Outcomes of Nulliparous Women With Spontaneous Labor Onset Admitted to Hospitals in Preactive Versus Active Labor

Background The purpose of this investigation was to determine if epidural analgesia, established during active phase labor, results in elimination or reversal of fundal dominance (lower uterine segment pressure equal to or greater than fundal pressure). Methods Upper and lower uterine segment intrauterine pressures were prospectively evaluated for 50 min before and 50 min after epidural analgesia using 0.25% bupivacaine in 11 nulliparous women in spontaneous active labor. A total of 958 contractions were evaluated. Results No significant differences were found in the number of contractions in the interval before epidural analgesia compared to after epidural analgesia. Significantly greater pressure readings were recorded in the upper segment than in the lower segment (consistent with fundal dominance) both before and after epidural analgesia (P<0.01). In addition, fundal dominance increased after epidural analgesia when compared to the preanalgesia period (P<0.01). Conclusions Fundal dominance is present both before and after active phase epidural analgesia and is increased during the immediate 50-min postanalgesia period.

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Risk of cesarean delivery in ongoing pregnancies of nulliparous women after 37 weeks of gestation: a prospective cohort study

10.22541/au.163253033.36490819/v1 ◽

2021 ◽

Author(s):

Thibaud Quibel ◽

Camille Bouyer ◽

Patrick Rozenberg ◽

Jean Bouyer

Keyword(s):

Cohort Study ◽

Regression Models ◽

Outcome Measure ◽

Population Based ◽

Maternal Characteristics ◽

Nulliparous Women ◽

Perinatal Network ◽

Gestational Week ◽

Labor Onset ◽

Caesarean Delivery Rate

Objective: To study the risk of CD for each gestational week among ongoing pregnancies of nulliparous women at term. Design: A retrospective, population-based cohort study from January 1, 2016, through December 31, 2017 Setting: a French perinatal network of the Yvelines district, France Population: 11 308 nulliparous women with a singleton fetus in a cephalic presentation and delivered at term (≥37-week +0 day) Methods: for each week of gestation at term, we defined ongoing pregnancies as all pregnancies undelivered at the start of each week. Regression models adjusted by maternal characteristics and hospital status were used to compare the CD risk between ongoing pregnancies and the pregnancies delivered the preceding week. The same methods were applied to subgroups defined by the mode of labor onset. Main outcome measure: The caesarean delivery rate (CD) Results: Ongoing pregnancies > 40 weeks+0 days were associated with a higher risk of CD compared with pregnancies delivered the previous week: 24.3% in ongoing pregnancies ≥ 40 weeks +0 days versus 19.9% in deliveries between 39 weeks +0 days and 39 weeks+6 days (Odd ratio adjusted of 1.28, 95%CI [1.15-1.44]; 30.4% in ongoing pregnancies ≥ 41 weeks +0 days versus 19.6% in deliveries between 40 weeks +0 days and 40 weeks+6 days (OR 1.73, 95%CI [1.51-1.96]). This was also shown for all modes of labor onset and in every maternity unit. Conclusions: CD rates increased starting at 40 weeks +0 days in ongoing pregnancies, regardless of the mode of labor onset.

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Incidence and outcomes of dystocia in the active phase of labor in term nulliparous women with spontaneous labor onset

Acta Obstetricia Et Gynecologica Scandinavica ◽

10.1080/00016340902811001 ◽

2009 ◽

Vol 88 (4) ◽

pp. 402-407 ◽

Cited By ~ 62

Author(s):

Hanne Kjærgaard ◽

Jørn Olsen ◽

Bent Ottesen ◽

Anna-Karin Dykes

Keyword(s):

Active Phase ◽

Nulliparous Women ◽

Labor Onset

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What is the Slowest-Yet-Normal Cervical Dilation Rate Among Nulliparous Women With Spontaneous Labor Onset?

Journal of Obstetric Gynecologic & Neonatal Nursing ◽

10.1111/j.1552-6909.2010.01154.x ◽

2010 ◽

Vol 39 (4) ◽

pp. 361-369 ◽

Cited By ~ 43

Author(s):

Jeremy L. Neal ◽

Nancy K. Lowe ◽

Thelma E. Patrick ◽

Lori A. Cabbage ◽

Elizabeth J. Corwin

Keyword(s):

Cervical Dilation ◽

Nulliparous Women ◽

Labor Onset ◽

Dilation Rate

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Impact of Peanut Ball Device on the Duration of Active Labor: A Randomized Control Trial

American Journal of Perinatology ◽

10.1055/s-0038-1636531 ◽

2018 ◽

Vol 35 (10) ◽

pp. 1006-1011 ◽

Cited By ~ 4

Author(s):

