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Peng L, Chen Z, Weng S, Huang J, Peng M, Deng Y, Xu Y, Zhou F, Li Y. Labor patterns of spontaneous first-stage labor in Chinese women with normal neonatal outcomes. PLoS One 2024; 19:e0305243. [PMID: 38959186 PMCID: PMC11221650 DOI: 10.1371/journal.pone.0305243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 05/27/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Friedman's standards, developed almost 50 years ago, may no longer align with the needs of today's obstetric population and current pregnancy management practices. This study aims to analyze contemporary labor patterns and estimate labor duration in China, focusing on first-stage labor data from Chinese parturients with a spontaneous onset of labor. METHODS This retrospective observational study utilized data from electronic medical records of a tertiary hospital in Changsha, Hunan. Out of a total of 2,689 parturients, exclusions were made for multiple gestations, preterm, post-term, or stillbirth, cesarean delivery, non-vertex presentation, and neonatal intensive care unit admission. Average labor curves were constructed by parity using repeated-measure analysis, and labor duration was estimated through interval-censored regression, stratified by cervical dilation at admission. We performed an analysis to assess the impact of oxytocin augmentation and amniotomy on labor progression and conducted a sensitivity analysis using women with complicated outcomes. RESULTS Nulliparous women take over 180 minutes for cervical dilation from 3 to 4 cm, and the duration from 5 to 6 cm exceeds 145 minutes. Multiparous women experience shorter labor durations than nulliparous. Labor acceleration is observed after 5 cm in nulliparous, but no distinct inflection point is evident in the average labor curve. In the second stage of labor, the 95th percentile for nulliparous, with and without epidural analgesia, is 142 minutes and 127 minutes, respectively. CONCLUSIONS These findings provide valuable insights for the reassessment of labor and delivery processes in contemporary obstetric populations, including current Chinese obstetric practice.
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Affiliation(s)
- Li Peng
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zengyu Chen
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Shiyu Weng
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jian Huang
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Mei Peng
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yali Deng
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ying Xu
- The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Fangfang Zhou
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yamin Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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Gaudernack LC, Einarsen AES, Sørbye IK, Lukasse M, Gunnes N, Michelsen TM. The effect of intravenous hyoscine butylbromide on slow progress in labor (BUSCLAB): A double-blind randomized placebo-controlled trial. PLoS Med 2024; 21:e1004352. [PMID: 38547322 PMCID: PMC11008832 DOI: 10.1371/journal.pmed.1004352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 04/11/2024] [Accepted: 01/25/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Prolonged labor is a common condition associated with maternal and perinatal complications. The standard treatment with oxytocin for augmentation of labor increases the risk of adverse outcomes. Hyoscine butylbromide is a spasmolytic drug with few side effects shown to shorten labor when used in a general population of laboring women. However, research on its effect on preventing prolonged labor is lacking. We aimed to assess the effect of hyoscine butylbromide on the duration of labor in nulliparous women showing early signs of slow labor. METHODS AND FINDINGS In this double-blind randomized placebo-controlled trial, we included 249 nulliparous women at term with 1 fetus in cephalic presentation and spontaneous start of labor, showing early signs of prolonged labor by crossing the alert line of the World Health Organization (WHO) partograph. The trial was conducted at Oslo University Hospital in Norway from May 2019 to December 2021. One hundred and twenty-five participants were randomized to receive 1 ml hyoscine butylbromide (Buscopan) (20 mg/ml), while 124 received 1 ml sodium chloride intravenously. Randomization was computer-generated, with allocation concealment by opaque sequentially numbered sealed envelopes. The primary outcome was duration of labor from administration of the investigational medicinal product (IMP) to vaginal delivery, which was analyzed by Weibull regression to estimate the cause-specific hazard ratio (HR) of vaginal delivery between the 2 treatment groups, with associated 95% confidence interval (CI). A wide range of secondary maternal and perinatal outcomes were also evaluated. Time-to-event outcomes were analyzed by Weibull regression, whereas continuous and dichotomous outcomes were analyzed by median regression and logistic regression, respectively. All main analyses were based on the modified intention-to-treat (ITT) set of eligible women with signed informed consent receiving either of the 2 treatments. The follow-up period lasted during the postpartum hospital stay. All personnel, participants, and researchers were blinded to the treatment allocation. Median (mean) labor duration from IMP administration to vaginal delivery was 401 (440.8) min in the hyoscine butylbromide group versus 432.5 (453.6) min in the placebo group. We found no statistically significant association between IMP and duration of labor from IMP administration to vaginal delivery: cause-specific HR of 1.00 (95% CI [0.77, 1.29]; p = 0.993). Among 255 randomized women having received 1 dose of IMP, 169 women (66.3%) reported a mild adverse event: 75.2% in the hyoscine butylbromide group and 57.1% in the placebo group (Pearson's chi-square test: p = 0.002). More than half of eligible women were not included in the study because they did not wish to participate or were not included upon admission. The participants might have represented a selected group of women reducing the external validity of the study. CONCLUSIONS One intravenous dose of 20 mg hyoscine butylbromide was not found to be superior to placebo in preventing slow labor progress in a population of first-time mothers at risk of prolonged labor. Further research is warranted to answer whether increased and/or repeated doses of hyoscine butylbromide might have an effect on duration of labor. TRIAL REGISTRATION ClinicalTrials.gov (NCT03961165) EudraCT (2018-002338-19).
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Affiliation(s)
- Lise Christine Gaudernack
- Department of Obstetrics, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Angeline Elisabeth Styve Einarsen
- Department of Obstetrics, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ingvil Krarup Sørbye
- Department of Obstetrics, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Mirjam Lukasse
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Campus Vestfold, Borre, Norway
| | - Nina Gunnes
- Norwegian Research Centre for Women’s Health, Oslo University Hospital, Oslo, Norway
| | - Trond Melbye Michelsen
- Department of Obstetrics, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Sanchez-Ramos L, Levine LD, Sciscione AC, Mozurkewich EL, Ramsey PS, Adair CD, Kaunitz AM, McKinney JA. Methods for the induction of labor: efficacy and safety. Am J Obstet Gynecol 2024; 230:S669-S695. [PMID: 38462252 DOI: 10.1016/j.ajog.2023.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/20/2023] [Accepted: 02/01/2023] [Indexed: 03/12/2024]
Abstract
This review assessed the efficacy and safety of pharmacologic agents (prostaglandins, oxytocin, mifepristone, hyaluronidase, and nitric oxide donors) and mechanical methods (single- and double-balloon catheters, laminaria, membrane stripping, and amniotomy) and those generally considered under the rubric of complementary medicine (castor oil, nipple stimulation, sexual intercourse, herbal medicine, and acupuncture). A substantial body of published reports, including 2 large network meta-analyses, support the safety and efficacy of misoprostol (PGE1) when used for cervical ripening and labor induction. Misoprostol administered vaginally at doses of 50 μg has the highest probability of achieving vaginal delivery within 24 hours. Regardless of dosing, route, and schedule of administration, when used for cervical ripening and labor induction, prostaglandin E2 seems to have similar efficacy in decreasing cesarean delivery rates. Globally, although oxytocin represents the most widely used pharmacologic agent for labor induction, its effectiveness is highly dependent on parity and cervical status. Oxytocin is more effective than expectant management in inducing labor, and the efficacy of oxytocin is enhanced when combined with amniotomy. However, prostaglandins administered vaginally or intracervically are more effective in inducing labor than oxytocin. A single 200-mg oral tablet of mifepristone seems to represent the lowest effective dose for cervical ripening. The bulk of the literature assessing relaxin suggests this agent has limited benefit when used for this indication. Although intracervical injection of hyaluronidase may cause cervical ripening, the need for intracervical administration has limited the use of this agent. Concerning the vaginal administration of nitric oxide donors, including isosorbide mononitrate, isosorbide, nitroglycerin, and sodium nitroprusside, the higher incidence of side effects with these agents has limited their use. A synthetic hygroscopic cervical dilator has been found to be effective for preinduction cervical ripening. Although a pharmacologic agent may be administered after the use of the synthetic hygroscopic dilator, in an attempt to reduce the interval to vaginal delivery, concomitant use of mechanical and pharmacologic methods is being explored. Combining the use of a single-balloon catheter with dinoprostone, misoprostol, or oxytocin enhances the efficacy of these pharmacologic agents in cervical ripening and labor induction. The efficacy of single- and double-balloon catheters in cervical ripening and labor induction seems similar. To date, the combination of misoprostol with an intracervical catheter seems to be the best approach when balancing delivery times with safety. Although complementary methods are occasionally used by patients, given the lack of data documenting their efficacy and safety, these methods are rarely used in hospital settings.
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Affiliation(s)
- Luis Sanchez-Ramos
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, FL.
| | - Lisa D Levine
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA
| | - Anthony C Sciscione
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Christiana Hospital, Newark, DE
| | - Ellen L Mozurkewich
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM
| | - Patrick S Ramsey
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health Science Center San Antonio, TX
| | - Charles David Adair
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Tennessee College of Medicine, Chattanooga, TN
| | - Andrew M Kaunitz
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, FL
| | - Jordan A McKinney
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, FL
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Maaløe N, Kujabi ML, Nathan NO, Skovdal M, Dmello BS, Wray S, van den Akker T, Housseine N. Inconsistent definitions of labour progress and over-medicalisation cause unnecessary harm during birth. BMJ 2023; 383:e076515. [PMID: 38084433 PMCID: PMC10726361 DOI: 10.1136/bmj-2023-076515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Nanna Maaløe
- Global Health Section, Department of Public Health, University of Copenhagen, Denmark
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital-Herlev Hospital, Copenhagen, Denmark
| | - Monica Lauridsen Kujabi
- Global Health Section, Department of Public Health, University of Copenhagen, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Skejby, Denmark
| | - Nina Olsén Nathan
- Department of Obstetrics, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Morten Skovdal
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Denmark
| | - Brenda Sequeira Dmello
- Global Health Section, Department of Public Health, University of Copenhagen, Denmark
- CCBRT Hospital, Dar es Salaam, Tanzania, East Africa
| | - Susan Wray
- Women and Children's Health, University of Liverpool, Liverpool, UK
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, Netherlands
- Athena Institute, VU University, Amsterdam, Netherlands
| | - Natasha Housseine
- Global Health Section, Department of Public Health, University of Copenhagen, Denmark
- Department of Obstetrics and Gynaecology, Aga Khan University, Tanzania, East Africa
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Torloni MR, Betran AP, Vazquez Corona M, Bohren M, Widmer M. What do healthcare providers think of the quality of uterotonics? A mixed-methods systematic review. BMJ Open 2023; 13:e068442. [PMID: 37899165 PMCID: PMC10618966 DOI: 10.1136/bmjopen-2022-068442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/09/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVES To synthesise evidence on the perceptions of healthcare providers (HCPs) about the quality of oxytocin and misoprostol available in their settings, and their actions as a result of these perceptions. DESIGN Mixed-methods systematic review. ELIGIBILITY CRITERIA We included quantitative and qualitative studies reporting HCPs' perceptions about oxytocin or misoprostol quality. DATA SOURCES We searched CINAHL, Cochrane Library, Ebscohost, Embase, PubMed, Global Index Medicus, Portal regional BVS, PsycNET, Scopus and Web of Science from inception to 31 March 2022 and grey literature. RISK OF BIAS We used the Center for Evidence-Based Management critical appraisal tool for surveys. For qualitative studies, we used the Critical Appraisal Skills Programme tool. DATA EXTRACTION AND SYNTHESIS Two independent reviewers performed study selection, data extraction and quality assessment. We conducted separate quantitative and qualitative syntheses and integrated the evidence into a narrative synthesis (convergent segregated review design). RESULTS We included five (three quantitative and two qualitative) studies, of moderate or high quality, conducted in low-income and middle-income countries (LMICs). In the three quantitative studies (N=7065 participants), 8.2-21.3% of HCPs had experienced problems due to known/suspected low-quality oxytocin and 3.3% due to low-quality misoprostol. In the two qualitative studies, perception of oxytocin quality varied. In quantitative studies, when confronted with suspected/known low-quality oxytocin, 29-78% of HCPs would inform a supervisor, 62% would document this in writing, 45-54% would change to another drug and 5-37% would double the dose of oxytocin. Qualitative evidence suggests that many HCPs do not formally report suspected low-quality oxytocin or misoprostol, and use higher doses or additional uterotonics. CONCLUSIONS A proportion of HCPs from LMICs perceive oxytocin to be of low quality. There is very limited evidence on their perceptions about misoprostol. Many HCPs do not report suspected low-quality uterotonics but change to another medicine or double the dose of oxytocin. PROSPERO REGISTRATION NUMBER CRD42022323812.
