Sexuality in pregnancy and premature labour

The relation of sexual behaviour during pregnancy to the initiation of labour was investigated in 358 patients of whom 58 were delivered after premature labour and 300 were delivered spontaneously at term. In all patients the mean weekly coital frequency and the frequency of orgasm were investigated by means of a retrospective questionnaire. There was no significant difference in coital or orgasmic frequency between the women who had a premature labour and those who had a spontaneous delivery at term. This was also true when those having premature labour were divided into those starting labour with ruptured membranes and those starting with contractions.     

Outcome of the second labour in patients whose first labour was prolonged: the Dublin experience.

This observational study examined the outcome of the second delivery in patients whose first labour was prolonged. The onset of labour was defined as that time when the diagnosis of labour was made on admission to the delivery unit. The first labour was defined as prolonged when delivery occurred more than 12 h later. The study was confined to those patients (n = 66) who had a prolonged first labour with a single, live fetus and cephalic presentation during 1984-1987 and who had a subsequent labour. Sixty-one of the 66 patients (92%) delivered vaginally, and 5 were delivered by emergency caesarean section. Forty-six (70%) delivered within 6 h of admission. Although all 66 had received oxytocin in their first labour, only 8 (12%) required oxytocin in their second labour. Fourteen (82.4%) of the 17 patients with a previous caesarean section had a vaginal delivery. These results indicate that compared to the first labour the duration of the second labour and the oxytocin requirements in the second labour were significantly reduced. These findings are reassuring for patients who have had a long difficult first labour.     

Pregnancy outcome in medically complicated and uncomplicated patients aged 40 years or older

Patients (183) who were delivered at age greater than or equal to 40 years were studied to ascertain the nature and frequency of maternal and fetal complications at a single institution in a recent time period. These patients were further grouped into those of low parity, those who began pregnancy without underlying disease, and those who began pregnancy with underlying medical disorders. For the entire group preeclampsia, premature labor, precipitate labor, and malpresentation were significantly more common. The rate of vaginal delivery was substantially decreased, and serious postpartum morbidity was relatively common. The incidence of stillbirth, perinatal mortality, and abnormal birth weight was significantly increased. There were some differences in the nature and frequency of complications encountered among the subgroups, but no subgroup had a complication rate comparable to our general obstetric population.     

Myometrial oxytocin receptor mRNA concentrations at preterm and term delivery – the influence of external oxytocin

The hormonal system for induction of term and preterm labour is not fully understood. Therefore, we investigated myometrial gene expressions for neurohypophyseal hormones and their receptors, prostaglandin F_2α and ovarian steroid receptors in women delivered by Caesarean section. Myometrial tissue for real time PCR was collected from 39 women delivered at term before and after the onset of labour and preterm. Women delivered electively at term had significantly higher oxytocin receptor mRNA expressions (2.52 ± 0.37 oxytocin receptor/actin; median ± SEM) than those delivered with ongoing labour at term (1.01 ± 0.34; p = 0.015) and those at preterm (1.08 ± 0.25; p = 0.004). Sub-analyses revealed that the difference at term pregnancies solely was related to patients receiving oxytocin during labour (p = 0.007). These patients had higher oxytocin peptide mRNA levels than those without labour at term (p = 0.009). PGF_2α receptor mRNA concentrations were 27.80 ± 3.55, 11.46 ± 2.87 and 19.54 ± 5.52 PGF receptor/actin, respectively, for the groups. Women without labour at term had higher concentration than those with labour (p = 0.005). Our results suggest that oxytocin, its receptor and the PGF_2α receptor are involved in the regulation of labour through a paracrine mechanism.     

Catecholamine abnormalities in transient tachypnoea of the premature newborn.

