Predicting success of labor induction in singleton term pregnancies by combining maternal and ultrasound variables.

OBJECTIVE: To assess pre-induction maternal and ultrasonographic factors in the prediction of the onset of labor within 12 h, and vaginal delivery (VD) irrespective of the induction-to-delivery interval in term pregnancies. METHODS: We performed a prospective cohort study with 204 singleton pregnant women between 37 and 42 weeks of gestation. The following maternal and ultrasonographic variables were assessed: parity, marital status, height, body mass index (BMI), previous cesarean section (Cs), Bishop score, variety of fetal position, single deepest pocket (SDP), fetal middle cerebral and umbilical artery resistance indices, cervical length (CL) measurement, posterior cervical angle (PCA), head circumference (HC) and estimated fetal weight (EFW). χ(2) test and logistic regression analysis were applied to compare the groups. Receiver operating characteristics (ROC) curves were determined. RESULTS: VD occurred in 116 (56.9%) women. Prediction of the onset of labor within 12 h was provided by the BMI and resistance index of the fetal middle cerebral artery. Prediction of the VD irrespective of the induction-to-delivery interval was provided by height, BMI, parity, number of prenatal visits, consistency, effacement and dilation of uterine cervix, PCA, oligohydramnios, HC and EFW. Area under ROC curve for PCA and EFW were 63.5 (sensibility: 66.4%, specificity: 59.1%) and 60.2 (sensibility: 54.3%, specificity: 70.4%), respectively. CONCLUSIONS: Several pre-induction maternal and ultrasonographic factors can increase the chance of achieving a successful VD. PCA and EFW were the best ultrasonographic predictors for the success of induction of labor; however, with limited potential to be used in the clinical practice.

[Early analgesia does not block labor in first pregnancies]. / La aplicación temprana de analgesia no detiene el trabajo de parto en mujeres primigestas.

Pain during labor alters the well-being of the mother and fetus. Peridural analgesia may prevent pain, but some physicians prefer to administrate this until labor has progressed in order to avoid blocking labor so a cesarean surgery would be required. In this case, the mother suffers pain until labor has progressed enough to apply analgesia. Thus, the mother suffers pain while labor has progressed enough. Cesarean surgery increases maternal morbidity, thus it is important to evaluate labor progression when analgesia is applied at an early or advanced stage of labor. This study evaluated the effect of early analgesia on labor progression. First pregnancies at a latent or active stage of labor were included. Ropivacaine peridural analgesia was applied. All the patients completed labor (latent labor: final dilation 10 cm (10-10 cm); active labor: final dilation 10 cm (10-10 cm); p = 0.812). The proportion of patients undergoing cesarean surgery was not different between the groups (four in latent labor (7%), eight in active labor (12%); p = 0.545). Our results suggest that early analgesia may be applied without compromising labor progression.

Early intensive obstetric and medical nutrition care is associated with decreased prepregnancy obesity impact on perinatal outcomes.

BACKGROUND/AIMS: To compare the gestational weight gain and adverse perinatal outcomes in urban Mexican women with prepregnancy overweight or obesity, under an early intensive obstetric and nutrition program versus women with prepregnancy normal weight. METHODS: A cohort of 546 pregnant women with prepregnancy normal weight (n = 201, NW), overweight (n = 171, OW) or obesity (n = 174, OB), ≤13 weeks of gestation and a singleton pregnancy. OW and OB groups were under early intensive obstetric and nutritional care and NW group was under routine prenatal care. Miscarriage, hypertensive disorders, premature rupture of membranes, preterm birth, stillbirth, gestational diabetes mellitus (GDM) and large- or small-for-gestational-age newborns, were compared between groups. RESULTS: Weight gain was smaller in OB than in OW or NW (mean ± SD): 6.1 ± 4.4, 9.5 ± 5.1, 10.3 ± 5.4 kg, respectively (p < 0.001). OB women had the highest frequency of GDM (p < 0.001), lack of spontaneous labor (p < 0.001) and preeclampsia (p < 0.001), but no other between-group differences existed. CONCLUSION: Early intensive medical-nutrition prenatal care and adequate gestational weight gain may contribute to decreasing most maternal and newborn adverse outcomes associated with prepregnancy overweight or obesity.

[Evidence that periplacentary leukocytes subpopulations of term pregnancy have functional properties associated with labor induction]. / Evidencia de que las subpoblaciones de leucocitos periplacentarios al término de la gestación poseen propiedades funcionales relacionadas con la inducción del trabajo de parto.

BACKGROUND: The rise of cholagenolitic activity in fetal membranes, associated to premature rupture, have been related to abnormal activity of the extracellular matrix metalloproteinases discharged to the extracellular space as inactive enzymes that have to be activated to selectively degrade its components. OBJECTIVE: To analyze the functional properties of leukocytes subpopulations coming from the placental circulation. MATERIAL AND METHODS: Biomedical experimental study in which placental and outlying blood leukocytes were cultivated during 96 hours, from women with pregnancy to term without labor. Leukocytes subpopulations were stained by flow cytometry. Culture media were analyzed with zymography and enzymatic activity profile was evaluated in presence of proteases inhibitors. RESULTS: Placental leukocytes are composed of T-, NK- and B-lymphocytes, and monocytes; it was documented a progressive increase of inactive MMP-9 secretion (92 kDa), accompanied by an 82 kDa form MMP-9 activation since 48 hours. Enzymatic profile mainly showed metalloproteasas. CONCLUSIONS: Placental blood leukocytes showed functional capacities different from those that circulate in pregnant women's outlying circulation. Placental leukocytes, mainly T-lymphocytes, are characterized by the specific capacity to secrete and activate MMP-9; an enzyme that participates in fetal membranes degradation. It suggests that in placental surroundings are recruited cells specialized in labor changes induction.