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Affiliation(s)
- Maria Regina Torloni
- Evidence Based Healthcare Post-Graduate Program, São Paulo Federal University, São Paulo, Brazil
| | - Ana Pilar Betran
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Martha Vazquez Corona
- Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Meghan Bohren
- Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mariana Widmer
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
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Abdou AM, Eldesouky E, Farag E, Mohammed A, Abdelaziz DFM, Shaaban A, Ellaban M, Elhalim AEMA, Elsror AGA, Marai AAE, Abdel-Hakam F, Abd-ElGawad M, Elrashedy AA, Abdelmonem H, Kamel MA, Afiffi IK, Elsayed HGA, Abdelhamed SA, Bosilah AH, Marie H. Oxytocin versus a combination of tranexamic acid and ethamsylate in reducing intraoperative bleeding during abdominal myomectomy: a randomized clinical trial. BMC Womens Health 2023; 23:398. [PMID: 37516864 PMCID: PMC10387195 DOI: 10.1186/s12905-023-02549-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/15/2023] [Indexed: 07/31/2023] Open
Abstract
OBJECTIVE Myomectomy is the preferred surgical approach to manage uterine fibroids. However, uterine fibroids are highly vascular tumors and, consequently, extremely susceptible to problems from myomectomy-related hemorrhage. Hence, we aim to compare oxytocin efficacy and safety profile versus tranexamic acid (TA) with ethamsylate for reducing bleeding during myomectomy. METHODS This randomized, double-blinded multicenter study was performed between 20th August 2020 and 20th October 2020 at El-Galaa Teaching Hospital, El Hussein University Hospital, Al-Azhar University Hospitals of Assiut, and Al-Azhar University Hospitals of Damietta. One hundred and eighty patients were enrolled and divided into three groups: group (1) received an injection of 30 IU of oxytocin in 500 ml of normal saline; group (2) received injections of 1 g of TA, 250 mg of Ethamsylate, and 110 ml of normal saline IV; and group (3) received an injection of 110 ml of normal saline IV just before surgical incision. RESULTS In 180 premenopausal women, oxytocin and TA with ethamsylate had no significant value in lowering intraoperative blood loss compared with the placebo for abdominal myomectomy (666.25 ± 183.03, 630.72 ± 145.83, and 646.67 ± 168.92, respectively (P = 0.506)). Non-significant trends were observed for a reduction in operation time (P = 0.760), intra/postoperative blood transfusion (P = 0.624), hospital stay (P = 0.986), postoperative fever (P = 0.659), and wound infection (P = 1). CONCLUSION Oxytocin and TA with ethamsylate had no significant value in lowering intraoperative blood loss compared with the placebo for abdominal myomectomy which opens a new question about the role of the use of the hemostatic drug during myomectomy especially in centers with limited resources and had higher rates. TRIAL REGISTRATION The study was registered on Pan African Clinical Trials Registry with the following number: PACTR202008739887429 and was approved on 24/08/2020.
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Affiliation(s)
- Ahmed Mahmoud Abdou
- Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Elsayed Eldesouky
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alazhar University in Cairo, Cairo, Egypt
| | - Elsayed Farag
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alazhar University in Cairo, Cairo, Egypt
| | - Attia Mohammed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alazhar University in Cairo, Cairo, Egypt
| | | | - A Shaaban
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alazhar University in Cairo, Cairo, Egypt
| | - Mostafa Ellaban
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alazhar University in Cairo, Cairo, Egypt
| | | | - Ahmed Gamal Abo Elsror
- International Islamic Institute for Studies and Population Research Alazhar University in Cairo, Cairo, Egypt
| | | | - Faiza Abdel-Hakam
- Department of Obstetrics and Gynecology, Alazhar University for Girls in Cairo, Cairo, Egypt
| | | | | | | | | | - Ibtesam K Afiffi
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Tanta University, Tanta, Egypt
- Department of Basic &Clinical Oral Sciences &, Faculty of Dental Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | | | - Almandouh H Bosilah
- Department of Obstetrics and Gynecology, Faculty of Medicine, Damiata University, Damiata, Egypt
| | - Heba Marie
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Negash BT, Alelgn Y. Proper partograph utilization among skilled birth attendants in Hawassa city public health facilities, Sidama region, Ethiopia, in 2021. BMC Womens Health 2022; 22:539. [PMID: 36550470 PMCID: PMC9773518 DOI: 10.1186/s12905-022-02117-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Abnormalities of labor are the major causes of maternal and fetal mortality and morbidity. Proper partograph utilization is a key intervention to detect labor abnormalities and subsequent initiation of management. Although a great deals of studies were conducted about partograph utilization, they have failed to explore some critical factors which correlate with correct filling of partograph so far. To assess magnitude and factors associated with proper partograph recording among skilled delivery attendants in public health facilities of Hawassa city, Sidama Ethiopia, in 2021. An institution based cross-sectional study was conducted to assess proper partograph filling practice among skilled delivery providers of public health facilities of Hawassa city, Sidama region, Ethiopia from November to December 15, in 2021. Data were collected using self-administered questionnaire, and client chart review. Data were entered, cleaned, and analyzed using SPSS software. Binary and multivariate logistic regression analysis was used to show association between outcome and explanatory variables. Multi-collinearity test was done using VIF. Adjusted Odds Ratio with 95% CI and p value less than 0.05 was taken as cuff of value for statistically significant value at final model. Out of 405 study participants, only 370 study subjects have provided full response for questions making a response rate of 91.4% in this study. The reason of non-responders was evaluated as not related with the issue of the outcome variable. The mean age of study subjects was 28 ± 3.9 years. Magnitude of proper partograph utilization was found to be58.4% (95% CI, 55.8-60.9%) among skilled delivery attendants in this study. Factors associated with partograph uptake were: On job training (AOR = 1.9, 95% CI: (1.1, 3.2), good knowledge (AOR = 3.1, 95% CI: (1.8, 5.3) and supportive supervision (AOR = 4.5, 95% CI, 2.5, 7.9), client took Uterotonics (AOR = 2.3, 95% CI: 1.4, 3.9), and day time admission (AOR = 3.5, 95% CI, 1.9-6.4). These factors were associated positively with proper partograph utilization. In conclusion, magnitude of proper partograph utilization was found to be lower than magnitude of WHO threshold. Hence, on job training should be enhanced about proper partograph utilization. Furthermore, monitoring, supervision and strengthening the human resource of delivery process would be mandatory by managers of delivery units.
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Affiliation(s)
- Berhan Tsegaye Negash
- grid.192268.60000 0000 8953 2273Department of Midwifery Collage of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Yitateku Alelgn
- grid.192268.60000 0000 8953 2273Department of Midwifery Collage of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
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8
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Sørbye IK, Gaudernack LC, Einarsen A, Rosseland LA, Lukasse M, Gunnes N, Michelsen TM. Study protocol for the BUSCopan in LABor (BUSCLAB) study: A randomized placebo-controlled trial investigating the effect of butylscopolamine bromide to prevent prolonged labor. PLoS One 2022; 17:e0276613. [PMID: 36327275 PMCID: PMC9632812 DOI: 10.1371/journal.pone.0276613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 09/23/2022] [Indexed: 11/05/2022] Open
Abstract
Background First-time mothers are prone to prolonged labor, defined as the crossing of partograph alert or action lines. Prolonged labor may occur among as many as one out of five women, and is associated with a range of adverse birth outcomes. Oxytocin is the standard treatment for prolonged labor, but has a narrow therapeutic window, several adverse effects and limited efficacy. Despite poor evidence, labor wards often use antispasmodic agents to treat prolonged labor. The antispasmodic drug butylscopolamine bromide (Buscopan®) may shorten duration of labor, but studies on prevention of prolonged labor are lacking. In this randomized double-blind placebo-controlled clinical trial, we aim to evaluate the effect of butylscopolamine bromide on duration of labor in first-time mothers showing first signs of slow labor progress by crossing the World Health Organization partograph alert line. Methods and analysis The study is a single center study at Oslo University Hospital, Oslo, Norway. We will recruit 250 primiparous women with spontaneous labor start at term. Women are included in the first stage of labor if they show signs of slow labor progress, defined as the crossing of the partograph alert line with a cervical dilation between 3–9 cm. Participants are randomized 1:1 to either 20 mg intravenous butylscopolamine bromide or intravenous placebo (1 mL sodium chlorine 9 mg/mL). We considered a mean difference of 60 minutes in labor duration clinically relevant. The primary outcome is duration of labor from the provision of the investigational medicinal product to vaginal delivery. The secondary outcomes include change in labor pain, use of oxytocin augmentation, delivery mode, and maternal birth experience. The primary data for the statistical analysis will be the full analysis set and will occur on completion of the study as per the prespecified statistical analysis plan. The primary outcome will be analyzed using Weibull regression, and we will treat cesarean delivery as a censoring event.
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Affiliation(s)
- Ingvil Krarup Sørbye
- Division of Obstetrics and Gynecology, Department of Obstetrics, Oslo University Hospital, Oslo, Norway
- * E-mail:
| | - Lise Christine Gaudernack
- Division of Obstetrics and Gynecology, Department of Obstetrics, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Angeline Einarsen
- Division of Obstetrics and Gynecology, Department of Obstetrics, Oslo University Hospital, Oslo, Norway
| | - Leiv Arne Rosseland
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mirjam Lukasse
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Department of Nursing and Social Sciences, University of South-Eastern Norway, Notodden, Norway
| | - Nina Gunnes
- Norwegian Research Centre for Women’s Health, Oslo University Hospital, Oslo, Norway
| | - Trond Melbye Michelsen
- Division of Obstetrics and Gynecology, Department of Obstetrics, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Muacevic A, Adler JR. Intravenous Carbetocin Versus Rectal Misoprostol for the Active Management of the Third Stage of Labor: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Cureus 2022; 14:e30229. [PMID: 36246091 PMCID: PMC9555680 DOI: 10.7759/cureus.30229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 11/07/2022] Open
Abstract
Globally, postpartum hemorrhage (PPH) is the top cause of maternal death. Multiple uterotonic medications are available to prevent PPH; however, it is still unclear whether one is the most effective. The current study compared the efficacy and safety of intravenous carbetocin with rectal misoprostol for the active management of the third stage of labor in order to prevent PPH. Eligible studies were found utilizing digital medical sources, including the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science (WOS), PubMed, Scopus, and Google Scholar, from inception until September 2022. Only randomized controlled trials (RCTs) that matched the inclusion requirements were chosen. We used the Cochrane Risk of Bias scale (version 2) to assess the quality of the included studies. The Review Manager (version 5.4 for Windows) was used to conduct the meta-analysis. The results were summarized as mean difference (MD) or risk ratio (RR) with a 95% confidence interval (CI) in fixed- or random-effects models according to the degree of between-study heterogeneity. Collectively, we screened 621 articles after omitting duplicates and eventually included three RCTs for analysis. Overall, 404 patients were included in these studies; 202 patients were allocated to the intravenous carbetocin group whereas 202 patients were allocated to the rectal misoprostol group. Two RCTs were judged as “low” risk of bias, whereas one RCT was judged as having “some concerns” regarding the quality assessment. Regarding efficacy endpoints, the intravenous carbetocin group had significantly lower blood loss (n=3 RCTs, MD=-117.74 mL, 95% CI [-185.41, -50.07], p<0.001), need for additional uterotonics (n=2 RCTs, RR=0.06, 95% CI [0.01, 0.46], p=0.007), need for uterine massage (n=2 RCTs, RR=0.40, 95% CI [0.20, 0.80], p=0.009), and need for blood transfusion (n=2 RCTs, RR=0.38, 95% CI [0.15, 0.95], p=0.04) compared with the rectal misoprostol group. Regarding safety endpoints, the rates of diarrhea (n=3 RCTs, RR=0.18, 95% CI [0.06, 0.55], p=0.003) and chills (n=2 RCTs, RR=0.31, 95% CI [0.12, 0.83], p=0.02) were significantly lower in the intravenous carbetocin group compared with the rectal misoprostol group. However, there was no significant difference between both groups regarding the rates of headache (n=3 RCTs, RR=1.23, 95% CI [0.06, 1.91], p=0.35) and facial flushing (n=2 RCTs, RR=0.88, 95% CI [0.46, 1.68], p=0.70). In conclusion, it was discovered that intravenous carbetocin was a superior substitute for rectal misoprostol for the active management of the third stage of labor. With far fewer side effects, intravenous carbetocin decreased postpartum blood loss and further uterotonic use. For women who have a high risk of PPH, intravenous carbetocin is advised.
