Does the fetus produce the trigger for spontaneous labour?

Placenta ◽  
2021 ◽  
Vol 112 ◽  
pp. e13
Author(s):  
Katherine Birchenall ◽  
Gavin Welsh ◽  
Andres Lopez Bernal
Keyword(s):  
Spontaneous Labour

scholarly journals Postpartum femoral neuropathy: managing the next pregnancy

2019 ◽  
Vol 12 (12) ◽  
pp. e232967 ◽  
Author(s):  
Cathy Rowland ◽  
Daniel Kane ◽  
Maeve Eogan
Keyword(s):  
Caesarean Section ◽  
Motor Function ◽  
Lower Limb ◽  
Elective Caesarean Section ◽  
Mode Of Delivery ◽  
Primiparous Woman ◽  
Limb Weakness ◽  
Femoral Neuropathy ◽  
Lower Limb Weakness ◽  
Spontaneous Labour

A 34-year-old primiparous woman presented in spontaneous labour and had an unassisted vaginal birth of a 3.5 kg infant. Postnatally, the patient experienced lower limb weakness and was unable to mobilise unassisted. A diagnosis of postpartum femoral neuropathy was made. Full recovery of normal motor function was not achieved until 5 months postpartum. She returned in her next pregnancy, seeking advice on how to avoid this complication from reoccurring. It was decided that an elective caesarean section was an appropriate mode of delivery, which she underwent at 39 weeks without complication and without recurrence of the femoral neuropathy.

Prediction of Spontaneous Preterm Delivery in Twin Pregnancies By Cervical Length at Mid-Gestation

2008 ◽  
Vol 11 (5) ◽  
pp. 552-557 ◽  
Author(s):  
Katharina Klein ◽  
Hubertus Gregor ◽  
Kora Hirtenlehner-Ferber ◽  
Maria Stammler-Safar ◽  
Armin Witt ◽  
...  
Keyword(s):  
Preterm Delivery ◽  
Smoking Habit ◽  
Cervical Length ◽  
Spontaneous Preterm Delivery ◽  
Spontaneous Labour ◽  
High Incidence ◽  
High Cervical ◽  
Twin Pregnancies ◽  
Preterm Rupture Of Membranes ◽  
Spontaneous Delivery

AbstractThe objective of our study was to evaluate the correlation of the cervical length at 20–25 weeks of gestation with the incidence of spontaneous preterm delivery in twins in a country with a high incidence of preterm delivery compared to other European countries. Cervical length was measured in 262 consecutive patients. Previous preterm delivery before 34 weeks of gestation, chorionicity, maternal age, body-mass-index, smoking habit and parity were recorded as risk factors for preterm delivery. Women who were symptomatic at 20–25 weeks and who delivered because of other reasons than spontaneous labour and preterm rupture of membranes or at term were excluded. The primary outcome was incidence of preterm birth before 34 weeks. Two hundred and twenty-three patients were analyzed. Thirty-two (14%) delivered before 34 weeks. There was a significant correlation between cervical length of less than 25 mm and spontaneous delivery before 34 weeks (50% vs. 13%,p= .007). In addition, logistic regression analysis found cervical length to be the only significant predictor of spontaneous delivery before 34 weeks (OR 1.084; 95% CI 1.015; 1.159;p= .017). We conclude that the risk of severe preterm delivery in twins is high. Cervical length at mid-gestation was the only predictor of delivery before 34 weeks.

scholarly journals Interinstitutional Variation of Caesarean Delivery Rates According to Indications in Selected Obstetric Populations: A Prospective Multicenter Study

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Gianpaolo Maso ◽  
Monica Piccoli ◽  
Marcella Montico ◽  
Lorenzo Monasta ◽  
Luca Ronfani ◽  
...  
Keyword(s):  
Caesarean Delivery ◽  
Relative Size ◽  
Group Classification ◽  
Prospective Multicenter Study ◽  
Nulliparous Women ◽  
Spontaneous Labour ◽  
Multiparous Women ◽  
Regional Centers ◽  
Spearman’S Correlation ◽  
Failure To Progress