Conhecimento de gestantes acerca dos sinais e sintomas do início do trabalho de parto / Expectant mothers' knowledge of the signs and symptoms of the onset of labor

Este trabalho tem como finalidade identificar o conhecimento das gestante acerca dos sinais e sintomas do início do trabalho de parto. Foi realizado em uma maternidade do município de Ribeirão Preto, onde a população assistida, gestantes de baixo risco, é dependente do Sistema Único de Saúde (SUS), em 2001. Para identificar o conhecimento da gestante, foi aplicado um formulário (perguntas abertas e check-list), o qual foi respondido por 30 gestantes de acordo com o seu conhecimento na primeira consulta pré-natal na referida maternidade, na segunda consulta subseqüente e na admissão para resolução da gravidez. Os resultados mostraram que a maioria das gestantes, apesar de conhecer os sinais de início de trabalho de parto, fica ansiosa e, muitas vezes, adianta a ida à maternidade

Ruptura prematura de membranas en embarazos de término o cercano a término (Dos enfoques terapéuticos) / Premature rupture of membrans in pregnancies the end or near the end (two therapeutic focusing)

Se realiza un estudio prospectivo analítico cuali-cuantitativo en la Maternidad del Hopital San Juan de Dios en San José, Costa Rica, en mujeres con embarazos entre 36 y 42 semanas de gestación y con RPM. El estudio tiene como objeto determinar cual abordaje es mejor para el pronóstico del binomio feto madre. Los abordajes utilizados que se analizan comparativamente son: tratamiento intervencionista (inducción inmediata conoxitocina) y Tratamiento conservador (periodo de latencia de hasta 36 horas para que haya inicio de labor espontánea, e inducción con oxitocina si esto no sucede). Se establecen datos comparativos para tiempo de labor, tipo de parto, signos de infección y condición del neonato al nacer. Se concluye que el tiempo de labor es más corto con el método conservador, pero no traduce beneficio real. Hay más partos espontáneos con este método, pero tampoco traduce beneficio real. El costo del tratamiento, asi como el riesgo de infección y el uso de antibióticos (costo), es más alto. Por tanto se recomienda que el tratamiento a utilizar sea el intervencionista, que si bien tiene mayor tiempo de labor de parto, tiene menor estancia hospitalaria, menor uso de antibióticos, menos riesgo de infección materna y similar condición del neonato y materna después del parto

Estudo multicêntrico para construçäo de curvas de dilataçäo cervical em funçäo do tempo, em gestantes brasileiras / A multicentric study to create a partograph model in brazilian pregnancy women

Um estudo prospectivo foi realizado em nove hospitais Públicos localizados em distintas regioes brasileiras com o objetivo de construir uma curva de partograma da mulher brasileira. A populaçao incluiu 1382 parturientes de baixo risco que foram internadas em trabalho de parto com dilataçao de colo uterino igual ou inferior a 4cm. Os caracteres epidemiológicos, resultados perinatais e evoluçao do trabalho de parto sao apresentados e discutidos. Foram construídos dois padroes de curvas de partograma nao muito distintos dos já descritos para outros países.

Partograma con curvas de alerta en pacientes del cono sur de Lima / Partograph with alert linen in pregnancy patients of Lima

Durante los años 1991 y 1992, en el "Hospital María Auxiliadora" se escogió 1500 parturientas, de las cuales 587 fueron nuliparas y 913 multiparas. A todas se les aplicó los siguientes criterios: cronologia del embarazo entre 37 y 41 semanas, ausencia de patología, parto de inicio y evolución espontanea, no medicación durante el parto, pelvis normal, presentación cefálica y recien nacido de 2500 a 4000 gramos con score de Apgar mayor de 6 al nacer. Despues de aplicar estos criterios, reunimos finalmente 317 nuliparas (209 con membranas integras y 108 con membranas rotas) y 306 multiparas (231 con membranas integras y 75 con membranas rotas). Todas las pacientes estuvieron en decubito durante el trabajo de parto y fueron controladas en el centro obstetrico utilizando el partograma diseñado por el CLAP y cuidando de hacer los registros gráficos a partir de los 4 a 5 cms de dilatación cervical en adelante. Los datos de dilatación del cuello uterino en relación al tiempo fueron procesados en computadoras y se calculo el percentil 10, o sea el tiempo máximo aceptable que demora la dilatación cervical de centimetro a centimetro hasta el periodo expulsivo, y con ellos se construyo las curvas de alerta para cada uno de los cuatros subgrupos. La pendiente seguida en el proceso de dilatación del cuello uterino es la misma en nuestras parturientas que las reportadas por el CLAP, pero los tiempos estan recostados un poco hacia la derecha, particularmente en el subgrupo de nuliparas con membranas integras