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Asadi N, Vafaei H, Hessami K, Darabi MH, Kasraeian M, Faraji A, Alavi A, Abdi N, Gissuei A, Roozmeh S, Bazrafshan K, Gharibpour F. Vaginal misoprostol and intravenous oxytocin for success of termination in the second-trimester intrauterine fetal demise: A randomized controlled clinical trial. J Obstet Gynaecol Res 2022; 48:966-972. [PMID: 35261120 DOI: 10.1111/jog.15180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 10/29/2021] [Accepted: 01/22/2022] [Indexed: 11/29/2022]
Abstract
AIM To compare the success rate of vaginal misoprostol versus intravenous (IV) oxytocin in termination of pregnancy in the second trimester intrauterine fetal death (IUFD). METHODS This was an open-label randomized controlled study for 106 women with second trimester IUFD. Patients were randomly divided into two groups: women given vaginal misoprostol (400 mcg every 6 h up to 48 h) versus those given IV oxytocin (starting with 50 units up to a maximum of 300 units). When the first-line treatment (as mentioned above) failed, treatment methods were replaced with each other. When the second-line treatment failed, the patients underwent dilation and evacuation. RESULTS The first-line treatment yielded the successful rate of 88.7% versus 73.7% for misoprostol versus oxytocin, respectively (p = 0.047). Among those with first-line treatment failure, the second-line treatment yielded success rate of 85.7% versus 83.3% for misoprostol versus oxytocin (p = 0.891). The mean duration of induction to delivery in women with successful response to first-line treatment was 28.72 and 20.55 h after initially receiving misoprostol versus oxytocin, respectively (p < 0.001). While during second-line treatment, this mean interval was not significantly different among those with misoprostol versus oxytocin (p = 0.128). No severe adverse events were observed. CONCLUSION Vaginal misoprostol was associated with higher termination rate than oxytocin without adverse events when used as the first-line treatment. Both methods yielded the same success rate when used as the second-line treatment.
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Affiliation(s)
| | - Homeira Vafaei
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamaran Hessami
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Mohammad Hasan Darabi
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Kasraeian
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azam Faraji
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azin Alavi
- Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Nazanin Abdi
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Atena Gissuei
- Department of Obstetrics and Gynecology, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Shohre Roozmeh
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Khadije Bazrafshan
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fereshteh Gharibpour
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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11
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Albazee E, Sayad R, Elrashedy AA, Samy Z, Faraag E, Baradwan S, Samy A. Efficacy of oxytocics on reducing intraoperative blood loss during abdominal myomectomy: a systematic review and meta-analysis of randomized placebo-controlled trials. J Gynecol Obstet Hum Reprod 2022; 51:102358. [DOI: 10.1016/j.jogoh.2022.102358] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/07/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022]
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12
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Svelato A, Carabaneanu A, Sergiampietri C, Mannella P, D'Avino S, De Luca C, Bartolone M, Angioli R, Ragusa A. "To get the baby out off the hook": a prospective, longitudinal, multicenter, observational study about decision making in vacuum-assisted operative vaginal delivery. BMC Pregnancy Childbirth 2022; 22:128. [PMID: 35172781 PMCID: PMC8848824 DOI: 10.1186/s12884-022-04440-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since operative vaginal delivery may be risky for women and might cause neonatal complications, the aim of this study is to assess appropriateness of the procedure. This is a prospective, longitudinal, multicenter, observational study and it was conducted in three Italian Obstetric Units (Pisa, Massa Carrara and Prato). All term pregnant women, either nulliparous and multiparous, with singleton pregnancy and a cephalic fetus, with spontaneous or induced labour, requiring vacuum-assisted delivery were enrolled. Indications to operative vaginal delivery were grouped as alterations of fetal cardiotocography (CTG) patterns, delay/arrest of second stage of labour or elective shortening of second stage of labour. A board consisting of five among authors evaluated appropriateness of the procedure. RESULTS Overall, 466 women undergoing operative vaginal deliveries were included. Cardiotocography, classified as ACOG category 2 or 3 was the indication for vacuum assisted delivery in 253 patients (54.29%). Among these, 66 women (26.1%) had an operative vaginal delivery which was then considered to be inappropriate, while in 114 cases (45.1%) CTG traces resulted to be unreadable. CONCLUSION Decision making process, which leads clinicians to go for operative vaginal delivery, is often influenced by shortness of time and complexity of the situation. Therefore, clinicians tend to intervene performing vacuum delivery without adopting critical analysis and without adequately considering the clinical situation. Operative vaginal delivery might be a risky procedure and should be performed only when clinically indicated and after adequate critical analysis.
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Affiliation(s)
- Alessandro Svelato
- Department of Obstetrics and Gynecology, San Giovanni Calibita Fatebenefratelli Hospital, Isola Tiberina, Via di Ponte Quattro capi, 39, 00186, Rome, Italy.
| | - Alis Carabaneanu
- Department of Obstetrics and Gynecology, Prato General Hospital, Prato, Italy
| | | | - Paolo Mannella
- Department of Reproductive Medicine and Child Development, University of Pisa, Pisa, Italy
| | - Sara D'Avino
- Department of Obstetrics and Gynecology, San Giovanni Calibita Fatebenefratelli Hospital, Isola Tiberina, Via di Ponte Quattro capi, 39, 00186, Rome, Italy
| | - Caterina De Luca
- Department of Obstetrics and Gynecology, San Giovanni Calibita Fatebenefratelli Hospital, Isola Tiberina, Via di Ponte Quattro capi, 39, 00186, Rome, Italy
| | - Martina Bartolone
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Roberto Angioli
- Department of Gynecology, University Campus Biomedico, Rome, Italy
| | - Antonio Ragusa
- Department of Obstetrics and Gynecology, San Giovanni Calibita Fatebenefratelli Hospital, Isola Tiberina, Via di Ponte Quattro capi, 39, 00186, Rome, Italy
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Gupta J, Baev O, Duro Gomez J, Garabedian C, Hellmeyer L, Mahony R, Maier J, Parizek A, Radzinsky V, Stener Jorgensen J, Britt Wennerholm U, Carlo Di Renzo G. Mechanical methods for induction of labor. Eur J Obstet Gynecol Reprod Biol 2021; 269:138-142. [PMID: 34740471 DOI: 10.1016/j.ejogrb.2021.10.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | - Oleg Baev
- Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
| | | | - Charles Garabedian
- Division of Obstetrics, Hospitalier Régional Universitaire de Lille, Lille, France
| | - Lars Hellmeyer
- Department of Gynecology and Obstetrics, Vivantes International Medicine, Am Nordgraben 2, 13509 Berlin - Germany
| | | | - Josefine Maier
- Department of Gynecology and Obstetrics, Vivantes International Medicine, Am Nordgraben 2, 13509 Berlin - Germany
| | - Antonin Parizek
- Department of Obstetrics and Gynaecology of the 1st Faculty of Medicine and General University Hospital, Prague, Czech Rep
| | - Viktor Radzinsky
- People's Friendship University of Russia, 6, Miklukho-Maklaya st., Moscow
| | | | - Ulla Britt Wennerholm
- Department of Obstetrics and Gynecology, The University of Gothenburg, Gothenburg, Sweden
| | - Gian Carlo Di Renzo
- Department of Obstetrics and Gynecology, University of Perugia, Perugia, Italy
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14
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Wilkinson C. Outpatient labour induction. Best Pract Res Clin Obstet Gynaecol 2021; 77:15-26. [PMID: 34556409 DOI: 10.1016/j.bpobgyn.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 11/26/2022]
Abstract
The inexorable rise in induction rates over the past two decades, in parallel with increasing medical costs and pressure to reduce length of stay, has led to marked logistic difficulties for health care workers, managers and planners. Maternity services are being overwhelmed by the need to allocate staff and delivery suite space for the scheduling and undertaking of induction processes, rather than focussing care for women in spontaneous labour. Induction of labour according to the majority of current protocols and guidelines necessitates increased length of stay and relatively aggressive use of oxytocin (to reduce the time expended in the labour ward from artificial rupture of membranes (AROM) to establishment of labour). This increased oxytocin usage requires increased use of continuous electronic foetal monitoring, and may also increase epidural usage, further increasing the complexity of labour for the woman and her health care workers. Outpatient care after cervical priming and even outpatient care after AROM may help to ease these pressures and may reduce the medicalisation of the birth experience when induction is indicated, with a potential to reduce oxytocin use and associated interventions. If the period between cervical priming to AROM is managed as outpatient care, then the woman may be able to find better psychological and social support at home, as well as maintain autonomy and get better rest prior to the onset of labour. Inpatient AROM could also be followed by outpatient care until the pregnant person returns to the hospital, either in spontaneous labour, or for initiation of syntocinon after 12-18 h. High-quality research has already demonstrated that outpatient care for cervical ripening is acceptable to mothers and caregivers, has economic benefits and has an acceptable safety profile in appropriately selected low-risk inductions.
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Affiliation(s)
- Chris Wilkinson
- Women's and Children's Hospital, North Adelaide, 5006, South Australia, Australia; Robinson Institute, University of Adelaide, Adelaide, 5000, South Australia, Australia.
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15
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Nunes I, Dupont C, Timonen S, Ayres de Campos D, Cole V, Schwarz C, Kwee A, Yli B, Vayssiere C, Roth GE, Gliozheni E, Savochkina Y, Ivanisevic M, Janku P, Timonen S, Daskalakis G, Beke A, Santo S, Druškovič M, Duvekot JJ, Farr A, Dreyfus M. European Guidelines on Perinatal Care - Oxytocin for induction and augmentation of labor[Formula: see text]. J Matern Fetal Neonatal Med 2021; 35:7166-7172. [PMID: 34470113 DOI: 10.1080/14767058.2021.1945577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OF RECOMMENDATIONS1. Oxytocin for induction or augmentation of labor should not be started when there is a previous scar on the body of the uterus (such as previous classical cesarean section, uterine perforation or myomectomy when uterine cavity is reached) or in any other condition where labor or vaginal delivery are contraindicated. (Moderate quality evidence +++-; Strong recommendation).2. Oxytocin should not be started before at least 1 h has elapsed since amniotomy, 6 h since the use of dinoprostone (30 min if vaginal insert) and 4 h since the use of misoprostol (Low quality evidence ++- -; Moderate recommendation).3. Cardiotocography (CTG) should be performed and a normal pattern without tachysystole should be documented for at least 30 min before oxytocin is used. Continuous CTG, with adequate monitoring of both fetal heart rate and uterine contractions, should be maintained for as long as oxytocin is used, and thereafter until delivery (Low ++- - to moderate +++- quality evidence; Strong recommendation).4. For labor induction, at least 1-h should be allowed after amniotomy before oxytocin infusion is started, to evaluate whether adequate uterine contractility has meanwhile ensued. For augmentation of labor, if the membranes are intact and there are conditions for a safe amniotomy, the latter should be considered before oxytocin is started (Very low quality evidence +- --; Weak recommendation).5. Oxytocin should be administered intravenously using the following regimen: 5 IU oxytocin diluted in 500 mL of 0.9% normal saline (NaCl) (each mL contains 10 mIU of oxytocin), in an infusion pump at increasing rates, as shown in Table 1, until a frequency of 3-4 contractions per 10 min is reached, a non-reassuring CTG pattern ensues, or maximum rates are reached (Low quality evidence ++ - -; Strong recommendation). If the frequency of contractions exceeds 5 in 10 min, the infusion rate should be reduced, even if a normal CTG pattern is present. With a non-reassuring CTG pattern, urgent clinical assessment by an obstetrician is indicated, and strong consideration should be given to reducing or stopping the oxytocin infusion. The minimal effective dose of oxytocin should always be used. (Low ++- - to Moderate +++- - quality evidence; Strong recommendation).[Table: see text]6. Use of oxytocin for induction and augmentation of labor should be regularly audited (Low quality evidence ++--; Strong recommendation).
