preterm labor could prevent cerebral palsy. Unexpectedly, in the tocolytic arms of the trial, seven (including one set of twins) of 46 cases assigned to receive magnesium ended ...

OBJECTIVES: To assess the impact of breech labor management using the WHO partograph on fetal and maternal outcomes of labor. METHOD: All 1,740 breech presentations in a larger multicenter hospital-based study in South East Asia of the use of the WHO partograph in labor management were studied. The partograph was ...

The safety, toxicity, and pharmacokinetics of intrapartum and early newborn nevirapine were evaluated in 17 human immunodeficiency virus type 1-infected women in labor and their newborns. No adverse effects of nevirapine were noted in any study mothers or infants. Following maternal dosing with 200 mg during labor, concentrations exceeding 100 ...

Objective: To determine predictive variables identifying infants admitted to neonatal intensive care (NIC) following cesarean section for fetal distress in labor at term.Methods: Two hundred eight patients were studied. Sixty-six patients delivered by cesarean section at term for fetal distress were compared to 142 term patients not diagnosed as fetal ...