DOCSLIB.ORG

Continued Versus Discontinued Oxytocin Stimulation In

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Continued Versus Discontinued Oxytocin Stimulation In RESEARCH Continued versus discontinued oxytocin stimulation in the active phase of labour (CONDISOX): double blind randomised BMJ: first published as 10.1136/bmj.n716 on 14 April 2021. Downloaded from controlled trial Sidsel Boie,1 Julie Glavind,2 Niels Uldbjerg,2 Philip J Steer,3 Pinar Bor,1 on behalf of the CONDISOX trial group 1Department of Obstetrics and ABSTRACT from randomisation to delivery 282 v 201 min; Gynaecology, Randers Regional OBJECTIVE P<0.001), a reduced risk of hyperstimulation (20/546 Hospital, Randers, Denmark To determine whether discontinuing oxytocin (3.7%) v 70/541 (12.9%); P<0.001), and a reduced 2Department of Obstetrics and Gynaecology, Aarhus University stimulation in the active phase of induced labour is risk of fetal heart rate abnormalities (153/548 Hospital, Aarhus, Denmark associated with lower caesarean section rates. (27.9%) v 219/537 (40.8%); P<0.001) but rates of 3Academic Department of DESIGN other adverse maternal and neonatal outcomes were Obstetrics and Gynaecology, International multicentre, double blind, randomised similar between groups. Chelsea and Westminster Hospital, Imperial College controlled trial. CONCLUSIONS London, London, UK SETTING In a setting where monitoring of the fetal condition Correspondence to: S Boie Nine hospitals in Denmark and one in the Netherlands and the uterine contractions can be guaranteed, [email protected] routine discontinuation of oxytocin stimulation may (or @BoieSidsel on Twitter: between 8 April 2016 and 30 June 2020. lead to a small increase in caesarean section rate but ORCID 0000-0002-8725-2117) PARTICIPANTS a significantly reduced risk of uterine hyperstimulation Additional material is published 1200 women stimulated with intravenous oxytocin online only. To view please visit and abnormal fetal heart rate patterns. the journal online. infusion during the latent phase of induced labour. TRIAL REGISTRATION C ite this as: BMJ 2021;372:n716 INTERVENTION ClinicalTrials.gov NCT02553226. http://dx.doi.org/10.1136/bmj.n716 Women were randomly assigned to have their oxytocin Accepted: 25 February 2021 stimulation discontinued or continued in the active phase of labour. Introduction MAIN OUTCOME MEASURE Approximately a quarter of all term pregnant women 1-3 Delivery by caesarean section. have their labour induced. This often includes http://www.bmj.com/ stimulation with oxytocin.4 The stimulation requires RESULTS a delicate balance between the wish for progression A total of 607 women were assigned to of labour and the risks to the fetus and mother of discontinuation and 593 to continuation of the uterine hyperstimulation, defined as more than five oxytocin infusion. The rates of caesarean section were 5-7 16.6% (n=101) in the discontinued group and 14.2% contractions in 10 minutes in response to oxytocin. (n=84) in the continued group (relative risk 1.17, 95% Different approaches to oxytocin administration have been suggested, such as pulsatile or intermittent confidence interval 0.90 to 1.53). In 94 parous women on 2 October 2021 by guest. Protected copyright. 8 9 10 with no previous caesarean section, the caesarean administration, an automatic feedback system, 11 section rate was 7.5% (11/147) in the discontinued high versus low dose, and/or discontinuation of group and 0.6% (1/155)in the continued group the stimulation when the active phase of labour is 12 (relative risk 11.6, 1.15 to 88.7). Discontinuation was reached. associated with longer duration of labour (median Four meta-analyses and two more recent studies have suggested that once a woman is in active labour, the labour will continue even if oxytocin WH AT IS ALREADY KNOWN ON THIS TOPIC stimulation is stopped, resulting in a lower risk of Four meta-analyses suggest that once a woman is in active labour, the labour caesarean section for fetal indications secondary to uterine hyperstimulation.12-17 However, only one process continues even if oxytocin stimulation is stopped and results in a lower study randomised women at time of the intervention, risk of caesarean section whereas the remaining studies randomised women in A 2018 Cochrane review questions the quality of previous studies owing to early labour and consequently included a significant design limitations and judges many of the