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Affiliation(s)
| | - Inês Nunes
- School of Medicine and Biomedical Sciences (ICBAS), University Hospital Center of Porto, CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Corinne Dupont
- University Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE) INSERM U1290; AURORE Perinatal Network, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France
| | - Susanna Timonen
- Finnish Society of Perinatology, Turku University Hospital, Turku University, Turku, Finland
| | | | | | | | - Christiane Schwarz
- Dept. Midwifery Science, University Lubeck, Institute for Health Sciences, Lubeck, Germany
| | - Anneke Kwee
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Branka Yli
- Delivery Deparment, Oslo University Hospital, Oslo, Norway
| | - Christophe Vayssiere
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse; UMR1295 CERPOP (Centre for Epidemiology and Population Health Research), Team SPHERE (Study of Perinatal, Paedriatric and Adolescent Health: Epidemiological Research and Evaluation) Toulouse III University, Toulouse, France
| | | | - Elko Gliozheni
- Albanian Association of Perinatology, Department of Obstetrics and Gynecology, University Hospital of Obstetrics and Gynaecology 'Koco Gliozheni', Tirana, Albania
| | - Yuliya Savochkina
- Bielorussian Society of Human Reproduction, 5th Minsk City Hospital and Belarus Medical Academy of Postgraduate Education, Minsk, Belarus
| | - Marina Ivanisevic
- Croatian Association of Perinatal Medicine, University Clinic for Obstetrics and Gynecology, School of Medicine, Zagreb, Croatia
| | - Petr Janku
- Czech Society of Perinatology and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, University Hospital Brno, Masaryk University Brno, Brno, Czech Republic; Department of Nursing and Midwifery, Masaryk University Brno, Czech Republic
| | - Susanna Timonen
- Finnish Society of Perinatology, Turku University Hospital, Turku University, Turku, Finland
| | - George Daskalakis
- Hellenic Society of Perinatal Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Artur Beke
- Hungarian Society of Perinatology and Obstetric Anesthesiology, Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Susana Santo
- Portuguese Society of Obstetrics and Maternal-Fetal Medicine, Santa Maria Hospital, University of Lisbon Medical School, Lisbon, Portugal
| | - Mirjam Druškovič
- Slovenia Medical Association - Society of Perinatal Medicine, Division of Obstetrics and Gynecology, UMC Ljubljana, Ljubljana, Slovenia
| | - J J Duvekot
- Dutch Society of Obstetrics and Gynecology, Department of Obstetrics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Alex Farr
- Austrian Society for Pre- and Perinatal Medicine, Department of Obstetrics and Gynecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Michel Dreyfus
- Societé Française de Medicine Perinatale, Service d'Obstétrique, Gynécologie et Médecine de la Reproduction, Centre Hospitalier Universitaire de Caen, Caen, France
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Monks DT, Palanisamy A. Oxytocin: at birth and beyond. A systematic review of the long-term effects of peripartum oxytocin. Anaesthesia 2021; 76:1526-1537. [PMID: 34389972 DOI: 10.1111/anae.15553] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 02/07/2023]
Abstract
Oxytocin is one of the most commonly used medications during labour and delivery. Recent insights from basic neuroscience research suggest that the uterotonic effects of oxytocin may arguably be trivial when compared with its profound effects on higher-order human behaviour. The purpose of this review is to highlight the potential consequences of manipulating oxytocinergic signalling during the peripartum period and its long-term impact on the maternal-infant dyad. We identified four domains where modulation of oxytocinergic signalling might be consequential: postpartum depression; breastfeeding; neurodevelopment; and chronic pain, and performed a literature search to address the impact of peripartum oxytocin administration. We have shown modest, but inconsistent, evidence linking peripartum oxytocin administration with postpartum depression. Breastfeeding success appeared to be negatively correlated with peripartum oxytocin exposure, perhaps secondary to impaired primitive neonatal reflexes and maternal-infant bonding. The association between perinatal oxytocin exposure and subsequent development of neurodevelopmental disorders such as autism in the offspring was weak, but these studies were limited by the lack of information on the cumulative dose. Finally, we identified substantial evidence for analgesic and anti-hypersensitivity effects of oxytocin which might partly explain the low incidence of chronic pain after caesarean birth. Although most data presented here are observational, our review points to a compelling need for robust clinical studies to better dissect the impact of peripartum oxytocin administration, and as stewards of its use, increase the precision with which we administer oxytocin to prevent overuse of the drug.
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Affiliation(s)
- D T Monks
- Washington University School of Medicine in St. Louis, St Louis, MO, USA
| | - A Palanisamy
- Washington University School of Medicine in St. Louis, St Louis, MO, USA
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17
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Nathan NO, Hedegaard M, Karlsson G, Knudsen LE, Mathiesen L. Intrapartum transfer of oxytocin across the human placenta: An ex vivo perfusion experiment. Placenta 2021; 112:105-110. [PMID: 34329968 DOI: 10.1016/j.placenta.2021.07.289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/24/2021] [Accepted: 07/19/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Investigation of the maternal to fetal transfer of oxytocin across the dually perfused term human placenta. METHODS Human placentae obtained from term singleton pregnancies were utilized in a dual recirculating model of ex vivo placental perfusion. Six placentae from women delivering by elective cesarean at term were perfused, one blank and five with the test substance synthetic oxytocin (0.8 ng/mL) (OX) added to the maternal perfusate for 180 min. Antipyrine was used as positive control to validate overlap of the maternal and fetal circuits. The concentration of OX was determined by radioimmunoassay. RESULTS A fall in maternal concentration of OX was seen throughout the experiment. At 90 min of perfusion a state of equilibrium was reached between maternal and fetal concentrations; however after 180 min the fetal concentration of OX was higher than that of the maternal. 31 % of the test substance was accounted for at the end of the experiment - suggesting OX protein binding and a high degree of oxytocinase activity. DISCUSSION The ex vivo perfusion experiments revealed low transfer of OX to the fetal circuit below physiologically relevant concentrations.
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Affiliation(s)
- Nina Olsén Nathan
- The Research Unit Women's and Children's Health, The Juliane Marie Centre for Women, Children and Reproduction, Copenhagen University Hospital, Rigshospitalet, Tagensvej 22, 2200, Copenhagen, Denmark; Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Morten Hedegaard
- Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Gösta Karlsson
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Lisbeth E Knudsen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1014, Copenhagen, Denmark
| | - Line Mathiesen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1014, Copenhagen, Denmark.
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Son M, Roy A, Stetson BT, Grady NT, Vanecko MC, Bond N, Swanson K, Grobman WA, Miller ES, Peaceman AM. High-Dose Compared With Standard-Dose Oxytocin Regimens to Augment Labor in Nulliparous Women: A Randomized Controlled Trial. Obstet Gynecol 2021; 137:991-998. [PMID: 33957657 DOI: 10.1097/aog.0000000000004399] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/04/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate whether a high-dose oxytocin regimen reduces the risk for primary cesarean birth and other obstetric morbidities when compared with standard dosing. METHODS In a double-blind randomized clinical trial of nulliparous women at or beyond 36 weeks of gestation who were undergoing augmentation of labor, participants were assigned to high-dose (initial and incremental rates of 6 milliunits/min) or standard-dose (initial and incremental rates of 2 milliunits/min) oxytocin regimens. The primary outcome was cesarean birth. Prespecified secondary outcomes included labor duration, clinical chorioamnionitis, endometritis, postpartum hemorrhage, Apgar score 3 or less at 5 minutes, umbilical artery acidemia, neonatal intensive care unit admission, perinatal death, and a severe perinatal morbidity composite. A sample size of 501 per group (n=1,002) was planned to detect a 6.6% absolute reduction in rate of the primary outcome, from 20% in the standard-dose group to 13.4% in the high-dose group with 80% power. RESULTS From September 2015 to September 2020, 1,003 participants were randomized-502 assigned to high-dose and 501 assigned to standard dosing. The majority of participants were of White race, were married or living as married, and had commercial insurance. Baseline characteristics between groups were similar. The primary outcome occurred in 14.5% of those receiving high-dose compared with 14.4% of those receiving standard-dose oxytocin (relative risk, 1.01; 95% CI 0.75-1.37). The high-dose group had a significantly shorter mean labor duration (9.1 vs 10.5 hours; P<.001), and a significantly lower chorioamnionitis incidence (10.4% vs 15.6%; relative risk, 0.67; 95% CI 0.48-0.92) compared with standard dosing. Umbilical artery acidemia was significantly less frequent in the high-dose group in complete case analysis, but this finding did not persist after multiple imputation (relative risk, 0.55; 95% CI 0.29-1.04). There were no significant differences in other secondary outcomes. CONCLUSION Among nulliparous participants who were undergoing augmentation of labor, a high-dose oxytocin regimen, compared with standard dosing, did not affect the cesarean birth risk but significantly reduced labor duration and clinical chorioamnionitis frequency without adverse effects on perinatal outcomes. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT02487797.
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Affiliation(s)
- Moeun Son
- Yale School of Medicine, New Haven, Connecticut; Northwestern University Feinberg School of Medicine, Northwestern University, and Northwestern Memorial Hospital, Chicago, Illinois; and the University of California, San Francisco, San Francisco, California
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Almutairi WM. Literature Review: Physiological Management for Preventing Postpartum Hemorrhage. Healthcare (Basel) 2021; 9:658. [PMID: 34073073 PMCID: PMC8227540 DOI: 10.3390/healthcare9060658] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/26/2021] [Indexed: 11/17/2022] Open
Abstract
The aim of this paper was to summarize the existing literature regarding postpartum hemorrhage (PPH) and its physiological management (i.e., skin-to-skin contact and breastfeeding). The background surrounding PPH and the role of skin-to-skin contact (SSC) and breastfeeding (BF) in PPH are identified, and these interventions are supported as a crucial means of preventing or minimizing the incidence of PPH. Despite its importance, to the best of my knowledge, an evaluation of this relationship has not yet been undertaken. The narrative literature review approach was used to summarize topic related researches. The search included three databases: CINAHL, PubMed, and Google Scholar. All articles related to the role of SSC and BF in PPH were chosen from the different databases. The findings demonstrate that SSC and BF are cost-effective methods that could be considered practices for the prevention of PPH. Immediate Skin-to-skin contact (SSC) and breastfeeding (BF) are central mediators of the psychophysiological process during the first hour after delivery (the third and fourth stages of labor).
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Affiliation(s)
- Wedad M Almutairi
- Maternity and Child Department, Faculty of Nursing, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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20
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Maged AM, Sorour EH, ElSadek MM, Hassan SM, Shoab AY. A randomized controlled study of the effect of hyoscine butylbromide on duration of labor in primigravida women with prolonged labor. Arch Gynecol Obstet 2021; 304:1513-1518. [PMID: 33983512 DOI: 10.1007/s00404-021-06087-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the safety and efficacy of hyoscine butyl bromide (HBB) in primipara with prolonged 1st stage of labor. MATERIALS AND METHODS A double-blinded randomized controlled trial included 100 primiparas diagnosed with prolonged labor. They were randomly divided two equal groups. Group I received 40 mg HBB intravenously. Group II received 2 ml of normal saline. The primary outcome was the duration of the 1st stage of labor. Secondary outcomes included success of vaginal delivery, rate of cervical dilation, duration of 2nd and 3rd stages of labor, causes of CS, neonatal outcome and drug side effects. RESULTS The duration of the 1st stage was 322.3 ± 89.8 min in women who received HBB compared with 451.3 ± 198.3 min in the control women (P < 0.001). The rate of cervical dilation was increased from 0.4 ± 0.2 to 1.5 ± 0.6 in women who received HBB compared with its increase from 0.4 ± 0.1 to 0.9 ± 0.2 in other women (P < 0.001). The rate of CS were significantly higher in control women when compared to those received HBB (34 vs. 20%, P < 0.001). The commonest indication for the operation was arrest of cervical dilatation (28 and 16%, respectively). CONCLUSION HBB is associated with shortening of the 1st stage, lowered rate of CS without any side effects. CLINICAL TRIAL GOV ID NCT03430362 date of registration 6 February 2018. Synopsis Hyoscine butyl bromide is associated with shortening of the 1st stage, lowered rate of CS in primiparas with prolonged labor.