The aim of the present study was to assess if there was an association between low catecholamine levels at birth in the premature infant and the development of TTN. Blood samples were collected at delivery from the umbilical artery of all preterm infants with a gestational age less than 36 weeks for determination of pH and catecholamine levels (noradrenaline and adrenaline). Amongst non-asphyxiated infants only, cord pH greater than 7.25 and/or Apgar score greater than 7 at five minutes, catecholamine levels were compared between the 10 infants who developed transient tachypnoea of the newborn (TTN) and 13 controls of a similar gestational age range (31-35 weeks) who developed no respiratory distress in the neonatal period. Infants who developed TTN were more often delivered without labour, 8 of 10 compared to 2 of 13 controls (p less than 0.01). There were no significant differences in adrenaline levels between the two groups. Noradrenaline levels, however, were significantly lower in the infants who developed TTN, being a median of 3.1 nmol/l (range 1.07-5.85 nmol/l) compared to a median of 6.4 nmol/l (range 2.38-22.83) in the controls (p less than 0.01). Infants who were delivered following labour had significantly elevated noradrenaline levels compared those delivered without labour (elective delivery) (p less than 0.05). These results suggest that low noradrenaline levels in preterm infants may explain the association in this group of TTN and "elective" delivery.     

Relationships of vaginal Lactobacillus species, cervical Chlamydia trachomatis, and bacterial vaginosis to preterm birth

The frequency of genital infection was compared among women in premature labor who delivered preterm (before 37 weeks), women in preterm labor who delivered at term, and control women who delivered at term. Both groups of women in premature labor were younger and had more previous preterm births than did control women. Women in premature labor who delivered preterm were more likely to experience rupture of membranes, intrapartum fever, and postpartum fever than were control women. The presence of bacterial vaginosis (odds ratio 2.3) and Chlamydia trachomatis (odds ratio 3.9) was positively associated, and Lactobacillus sp (odds ratio 0.2) was negatively associated, with birth before 37 weeks, using multivariable analysis to control for confounding variables.     

Coital rates,age and method of contraception: results of a BJSM pilot questionnaire survey

A study was undertaken to determine whether differences in coital rates exist among the users of different contraceptive methods. Data about the frequency of intercourse, age of respondent, and method of contraception were collected from a questionnaire and included in the December 1983 edition of the "British Journal of Sexual Medicine." Analysis of variance was used to analyze the data, and a Box Cox plot revealed that the square root transformation was the most appropriate. The following contrasts were considered: oral contraception (OC) and IUD versus sheath; OC, IUD, sheath, and diaphragm versus female sterilization and vasectomy; OC versus diaphragm; and sheath versus diaphragm. The age of the female partner was used in the statistical model to assess whether the differences in coital frequency between the 2 elements in the contrasts depended on age. There was no interaction between any of the contrasts and age at the 5% level. This means that the difference between the individual elements of a contrast does not depend on the age of the female partner. Paired age of female and coital frequency data were available for 435 respondents. The frequency decreased with increasing age. The reported frequency of coitus ranged from less than once a month to 37 times a month. There was a significant decrease in the coital rate as the age of the female partner increased at the 0.1% level. When the contrasts were considered, there was a significant difference in coital frequency between the OC and IUD group and the sheath group and between the sheath and diaphragm group, but there was no difference between the OC and diaphragm group. There also was no significant difference in coital frequency among the OC, IUD, sheath, and diaphragm groups and female sterilization and vasectomy group. The study results confirm a significant decreasing relationship between frequency of intercourse and the age of the female partner. Duration of marriage has been shown to be a more important factor in determining coital rates than the age of either spouse, but this was not inquired about in this study. Respondents who used the sheath had a lower mean coital rate than those who used OC, IUD, or the diaphragm.     

The role of vaginal apex excision in the management of persistent posthysterectomy dyspareunia

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of vaginal apex excision in the treatment of patients with posthysterectomy dyspareunia. STUDY DESIGN: This was a case series with an independent third-party survey of patients with posthysterectomy dyspareunia managed at the University of Utah Pelvic Pain Clinic. Thirteen patients were first treated with local injections of anesthetics into localized vaginal pain foci. Further evaluation included formal psychometric testing and a diagnostic spinal block. Nine patients underwent surgical excision of the vaginal apex. An independent interviewer who did not know the patients assessed the effects of this procedure on dyspareunia and coital frequency at a mean of 36.4 +/- 3.7 months after the operation. RESULTS: The mean coital verbal analog pain score (1-10 scale) decreased from 9.22 +/- 0.27 before excision of the vaginal apex to 3.11 +/- 0.84 after the operation (P <.001), and coital frequency improved from 5.22 +/- 2.02 episodes per month before surgery to 11.11 +/- 1.82 episodes per month after surgery (P =.02). Of the 9 patients, 5 essentially had the dyspareunia cured. Dyspareunia was decreased and coital frequency was markedly increased in all but 1 of the other 4 cases. CONCLUSION: Excision of the vaginal apex is an effective treatment for carefully selected patients with posthysterectomy dyspareunia.     

