Rupture of the uterus in labour

Summary In this case report a 27-year-old parturient with a previous caesarean section was diagnosed as having had a uterine rupture in labour. The diagnosis was based on the sonographic demonstration of considerable amounts of free fluid in the abdomen 2 h postpartum, and confirmed by finding fetal skin cells in this fluid. There was no hemorrhage and the fluid disappeared overnight. She was managed expectantly and made a rapid and full recovery.     

The influence of pressure upon the fetal head during labour

In contracted pelvis, moulding of the skull bones is caused by the force of the amniotic fluid pressure and the resistance of the pelvis. In normal labour and abnormal uterine action the moulding of the skull bones is caused by the head to cervix pressure, as has been demonstrated by intra-uterine tokometry. By contrast, in the contracted pelvis there are no mouldings between the two parietal bones. In breech presentation during the first stage of labour the moulding of the skull bones is explained, by the differing resistance of the various skull bones against the amniotic fluid pressure.     

The motility of the nonpregnant congenitally malformed uterus

Uterine motility in 5 patients with a complete double uterus and in 1 patient with a bicornuate uterus is described. In all cases the right and left side seldom contracted synchronously and sometimes not even with the same force. In 5 patients the motility patterns were the same for right and left uterus. In 1 patient with a complete double uterus, however, the motility patterns of the left uterus followed the menstrual cycle and could be influenced by estrogens or Vasopressin^® (Sandoz), whereas the right uterus did not react to these stimuli and continued to contract in its own ‘ahormonal’ way. The endometrium of both uteri reacted in a normal way to hormonal stimuli. This suggests lacking of receptors for estrogens and progesterone in the myometrium of the right uterus, whereas the endometrium of both uteri seems to have these receptors. The patient became pregnant in the left uterus. According to these findings it might be indicated to add intrauterine pressure recording to the preoperative diagnostic procedures before undertaking operative correctional procedures in cases of uterine anomalies.     

Effect of methoxamine on spontaneous motility of the isolated rat uterus

In the present study the effect of methoxamine and its modification by several adrenergic antagonists is described in the isolated oestrogenized rat uterus. Methoxamine produced a dose-related increase in uterine activity, prazosin produced a rightward displacement of the dose-response curve of methoxamine reaching the same maximal effect. Yohimbine abolished the contractile response to methoxamine. propranolol or reserpine failed to modify the effect of methoxamine. Pretreatment with reserpine abolished the inhibitory effect of yohimbine. These results suggest the presence of excitatory alpha-adrenoceptors in the rat uterus.     

The contractions of the human uterus during the menstrual cycle: The effect of progesterone and posterior pituitary extract upon the motility of the human uterus

In each of four women with fairly normal ovarian and uterine function as shown by their ability to conceive, one or more cycles were fully studied; including pregnanediol assays, endometrial biopsies, and uterine tracings; a fifth was completely studied except that urinary assays were not done on every day; a sixth whose cycles were abnormal to the extent that she was unable to conceive was also studied and a seventh had tracings and biopsies done in one cycle but no pregnanediol assays were made. In each the uterus contracted more strongly and was much more greatly affected by pituitrin in the presence of the corpus luteum than during the follicle phase. An artificially produced cycle showed a similar increase in spontaneous activity and response to pituitrin after injection of 20 mg. of progesterone. Two cases of anovulatory cycles showed spontaneous activity and response to pituitrin characteristic of the follicle phase.     

Use of partusisten during labour for treatment of increased uterus tonus (author's transl)

Partusisten slow-drop infusions were applied to twelve women in labour with spontaneous increase of the uterus tonus in rest. The preparation was found to lower the tonus in rest and to increase the amplitude of uterus contractions.     

Comparison of active and expectant management on the duration of the third stage of labour and the amount of blood loss during the third and fourth stages of labour: a randomised controlled trial

Background

Postpartum haemorrhage is one of the most important causes of maternal death.

Objectives

To evaluate the effect of active management of the third stage of labour on the amount of blood loss in the third and fourth stages of labour, and the duration of the third stage of labour.

Methods

A randomised controlled trial was completed on 200 women who gave birth at a maternity unit in Iran. In the intervention group (n=100), 10 IU of oxytocin was injected intramuscularly into the mother following birth of the anterior shoulder of the baby. After clamping and cutting the umbilical cord, the uterus was pushed upwards and posterior, while the cord was pulled down with constant and intermittent traction until the placenta was delivered. In the control group (n=100), on observing signs of placental separation, the placenta was expulsed by maternal force. In both groups of women, blood loss was measured at birth using collecting devices, and drapes and sheets were weighed to estimate blood loss.

Findings

Mean blood loss during the third stage of labour was 216.93±165.16 ml and 232.12±150.35 ml in the intervention and control groups, respectively; the difference was not significant (p=0.49). In contrast, mean blood loss during the fourth stage of labour differed significantly (422.62±324.7 ml and 327.27±255.99 ml in the intervention and control groups, respectively; p=0.02). The mean duration of the third stage of labour was less in the intervention group than in the control group (4.69±5.51 mins and 6.34±5.03 mins; p=0.028).

Conclusions

Active management did not decrease blood loss during the third stage of labour, but did decrease the duration of this stage. Active management was associated with increased blood loss during the fourth stage of labour. Due to conflicting results between studies, further research should be undertaken to determine the optimal method by which to manage the third stage of labour.     

A double-blind, randomised, placebo controlled study on the influence of carbohydrate solution intake during labour

Objective Although there has been much debate on whether women should be allowed to eat and drink during labour, little scientific data are available on the effects of caloric intake on the course of labour.
Design Double-blind, randomised, placebo controlled.
Setting Leyenburg Hospital, The Hague, The Netherlands.
Population Two hundred and one consecutive nulliparous women, pregnant of a single fetus in cephalic presentation.
Methods All women were included in early labour (2cm–4cm of cervical dilatation) and were allowed to drink at will.
Main outcome measures The duration of labour, the need for augmentation and pain medication and the incidence of abdominal and vaginal instrumental deliveries.
Results Drinking of carbohydrate solutions was well tolerated, but did not show any beneficial effects regarding labour outcome when compared with the control group. In the carbohydrate group, a higher caesarean section rate was observed (RR 2.9, 95% CI 1.29–6.54).
Conclusions Women in the carbohydrate group had worse labour outcome. It is unclear whether a statistical coincidence, a negative effect of the carbohydrate intake or an incorrect carbohydrate intake strategy is responsible for these results. Further studies are necessary before any definite conclusion can be drawn.     

Influence of na-salicylate on uterine motility in labour (author's transl)]

A dosage of 10 mg/kg body weight Na-salicylate has no depressive effect on uterine motility. The examination carried out intra partum in the condition of normal uterine activity support our opinion that relatively high doses of 3--5 g per day or the simultaneous administration of beta-adrenergical substances are necessary to obtain an effective tocolysis.