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Affiliation(s)
- Ahmed M Maged
- Obstetrics and Gynecology Department, Kasr AlAini Hospital Cairo University, 11 Eid Mostafa from King Faisal Street Haram Giza, Cairo, 12111, Egypt.
| | - Ehab H Sorour
- Obstetrics and Gynecology Department, Kasr AlAini Hospital Cairo University, 11 Eid Mostafa from King Faisal Street Haram Giza, Cairo, 12111, Egypt
| | - Mostafa M ElSadek
- Obstetrics and Gynecology Department, Kasr AlAini Hospital Cairo University, 11 Eid Mostafa from King Faisal Street Haram Giza, Cairo, 12111, Egypt
| | - Sarah M Hassan
- Obstetrics and Gynecology Department, Kasr AlAini Hospital Cairo University, 11 Eid Mostafa from King Faisal Street Haram Giza, Cairo, 12111, Egypt
| | - Amira Y Shoab
- Obstetrics and Gynecology Department, Kasr AlAini Hospital Cairo University, 11 Eid Mostafa from King Faisal Street Haram Giza, Cairo, 12111, Egypt
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21
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Espada-Trespalacios X, Ojeda F, Perez-Botella M, Milà Villarroel R, Bach Martinez M, Figuls Soler H, Anquela Sanz I, Rodríguez Coll P, Escuriet R. Oxytocin Administration in Low-Risk Women, a Retrospective Analysis of Birth and Neonatal Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4375. [PMID: 33924137 PMCID: PMC8074312 DOI: 10.3390/ijerph18084375] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND In recent years, higher than the recommended rate of oxytocin use has been observed among low-risk women. This study examines the relationship between oxytocin administration and birth outcomes in women and neonates. METHODS A retrospective analysis of birth and neonatal outcomes for women who received oxytocin versus those who did not. The sample included 322 women with a low-risk pregnancy. RESULTS Oxytocin administration was associated with cesarean section (aOR 4.81, 95% CI: 1.80-12.81), instrumental birth (aOR 3.34, 95% CI: 1.45-7.67), episiotomy (aOR 3.79, 95% CI: 2.20-6.52) and length of the second stage (aOR 00:18, 95% CI: 00:04-00:31). In neonatal outcomes, oxytocin in labor was associated with umbilical artery pH ≤ 7.20 (OR 3.29, 95% CI: 1.33-8.14). Admission to neonatal intensive care unit (OR 0.56, 95% CI: 0.22-1.42), neonatal resuscitation (OR 1.04, 95% CI: 0.22-1.42), and Apgar score <7 (OR 0.48, 95% CI: 0.17-1.33) were not associated with oxytocin administration during labor. CONCLUSIONS Oxytocin administration during labor for low-risk women may lead to worse birth outcomes with an increased risk of instrumental birth and cesarean, episiotomy and the use of epidural analgesia for pain relief. Neonatal results may be also worse with an increased proportion of neonates displaying an umbilical arterial pH ≤ 7.20.
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Affiliation(s)
- Xavier Espada-Trespalacios
- Department of Obstetrics and Gynecology, Hospital General de Granollers, Avinguda Francesc Ribas s/n, 08402 Granollers, Spain; (F.O.); (M.B.M.); (H.F.S.)
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Doctor Aiguader 88, 08003 Barcelona, Spain
- Research Group in Global Health, Gender and Society (GHenderS), Universitat Ramon Llull, Carrer Padilla 326, 08025 Barcelona, Spain;
| | - Felipe Ojeda
- Department of Obstetrics and Gynecology, Hospital General de Granollers, Avinguda Francesc Ribas s/n, 08402 Granollers, Spain; (F.O.); (M.B.M.); (H.F.S.)
| | - Mercedes Perez-Botella
- Research in Childbirth and Health Unit (ReaRH), University of Central Lancashire, Preston PR1 2HE, UK;
- Department of Neonatology, Hospital General de Granollers, Avinguda Francesc Ribas s/n, 08402 Granollers, Spain
| | - Raimon Milà Villarroel
- School of Health Sciences Blanquerna, Universitat Ramon Llull, Carrer Padilla 326, 08025 Barcelona, Spain; (R.M.V.); (I.A.S.)
| | - Montserrat Bach Martinez
- Department of Obstetrics and Gynecology, Hospital General de Granollers, Avinguda Francesc Ribas s/n, 08402 Granollers, Spain; (F.O.); (M.B.M.); (H.F.S.)
| | - Helena Figuls Soler
- Department of Obstetrics and Gynecology, Hospital General de Granollers, Avinguda Francesc Ribas s/n, 08402 Granollers, Spain; (F.O.); (M.B.M.); (H.F.S.)
| | - Israel Anquela Sanz
- School of Health Sciences Blanquerna, Universitat Ramon Llull, Carrer Padilla 326, 08025 Barcelona, Spain; (R.M.V.); (I.A.S.)
| | - Pablo Rodríguez Coll
- Obstetric Care Area, Hospital Germans Trias i Pujol, Carretera de Canyet s/n, 08916 Badalona, Spain;
| | - Ramon Escuriet
- Research Group in Global Health, Gender and Society (GHenderS), Universitat Ramon Llull, Carrer Padilla 326, 08025 Barcelona, Spain;
- Catalan Health Service, Government of Catalonia, Travessera de les Corts 131, 08028 Barcelona, Spain
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22
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Cohen WR, Friedman EA. Clinical evaluation of labor: an evidence- and experience-based approach. J Perinat Med 2021; 49:241-253. [PMID: 33068385 DOI: 10.1515/jpm-2020-0256] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/17/2020] [Indexed: 01/20/2023]
Abstract
During labor mother and fetus are evaluated at intervals to assess their well-being and determine how the labor is progressing. These assessments require skillful physical diagnosis and the ability to translate the acquired information into meaningful prognostic decision-making. We describe a coordinated approach to the assessment of labor. Graphing of serial measurements of cervical dilatation and fetal station creates "labor curves," which provide diagnostic and prognostic information. Based on these curves we recognize nine discrete labor abnormalities. Many may be related to insufficient or disordered contractile mechanisms. Several factors are strongly associated with development of labor disorders, including cephalopelvic disproportion, excess analgesia, fetal malpositions, intrauterine infection, and maternal obesity. Clinical cephalopelvimetry involves assessing pelvic traits and predicting their effects on labor. These observations must be integrated with information derived from the labor curves. Exogenous oxytocin is widely used. It has a high therapeutic index, but is easily misused. Oxytocin treatment should be restricted to situations in which its potential benefits clearly outweigh its risks. This requires there be a documented labor dysfunction or a legitimate medical reason to shorten the labor. Normal labor and delivery pose little risk to a healthy fetus; but dysfunctional labors, especially if stimulated excessively by oxytocin or terminated by complex operative vaginal delivery, have the potential for considerable harm. Conscientiously implemented, the approach to the evaluation of labor outlined in this review will result in a reasonable cesarean rate and minimize risks that may accrue from the labor and delivery process.
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Affiliation(s)
- Wayne R Cohen
- Department of Obstetrics and Gynecology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Emanuel A Friedman
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
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23
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El Ahmadi W, Ghesquiere L, Drumez E, Subtil D, Debarge V, Garabedian C. [Impact of a protocol based on the new national recommendations on the use of oxytocin and its maternal-fetal consequences: A single-center before/after study]. ACTA ACUST UNITED AC 2021; 49:744-749. [PMID: 33757924 DOI: 10.1016/j.gofs.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Evaluate oxytocin use and impact on maternal and fetal morbidity before and after implementation of a protocol based on national recommendations. MATERIALS AND METHODS A single-center retrospective before-and-after study (Lille, France). A service protocol to harmonize the use of oxytocin was implemented in May 2017 following national recommendations. Data were collected from January to March 2016 for period 1, and from January to March 2019 for period 2. Nulliparous patients in spontaneous labor=37SA delivering a live newborn in cephalic presentation were included. The primary outcome was the use of oxytocin. RESULTS Five hundred eighty-seven patients were included, 302 for period 1 and 285 for period 2. The rate of oxytocin use was 48% (n=144) in 2016 versus 28% (n=79) in 2019 (P<0.001). Total labor time was significantly longer after protocol implementation (425.7min vs. 510.4min ; P<0.001). The cesarean section rate was identical between the 2 periods (7.0% vs. 6.0%; P=0.62). The rate of postpartum hemorrhage greater than 500mL was higher in period 1 (17.7% vs. 10.9%; P=0.019), as was the occurrence of a pH<7.05 (5.4% vs. 1.1%; P=0.004). CONCLUSION The implementation of a protocol contributed to a decrease in the use of oxytocin and thus would allow a decrease in the rate of postpartum hemorrhage and neonatal acidosis, but with an increase in the duration of labor.
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Affiliation(s)
- W El Ahmadi
- Clinique d'obstétrique, CHU de Lille, avenue Eugène-Avinée, 59000 Lille, France.
| | - L Ghesquiere
- Clinique d'obstétrique, CHU de Lille, avenue Eugène-Avinée, 59000 Lille, France; EA 2694 Metrics, environnement périnatal et santé, université de Lille, 59000 Lille, France
| | - E Drumez
- Département de biostatistiques, CHU de Lille, 59000 Lille, France
| | - D Subtil
- Clinique d'obstétrique, CHU de Lille, avenue Eugène-Avinée, 59000 Lille, France; EA 2694 Metrics, environnement périnatal et santé, université de Lille, 59000 Lille, France
| | - V Debarge
- Clinique d'obstétrique, CHU de Lille, avenue Eugène-Avinée, 59000 Lille, France; EA 2694 Metrics, environnement périnatal et santé, université de Lille, 59000 Lille, France
| | - C Garabedian
- Clinique d'obstétrique, CHU de Lille, avenue Eugène-Avinée, 59000 Lille, France; EA 2694 Metrics, environnement périnatal et santé, université de Lille, 59000 Lille, France
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24
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Abstract
Cervical ripening and induction and augmentation of labor are common procedures in labor and birth units. The potential risks and benefits for the procedure should be explained to women so that they can make informed decisions. Clinicians should be knowledgeable about the methods and medications used and be skilled in maternal-fetal assessment. Adequate nurse staffing is required to monitor the mother and fetus to promote the best possible outcomes. This practice monograph includes information on mechanical and pharmacologic methods for cervical ripening; labor induction and augmentation with oxytocin, a high alert drug; and nurse staffing levels and skills needed to provide safe and effective care during cervical ripening and labor induction and augmentation.
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25
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Obel J, Martin AIC, Mullahzada AW, Kremer R, Maaløe N. Resilience to maintain quality of intrapartum care in war torn Yemen: a retrospective pre-post study evaluating effects of changing birth volumes in a congested frontline hospital. BMC Pregnancy Childbirth 2021; 21:36. [PMID: 33413161 PMCID: PMC7791801 DOI: 10.1186/s12884-020-03507-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/16/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Fragile and conflict-affected states contribute with more than 60% of the global burden of maternal mortality. There is an alarming need for research exploring maternal health service access and quality and adaptive responses during armed conflict. Taiz Houbane Maternal and Child Health Hospital in Yemen was established during the war as such adaptive response. However, as number of births vastly exceeded the facility's pre-dimensioned capacity, a policy was implemented to restrict admissions. We here assess the restriction's effects on the quality of intrapartum care and birth outcomes. METHODS A retrospective before and after study was conducted of all women giving birth in a high-volume month pre-restriction (August 2017; n = 1034) and a low-volume month post-restriction (November 2017; n = 436). Birth outcomes were assessed for all births (mode of birth, stillbirths, intra-facility neonatal deaths, and Apgar score < 7). Quality of intrapartum care was assessed by a criterion-based audit of all caesarean sections (n = 108 and n = 82) and of 250 randomly selected vaginal births in each month. RESULTS Background characteristics of women were comparable between the months. Rates of labour inductions and caesarean sections increased significantly in the low-volume month (14% vs. 22% (relative risk (RR) 0.62, 95% confidence interval (CI) 0.45-0.87) and 11% vs. 19% (RR 0.55, 95% CI 0.42-0.71)). No other care or birth outcome indicators were significantly different. Structural and human resources remained constant throughout, despite differences in patient volume. CONCLUSIONS Assumptions regarding quality of care in periods of high demand may be misguiding - resilience to maintain quality of care was strong. We recommend health actors to closely monitor changes in quality of care when implementing resource changes; to enable safe care during birth for as many women as possible.
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Affiliation(s)
- Josephine Obel
- Médecins Sans Frontières, Saana, Yemen.
