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Oxytocin Alone (oxytocin + alone)
Selected AbstractsTrends in induction of labour, 1998,2007: A population-based studyAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 6 2009N. M. MEALING Background:, Increasing rates of induction have been reported in the UK, the USA, Canada and Australia since the early 1990s; however, there is a lack of population-based studies on trends and pharmacological management of induction of labour. Aims:, To determine population trends in induction of labour and predictors of failed induction (in caesarean section, specifically for failure to progress with cervix dilation ,3 cm). Methods:, Trends in induction were determined for women in NSW who laboured at , 32 weeks from 1998 to 2007 (N = 739 904). To determine the predictors of failed induction, 92 359 deliveries of live singletons for whom linked birth and hospital data were available (2001,2005) were examined using logistic regression analysis. Results:, The rate of induction increased over the decade from 25.3 to 29.1%; however, among those induced with prostaglandin alone, it decreased from 33.5 to 23.8%. Oxytocin alone was the most commonly used labour induction agent overall (51%) and in most population subgroups. The predictors of failed induction in both nullipara and multipara included increasing maternal age, pre-term and post-term birth and the use of prostaglandin or mechanical methods of induction (neither oxytocin nor prostaglandin). Conclusions:, The pharmacological agents used for induction of labour have changed over the past decade. An important area for future research is to investigate how the dosage of oxytocin and prostaglandin affects pregnancy outcomes. [source] A comparison between the effect of oxytocin only and oxtocin plus propranolol on the labor (A double blind randomized trial)JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 3 2008Maryam Kashanian Abstract Objective:, The comparison between the effect of oxytocin alone or in combination with propranolol on labor. Methods:, A double blind randomized controlled trial was performed on 150 nulliparas with a gestational age of 39,41 weeks of pregnancy and a Bishop score of ,5. In the first group (oxytocin group = 75), oxytocin alone was used for induction of labor. In the second group (propranolol group = 75 cases), before the beginning of oxytocin, 2 mg propranolol was slowly injected intravenously then the oxytocin was initiated. Results:, The number of patients who delivered in the first day showed no difference between the two groups. The mean duration for obtaining good contractions was shorter in the propranolol group in both the first and second day of induction The mean interval between the beginning of induction until the beginning of active phase at the first day of induction was shorter in the propranolol group. The mean interval between the beginning of induction until delivery at the first day of induction was shorter in the propranolol group. The amount of necessary oxytocin for the first day of induction was less in the propranolol group. Conclusion:, Propranolol may shorten the induction duration and labor and reduce the amount of necessary oxytocin. [source] Titrated low-dose vaginal and/or oral misoprostol to induce labour for prelabour membrane rupture: a randomised trialBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 12 2008L Bricker Objective, To evaluate the clinical effectiveness and safety of titrated low-dose misoprostol for induction of labour (IOL) in the presence of prelabour rupture of membranes (PROM). Design, Randomised controlled trial. Setting, Maternity units in the UK (9) and Egypt (1). Population, Women >34 weeks of gestation with PROM, singleton viable fetus and no previous caesarean section. Methods, Subjects randomised to IOL with a titrated low-dose misoprostol regimen (oral except if unfavourable cervix, where initial dose vaginal) or a standard induction method, namely vaginal dinoprostone followed by intravenous oxytocin if the cervix was unfavourable or intravenous oxytocin alone if the cervix was favourable. Main outcome measures, Primary outcome measures were caesarean section and failure to achieve vaginal delivery within 24 hours. Analysis was by intention to treat. Results, The trial did not achieve the planned sample size of 1890 due to failure in obtaining external funding. Seven hundred and fifty-eight women were randomised (375 misoprostol and 383 standard). There were less caesarean section (14 versus 18%, relative risk [RR] 0.79; 95% CI 0.57,1.09) and less women who failed to achieve vaginal delivery within 24 hours in the misoprostol group (24 versus 31%, RR 0.79; 95% CI 0.63,1.00), but the differences were not statistically significant. Subgroup analysis showed that with unfavourable cervix, misoprostol may be more effective than vaginal dinoprostone. There