trials to be at either high or unclear fraction of women who delivered by caesarean risk of bias across several “risk of bias” domains 12 section before they received the intervention. In WH AT THIS STUDY ADDS the Cochrane meta-analysis, a subanalysis restricted to trial participants who actually reached the active This is the largest truly double blinded trial on discontinuation of oxytocin phase of labour showed little or no effect on the stimulation in the active phase of induced labour caesarean section rate.12 Whether discontinuing In a setting where monitoring of the fetal condition and the uterine contractions oxytocin stimulation is advantageous therefore can be guaranteed, routine discontinuation of oxytocin stimulation may lead to a remains uncertain. The aim of this trial was to test small increase in the rate of caesarean section whether discontinuation of oxytocin stimulation, once However, the risks of uterine hyperstimulation and abnormal fetal heart rate the active phase of induced labour is achieved, reduces were significantly reduced after discontinuation the overall caesarean section rate. the bmj | BMJ 2021;372:n716 | doi: 10.1136/bmj.n716 1 RESEARCH Methods caesarean), and indication for oxytocin infusion Trial design (induction of labour or induction due to pre-labour BMJ: first published as 10.1136/bmj.n716 on 14 April 2021. Downloaded from We conducted a double blind, randomised, placebo rupture of membranes). The randomisation number controlled multicentre trial. Recruitment took place generated by the computer program corresponded in nine delivery wards in Denmark and one in the to the number on the study medication (Denmark: Netherlands. The protocol was published in 2018.18 masked, identical ampoules; Netherlands: masked, identical infusions). In case of technical or staff Participants difficulties with the computerised randomisation Women were eligible if they had a singleton live (n=26), the women were given the study medication fetus with a cephalic presentation at term and were with the lowest available number. Accordingly, women, stimulated with oxytocin for elective induction of care givers, and trial managers were all blinded to the labour or following spontaneous pre-labour rupture allocation. of membranes without progression in labour. The exclusion criteria were age under 18 years, need for Oxytocin stimulation protocol an interpreter to understand the information material, The stimulation regimen used in this study was similar multiple pregnancy, more than one previous caesarean to the current Danish and Dutch recommendations section, greater than 4 cm of cervical dilatation at the on oxytocin stimulation for induced labour. An time of oxytocin infusion, fetal heart rate abnormalities intravenous infusion of 10 IU oxytocin (Sigma Tau before oxytocin infusion, and an estimated fetal weight Pharmaceuticals) diluted in 1000 mL of isotonic of more than 4500 g. All participants gave verbal and saline (Denmark) or 5 IU oxytocin diluted in written informed consent before randomisation on or 50 mL of isotonic saline (Netherlands) was started at after initiation of induction of labour. 3.3 mIU/min and increased every 20 minutes by 3.3 mIU/min until regular contractions (three to five R andomisation and masking contractions every 10 minutes) were achieved. The Inclusion and randomisation were primarily facilitated maximum authorised infusion rates were 30 mIU/min by the midwives on duty. They used an internet based in Denmark and 33 mIU/minute in the Netherlands. randomisation programme to randomly assign eligible Women were randomised when the active phase women to one of the two interventions in a one to of labour was established, defined as ruptured one ratio. Random block sizes of four, six, and eight membranes with complete effacement of the cervix, were used, and the women were stratified by site, cervical dilatation of at least 6 cm, and at least three http://www.bmj.com/ parity (nulliparous; parous with or without previous contractions every 10 minutes. After randomisation, the infusion was replaced by the study medication. The continued group received oxytocin at the standard concentration, whereas the discontinued group Visual Abstract Reduced oxytocin stimulation in labour received placebo with saline. The study medication The impact of discontinuing infusion in active phase was set to the same infusion rate as the initial oxytocin infusion and was