Infant outcome following labor induction

Development of peptidergic systems in the rat brain

The brain contains a large variety and number of peptides some of which were known earlier as hypothalamic hormones (vasopressin, oxytocin, luteinizing hormone-releasing hormone, thyrotropin-releasing hormone, somatostatin) or as pituitary hormones (the family of opiomelanocortins), while others, not primarily known as hypothalamic or pituitary hormones, may also have endocrine effects (substance P, angiotensin II, neurotensin, bombesin, vasoactive intestinal peptide (VIP), gastrin-cholecystokinin, glucagon, carnosine, bradykinin). These peptides, which form a new class of putative neurotransmitters, are present early in brain development and show important sex differences in both their pattern of innervation and their effects. Their peripheral effects may include intrauterine growth of the placenta and fetus, the timing of birth, acceleration of the course of labour and responses to haemorrhage (redistribution of cardiac output and stimulation of blood cell formation). Endogenous peptides are probably involved in brain development, which may explain their general, permanent and sex-dependent effects when given in the period of rapid brain development. Although peptides might in the future be useful for stimulating recovery from retarded brain development, at present one should be aware of the potential dangers of their use in, for example, obstetrics.

Outcomes of care in birth centers. The National Birth Center Study

We studied 11,814 women admitted for labor and delivery to 84 free-standing birth centers in the United States and followed their course and that of their infants through delivery or transfer to a hospital and for at least four weeks thereafter. The women were at lower-than-average risk of a poor outcome of pregnancy, according to many but not all of the recognized demographic and behavioral risk factors. Among the women, 70.7 percent had only minor complications or none; 7.9 percent had serious emergency complications during labor and delivery or soon thereafter, such as thick meconium or severe shoulder dystocia. One woman in six (15.8 percent) was transferred to a hospital; 2.4 percent had emergency transfers. Twenty-nine percent of nulliparous women and only 7 percent of parous women were transferred, but the frequency of emergency transfers was the same. The rate of cesarean section was 4.4 percent. There were no maternal deaths. The overall intrapartum and neonatal mortality rate was 1.3 per 1000 births. The rates of infant mortality and low Apgar scores were similar to those reported in large studies of low-risk hospital births. We conclude that birth centers offer a safe and acceptable alternative to hospital confinement for selected pregnant women, particularly those who have previously had children, and that such care leads to relatively few cesarean sections.

Elective induction of labor: a prospective clinical study, I: Obstetric and neonatal effects

Elective induction of labor is still a controversial obstetric procedure. The safety of the procedure and the possibility to program labor during daytime is an often heard argument in favor of it. Also the possibility to prevent term intrauterine fetal death of unknown cause and the possibility to apply fetal monitoring from the beginning of labor are put forward as arguments in favor of elective induction of labor. Feelings of unnaturalness and the dangers of prematurely induced delivery are the most often heard arguments against it. We performed a prospective study to determine the differences between elective induction of labor and spontaneous labor. During 17 consecutive months a group of 184 elective inductions was studied in the Department of Obstetrics, University Hospital - Dijkzigt, Rotterdam. Only healthy women with an uncomplicated pregnancy were included in the study group and all women were allowed a free choice of elective induction or spontaneous labor. The reference group was composed by a system of "matched controls". For induction of labor a standard technique including artificial rupture of the membranes and constant intrauterine fetal monitoring was used. Oxytocin was administered intravenously in an incremental dose. After delivery the acid-base status of the newborns was determined, and part of the newborns were subjected to a neurological screening according to Prechtl. The developments of the infants was followed during one year using a "psychomotor development scheme 0-15 months".(ABSTRACT TRUNCATED AT 250 WORDS)

A prospective randomized study of induction of labor

In a prospective randomized study spontaneous and oxytocin induced labor have been compared with respect to duration of labor and the condition of the fetus and the newborn infant. The study consists of 166 normal patients at full term. No significant differences between the two groups were found, and the results of the study showed that induction of labor between the 40th and 41st week of pregnancy was safe for the fetus. It is concluded that there seems to be no increased risks to mother or fetus from induction of labor compared to normal labor provided that there is cephalic presentation and a normal pregnancy.

Induction of labour with oral prostaglandin E2: a Canadian multicentre study

Prostaglandin E2 (PgE2) tablets were administered orally for the induction of labour at or near term to 680 patients. Successful vaginal delivery occurred in 81.8% of patients with a mean total dose of 3.7 mg and a mean induction-delivery interval of 7.1 hours. PgE2 was most efficacious in parous patients and in those with high Bishop scores. The most common maternal side-effects were gastro-intestinal in nature and uterine hypertonus was observed in six patients. Foetal heart rate changes occurred in fifty patients.

Children born after elective induction of labour

A comparison was made between the performance at eight years of age of 63 children who were born after elective induction of labour, and 29 spontaneously born children. The children had been tested previously at five years of age. Tests of reading and arithmetic achievement, visuomotor coordination, aural-visual coordination, auditory discrimination, and behavioural rating scales were administered. On two of the 12 measures (reading comprehension and euroticism) the induced children performed better than the spontaneously born. On all other measures there were no significant differences. There appeared to be no evidence of specific learning disabilities or behavioural problems among the induced children.