The aim of the study was to identify which groups of women contribute to interinstitutional variation of caesarean delivery (CD) rates and which are the reasons for this variation. In this regard, 15,726 deliveries from 11 regional centers were evaluated using the 10-group classification system. Standardized indications for CD in each group were used. Spearman’s correlation coefficient was used to calculate (1) relationship between institutional CD rates and relative sizes/CD rates in each of the ten groups/centers; (2) correlation between institutional CD rates and indications for CD in each of the ten groups/centers. Overall CD rates correlated with both CD rates in spontaneous and induced labouring nulliparous women with a single cephalic pregnancy at term (P=0.005). Variation of CD rates was also dependent on relative size and CD rates in multiparous women with previous CD, single cephalic pregnancy at term (P<0.001). As for the indications, “cardiotocographic anomalies” and “failure to progress” in the group of nulliparous women in spontaneous labour and “one previous CD” in multiparous women previous CD correlated significantly with institutional CD rates (P=0.021,P=0.005, andP<0.001, resp.). These results supported the conclusion that only selected indications in specific obstetric groups accounted for interinstitutional variation of CD rates.

scholarly journals Spontaneous Rupture of the Anterior Vaginal Wall during the First Stage of Labour

2012 ◽  
Vol 2012 ◽  
pp. 1-2 ◽  
Author(s):  
Meleesa Joy Schultz ◽  
Triveni Nanda
Keyword(s):  
Uterine Rupture ◽  
Spontaneous Rupture ◽  
Rare Case ◽  
Caesarean Delivery ◽  
Vaginal Wall ◽  
Anterior Vaginal Wall ◽  
Multiparous Woman ◽  
Obstructed Labour ◽  
Trial Of Labor ◽  
Spontaneous Labour

The risk of uterine rupture during attempted trial of labor after caesarean delivery (TOLAC) is well documented. However, vaginal rupture (in the absence of obstructed labour) is exceptionally uncommon. Below is described the rare case of a 37-year-old multiparous woman attempting TOLAC, who suffered a vaginal—rather than uterine—rupture, during the first stage of spontaneous labour. This case is an important reminder to obstetricians that concealed ruptures of both the vagina and uterus do occur and must be considered in clinical situations where another explanation is not apparent.

Gestational tissue phospholipase A2 messenger RNA content and the onset of spontaneous labour in the human

1990 ◽  
Vol 2 (5) ◽  
pp. 575 ◽  
Author(s):  
MA Aitken ◽  
GE Rice ◽  
SP Brennecke
Keyword(s):  
Gene Expression ◽  
Phospholipase A2 ◽  
Messenger Rna ◽  
Elective Caesarean Section ◽  
Normal Vaginal Delivery ◽  
Spontaneous Labour ◽  
Human Labour ◽  
Gestational Tissues ◽  
Spontaneous Onset ◽  
Human Placentae

Considerable evidence supports a central role for prostaglandins in the genesis of uterine activity and cervical dilatation at the time of human labour. The first step in prostaglandin synthesis is the liberation of arachidonic acid from glycerophospholipids by phospholipase A2. In this study, we examined the periparturitional gene expression of PLA2 in human placentae and fetal membranes, using a cDNA clone for non-pancreatic PLA2. PLA2 gene expression was found to be significantly increased (P less than 0.05) in placentae obtained after spontaneous-onset labour and normal vaginal delivery as compared with placentae from elective Caesarean section. In both of these groups, PLA2 expression in amnion and chorion was significantly less than that in placenta. The results of this study suggest that placental PLA2 gene expression increases in association with spontaneous-onset of labour in the human. This conclusion is consistent with the finding of increased levels of prostaglandins in gestational tissues, amniotic fluid and blood plasma at the time of labour.

scholarly journals Temporal trends in neonatal mortality and morbidity following spontaneous and clinician-initiated preterm birth in Washington State, USA: a population-based study

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e023004 ◽  
Author(s):  
Lindsay L Richter ◽  
Joseph Ting ◽  
Giulia M Muraca ◽  
Anne Synnes ◽  
Kenneth I Lim ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Preterm Infants ◽  
Temporal Trends ◽  
Population Based ◽  
Washington State ◽  
Late Preterm ◽  
Population Based Study ◽  
Mortality And Morbidity ◽  
Late Preterm Infants ◽  
Spontaneous Labour

