The aim of this paper has been to compare the uterine contractility, pain produced by contractions and comfort of the patients between standing and supine position. The study has been performed in twenty normal nulliparae who were changed from supine to standing position and viceversa at intervals of approximately thirty minutes. Intrauterine pressure and fetal heart rate were continuously monitored. Cervial dilatation was evaluated every thirty minutes. No medication was given to the patients. They were asked to assess the pain produced by uterine contractions in each one of both positions and which was the more comfortable. It has been found: 1. That the intensity of contractions was significantly higher in fifteen out of the twenty patients in standing position. 2. Frequency of contractions diminished significantly in one third of the patients. 3. Uterine activity increased significantly in half of them. 4. Consistently, less pain accompanied uterine contractions in standing position. 5. Patients reported more comfort in this position. The average duration of labor was 3 hrs 55 min. This duration is short, compared with standard clinical experience and with published data. No complications occurred, by the use of standing position during labor, on the mother or fetus. The physiological mechanisms responsible for the above mentioned effects of standing position are unknown. It is condluced that there are no clear arguments against the use of standing position during labor and that this position should be used more frequently in clinical obstetrics, provided obstetrical conditions are similar to those reported in this paper.

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Effects of standing position on spontaneous uterine contractility and other aspects of labor.

&NA; This paper explores the relationship between emotional factors and “psychogenic” obstetric complications (those involving no discernible physical cause) by reviewing the pertinent articles that have appeared during primarily the past 15 years. The literature provides no conclusive evidence of causal relationships between emotional factors and such complications. The most consistent findings were that women who subsequently experienced any of a variety of obstetric complications had higher anxiety levels and used fewer repressive‐type defenses than women who experienced normal pregnancies and deliveries. These findings are discussed in terms of the presumed causal role of emotional factors in psychogenic obstetric complications.

The role of emotional factors in obstetric complications: a review.

The uterine muscle (the myometrium) plays its most evident role during pregnancy, when quiescence is required for adequate nourishment and development of the foetus, and during labour, when forceful contractions are needed to expel the foetus and the other products of conception. The myometrium is composed of smooth muscle cells. Contraction is initiated by the spontaneous generation of electrical activity at the cell level in the form of action potentials. The mechanisms underlying uterine quiescence during pregnancy and electrical activation during labour remain largely unknown; as a consequence, the clinical management of preterm contractions during pregnancy and inefficient uterine contractility during labour remains suboptimal. In an effort to improve clinical management of uterine contractions, research has focused on understanding the propagation properties of the electrical activity of the uterus. Different perspectives have been undertaken, from animal and in vitro experiments up to clinical studies and dedicated methods for non-invasive parameter estimation. A comparison of the results is not straightforward due to the wide range of different approaches reported in the literature. However, previous studies unanimously reveal a unique complexity as compared to other organs in the pattern of uterine electrical activity propagation, which necessarily needs to be taken into consideration for future studies to be conclusive. The aim of this review is to structure current variegated knowledge on the properties of the uterus in terms of pacemaker position, pattern, direction and speed of the electrical activity during pregnancy and labour.

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Propagation of electrical activity in uterine muscle during pregnancy: a review

This study was designed to observe the effects of i.v. fluid infusion on uterine activity during normal labour in women receiving an extradural block. Thirty-four women in spontaneous labour at term gestation were allocated randomly and prospectively to one of three i.v. pre-extradural fluid load groups: group A, no fluid load; group B, normal saline 500 ml; and group C, normal saline 1000 ml. Continuous internal measurement of uterine activity was observed before, during and after fluid infusion and extradural block. In groups A and B, uterine activity did not change. In group C, uterine activity decreased after infusion of saline (P

W C W Nixon

Papers

Abnormal uterine action in labour.