The duration of labor in primiparas undergoing vaginal birth after cesarean delivery

Article Abstract:

The dramatic increase in the rate of cesarean deliveries has led to closer scrutiny of the rationale for performing the procedure. The most common reasons, each accounting for a bit less than one third of the increase since the 1970s, are dystocia (difficult labor) and a previous cesarean birth. It has been shown, however, that most women with a cesarean delivery accomplished through a low transverse incision can have subsequent successful vaginal deliveries. However, little is known regarding the characteristics of labor for such women; for instance, is the duration of their labor more similar to that experienced by women delivering their first child vaginally, or to that of women with more than one prior delivery? This issue was addressed by studying 73 women (primarily white, with complete prenatal care) whose previous cesarean records were available. The cesarean deliveries were performed because of dystocia. Each of these patients was matched with two controls for age, race, and gestational age; of these control pairs, one had delivered no previous children (nullipara) and the other had one prior vaginal delivery (primipara). The course of labor was then timed and evaluated; the fetal heart rate and uterine activity were also monitored. Results showed that patients who had undergone a cesarean in the latent phase (early part of the first stage) of their previous labor had a longer first stage in their current labor than those whose cesarean had been performed in later stages. Patients who had a cesarean in the active phase or second stage of the previous labor had a longer first stage than primiparous controls. Finally, primiparous controls had the shortest second stage of labor of all women studied. Overall, women who deliver vaginally after one cesarean delivery are more similar to nulliparous than to multiparous women (who have delivered more than one child). Obstetricians should not, therefore, expect the labors of these women to progress as quickly as those of women with previous vaginal deliveries. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Complications and side effects, Risk factors, Labor (Obstetrics), Cesarean section, Vaginal birth after cesarean, Labor, Complicated, Labor complications

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The association of antiphospholipid antibodies with pregnancies complicated by fetal growth restriction

Article Abstract:

An association between fetal growth restriction and abnormally high maternal levels of antiphospholipid antibodies, particularly the lupus anticoagulant and anticardiolipin antibodies, is frequently cited in the literature. There is a theoretical basis for hypothesizing that excessive antiphospholipid antibody levels could cause fetal growth restriction. However, no direct studies have been performed to examine this issue. To determine whether elevated maternal antiphospholipid antibodies are associated with fetal growth retardation, pregnant women being cared for at Madigan Army Medical Center between March 1990 and March 1991 were evaluated for lupus anticoagulant and anticardiolipin antibody levels and for evidence of fetal growth restriction. Based on ultrasound results, fetal growth restriction was diagnosed in 55 cases. These women were followed until delivery with frequent ultrasound examinations and antibody measurements. Newborn weights were below the 10th percentile for 37 of the infants, and all 55 infant weights were below the 45th percentile. Fifteen of the 55 women (27 percent) tested positive for anticardiolipin antibodies, but none tested positive for lupus anticoagulant. Of the 37 women delivering newborns with birthweights below the 10th percentile, 9 were positive for anticardiolipin antibodies (24 percent). In a control population of obstetric patients, the prevalence of this antibody was only 2.5 percent. These results demonstrate a significant relation between elevated maternal levels of anticardiolipin antibody and fetal growth restriction. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Causes of, Fetus, Birth weight, Low, Low birth weight, Fetal growth retardation, Antiphospholipid antibodies, Anticardiolipin antibodies

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