was no difference in hyperstimulation syndrome. There were more maternal adverse effects with misoprostol, but no significant differences in maternal and neonatal complications. Conclusions, Titrated low-dose misoprostol may be a reasonable alternative for IOL in the presence of PROM, particularly in women with an unfavourable cervix. Safety and rare serious adverse events could not be evaluated in a trial of this size. [source] Oxytocin,ergometrine co-administration does not reduce blood loss at caesarean delivery for labour arrest,BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2008M Balki Objective, To determine if intravenous infusion of a combination of oxytocin and ergometrine maleate is better than oxytocin alone to decrease blood loss at caesarean delivery for labour arrest. Design, Prospective, double-blinded, randomised controlled trial. Setting, Mount Sinai Hospital, Toronto, Canada. Population, Women undergoing caesarean deliveries for labour arrest. Methods, Forty-eight women were randomised to receive infusion of either ergometrine maleate 0.25 mg + oxytocin 20 iu or oxytocin 20 iu alone, diluted in 1 l of lactated Ringer's Solution, immediately after delivery of the infant. Unsatisfactory uterine contractions after delivery were treated with additional boluses of the study solution or rescue carboprost. Blood loss was estimated based on the haematocrit values before and 48 hours after delivery. Main outcome measures, The primary outcome was the estimated blood loss, while the secondary outcomes included the use of additional uterotonics, need for blood transfusion and the incidence of adverse effects. Results, The estimated blood loss was similar in the oxytocin,ergometrine and oxytocin-only groups; 1218 ± 716 ml and 1299 ± 774 ml, respectively (P= 0.72). Significantly fewer women required additional boluses of the study drug in the oxytocin,ergometrine group (21 and 57%; P= 0.01). Nausea (42 and 9%; P= 0.01) and vomiting (25 and 4%; P= 0.05) were significantly more prevalent in the oxytocin,ergometrine group. Conclusions, In women undergoing caesarean delivery for labour arrest, the co-administration of ergometrine with oxytocin does not reduce intraoperative blood loss, despite apparently superior uterine contraction. [source] Rupture of the uterine scar during term labour: contractility or biochemistry?BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 1 2005Catalin S. Buhimschi Objective Vaginal birth after a prior low transverse caesarean section (VBAC) is advocated as a safe and effective method to reduce the total caesarean section rate. However, the risk of uterine rupture has dampened the enthusiasm of practising clinicians for VBAC. Uterine rupture occurs more frequently in women receiving prostaglandins in preparation for the induction of labour. We hypothesised that similar to the cervix, prostaglandins induces biochemical changes in the uterine scar favouring dissolution, predisposing the uterus to rupture at the scar of the lower segment as opposed to elsewhere. Design We tested aspects of this hypothesis by investigating the location of uterine rupture associated with prostaglandins and compared it with the sites of rupture in the absence of prostaglandins. Settings Two North American University Hospitals. Population Twenty-six women with a prior caesarean section, experiencing uterine rupture in active labour. Methods Retrospective review of all pregnancies complicated by uterine rupture at two North American teaching hospitals from 1991 to 2000. Main outcome measure Site of the uterine rupture. Results Thirty-four women experienced rupture after a previous caesarean section with low transverse uterine incision. Ten of the women who ruptured (29%) received prostaglandins for cervical ripening (dinoprostone: n= 8 or misoprostol: n= 2) followed by either spontaneous contractions (n= 3) or oxytocin augmentation during labour (n= 7). In 16 women (47%), oxytocin alone was sufficient for the induction/augmentation of labour. Eight (23%) women ruptured at term before reaching the active phase of labour in the absence of pro-contractile agents or attempted VBAC. There were no differences among the groups in terms of age, body mass index, parity, gestational age, fetal weight or umbilical cord pH measurements. Women treated with prostaglandins experienced rupture at the site of their old scar more frequently than women in the oxytocin-alone group whose rupture tended to occur remote from their old scar (prostaglandins 90%vs oxytocin 44%; OR: 11.6, 95% CI: 1.2,114.3). Conclusion Women in active labour treated with prostaglandins for cervical ripening appear more likely to rupture at the site of their old scar than women augmented without prostaglandins. We propose that prostaglandins induce local, biochemical modifications that weaken the scar, predisposing it to rupture. [source] | ||||||||||