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Spontaneous Labour (spontaneous + labour)

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Medical Sciences	100%

Selected Abstracts

Amniotomy for Shortening Spontaneous Labour

BIRTH, Issue 2 2001
W.D. Fraser
A substantive amendment to this systematic review was last made on 25 June 1999. Cochrane reviews are regularly checked and updated if necessary. ABSTRACT Background: Early amniotomy has been advocated as a component of the active management of labour. Several randomised trials comparing routine amniotomy to an attempt to conserve the membranes have been published. Their limited sample sizes limit their ability to address the effects of amniotomy on indicators of maternal and neonatal morbidity. Objectives: To study the effects of amniotomy on the rate of Cesarean delivery and on other indicators of maternal and neonatal morbidity (Apgar less than 7 at 5 minutes, admission to NICU). Search strategy: The register of clinical trials maintained and updated by the Cochrane Pregnancy and Childbirth Group. Selection criteria: All acceptably controlled trials of amniotomy during first stage of labour were eligible. Data collection and analysis: Data were extracted by two trained reviewers from published reports. Trials were assigned methodological quality scores based on a standardised rating system. Typical odds ratios (ORs) were calculated using Peto's method. Main results: Amniotomy was associated with a reduction in labour duration of between 60 and 120 minutes. There was a marked trend toward an increase in the risk of Cesarean delivery: OR = 1.26; 95% Confidence Interval (CI) = 0.96,1.66. The likelihood of a 5-minute Apgar score less than 7 was reduced in association with early amniotomy (OR = 0.54; 95% CI = 0.30,0.96). Groups were similar with respect to other indicators of neonatal status (arterial cord pH, NICU admissions). There was a statistically significant association of amniotomy with a decrease in the use of oxytocin: OR = 0.79; 95% CI = 0.67,0.92. Reviewers' conclusions: Routine early amniotomy is associated with both benefits and risks. Benefits include a reduction in labour duration and a possible reduction in abnormal 5-minute Apgar scores. The meta-analysis provides no support for the hypothesis that routine early amniotomy reduces the risk of Cesarean delivery. Indeed there is a trend toward an increase in Cesarean section. An association between early amniotomy and Cesarean delivery for fetal distress is noted in one large trial. This suggests that amniotomy should be reserved for women with abnormal labour progress. Citation: Fraser WD, Turcot L, Krauss I, Brisson-Carrol G. Amniotomy for shortening spontaneous labour (Cochrane Review). In: The Cochrane Library, 1, 2001. Oxford: Update Software. MeSH: Amnion/*surgery; Cesarean Section; Female; Human; *Labor; Labor Complications/*prevention & control; Pregnancy The preceding reports are abstracts of regularly updated, systematic reviews prepared and maintained by the Cochrane Collaboration. The full text of the reviews are available in The Cochrane Library (ISSN 1464-780X). The Cochrane Library is prepared and published by Update Software Ltd. All rights reserved. See www.update-software.com or contact Update Software, info@update.co.uk, for information on subscribing to The Cochrane Library in your area. Update Software Ltd, Summertown Pavilion, Middle Way, Oxford OX2 7LG, United Kingdom. (Tel: +44 1865 513902; Fax: +44 1865 516918). [source]

Trends and determinants of caesarean sections births in Queensland, 1997,2006

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 6 2009
Stuart HOWELL
Background:, The determinants of Queensland's rising caesarean section (CS) rate remain poorly understood because of the historical absence of standard classification methods. Aims:, We applied the Robson Ten Group Classification System (RTGCS) to population-based data to identify the main contributors to Queensland's rising CS rate. Method:, The RTGCS was applied retrospectively to the Queensland Perinatal Data Collection. CS rates were described for all ten RTGCS groups using data from 2006. Trends were evaluated using data for the years 1997,2006. Public and private sector patients were evaluated separately. Results:, In Queensland, in 2006, CS rates were 26.9 and 48.0% among public and private sector patients, respectively. Multiparous women with a previous caesarean birth (Group 5) made the greatest contribution to the CS rate in both sectors, followed by nulliparous women who had labour induced or were delivered by CS prior to the onset of labour (Group 2) and nulliparous women in spontaneous labour (Group 1). CS rates have risen in all RTGCS groups between 1997 and 2006. The trend was pronounced among multiparous women with a previous caesarean delivery (Group 5), among women with multiple pregnancies (Group 8) and among nulliparous women who had labour induced or were delivered by CS prior to the onset of labour (Group 2). Conclusions:, The CS rate in Queensland in 2006 was higher than in any other Australian state. The increase in Queensland's CS rates can be attributed to both the rising number of primary caesarean births and the rising number of repeat caesareans. [source]

Maternal height and length of gestation: Does this impact on preterm labour in Asian women?

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2009
Ben Chong-Pun CHAN
Background: Both maternal height and ethnicity may influence the gestation length, but their independent effect is unclear. Aim: This study was performed to examine the relationship between maternal height and gestational length in women with singleton pregnancies in a Chinese and southeast Asian population. Methods: A retrospective cohort study was performed on women carrying singleton pregnancies with spontaneous labour in a 48-month period managed under our department to determine the relationship between maternal height, expressed in quartiles, with the mean gestational age and incidence of preterm labour. Results: Of the 16 384 women who delivered within this period, the 25th, 50th and 75th percentile values of maternal height were 153 cm, 156 cm and 160 cm respectively. Excluded from analysis were 6597 women because of multifetal pregnancy, teenage pregnancy (maternal age , 19 years old), induction of labour or elective caesarean section, or incomplete data due to no antenatal booking in our hospital. Significant differences were found in the maternal weight and body mass index, incidences of multiparity and smokers, gestational age and birthweight among the four quartiles. There was significantly increased incidence of preterm birth between 32 and 37 weeks gestation in women with shorter stature. Conclusions: In our population, maternal height has an influence on gestational length, and the lower three quartiles was associated with increased odds of labour at > 32 to < 37 weeks. This effect should be taken into consideration in the adoption of international recommendations in obstetric management and intervention. [source]