ObjectiveAfter a decade of increase, the preterm birth (PTB) rate has declined in the USA since 2006, with the largest decline at late preterm (34–36 weeks). We described concomitant changes in gestational age-specific rates of neonatal mortality and morbidity following spontaneous and clinician-initiated PTB among singleton infants.Design, setting and participantsThis retrospective population-based study included 754 763 singleton births in Washington State, USA, 2004–2013, using data from birth certificates and hospitalisation records. PTB subtypes included preterm premature rupture of membranes (PPROM), spontaneous onset of labour and clinician-initiated delivery.Outcome measuresThe primary outcomes were neonatal mortality and a composite outcome including death or severe neonatal morbidity. Temporal trends in the outcomes and individual morbidities were assessed by PTB subtype. Logistic regression yielded adjusted odds ratios (AOR) per 1 year change in outcome and 95% CI.ResultsThe rate of PTB following PPROM and spontaneous labour declined, while clinician-initiated PTB increased (all p<0.01). Overall neonatal mortality remained unchanged (1.3%; AOR 0.99, CI 0.95 to 1.02), though gestational age-specific mortality following clinician-initiated PTB declined at 32–33 weeks (AOR 0.85, CI 0.74 to 0.97) and increased at 34–36 weeks (AOR 1.10, CI 1.01 to 1.20). The overall rate of the composite outcome increased (from 7.9% to 11.9%; AOR 1.06, CI 1.05 to 1.08). Among late preterm infants, combined mortality or severe morbidity increased following PPROM (AOR 1.13, CI 1.08 to 1.18), spontaneous labour (AOR 1.09, CI 1.06 to 1.13) and clinician-initiated delivery (AOR 1.10, CI 1.07 to 1.13). Neonatal sepsis rates increased among all preterm infants (AOR 1.09, CI 1.08 to 1.11).ConclusionsTiming of obstetric interventions is associated with infant health outcomes at preterm. The temporal decline in late PTB among singleton infants was associated with increased mortality among late preterm infants born following clinician-initiated delivery and increased combined mortality or severe morbidity among all late preterm infants, mainly due to increased rate of sepsis.

scholarly journals Metabolite Changes in Maternal and Fetal Plasma Following Spontaneous Labour at Term in Humans Using Untargeted Metabolomics Analysis: A Pilot Study

2019 ◽  
Vol 16 (9) ◽  
pp. 1527 ◽  
Author(s):  
Katherine A. Birchenall ◽  
Gavin I. Welsh ◽  
Andrés López Bernal
Keyword(s):  
High Performance ◽  
Elective Caesarean Section ◽  
Maternal Plasma ◽  
Plasma Metabolites ◽  
Fetal Plasma ◽  
Causal Pathways ◽  
Spontaneous Labour ◽  
Liquid Chromatography Tandem Mass ◽  
Comprehensive Picture ◽  
Physiological Demands

The mechanism of human labour remains poorly understood, limiting our ability to manage complications of parturition such as preterm labour and induction of labour. In this study we have investigated the effect of labour on plasma metabolites immediately following delivery, comparing cord and maternal plasma taken from women who laboured spontaneously and delivered vaginally with women who were delivered via elective caesarean section and did not labour. Samples were analysed using ultra high-performance liquid chromatography-tandem mass spectrometry. Welch’s two-sample t-test was used to identify any significant differences. Of 826 metabolites measured, 26.9% (222/826) were significantly altered in maternal plasma and 21.1% (174/826) in cord plasma. Labour involves changes in many maternal organs and poses acute metabolic demands in the uterus and in the fetus and these are reflected in our results. While a proportion of these differences are likely to be secondary to the physiological demands of labour itself, these results present a comprehensive picture of the metabolome in the maternal and fetal circulations at the time of delivery and can be used to guide future studies. We discuss potential causal pathways for labour including endocannabinoids, ceramides, sphingolipids and steroids. Further work is necessary to confirm the specific pathways involved in the spontaneous onset of labour.

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