adjusted (discontinued, reduced, or Summary Routine discontinuation of oxytocin stimulation in the active phase on 2 October 2021 by guest. Protected copyright. of labour (≥ cm of cervical dilatation) may lead to a small increase increased) by the birth attendants according to the in caesarean section rate but a significantly reduced risk of uterine clinical situation. All participants were continuously hyperstimulation and abnormal fetal heart rate patterns monitored with cardiotocography. Antibiotics were Study design Randomised Double People recruited from one Dutch recommended if the woman was a candidate for controlled trial blind and nine Danish hospitals group B Streptococcus prophylaxis, in case of an 1198 isolated temperature of 38.5°C or higher, or in case of Population pregnant Mean age Nulliparous Median
Load more

Recommended publications
  • Fetal Compromise (Acute): Management If Suspected This Document Should Be Read in Conjunction with the Disclaimer
    King Edward Memorial Hospital King Edward Memorial Hospital Obstetrics & Gynaecology Obstetrics & Gynaecology CLINICAL PRACTICE GUIDELINE Fetal compromise (acute): Management if suspected This document should be read in conjunction with the Disclaimer Aim To identify suspected or actual fetal compromise and initiate early intervention to promote placental and umbilical blood flow to decrease risk of hypoxia and acidosis. Key points1 1. Fetal compromise in labour may be due to a variety of pathologies including placental insufficiency, uterine hyperstimulation, maternal hypotension, cord compression and placental abruption. Identification and management of reversible abnormalities may prevent unnecessary intervention. 2. Continuous electronic cardiotocograph (CTG) monitoring should be commenced when fetal compromise is detected at the onset of labour or develops during labour. 3. A normal CTG is associated with a low probability of fetal compromise and has the following features: Baseline rate 110-160 bpm Baseline variability 6-25 bpm Accelerations of 15 bpm for 15 seconds No decelerations. 4. The following features are unlikely to be associated with fetal compromise when occurring in isolation: Baseline rate 100-109 bpm Absence of accelerations Early decelerations Variable decelerations without complicating features. 5. The following features may be associated with significant fetal compromise and require further action (see management section on next page): Baseline fetal tachycardia >160 bpm Reduced or reducing baseline variability
    [Show full text]
  • Intra-Vaginal Prostaglandin E2 Versus Double-Balloon Catheter for Labor Induction in Term Oligohydramnios
    Journal of Perinatology (2015) 35, 95–98 © 2015 Nature America, Inc. All rights reserved 0743-8346/15 www.nature.com/jp ORIGINAL ARTICLE Intra-vaginal prostaglandin E2 versus double-balloon catheter for labor induction in term oligohydramnios G Shechter-Maor1, G Haran1, D Sadeh-Mestechkin1, Y Ganor-Paz1, MD Fejgin1,2 and T Biron-Shental1,2 OBJECTIVE: Compare mechanical and pharmacological ripening for patients with oligohydramnios at term. STUDY DESIGN: Fifty-two patients with oligohydramnios ⩽ 5 cm and Bishop score ⩽ 6 were randomized for labor induction with a vaginal insert containing 10 mg timed-release dinoprostone (PGE2) or double-balloon catheter. The primary outcome was time from induction to active labor. Time to labor, neonatal outcomes and maternal satisfaction were also compared. RESULT: Baseline characteristics were similar. Time from induction to active labor (13 with PGE2 vs 19.5 h with double-balloon catheter; P = 0.243) was comparable, with no differences in cesarean rates (15.4 vs 7.7%; P = 0.668) or neonatal outcomes. The PGE2 group had higher incidence of early device removal (76.9 vs 26.9%; P = 0.0001), mostly because of active labor or non-reassuring fetal heart rate. Fewer PGE2 patients required oxytocin augmentation for labor induction (53.8 vs 84.6% P = 0.034). Time to delivery was significantly shorter with PGE2 (16 vs 20.5 h; P = 0. 045) CONCLUSION: Intravaginal PGE2 and double-balloon catheter are comparable methods for cervical ripening in term pregnancies with oligohydramnios. Journal of Perinatology (2015) 35, 95–98; doi:10.1038/jp.2014.173; published online 2 October 2014 INTRODUCTION better mimic the natural course of labor and might have an Ultrasound estimation of amniotic fluid volume is an important advantage in cervical ripening.