- Department of Obstetrics and Gynaecology, Hvidovre University Hospital, Hvidovre, Denmark.
| | | | - Abdul Wasay Mullahzada
- Médecins Sans Frontières, Saana, Yemen
- Médecins Sans Frontières, Amsterdam, The Netherlands
| | - Ronald Kremer
- Médecins Sans Frontières, Amsterdam, The Netherlands
| | - Nanna Maaløe
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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26
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Rydahl E, Juhl M, Declercq E, Maimburg RD. Disruption of physiological labour; - A population register-based study among nulliparous women at term. SEXUAL & REPRODUCTIVE HEALTHCARE 2020; 27:100571. [PMID: 33157403 DOI: 10.1016/j.srhc.2020.100571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 09/11/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Current labour practices have seen an acceleration in interventions to either initiate, monitor, accelerate, or terminate the physiological process of pregnancy and childbirth. This study aimed to describe and analyse the use of interventions in childbirth in Denmark over almost two decades (2000-2017). We also examined the extent to which contemporary care adheres to current international recommendations towards restricted use of interventions. STUDY DESIGN A national retrospective Danish register-based cohort study including all nulliparous women with term births with singleton pregnancy and a foetus in cephalic between the years 2000 and 2017 (n = 380,326 births). Multivariate regression analyses with adjustment for change in population were performed. MAIN OUTCOME MEASURES Induction of labour, epidural analgesia, and augmentation of labour. RESULTS Between 2000/2001 and 2016/2017, the prevalence increased for induction of labour from 5.1% to 22.8%, AOR 4.84, 95% CI [4.61-5.10], epidural analgesia from 10.5% to 34.3% (AOR 4.10, 95% CI [3.95-4.26]), and augmentation of labour decreased slightly from 40.1% to 39.3% (AOR 0.84, 95% CI [0.81-0.86]). Having more than one of the three mentioned interventions increased from 12.8% in to 30.9%. CONCLUSIONS The number of interventions increased during the study period as well as the number of interventions in each woman. As interventions may interfere in physiological labour and carry the risk of potential short- and long-term consequences, the findings call for a careful re-evaluation of contemporary maternity care with a "first, do no harm" perspective.
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Affiliation(s)
- Eva Rydahl
- Department of Midwifery, University College Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Mette Juhl
- Department of Midwifery, University College Copenhagen, Copenhagen, Denmark
| | - Eugene Declercq
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Rikke Damkjær Maimburg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
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27
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Abstract
Cervical ripening and induction and augmentation of labor are common procedures in labor and birth units. The potential risks and benefits for the procedure should be explained to women so that they can make informed decisions. Clinicians should be knowledgeable about the methods and medications used and be skilled in maternal-fetal assessment. Adequate nurse staffing is required to monitor the mother and fetus to promote the best possible outcomes. This practice monograph includes information on mechanical and pharmacologic methods for cervical ripening; labor induction and augmentation with oxytocin, a high alert drug; and nurse staffing levels and skills needed to provide safe and effective care during cervical ripening and labor induction and augmentation.
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28
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Nippita TAC, Randall DA, Seeho SKM. Response to 'Induction of labour at 39 weeks should be routinely offered to low-risk women'. Aust N Z J Obstet Gynaecol 2020; 60:312-313. [PMID: 32291762 DOI: 10.1111/ajo.13139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/25/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Tanya A C Nippita
- Faculty of Medicine and Health, The University of Sydney Northern Clinical School, Sydney, New South Wales, Australia.,Women and Babies Research, Kolling Institute, Royal North Shore Hospital, The University of Sydney, Sydney, New South Wales, Australia.,Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, The University of Sydney Northern Clinical School, Sydney, New South Wales, Australia.,Department of Obstetrics and Gynaecology, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Deborah A Randall
- Faculty of Medicine and Health, The University of Sydney Northern Clinical School, Sydney, New South Wales, Australia.,Women and Babies Research, Kolling Institute, Royal North Shore Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Sean K M Seeho
- Faculty of Medicine and Health, The University of Sydney Northern Clinical School, Sydney, New South Wales, Australia.,Women and Babies Research, Kolling Institute, Royal North Shore Hospital, The University of Sydney, Sydney, New South Wales, Australia.,Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, The University of Sydney Northern Clinical School, Sydney, New South Wales, Australia
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29
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Blanc-Petitjean P, Legardeur H, Meunier G, Mandelbrot L, Le Ray C, Kayem G. Evaluation of the implementation of a protocol for the restrictive use of oxytocin during spontaneous labor. J Gynecol Obstet Hum Reprod 2019; 49:101664. [PMID: 31811971 DOI: 10.1016/j.jogoh.2019.101664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/28/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Use of oxytocin is associated with uterine hyperstimulation and postpartum hemorrhage with a dose-dependent effect. We aimed to evaluate the effect of the implementation of a protocol for the restrictive use of oxytocin during spontaneous labor on obstetric and neonatal outcomes. MATERIAL AND METHODS We performed an observational before-and-after study among 2174 women in spontaneous labor with a term singleton cephalic fetus. Obstetric and neonatal outcomes were compared according to the period, before (period A) and after (period B) the implementation of a protocol for the restrictive use of oxytocin. RESULTS 1235 women were included in period A and 939 in period B. Compared to period A, the use of oxytocin during period B was significantly lower (45.5 vs. 35.1%, p<0.001) in both nulliparous (61.2 vs 54.6%, p=0.04) and multiparous women (34.0 vs. 21.1%, p<0.001). Labor was significantly longer in period B, both in nulliparous (6.7 vs. 7.9 h, p<0.01) and multiparous women (4.1 vs. 4.5 h, p<0.01). A lower frequency of uterine hyperstimulation (6.6 vs. 2.7%, p=0.01) was observed in period B. The odds of instrumental and cesarean delivery were not different between the periods (respectively adjusted odds ratio (AOR), 95% confidence interval (CI), 1.1(0.8-1.4); 1.2(0.8-1.8)) including for nulliparous women (respectively, 1.3(0.9-1.7); 1.3(0.8-1.9)). DISCUSSION Reducing the use of oxytocin during spontaneous labor through the implementation of a protocol may reduce the iatrogenic effects without increasing the risk of caesarean section but this implies longer duration of labor.
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Affiliation(s)
- Pauline Blanc-Petitjean
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, 75014, Paris, France; Assistance Publique-Hôpitaux de Paris, Louis Mourier Hospital, Department of Obstetrics and Gynecology, DHU Risks in pregnancy, 92700, Colombes, France.
| | - Hélène Legardeur
- Assistance Publique-Hôpitaux de Paris, Louis Mourier Hospital, Department of Obstetrics and Gynecology, DHU Risks in pregnancy, 92700, Colombes, France
| | - Géraldine Meunier
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, 75014, Paris, France; Assistance Publique-Hôpitaux de Paris, Louis Mourier Hospital, Department of Obstetrics and Gynecology, DHU Risks in pregnancy, 92700, Colombes, France
| | - Laurent Mandelbrot
- Assistance Publique-Hôpitaux de Paris, Louis Mourier Hospital, Department of Obstetrics and Gynecology, DHU Risks in pregnancy, 92700, Colombes, France
| | - Camille Le Ray
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, 75014, Paris, France; Assistance Publique-Hôpitaux de Paris, Cochin Hospital, Port Royal Maternity Unit, DHU Risks in Pregnancy, 75014, Paris, France
| | - Gilles Kayem
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, 75014, Paris, France; Assistance Publique-Hôpitaux de Paris, Trousseau Hospital, Department of Obstetrics and Gynecology, 75012, Paris, France
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30
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Lu D, Zhang L, Duan T, Zhang J. Labor patterns in Asian American women with vaginal birth and normal perinatal outcomes. Birth 2019; 46:608-615. [PMID: 31297872 DOI: 10.1111/birt.12445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/24/2019] [Accepted: 06/24/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The pattern of normal labor progression can help to define prolonged labor and dystocia. Several studies had tried to establish the process of normal labor in different races. Previous findings in Asian women were limited and often incomparable. Our aim was to examine labor patterns in Asian American women. STUDY DESIGN A total of 3079 women with singleton term gestation, vertex presentation, vaginal delivery, and a normal perinatal outcome were extracted from the Consortium on Safe Labor study. A repeated measure analysis and an interval-censored regression were applied to depict the average labor curves and estimate the time interval of cervical dilation by 1 cm, respectively. A sensitivity analysis was conducted to assess the impact of oxytocin augmentation. The cumulative duration of the 1st stage of labor was calculated to draw a partograph. RESULTS It took an average of 5.2 hours for nulliparous Asian women with spontaneous labor onset to complete the 1st stage of labor, and the 95th centile was 14.4 hours. Labor progressed at a similar rate between nulliparous and multiparous women before 6 cm. Afterward, multiparous women progressed noticeably faster than nulliparous women. The differences in labor duration between women with and without oxytocin augmentation were <0.5 hour for both nulliparous and multiparous women. CONCLUSIONS A new partograph that restricted the diagnosis of dystocia to the slowest 5% of nulliparous women with normal perinatal outcomes was proposed. The labor pattern in Asian American women was similar to that of the overall United States population.
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Affiliation(s)
- Danni Lu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lin Zhang
- Department of Obstetrics and Gynecology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Duan
- Shanghai First Maternity and Infant Hospital, Tong Ji University School of Medicine, Shanghai, China
| | - Jun Zhang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Uvnäs-Moberg K, Ekström-Bergström A, Berg M, Buckley S, Pajalic Z, Hadjigeorgiou E, Kotłowska A, Lengler L, Kielbratowska B, Leon-Larios F, Magistretti CM, Downe S, Lindström B, Dencker A. Maternal plasma levels of oxytocin during physiological childbirth - a systematic review with implications for uterine contractions and central actions of oxytocin. BMC Pregnancy Childbirth 2019; 19:285. [PMID: 31399062 PMCID: PMC6688382 DOI: 10.1186/s12884-019-2365-9] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 06/17/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Oxytocin is a key hormone in childbirth, and synthetic oxytocin is widely administered to induce or speed labour. Due to lack of synthetized knowledge, we conducted a systematic review of maternal plasma levels of oxytocin during physiological childbirth, and in response to infusions of synthetic oxytocin, if reported in the included studies. METHODS An a priori protocol was designed and a systematic search was conducted in PubMed, CINAHL, and PsycINFO in October 2015. Search hits were screened on title and abstract after duplicates were removed (n = 4039), 69 articles were examined in full-text and 20 papers met inclusion criteria. As the articles differed in design and methodology used for analysis of oxytocin levels, a narrative synthesis was created and the material was categorised according to effects. RESULTS Basal levels of oxytocin increased 3-4-fold during pregnancy. Pulses of oxytocin occurred with increasing frequency, duration, and amplitude, from late pregnancy through labour, reaching a maximum of 3 pulses/10 min towards the end of labour. There was a maximal 3- to 4-fold rise in oxytocin at birth. Oxytocin pulses also occurred in the third stage of labour associated with placental expulsion. Oxytocin peaks during labour did not correlate in time with individual uterine contractions, suggesting additional mechanisms in the control of contractions. Oxytocin levels were also raised in the cerebrospinal fluid during labour, indicating that oxytocin is released into the brain, as well as into the circulation. Oxytocin released into the brain induces beneficial adaptive effects during birth and postpartum. Oxytocin levels following infusion of synthetic oxytocin up to 10 mU/min were similar to oxytocin levels in physiological labour. Oxytocin levels doubled in response to doubling of the rate of infusion of synthetic oxytocin. CONCLUSIONS Plasma oxytocin levels increase gradually during pregnancy, and during the first and second stages of labour, with increasing size and frequency of pulses of oxytocin. A large pulse of oxytocin occurs with birth. Oxytocin in the circulation stimulates uterine contractions and oxytocin released within the brain influences maternal physiology and behaviour during birth. Oxytocin given as an infusion does not cross into the mother's brain because of the blood brain barrier and does not influence brain function in the same way as oxytocin during normal labour does.