Predictive Oestradiol Surge of Premature Labour and its Suppression by Glucocorticoids

Summary: Plasma oestradiol-17β and plasma progesterone levels in premature labour have been compared with those measured serially in 33 primigravidae during normal pregnancy and labour. In 31 of the 38 patients in progressive premature labour, the plasma oestradiol level was 2 S.D. or more above the mean for control patients of similar gestational age and was similar to those patients during labour at term. Levels of plasma progesterone in patients in the premature labour group tended to be below the mean for gestation, although still within the normal range. In 12 patients studied serially, oestradiol levels rose dramatically, high values being detected 9.6 ± 5.2 days preceding parturition; progesterone levels gave no consistent trend. Progressive uterine activity in preterm labour and term labour seems to be associated with a progesterone to oestradiol ratio of 6:1. The steroid profiles of 2 patients in premature labour were studied before and after the administration of betamethasone. Both the premature labour and the elevated plasma oestradiol levels were suppressed by the therapy.     

Obstetric uterine rupture: a four-year clinical analysis.

OBJECTIVE: The purpose of our study was to identify the risk factors of uterine rupture during labour, to report maternal and neonatal outcome, and to propose preventive measures. STUDY DESIGN: A retrospective study with review of patients' files and monitor strips was performed. RESULTS: Between January 1, 1994 and November 30, 1998, there were 21 cases of uterine rupture at our institution. Of these, 6 patients had complete rupture, and 15 had incomplete rupture. The risk of uterine rupture was increased in patients who had a history of one or more Caesarean sections, obstructed labour, dysfunctional labour, and those who had injudicious use of uterine stimulants. There was no maternal death and fetal loss was 7 (33.3%). CONCLUSIONS: The high incidence of uterine rupture is attributed to lack of prenatal care, labour in high-risk patients outside hospital because of declining economy, and more patients with two or more previously scarred uterus. The maternal and neonatal complications have remained very high in the developing countries. We recommend that all patients with a history of Caesarean delivery should be delivered in hospital and observed closely for progression of labour, recognition of an active phase arrest requires operative delivery.     

Expansion of intravascular volume and fetal outcome in patients with chronic hypertension and pregnancy.

Measurements of blood volume were carried out between 24 and 40 weeks of gestation in 20 multiparous patients with chronic hypertension and pregnancy. Hypertensive patients had both reduced blood volume and infants of smaller weight (p less than 0.01) than nonhypertensive control subjects. There was a significant difference (p less than 0.01) in the degree of blood volume expansion in hypertensive mothers who were delivered of infants who were adequate for gestational age (AGA), term, or premature, compared to those who were delivered of infants who were small for gestational age (SGA) or stillborn. Classification of chronic hypertension during pregnancy according to the American Committee on Maternal Welfare classification or according to severity of the hypertension was of no value in identifying the mothers at risk of delivering intrauterine growth-retarded infants. However, failure in achieving a blood volume expansion of at least 60 c.c. per kilogram clearly identified those pregnancies leading to growth retardation and fetal death. The decrease or lack of intravascular volume expansion was reflected in the presence of creatinine clearance values at nonpregnant levels in the mothers who were delivered of SGA infants and in a significant reduction below the nonpregnant levels in those who were delivered of stillborn infants. These data suggest that measurement of blood volume and endogenous creatinine clearance in patients with chronic hypertension and pregnancy is a useful parameter in the identification of those patients who will have a poor fetal outcome.     