    [Show full text]
  • INTRODUCTION Effect of Different Dosages of Intravaginal Misoprostol
    Original Article Gynecology and Obstetrics Medical Journal of Islamic World Academy of Sciences Effect of Different Dosages of Intravaginal Misoprostol for Second Trimester Pregnancy Termination Maysoon Sharief1, Enaas S. Al-Khayat1 1Department of Gynecology and Obstetrics, College of Medicine, University of Basrah, Basrah, Iraq. ABSTRACT Miscarriage is a common complication of early pregnancy; however; curettage and dilation are considered standard methods taking care of early pregnancy failure. Misoprostol has been used as an alternative agent for termination of early pregnancy. Therefore, this study was aimed to compare the efficacy and side effects of two different intravaginal misoprostol trials for the second trimester pregnancy termination of missed miscarriage between 14 and 23 weeks. A clinical trial was carried out in Basrah Maternity & Children Hospital during the period from October 2011 to November 2012. A total of 100 women experienced missed miscarriages at 14-23 weeks of gestation were admitted for medical termination of pregnancy. Patients were divided into the following two groups: Group 1: 50 patients received 400 µg of intravaginal misoprostol/8 hours. Group 2: 50 patients received 800 µg of intravaginal misoprostol/8 hours. The patients were followed up for 24 hours. The primary outcome measure was induction-miscarriage interval; the secondary outcomes were the rate of successful miscarriage and complete miscarriage; the incidence of side effects was compared in both groups. The rates of successful termination of pregnancy in both groups 1 and 2 were 86% and 90%, respectively. The success rates of the drug in group 1 were 0%, 12%, 36%, 34%, 10%, and 4% after first, second, third, fourth, fifth, and sixth doses, respectively; whereas, the success rates in group 2 were 24%, 34%, 24%, 12%, 4%, and 0% after first, second, third, fourth, fifth, and sixth doses, respectively.
    [Show full text]
  • Confidential: for Review Only Continued Versus Discontinued Oxytocin Stimulation in the Active Phase of Labour (CONDISOX)- a Double-Blind Randomised Controlled Trial
    BMJ Confidential: For Review Only Continued versus discontinued oxytocin stimulation in the active phase of labour (CONDISOX)- A double-blind randomised controlled trial Journal: BMJ Manuscript ID BMJ-2020-063027 Article Type: Research BMJ Journal: BMJ Date Submitted by the 09-Nov-2020 Author: Complete List of Authors: Boie, Sidsel; Randers Regional Hospital, Obstetrics and Gynaecology Glavind, Julie; Aarhus University Hospital, Obstetrics and Gynaecology Uldbjerg, Niels; Aarhus University Hospital, Obstetrics and Gynecology Steer, Philip; Imperial College London, Academic Department of Obstetrics and Gynaecology Bothazi, Attila; Aalborg University Hospital, Obstetrics and Gynaecology Sundtoft, Iben ; Hospitalsenheden Vest, Obstetrics and Gynaecology Bakker, Jannet; Amsterdam UMC Location AMC, Obstetrics and Gynaecology Van der Post, Joris; Amsterdam UMC Location AMC, Obstetrics and Gynaecology Renault, Kristina; Rigshospitalet, Obstetrics and Gynaecology Huusom, Lene; Hvidovre Hospital, Obstetrics and Gynaecology Hvidman, Lone; Aarhus University Hospital, Obstetrics and Gynaecology Rask, Maja; Odense University Hospital, Obstetrics and Gynaecology Khalil, Mohammed; Sygehus Lillebalt Kolding Sygehus, Obstetrics and Gynaecology Møller, Nini; Nordsjaellands Hospital, Obstetrics and Gynaecology Greve, Tine; Hvidovre Hospital, Obstetrics and Gynaecology Bor, Pinar; Randers Regional Hospital, Obstetrics and Gynaecology induction of labour, oxytocin, discontinuation, Caesarean section, active Keywords: phase of labour, uterine tachysystole
    [Show full text]
  • Terms/Definitions
    9th Annual AABC Birth Institute 10/1/2015 HEAD COMPRESSION: PLAINTIFF’S NEW THEORY TO EXPLAIN CEREBRAL PALSY 9th ANNUAL AABC BIRTH INSTITUTE OCTOBER 1-4, 2015, SCOTTSDALE, AZ OCTOBER 2, 2015 Julia K. McNelis, R.N., J.D. Kitch Drutchas Wagner Valitutti & Sherbrook Mt. Clemens, Michigan (Detroit, Marquette, Lansing, Chicago, Toledo) Terms/Definitions • Freemans, 3rd Ed. 2003 • NICHD 2008 • ACOG 2009 • Williams, 23nd Ed. 2010 • Freeman’s, 4th Ed. 2012 1 9th Annual AABC Birth Institute 10/1/2015 Freeman’s 3rd Ed (2003) • Primary function of ctx is expulsion of uterine contents • Manual palpation has been traditional method of monitoring ctx • During labor strength varies 30mm Hg average early labor to 50 mm Hg later first stage • 50mm Hg to 80 mm Hg second stage • Once labor starts ctx become more frequent and stronger Freeman’s 3rd (2003) Fig 5.8 2 9th Annual AABC Birth Institute 10/1/2015 NICHD (2008) • Normal-5 or less ctx in 10 minutes, averaged over 30 minutes • Tachysystole-> 5 ctx in 10 minutes, averaged over 30 minutes • “Hyperstimulation” and “hypercontractility” are not defined and should be abandoned ACOG # 107 (2009) • Adopts NICHD definitions • Tachysystole should always be qualified as to the presence or absence of associated FHR decelerations • The term tachysystole applies to both spontaneous and stimulated labor 3 9th Annual AABC Birth Institute 10/1/2015 Williams 23 Ed. 2010 • Ctx in normal labor-forces are greatest and last longest at the fundus and diminish towards the cervix • The Montevideo group ascertained that the lowest limit of ctx pressure required to dilate the cervix is 15 mm Hg Williams 23 Ed.