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Affiliation(s)
| | - Anette Ekström-Bergström
- School of Health and Education, University of Skövde, Skövde, Sweden
- Department of Health Sciences, University West, Trollhättan, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
| | - Sarah Buckley
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Zada Pajalic
- Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Eleni Hadjigeorgiou
- Faculty of Health Sciences, Cyprus, University of Technology, Limassol, Cyprus
| | - Alicja Kotłowska
- Faculty of Health Sciences with Subfaculty of Nursing and Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Luise Lengler
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | | | - Fatima Leon-Larios
- Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - Claudia Meier Magistretti
- Department of Social Work Center for Health Promotion and Social Participation, Lucerne University of Applied Sciences and Arts, Luzern, Switzerland
| | - Soo Downe
- Research in Childbirth and Health (ReaCH) group, University of Central Lancashire, Preston, UK
| | - Bengt Lindström
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Anna Dencker
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
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Abstract
OBJECTIVE Develop a multidisciplinary, consensus-driven, evidence-based approach to oxytocin use, while adhering to national guidelines. DESIGN This was a quality improvement project that used the Plan Do Study Act method to create cycles of change over several years. To initiate discussion, a survey was administered at a social event for providers from divergent community practices that addressed the controversial aspects of oxytocin use. Graphic feedback was provided showing divergences between answers and the evidence. The perinatal team directed design and implementation of this project with specific involvement of a nurse quality improvement coordinator and nurse educator. MEASURES Process, outcome, and balancing measures were used to evaluate the program. Process measure: use of a standardized order-set. OUTCOME MEASURE rate of adherence to the resultant protocol. Balancing measures: 1) maximum oxytocin dose, 2) time from oxytocin initiation to birth, 3) cesarean birth rates, and 4) Apgar scores. RESULTS An initial increase in adherence to the protocol decreased with the loss of the "paper" order-set. Adherence improved when computerized physician order entry was adjusted: 2006: 73%, 2007: 95%; 2011: 57%, 2013: 100% (p = 0.007, 2006 vs. 2007) (p < 0.001, 2006 vs. 2013). Compliance with the protocol was associated with a decrease in maximum oxytocin dose and in time between oxytocin initiation and birth (p < 0.001). CONCLUSION Consistency and safety in patient care can be accomplished using literature-based evidence and active consensus building among members of the perinatal team. A standardization process must be integrated into the electronic medical record to become a sustained part of a practice culture.
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Helbig S, Petersen A, Sitter E, Daly D, Gross MM. Inter-institutional variations in oxytocin augmentation during labour in German university hospitals: a national survey. BMC Pregnancy Childbirth 2019; 19:238. [PMID: 31288780 PMCID: PMC6617790 DOI: 10.1186/s12884-019-2348-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 05/31/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND There are several international guidelines on oxytocin regimens for induction and augmentation of labour, but no agreement on a standardised regimen in Germany. This study collated and reviewed the oxytocin regimens used for labour augmentation in university hospitals, with the long-term aim of contributing to the development of a national clinical guideline. METHODS Germany has 34 university hospital compounds, representing 39 maternity units. In this observational study we asked units to provide standard operational procedures on oxytocin augmentation during labour or provide the details in a structured survey. Data were collected on the dosage of oxytocin, type and volume of solutions used, indications and contraindications for use and discontinuation, case-specific administration, and on who developed the procedures. Findings were analysed descriptively. RESULTS A total of 35 (90%) units participated in this study. Standard operating procedures were available in 24 units (69%), seven units (20%) did not have procedures and information was missing from four units (11%). Midwives participated in the development of standard operating procedures in 15 units (43%). Infusions were most commonly prepared using six units of oxytocin in 500 ml 0.9% normal saline solution (12 mU/ml). The infusions were started at 120 mU/hour and increased by 120 mU/hour at 20-min intervals up to a maximum dosage of 1200 mU/hour. The most common indication for use was delayed progress in labour. Infusions were stopped when uterine contractions became hypertonic and/or the fetal heart rate showed signs of distress. Most of the practices described aligned with international guidance. All units used reduced oxytocin dosages for women with a history of previous caesareans section, as recommended in the international guidelines, and restrictive use was advised in multiparous women. The main difference between units related to combined use of amniotomy and oxytocin, recommended by three guidelines but used in only four maternity units (11%). CONCLUSIONS While there was considerable variation in the oxytocin augmentation procedures, most but not all practices used in these 35 German maternity units were comparable. Establishing a national guideline on the criteria for and administration of oxytocin for augmentation of labour would eliminate the observed differences and minimise risk of administration and medication error.
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Affiliation(s)
- Sonja Helbig
- Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology & Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, D – 30625 Hannover, Germany
| | - Antje Petersen
- Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology & Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, D – 30625 Hannover, Germany
| | - Erika Sitter
- Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology & Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, D – 30625 Hannover, Germany
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, D02 T283 Ireland
| | - Mechthild M. Gross
- Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology & Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, D – 30625 Hannover, Germany
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Dalbye R, Bernitz S, Olsen IC, Zhang J, Eggebø TM, Rozsa D, Frøslie KF, Øian P, Blix E. The Labor Progression Study: The use of oxytocin augmentation during labor following Zhang's guideline and the WHO partograph in a cluster randomized trial. Acta Obstet Gynecol Scand 2019; 98:1187-1194. [PMID: 31017306 DOI: 10.1111/aogs.13629] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/12/2019] [Accepted: 04/14/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study aims to investigate the use of oxytocin augmentation during labor in nulliparous women following Zhang's guideline or the WHO partograph. MATERIAL AND METHODS This is a secondary analysis of a cluster randomized controlled trial in 14 birth-care units in Norway, randomly assigned to either the intervention group, which followed Zhang's guideline, or to the control group, which followed the WHO partograph, for labor progression. The participants were nulliparous women who had a singleton full-term fetus in a cephalic presentation and spontaneous onset of labor, denoted as group 1 in the Ten Group Classification System. RESULTS Between December 2014 and January 2017, 7277 participants were included. A total of 3219 women (44%) received augmentation with oxytocin during labor. Oxytocin was used in 1658 (42%) women in the Zhang group compared with 1561 (47%) women in the WHO group. The adjusted relative risk for augmentation with oxytocin was 0.98 (95% CI 0.84-1.15; P = .8) in the Zhang vs WHO group, with an adjusted risk difference of -0.8% (95% CI -7.8 to 6.1). The participants in the Zhang group were less likely to be augmented with oxytocin before reaching 6 cm of cervical dilatation (24%) compared with participants in the WHO group (28%), with an adjusted relative risk of 0.84 (95% CI 0.75-0.94; P = .003). Oxytocin was administered for almost 20 min longer in the Zhang group than in the WHO group, with an adjusted mean difference of 17.9 min (95% CI 2.7-33.1; P = .021). In addition, 19% of the women in the Zhang group and 23% in the WHO group received augmentation with oxytocin without being diagnosed with labor dystocia. CONCLUSIONS Although no significant difference in the proportion of oxytocin augmentation was observed between the 2 study groups, there were differences in how oxytocin was used. Women in the Zhang group were less likely to receive oxytocin augmentation before 6 cm of cervical dilatation. The duration of augmentation with oxytocin was longer in the Zhang group than in the WHO group.
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Affiliation(s)
- Rebecka Dalbye
- Department of Obstetrics and Gynecology, Østfold Hospital Trust, Grålum, Norway.,Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Met-Oslo Metropolitan University, Oslo, Norway
| | - Stine Bernitz
- Department of Obstetrics and Gynecology, Østfold Hospital Trust, Grålum, Norway.,Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Met-Oslo Metropolitan University, Oslo, Norway
| | | | - Jun Zhang
- MOE-Shanghai Key Lab of Children's Environmental Health, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Torbjørn Moe Eggebø
- National Center for Fetal Medicine, Trondheim University Hospital (St Olav's Hospital), Trondheim, Norway.,Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - Daniella Rozsa
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - Kathrine Frey Frøslie
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway
| | - Pål Øian
- Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
| | - Ellen Blix
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Met-Oslo Metropolitan University, Oslo, Norway
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Stokholm L, Talge NM, Christensen GT, Juhl M, Mortensen LH, Strandberg-Larsen K. Labor augmentation during birth and later cognitive ability in young adulthood. Clin Epidemiol 2018; 10:1765-1772. [PMID: 30538580 PMCID: PMC6263242 DOI: 10.2147/clep.s181012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Synthetic oxytocin for labor augmentation during birth has been linked to negative neurodevelopment effects in children. We examined whether maternal labor augmentation was associated with lower cognitive ability in young adulthoods. PATIENTS AND METHODS We identified 330,107 individuals (96.6% were men), with noninduced labor and with a cognitive ability test score, the Børge Priens Prøve (BPP) score, from draft board examinations in 1995-2015 (mean age, 18.8 years). Information on maternal labor augmentation was ascertained from the Danish Medical Birth Register, and we calculated mean differences in the BPP score according to maternal labor augmentation. We repeated our analyses in a sub-sample of siblings to control for unmeasured familial confounding. RESULTS Maternal labor augmentation was not associated with any noticeable decline in cognitive ability. However, the difference in the mean BPP score for exposure to maternal labor augmentation varied according to maternal parity, as the mean difference in BPP scores increased with increasing parity, in nulliparous: mean difference=-0.14 (95% CI=-0.23 to -0.04); in maternal parity 4+: mean difference=-1.21 (95% CI=-2.905 to -0.37). The sibling analysis showed little influence of shared familial factors on the association. CONCLUSION The mean BPP was slightly lower among labor augmented compared to nonaugmented and with an increasing difference with increasing parity. However, the differences were small and could not be considered of any clinical relevance. Furthermore, the sibling analyses suggested little confounding by familial factors.
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Affiliation(s)
- Lonny Stokholm
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark,
| | - Nicole M Talge
- Department of Epidemiology and Biostatistics, Michigan State University, Michigan, USA
| | - Gunhild Tidemann Christensen
- Department of Public Health, University of Southern Denmark, Danish Aging Research Center, Odense, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mette Juhl
- Department of Midwifery, Copenhagen University College, Copenhagen, Denmark
| | - Laust Hvas Mortensen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark,
- Methods and Analysis, Statistics Denmark, Copenhagen, Denmark
| | - Katrine Strandberg-Larsen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark,
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Fernández-Cañadas Morillo A, Durán Duque M, Hernández López AB, Muriel Miguel C, Pérez Riveiro P, Salcedo Mariña A, Royuela Vicente A, Casillas Santana ML, Marín Gabriel MA. Cessation of breastfeeding in association with oxytocin administration and type of birth. A prospective cohort study. Women Birth 2018; 32:e43-e48. [PMID: 29754970 DOI: 10.1016/j.wombi.2018.04.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/02/2018] [Accepted: 04/23/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Some studies have suggested an association between synthetic oxytocin administration and type of birth with the initiation and consolidation of breastfeeding. AIM This study aimed to test whether oxytocin administration and type of birth are associated with cessation of exclusive breastfeeding at different periods. A second objective was to investigate whether the administered oxytocin dose is associated with cessation of exclusive breastfeeding. METHODS We conducted a prospective cohort study (n=529) in a tertiary hospital. Only full-term singleton pregnancies were included. Four groups were established based on the type of birth (vaginal or cesarean) and the intrapartum administration of oxytocin. Follow-up was performed to evaluate the consolidation of exclusive breastfeeding at 1, 3 and 6months. FINDINGS During follow-up, the proportion of exclusive breastfeeding decreased in all groups. After adjusting for confounding variables, the group with cesarean birth without oxytocin (planned cesarean birth) had the highest risk of cessation of exclusive breastfeeding (odds ratio [95% confidence interval], 2.51 [1.53-4.12]). No association was found between the oxytocin dose administered during birth and puerperium period and the cessation of exclusive breastfeeding. CONCLUSION Planned cesarean birth without oxytocin is associated with the cessation of exclusive breastfeeding at 1, 3 and 6months of life. It would be desirable to limit elective cesarean births to essentials as well as to give maximum support to encourage breastfeeding in this group of women. The dose of oxytocin given during birth and puerperium period is not associated with cessation of exclusive breastfeeding.
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Affiliation(s)
| | - Modesto Durán Duque
- Department of Midwifery, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - Ana B Hernández López
- Department of Midwifery, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - Cristina Muriel Miguel
- Department of Midwifery, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - Pilar Pérez Riveiro
- Neonatology and Newborn Nursery Division, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - Angel Salcedo Mariña
- Department of Obstetrics, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - Ana Royuela Vicente
- Clinical Biostatistics Unit, Health Research Institute Puerta de Hierro-Segovia de Arana, Madrid, Spain
| | | | - Miguel A Marín Gabriel
- Department of Neonatology, Puerta de Hierro Majadahonda University Hospital, Madrid. Department of Pediatrics, Autónoma University, Madrid, Spain.