Mei Kwan ◽

Rebecca Mercier

Keyword(s):

Cesarean Delivery ◽

Statistical Significance ◽

Active Phase ◽

Cervical Dilation ◽

Nulliparous Women ◽

Significant Difference ◽

Active Labor ◽

English Speaking ◽

Randomized Control ◽

Singleton Pregnancies

Objective To evaluate whether the use of a peanut ball device shortens the duration of active labor in nulliparas. Study Design Single-site, nonblinded randomized trial in nulliparous women admitted for labor or labor induction. English-speaking women > 18 years of age with singleton pregnancies were enrolled. Participants were randomized to the use of peanut ball or usual care upon reaching the active phase of labor (≥ 6 cm cervical dilation) with an epidural. Primary outcome was rate of cervical dilation. Secondary outcomes were rates of cesarean delivery and fetal presentation at time of full dilation or delivery. Results Ninety-six patients enrolled; 63 reached full cervical dilation. There was no statistically significant difference in rates of cervical dilation (0.98cm/h vs. 0.79cm/h, p = 0.27) or length of labor (315 minutes vs. 387 minutes, p = 0.14) between the groups. There was no difference in the rates of cesarean delivery (33% vs. 35%, p = 0.8) or occiput posterior presentation. (28% vs. 9%, p = 0.09). Among the subgroup who had labor arrest, fewer patients using the peanut ball experienced arrest of dilation; this approached but did not reach statistical significance (30% vs. 73% p = 0.05). Conclusion Use of the peanut ball does not significantly increase rates of cervical dilation or decrease time in active labor.

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Prediction of Duration of Active Labor in Nulliparous Women at Term

American Journal of Perinatology ◽

10.1055/s-2007-1004827 ◽

2008 ◽

Vol 25 (2) ◽

pp. 085-089 ◽

Cited By ~ 7

Author(s):

Maddalena Incerti ◽

Anna Locatelli ◽

Alessandro Ghidini ◽

Elena Ciriello ◽

Silvia Malberti ◽

...

Keyword(s):

Nulliparous Women ◽

Active Labor

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Efficacy and safety of Misoprostol vaginal insert to induce labor beyond 40 + 0 weeks of gestation

10.21203/rs.3.rs-70051/v1 ◽

2020 ◽

Author(s):

Catharina Krause ◽

Christian Rudlowski ◽

Melanie Erices-Leclercq ◽

David Tenckhoff ◽

Sabine Lubig

Keyword(s):

Mode Of Delivery ◽

Fetal Distress ◽

Fetal Outcome ◽

Prostaglandin E ◽

Delivery Time ◽

Single Centre ◽

Blood Ph ◽

Nulliparous Women ◽

Active Labor ◽

Multiparous Women

Abstract IntroductionOne of the most common reasons for inducing labor are pregnancies beyond 40 + 0 weeks. Prostaglandins have been proven to induce labor whilst not increasing the rate of caesarean delivery. As a vaginal insert Misoprostol was available in Germany from 2014 to 2019. Studies show that Misoprostol vaginal insert (MVI) reduces induction to delivery time as well as active labor time. But it is also known to increase uterine tachysystole. This study aimed to clarify whether MVI is safe and efficient for women with pregnancies past 40 + 0 to 42 + 0 weeks since there is a lack of studies focussing on this particular group of women.MethodsThis single centre prospective cohort study was performed between December 2014 and September 2019 at a tertiary academic centre at the Presbyterian Hospital Bergisch Gladbach, Germany. A total of 304 women between 40 + 0 to 42 + 0 weeks of gestation have been induced to labor with MVI. MVI was placed in the posterior vaginal fornix to release to release 200 μg synthetic prostaglandin E1 in a controlled manner. Time from insertion of MVI to delivery was documented for each patient. In addition, we recorded all kinds of intervention, CTG alterations and fetal outcome. We recorded mode of delivery, the need of epidural anaesthesia as well as the rate of tocolysis to treat signs of fetal distress due to pathological heart rates. And thirdly we had an interest in fetal outcome reflected by cord blood pH-levels or admission to a neonatal clinic.Results75.7 % (n = 230) of women gave birth within 24 hours which means time from insertion to delivery. After MVI insertion 72.2 % (n = 140) nulliparous women and 81.8 % (n = 90) multiparous women gave birth within 24 hours. Subgroup analyses revealed that within 24 hours after removal of MVI 259 women out of 304 (85.2 %) delivered their babies. 67.8 % (n = 206) of women induced with MVI delivered vaginal. ConclusionMVI is an efficient and safe method to induce labor for women with pregnancies beyond 40 + 0 weeks. ISRCTN No. 14702259 date of registration: 21.08.2020URL: http://www.isrctn.com/ISRCTN14702259

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