    [Show full text]
  • Misoprostol Tablets
    Cytotec® misoprostol tablets WARNINGS CYTOTEC (MISOPROSTOL) ADMINISTRATION TO WOMEN WHO ARE PREGNANT CAN CAUSE BIRTH DEFECTS, ABORTION, PREMATURE BIRTH OR UTERINE RUPTURE. UTERINE RUPTURE HAS BEEN REPORTED WHEN CYTOTEC WAS ADMINISTERED IN PREGNANT WOMEN TO INDUCE LABOR OR TO INDUCE ABORTION. THE RISK OF UTERINE RUPTURE INCREASES WITH ADVANCING GESTATIONAL AGES AND WITH PRIOR UTERINE SURGERY, INCLUDING CESAREAN DELIVERY (see also PRECAUTIONS and LABOR AND DELIVERY). CYTOTEC SHOULD NOT BE TAKEN BY PREGNANT WOMEN TO REDUCE THE RISK OF ULCERS INDUCED BY NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs) (see CONTRAINDICATIONS, WARNINGS, and PRECAUTIONS). PATIENTS MUST BE ADVISED OF THE ABORTIFACIENT PROPERTY AND WARNED NOT TO GIVE THE DRUG TO OTHERS. Cytotec should not be used for reducing the risk of NSAID-induced ulcers in women of childbearing potential unless the patient is at high risk of complications from gastric ulcers associated with use of the NSAID, or is at high risk of developing gastric ulceration. In such patients, Cytotec may be prescribed if the patient has had a negative serum pregnancy test within 2 weeks prior to beginning therapy. is capable of complying with effective contraceptive measures. has received both oral and written warnings of the hazards of misoprostol, the risk of possible contraception failure, and the danger to other women of childbearing potential should the drug be taken by mistake. will begin Cytotec only on the second or third day of the next normal menstrual period. DESCRIPTION Cytotec oral tablets contain either 100 mcg or 200 mcg of misoprostol, a synthetic prostaglandin E1 analog. 1 Reference ID: 4228046 Misoprostol contains approximately equal amounts of the two diastereomers presented below with their enantiomers indicated by (±): Misoprostol is a water-soluble, viscous liquid.
    [Show full text]
  • 20180523 Vlemminx
    Real-time electrohysterography Citation for published version (APA): Vlemminx, M. W. C. (2018). Real-time electrohysterography: a novel technology used on the labour ward. Technische Universiteit Eindhoven. Document status and date: Published: 23/05/2018 Document Version: Publisher’s PDF, also known as Version of Record (includes final page, issue and volume numbers) Please check the document version of this publication: • A submitted manuscript is the version of the article upon submission and before peer-review. There can be important differences between the submitted version and the official published version of record. People interested in the research are advised to contact the author for the final version of the publication, or visit the DOI to the publisher's website. • The final author version and the galley proof are versions of the publication after peer review. • The final published version features the final layout of the paper including the volume, issue and page numbers. Link to publication General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal. If the publication is distributed under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license above, please follow below link for the End User Agreement: www.tue.nl/taverne Take down policy If you believe that this document breaches copyright please contact us at: [email protected] providing details and we will investigate your claim.