Amniotomy for Shortening Spontaneous Labour

Pregnancy outcome in women with heart disease undergoing induction of labour

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 7 2004
Galia Oron
Objective To examine the safety and outcome of induction of labour in women with heart disease. Design Prospective single-centre comparative study. Setting Major university-based medical centre. Population/Sample One hundred and twenty-one pregnant women with heart disease. Methods The sample included all women with acquired or congenital heart disease who attended our High-Risk Pregnancy Outpatient Clinic from 1995 to 2001. The files were reviewed for baseline data, cardiac and obstetric history, course of pregnancy and induction of labour and outcome of pregnancy. Findings were compared between women who underwent induction of labour and those who did not. Forty-seven healthy women in whom labour was induced for obstetric reasons served as controls. Main outcome measures Pregnancy outcome. Results Of the 121 women with heart disease, 47 (39%) underwent induction of labour. There was no difference in the caesarean delivery rate after induction of labour between the women with heart disease (21%) and the healthy controls (19%). Although the women with heart disease had a higher rate of maternal and neonatal complications than controls (17%vs 2%, P= 0.015), within the study group, there was no difference in complication rate between the patients who did and did not undergo induction of labour. Conclusion Induction of labour is a relatively safe procedure in women with cardiac disease. It is not associated with a higher rate of caesarean delivery than in healthy women undergoing induction of labour for obstetric indications, or with more maternal and neonatal complications than in women with a milder form of cardiac disease and spontaneous labour. [source]

The effect of fundal pressure manoeuvre on intrauterine pressure in the second stage of labour

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2002
Catalin S. Buhimschi
Objective To investigate the relationship between intrauterine pressure and the application of a standardised fundal pressure manoeuvre, and to determine the maternal, fetal and labour characteristics that modulate the relationship. Design Prospective measurement of intrauterine pressure during the second stage of labour. Setting North American university hospital. Population Forty full-term women in spontaneous labour were studied during the second stage. Each woman acted as her own control. All women laboured with requested epidural analgesia. Methods A fundal pressure manoeuvre was performed so as to standardise the level of force and the surface area of application. Intrauterine pressure was measured using a sensor,tip catheter. Five interventions were analysed: 1. valsalva during a uterine contraction; 2. fundal pressure and valsalva during a contraction; 3. fundal pressure during a contraction without valsalva; 4. fundal pressure in the absence of uterine contractions; and 5. valsalva in the absence of uterine contractions. Results Women in the second stage of labour transiently increased their expulsive force (as reflected by intrauterine pressure) by 86% of their baseline contraction using valsalva and fundal pressure simultaneously. The efficiency by which both contraction-enhancing manoeuvres increased intrauterine pressure was directly related to gestational age and inversely related to myometrial thickness. Conclusion Fundal pressure applied under controlled conditions significantly increases intrauterine pressure in some, but not all women. Simultaneous measurement of intrauterine pressure, to maintain feedback during application will create a ,controlled environment' for the obstetrician and reassurance that this manoeuvre can be applied in a controlled fashion. Future delineation of the group of women that could benefit from fundal pressure, as well as the group that is refractory is essential to avoid unnecessary or delayed operative interventions. [source]

Postpartum intrauterine pressure studies of the uterotonic effect of oral misoprostol and intramuscular syntometrine

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 1 2001
Y.S. Chong
Objectives To investigate the effect of oral misoprostol in dosages varying from 200 ,g to 800 ,g on postpartum uterine contractility and to establish their side effects. Design A prospective descriptive study. Participants Fifty-seven women who delivered vaginally after spontaneous labours not requiring augmentation. Methods Within 5 minutes of delivery of the placenta, a calibrated Gaeltec catheter with an intrauterine pressure transducer at its tip was inserted transcervically into the uterine cavity. Cumulative uterine activity was recorded for 30 minutes in each woman before administering the oral misoprostol tablets and continued for a further 90 minutes after its administration. Thus each woman acted as her own control regarding changes in uterine contractility. Uterine activity was recorded on a Sonicaid Meridian fetal monitor, which measures active contraction area automatically. The incidence of side effects was also recorded. Results There was no statistical difference (P=0.887) in the adjusted mean difference in cumulative uterine activity following all the doses of oral misoprostol, compared with intramuscular syntometrine, the largest difference being seen in oral misoprostol 200 ,g (adjusted mean difference ,2282 kPas s, 95% CI ,7954 to 3390 kPas s). The mean onset of action of oral misoprostol (6.1, SD 2.1 min) was significantly slower than that of intramuscular syntometrine (3.2, SD 1.5 min; P=0.002), but their durations of action were similar (P=0.637). In the misoprostol group the commonest side effects were shivering (36%) and a rise in body temperature above 38°C (40%). In the syntometrine group, the most commonly observed side effect was moderate uterine pain (nine out of ten women) and a rise in diastolic blood pressure of 20 mmHg (two out of ten women). Conclusion The results of this study show that oral misoprostol has a definite uterotonic effect on the postpartum uterus. At doses of 200 ,g to 400 ,g, oral misoprostol has a similar uterotonic effect to intramuscular syntometrine. Higher doses of oral misoprostol are associated with significantly more side effects. [source]