Symptoms and Signs with Scar Rupture - Value of Uterine Activity Measurements

To evaluate the symptoms and signs of scar rupture with special reference to intrauterine pressure measurement a retrospective analysis of labour records of those women who had trial of labour with a previous Caesarean scar in the National University Hospital over a period of 6 years (1985-1990) was carried out. Known symptoms and signs associated with scar rupture, cardiotocographic tracings and fetal and maternal outcome in these patients were studied. Of the 1,018 women with previous Caesarean scar (4.2% of our pregnant population at term) 722 (70.9%) had trial of labour; 70% delivered vaginally. There were 4 (0.55%) incomplete and 5 (0.69%) complete scar ruptures. All 9 women had an oxytocin infusion; 3 were diagnosed postdelivery (all 3 had complete ruptures); 3 of the 6 who had rupture prior to delivery had sudden reduction in uterine activity, 1 had scar pain and prolonged bradycardia and 2 had no symptoms or signs. Continuous cardiotocography with intrauterine pressure measurements may help to identify scar rupture early and may be of value especially in those who have an oxytocin infusion.     

Sexual adjustment to tubal sterilization

Sexual adjustment after laparoscopic sterilization has been investigated in a Danish population. The study comprises 659 patients who underwent laparoscopic sterilization during the 4-year period 1980-1983. The study focused on libido, coital frequency, coital enjoyment, lack of excitement, sexual life and feelings of femininity after sterilization in one group of patients satisfied with the sterilization and in another group dissatisfied with the decision to undergo tubal sterilization. There was no difference in libido, coital frequency and sexual satisfaction between the two groups. However, a significant difference was seen between the two groups concerning lack of excitement in sexual life, perception of a more relaxed sexual life, and, finally, perception of changed femininity.     

Determinants of pain perception in labour among parturients at the University College Hospital, Ibadan.

This cross-sectional study of one thousand parturients aims to evaluate the factors, which are associated with pain perception in labour and to identify women who will benefit most from analgesia in labour. The instrument applied was a structured questionnaire incorporating the Box numerical scale (BNS) for pain assessment. Patients who delivered by elective or emergency caesarean section and women who did not give informed consent were excluded from the study. Spearman's and Pearson's correlational analyses were applied. Pain scores showed significant correlation with age (r=- 0.087, p<0.01), parity (r=- 0.226, p<0.01), gestational age at delivery (r=- 0.074, p<0.05), onset of labour (rho=0.195, p<0.01), mode of delivery (rho=0.160, p<0.01), booking status (rho=- 0.070, p<0.05) and educational status (rho=0.182, p<0.01). Certain groups of patients would benefit from obstetric analgesia. These patients include, nulliparous patients, young patients, patients who have had labour induced, those with preterm deliveries and those with an assisted vaginal delivery especially if they are well educated.     

Outcome of a second pregnancy after a previous elective caesarean section

Summary. At Queen Charlotte's Maternity Hospital from 1980 to 1987, 195 women had a trial of scar in their second ongoing pregnancy, having been delivered previously by elective caesarean section. Overall 154 (79%) achieved a vaginal delivery. Patients who went into spontaneous labour had a significantly better chance of being delivered vaginally than those who were induced. A past history of early pregnancy loss had no influence on the outcome, nor was outcome compromised in the group of patients whose elective caesarean section had taken place before 32 weeks gestation.     

Outcome of a second pregnancy after a previous elective caesarean section

At Queen Charlotte's Maternity Hospital from 1980 to 1987, 195 women had a trial of scar in their second ongoing pregnancy, having been delivered previously by elective caesarean section. Overall 154 (79%) achieved a vaginal delivery. Patients who went into spontaneous labour had a significantly better chance of being delivered vaginally than those who were induced. A past history of early pregnancy loss had no influence on the outcome, nor was outcome compromised in the group of patients whose elective caesarean section had taken place before 32 weeks gestation.     

Follow-up of hydration and sedation in the pretherapy of premature labor

Intravenous fluids and sedation with 8 mg of morphine sulfate intramuscularly has been used for the last 12 years at our institution to define the patients in "real" premature labor. Only those who continue to have uterine contractions after this pretreatment are considered in actual premature labor. One hundred eighty-four pregnant patients with singleton pregnancies were evaluated after they were treated with hydration and sedation for the presence of regular uterine contractions. Fifty-five percent of the patients responded to hydration and sedation, and the rest required the use of tocolytic therapy. In the tocolytic therapy group, 11% gave birth to infants who were small for gestational age. The patients who responded to hydration and sedation had a 2.6-fold increase of delivering prematurely when compared to the general population. However, more than 85% of the patients who received only hydration and sedation were delivered more than 2 weeks after the first episode and most of them were delivered at term. Therefore, the use of hydration and sedation seems a useful and safe clinical test to determine patients in real premature labor. Patients who respond to hydration and therapy constitute a "high-risk group" and should be managed accordingly.     