    [Show full text]
  • PPH 2Nd Edn #23.Vp
    43 Standard Medical Therapy for Postpartum Hemorrhage J. Unterscheider, F. Breathnach and M. Geary INTRODUCTION firm contraction of the organ. If severe haemorrhage has already set in, it is highly recommended that the drug should Failure of the uterus to contract and retract following be given by the intravenous route. For this purpose one-third childbirth has for centuries been recognized as the of the standard size ampoule may be injected or, for those most striking cause of postpartum hemorrhage (PPH) who wish accurate dosage, a special ampoule containing and complicates up to 10% of pregnancies globally. In 0.125 mg is manufactured. An effect may be looked for in less the developing world, PPH is responsible for one than one minute.’ maternal death every 7 minutes1. Another uterotonic agent, oxytocin, the hypothalamic In the 19th century, uterine atony was treated by polypeptide hormone released by the posterior pitu- intrauterine placement of various agents with the aim itary, was discovered in 1909 by Sir Henry Dale8 and of achieving a tamponade effect. ‘A lemon imperfectly synthesized in 1954 by du Vigneaud9. The develop- quartered’ or ‘a large bull’s bladder distended with ment of oxytocin constituted the first synthesis of water’ were employed for this purpose, with apparent a polypeptide hormone and gained du Vigneaud a success. Douching with vinegar or iron perchloride Nobel Prize for his work. was also reported2,3. Historically, the first uterotonic The third group of uterotonics comprises the ever- drugs were ergot alkaloids,
    [Show full text]
  • OBGYN-Study-Guide-1.Pdf
    OBSTETRICS PREGNANCY Physiology of Pregnancy: • CO input increases 30-50% (max 20-24 weeks) (mostly due to increase in stroke volume) • SVR anD arterial bp Decreases (likely due to increase in progesterone) o decrease in systolic blood pressure of 5 to 10 mm Hg and in diastolic blood pressure of 10 to 15 mm Hg that nadirs at week 24. • Increase tiDal volume 30-40% and total lung capacity decrease by 5% due to diaphragm • IncreaseD reD blooD cell mass • GI: nausea – due to elevations in estrogen, progesterone, hCG (resolve by 14-16 weeks) • Stomach – prolonged gastric emptying times and decreased GE sphincter tone à reflux • Kidneys increase in size anD ureters dilate during pregnancy à increaseD pyelonephritis • GFR increases by 50% in early pregnancy anD is maintaineD, RAAS increases = increase alDosterone, but no increaseD soDium bc GFR is also increaseD • RBC volume increases by 20-30%, plasma volume increases by 50% à decreased crit (dilutional anemia) • Labor can cause WBC to rise over 20 million • Pregnancy = hypercoagulable state (increase in fibrinogen anD factors VII-X); clotting and bleeding times do not change • Pregnancy = hyperestrogenic state • hCG double 48 hours during early pregnancy and reach peak at 10-12 weeks, decline to reach stead stage after week 15 • placenta produces hCG which maintains corpus luteum in early pregnancy • corpus luteum produces progesterone which maintains enDometrium • increaseD prolactin during pregnancy • elevation in T3 and T4, slight Decrease in TSH early on, but overall euthyroiD state • linea nigra, perineum, anD face skin (melasma) changes • increase carpal tunnel (median nerve compression) • increased caloric need 300cal/day during pregnancy and 500 during breastfeeding • shoulD gain 20-30 lb • increaseD caloric requirements: protein, iron, folate, calcium, other vitamins anD minerals Testing: In a patient with irregular menstrual cycles or unknown date of last menstruation, the last Date of intercourse shoulD be useD as the marker for repeating a urine pregnancy test.
    [Show full text]
  • Prostaglandin E2 Induction of Labor and Cervical Ripening for Term Isolated Oligohydramnios in Pregnant Women with Bishop Score 5
    + MODEL Available online at www.sciencedirect.com ScienceDirect Journal of the Chinese Medical Association xx (2016) 1e4 www.jcma-online.com Original Article Prostaglandin E2 induction of labor and cervical ripening for term isolated oligohydramnios in pregnant women with Bishop score 5 Hatice Kansu-Celik*, Ozlem Gun-Eryılmaz, Nasuh Utku Dogan, Seval Haktankaçmaz, Mehmet Cinar, Saynur Sarici Yilmaz, Cavidan Gu¨lerman Zekai Tahir Burak Woman's Health, Research and Education Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey Received April 26, 2016; accepted July 15, 2016 Abstract Background: We aimed to evaluate the efficacy and safety of dinoprostone for cervical ripening and labor induction in patients with term oligohydramnios and Bishop score 5. Methods: This was a prospective caseecontrol study, which included 104 consecutive women with a Bishop score 5. Participants were divided into two groups. Women with term isolated oligohydramnios and Bishop score 5 underwent induction of labor with a vaginal insert containing 10-mg timed-release dinoprostone (prostaglandin E2; Group A, n ¼ 40). The control group, Group B, consisted of 64 cases of pregnancy with normal amniotic fluid volume (amniotic fluid index 5 cm) and Bishop score 5, and was matched for patient's age and parity. The primary outcome was time from induction to delivery; the secondary outcomes were the caesarean section (CS) rate, uterine hyperstimulation, rate of failed induction, and neonatal complications. Results: The mean time interval from induction to delivery was not different between the two groups ( p ¼ 0.849), but there was a statistically significant difference between the groups in terms of the CS rate ( p ¼ 0.005).
    [Show full text]
  • Does Labor Augmentation with Oxytocin
    her and ot C M h il n d i H s e c i a l n t i l h Mansy, Clinics Mother Child Health 2017, 14:3 C Clinics in Mother and Child Health DOI: 10.4172/2090-7214.1000268 ISSN: 2090-7214 Research Article Open Access Does Labor Augmentation with Oxytocin Increase the Risk of Postpartum Hemorrhage? A Randomized Controlled Trial Amr Mansy* Obstetrics & Gynecology, Faculty of Medicine, Alexandria University, Egypt *Corresponding author: Amr Mansy, Obstetrics & Gynecology, Faculty of Medicine, Alexandria University, Egypt, Tel: +201227494992; Fax: +201227494992; E-mail: [email protected] Received date: June 04, 2017; Accepted date: August 22, 2017; Published date: September 02, 2017 Copyright: ©2017 Mansy A. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Labour augmentation aims to shorten labour so prevent complications related to prolonged labour. There is evidence that a significant proportion of women with uncomplicated pregnancies are subjected to routine augmentation of labour with oxytocin in spite of the general rule that labour augmentation should only be performed for valid indications. Obstetric hemorrhage is one of the leading causes of maternal mortality in developing countries, accounting for 10%-30% of direct maternal deaths. The aim of the study was to compare between labour augmentation with oxytocin and no augmentation on the total volume of blood loss during vaginal delivery. The study included 250 cases admitted to the emergency department in El-Shatby maternity university hospital, group A (Oxytocin group) 125 cases received augmentation by oxytocin infusion using 2.5 IU oxytocin in 500 cc saline with a slow rate of 20-30 drops/minute, group B (Control group) 125 cases received only 500 cc saline.
    [Show full text]
  • Safety Profile of Misoprostol for Obstetrical Indications
    SAFETY PROFILE OF MISOPROSTOL FOR OBSTETRICAL INDICATIONS Lenita Wannmacher INTRODUCTION Cervical ripening, full‐term labour induction, and postpartum haemorrhage (PPH) are obstetric conditions that require proper and early interventions in order to save maternal and fetal lives. These interventions include pharmacological (uterotonic agents, mainly) and non‐pharmacological methods that have been tested and compared throughout the past decade. Regarding injectable uterotonic medicines (such as oxytocin, ergometrine, syntometrine, prostaglandins, and, more recently, carbetocin), factors limiting their use in low‐resource settings have been their cost, instability at high ambient temperatures, and difficult requirements of administration. In poor and rural settings, birth attendant skills are limited, transport facilities are inadequate, and injectable uterotonics and blood are hardly available. In contrast, misoprostol, a synthetic prostaglandin E1 analogue, presents low cost, storage at room temperature, and widespread availability. Misoprostol could also be easily administered by unskilled attendants or the women themselves, thus making them available for women giving birth at home or in isolated areas. These are benefits that make it particularly appealing for developing poor countries.1 Despite the built evidence of efficacy, induction of full‐term labour in women with a live fetus, as well as prevention and treatment of PPH, remains as a major challenge in modern obstetrics. Safety profile of misoprostol is still a matter of concern, especially relating to doses and routes used for the mentioned purposes.2 Misoprostol can be effectively administered vaginally, rectally, bucally, orally and sublingually. Pharmacokinetic studies have demonstrated the properties of misoprostol after various routes of administration. The rate of absorption varies considerably between routes, and care must be taken to use the correct dose and frequency for the specified route.
    [Show full text]