Induction of labour after 1 previous Caesarean section

The aim of this study was, after induction of labour in women with a previous Caesarean section, to compare the outcome in women with a history of a previous vaginal delivery with women who had never delivered vaginally. A retrospective analysis was performed over a 2-year period, in a Dublin teaching hospital. One hundred and three women who had had 1 previous lower segment Caesarean section had labour induced. Particular attention was given to delivery outcome, history of a vaginal delivery, cervical effacement at induction, influence of epidural analgesia, indication for induction and incidence of uterine rupture. The repeat Caesarean section rate after induction was 20.4%. Of the 51 women who had never previously delivered vaginally, the repeat section rate was 37.3% compared with only 3.9% of the 52 women who had previously delivered vaginally (p < 0.01). Fourteen women who had never delivered vaginally had an uneffaced cervix at induction and the repeat Caesarean section rate in this group was 64.3%. The commonest indication for induction was a postdates pregnancy. The use of epidural analgesia was greater in women who had never delivered vaginally. There were 2 cases of uterine scar rupture. Induction of labour following Caesarean section is associated with a significantly higher incidence of repeat Caesarean section in women who have not had a previous vaginal delivery. If the cervix is not effaced at induction, the repeat Caesarean section rate is higher than if the cervix has started to efface.     

Evaluation of midwife-led care provided at the Royal Bournemouth Hospital

OBJECTIVE: To compare the outcome of care given to women 'booking' for delivery in a midwife-led maternity unit with that for comparable women 'booking' for care in a consultant obstetric unit. DESIGN AND METHOD: Prospective cohort study with a quasi-experimental design and data extracted from case notes. SETTING: East Dorset, midwife-led maternity unit at Royal Bournemouth Hospital and consultant-led maternity unit at Poole General Hospital. SUBJECTS: Two cohorts of women who satisfied the criteria for 'booking' at the Royal Bournemouth Hospital. Of these 794 'booked' at Bournemouth from 1 November 1992 to 30 June 1993 and 705 'booked' at Poole over the same period. MAIN PROCESS AND OUTCOME MEASURES: Care given, morbidity in women and their babies, transfers during the antenatal period and in labour. FINDINGS: Of the women who initially 'booked' for Bournemouth, 62.3% actually delivered there, 27.1% transferred before labour and a further 9.2% transferred during labour. No differences were seen between those 'booked' for Bournemouth or Poole in the proportions of low birthweight babies, babies who were transferred to special care or babies who had congenital abnormality. Higher proportions of babies whose mothers 'booked' for delivery in Poole were resuscitated and had one minute Apgar scores below seven but there was no difference in the five minute scores. Similar proportions of women had perineal tears but fewer of the women 'booked' for delivery in Bournemouth had an episiotomy. 'Booking' for Poole was associated with higher rates of induction and augmentation of labour and greater use of anesthesia. 'Booking' for Bournemouth was associated with a shorter first stage and a longer third stage of labour. Women 'booked' for delivery in Bournemouth were no more likely to be delivered by a midwife than those 'booked' for Poole. CONCLUSIONS: There was very little difference between the groups of women who initially 'booked' for delivery at the two units. There were differences in the patterns of care received, but no major differences in the outcome for the women or their babies were detected.     

Elevation of total nitrite and nitrate concentration in vaginal secretions as a predictor of premature delivery

We measured the total concentration of nitrite and nitrate, metabolites of nitric oxide, in vaginal secretions from pregnant women at 22 to 32 weeks' gestation. Total nitrite and nitrate concentrations in patients with preterm premature rupture of membranes and in those with preterm labor and subsequent premature delivery were significantly higher than concentrations in patients who were delivered at term. Elevated total nitrite and nitrate concentration may predict premature delivery.