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Isidore J, Rousseau A. Administration of oxytocin during spontaneous labour: A national vignette-based study among midwives. Midwifery 2018; 62:214-219. [PMID: 29715598 DOI: 10.1016/j.midw.2018.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/20/2018] [Accepted: 04/15/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE (1) to assess variations in oxytocin use by midwives during spontaneous labour (indication, dose, moment), and (2) to identify factors potentially associated with oxytocin administration. DESIGN descriptive cross-sectional study using a case-vignette and questionnaire among French midwives from November 2015 to May 2016. METHODS Midwives were asked to complete an online survey including a case-vignette with hourly partograms of a slowly progressing labour, and a short self-administered questionnaire. Two choices were proposed with each hourly partogram: administration of oxytocin or expectant management. Midwives who selected oxytocin were then asked about the dose, dose-increment and dose-increase delay. The questionnaire asked the midwives about work experience, day or night work, and organisational factors. FINDINGS The study included 204 midwives. At some point during the case-vignette, 159 (77.9%) midwives responded that they would use oxytocin. Answers demonstrated variations in oxytocin administration for initial doses, dose-increments and dose-increase delays. Specifically, a substantial majority of respondents chose high doses of oxytocin (64.1% at doses exceeding 2 mIU/min) and short dose-increase delays (62.9% under 30 min). Excessive administration of oxytocin by midwives was significantly associated with the number of births per year in their maternity unit, midwives' workload (p < 0.001), overload of delivery rooms (p < 0.001) and lack of protocol (22% versus 55.6%, p < 0.001). Midwives considered that their use of oxytocin was related mainly to an overburdened department (48.5%). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE We observed overuse of oxytocin, influenced by organisational factors. Every maternity unit should implement a protocol and/or checklist for oxytocin administration to reduce variation in practice and improve safety of care by using evidence-based clinical indications, initial doses, dose-increments and dose-increase delays. Modifying the organisation of care appears necessary to reduce hospital patient volume or increase staffing to ensure that the number of midwives on duty matches the activity in the delivery room without causing excess work or stress to midwives.
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Affiliation(s)
- Johanne Isidore
- Department of Midwifery, Versailles-St Quentin en Yvelines University, UFR des Sciences de la Santé Simone Veil, 2 avenue de la source de la Bièvre, 78180 Montigny le Bretonneux, France.
| | - Anne Rousseau
- Department of Midwifery, Versailles-St Quentin en Yvelines University, UFR des Sciences de la Santé Simone Veil, 2 avenue de la source de la Bièvre, 78180 Montigny le Bretonneux, France; Research Unit EA 7285, Versailles-St Quentin University, UFR des Sciences de la Santé Simone Veil, 2 avenue de la source de la Bièvre, 78180 Montigny le Bretonneux, France .
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Liu J, Yi Y, Weiwei X. Effects of Increased Frequency, High Dose, and Pulsatile Oxytocin Regimens on Abnormal Labor Delivery. Med Sci Monit 2018; 24:2063-2071. [PMID: 29626416 PMCID: PMC5903316 DOI: 10.12659/msm.906728] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background The current guideline for oxytocin regimens in the abnormal labor of delivery is continuous infusion. The objective of the present study was to compare effects and safety measures of various available regimens of oxytocin in abnormal labor delivery. Material/Methods In this clinical experimental study, a total of 900 pregnant women admitted for delivery were randomized into 5 group with 162 each. Pregnant women received oxytocin as continuous administration of 16 mU/min (Group I), 1 mU/min (group II), 4 mU/min (group III), 5 mU/min quarter-hourly (group IV), and through a syringe pump (group V). Measurement of the expense of delivery, the ratio of the instrumental delivery, and the other secondary outcome measures was performed to find the best regimen of oxytocin. The 2-tailed paired t test and Mann-Whitney U test following Dunnett’s multiple comparison tests were used at 95% confidence level. Results Pulsatile delivery had least risk of instrumental delivery as compared to continuous infusion (p<0.0001, q=6.663) and normal-frequency low-dose (p<0.0001, q=5.638) of oxytocin. The time required from infusion to delivery was longer for group II (p=0.001, q=2.925), group IV (p<0.0001, q=4.829), and group V (p<0.0001, q=41.456) than for group I. The expense of delivery was: group I < group II < group IV < group III < group V. Conclusions High-dose and pulsatile preparation of oxytocin had reduced risks of operative delivery vs. continuous administration.
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Affiliation(s)
- Jiuying Liu
- Department of Gynecology and Obstetrics, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Yang Yi
- Department of Gynecology and Obstetrics, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland)
| | - Xu Weiwei
- Department of Gynecology and Obstetrics, Second People's Hospital of Huanggang, Huanggang, Hubei, China (mainland)
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Stokholm L, Juhl M, Lønfeldt NN, Mikkelsen SH, Obel C, Strandberg-Larsen K. Obstetric synthetic oxytocin use and subsequent hyperactivity/inattention problems in Danish children. Acta Obstet Gynecol Scand 2018; 97:880-889. [DOI: 10.1111/aogs.13344] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 03/09/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Lonny Stokholm
- Section of Epidemiology; Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - Mette Juhl
- Department of Midwifery; Metropolitan University College; Copenhagen Denmark
- Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - Nicole N. Lønfeldt
- Child and Adolescent Mental Health Services, Research Unit; Capital Region of Denmark Psychiatry; Copenhagen Denmark
| | - Susanne H. Mikkelsen
- Section for General Medical Practice; Department of Public Health; Aarhus University; Aarhus Denmark
| | - Carsten Obel
- Section for General Medical Practice; Department of Public Health; Aarhus University; Aarhus Denmark
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Rossen J, Klungsøyr K, Albrechtsen S, Løkkegård E, Rasmussen S, Bergholt T, Skjeldestad FE. Can oxytocin augmentation modify the risk of epidural analgesia by maternal age in cesarean sections? Acta Obstet Gynecol Scand 2018. [PMID: 29512836 DOI: 10.1111/aogs.13341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Maternal age is an established risk factor for cesarean section; epidural analgesia and oxytocin augmentation may modify this association. We investigated the effects and interactions of oxytocin augmentation, epidural analgesia and maternal age on the risk of cesarean section. MATERIAL AND METHODS In all, 416 386 nulliparous women with spontaneous onset of labor, ≥37 weeks of gestation and singleton infants with a cephalic presentation during 2000-2011 from Norway and Denmark were included [Ten-group classification system (Robson) group 1]. In this case-control study the main exposure was maternal age; epidural analgesia, oxytocin augmentation, birthweight and time period were explanatory variables. Chi-square test and logistic regression were used to estimate associations and interactions. RESULTS The cesarean section rate increased consistently with advancing maternal age, both overall and in strata of epidural analgesia and oxytocin augmentation. We observed strong interactions between maternal age, oxytocin augmentation and epidural analgesia for the risk of cesarean section. Women with epidural analgesia generally had a reduced adjusted odds ratio when oxytocin was used compared with when it was not used. In Norway, this applied to all maternal age groups but in Denmark only for women ≥30 years. Among women without epidural, oxytocin augmentation was associated with an increased odds ratio for cesarean section in Denmark, whereas no difference was observed in Norway. CONCLUSIONS Oxytocin augmentation in nulliparous women with epidural analgesia is associated with a reduced risk of cesarean section in labor with spontaneous onset.
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Affiliation(s)
- Janne Rossen
- Department of Obstetrics and Gynecology, Sørlandet Hospital Kristiansand, Kristiansand, Norway.,Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway
| | - Susanne Albrechtsen
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Haukeland, Denmark.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ellen Løkkegård
- Clinical Research Unit, Department of Obstetrics and Gynecology, Nordsjaellands Hospital, University of Copenhagen, Hillerød, Denmark
| | - Steen Rasmussen
- Clinical Research Unit, Department of Obstetrics and Gynecology, Nordsjaellands Hospital, University of Copenhagen, Hillerød, Denmark
| | - Thomas Bergholt
- Department of Obstetrics, Rigshospitalet University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Finn E Skjeldestad
- Research Group Epidemiology of Chronic Diseases, Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
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Abstract
Oxytocin is one of the most commonly used medications in obstetrics and has been associated with claims of negligence in cases of adverse outcomes. Errors involving intravenous oxytocin administration for induction or augmentation of labor are most commonly dose related and include failure to avoid or treat tachysystole or failure to asses or treat a fetal heart rate pattern indicative of disruption in oxygenation. Clinicians should be knowledgeable regarding pharmacokinetics of oxytocin and the effect of uterine contractions on fetal oxygenation as well as safe titration of oxytocin to achieve the desired effect while minimizing harm.
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Dy J, Rainey J, Walker MC, Fraser W, Smith GN, White RR, Waddell P, Janoudi G, Corsi DJ, Wei SQ. Accelerated Titration of Oxytocin in Nulliparous Women with Labour Dystocia: Results of the ACTION Pilot Randomized Controlled Trial. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:690-697. [PMID: 29276166 DOI: 10.1016/j.jogc.2017.08.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The primary objective was to determine the feasibility of a large RCT assessing the effectiveness of an accelerated oxytocin titration (AOT) protocol compared with a standard gradual oxytocin titration (GOT) in reducing the risk of CS in nulliparous women diagnosed with dystocia in the first stage of labour. The secondary objective was to obtain preliminary data on the safety and efficacy of the foregoing AOT protocol. METHODS This was a multicentre, double-masked, parallel-group pilot RCT. This study was conducted in three Canadian birthing centres. A total of 79 term nulliparous women carrying a singleton pregnancy in spontaneous labour, with a diagnosis of labour dystocia, were randomized to receive either GOT (initial dose 2 mU/min with increments of 2 mU/min) or AOT (initial dose 4 mU/min with increments of 4 mU/min), in a 1:1 ratio. An intention-to-treat analysis was applied. RESULTS A total of 252 women were screened and approached, 137 (54.4%) consented, and 79 (31.3%) were randomized. Overall protocol adherence was 76 of 79 (96.2%). Of the women randomized, 10 (25.6%) allocated to GOT had a CS compared with six (15.0%) allocated to AOT (Fisher exact test P = 0.27). CONCLUSION This pilot study demonstrated that a large, multicentre RCT is not only feasible, but also necessary to assess the effectiveness and safety of an AOT protocol for labour augmentation with regard to CS rate and indicators of maternal and perinatal morbidities.
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Affiliation(s)
- Jessica Dy
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, ON; Department of Obstetrics, Gynecology, and Newborn Care, The Ottawa Hospital, Ottawa, ON; Faculty of Medicine, University of Ottawa, Ottawa, ON.
| | - Jenna Rainey
- Department of Obstetrics, Gynecology, and Newborn Care, The Ottawa Hospital, Ottawa, ON
| | - Mark C Walker
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, ON; Department of Obstetrics, Gynecology, and Newborn Care, The Ottawa Hospital, Ottawa, ON; Faculty of Medicine, University of Ottawa, Ottawa, ON
| | - William Fraser
- Mother & Child Axis, Centre de recherche du CHUS, Sherbrooke, QC; Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC; Department of Obstetrics Gynecology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC
| | - Graeme N Smith
- Queen's Perinatal Research Unit, Clinical Research Centre, Kingston General Hospital, Kingston, ON; Department of Obstetrics & Gynaecology, Queen's University, Kingston, ON
| | - Ruth Rennicks White
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, ON; Department of Obstetrics, Gynecology, and Newborn Care, The Ottawa Hospital, Ottawa, ON
| | - Patti Waddell
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, ON
| | | | - Daniel J Corsi
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, ON
| | - Shu Qin Wei
- Obstetrics-Gynaecology Department, CHU Sainte-Justine Hospital, University of Montréal, Montréal, QC
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Effect of hyoscine butyl-bromide on the duration of active phase of labor: A randomized-controlled trial. Taiwan J Obstet Gynecol 2017; 56:725-730. [DOI: 10.1016/j.tjog.2017.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2017] [Indexed: 11/23/2022] Open
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Bernitz S, Dalbye R, Øian P, Zhang J, Eggebø TM, Blix E. Study protocol: the Labor Progression Study, LAPS - does the use of a dynamic progression guideline in labor reduce the rate of intrapartum cesarean sections in nulliparous women? A multicenter, cluster randomized trial in Norway. BMC Pregnancy Childbirth 2017; 17:370. [PMID: 29132336 PMCID: PMC5683365 DOI: 10.1186/s12884-017-1553-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 10/31/2017] [Indexed: 11/25/2022] Open
Abstract
Background The increasing rate of intrapartum cesarean sections is subject of attention and concern as it is associated with adverse outcomes. Labor dystocia is one of the most frequent indications for cesarean sections even though there is no consensus on criteria for labor dystocia. Traditionally the progression of labor follows guidelines based on Friedman’s curve from the mid 1950s. In 2010 Zhang presented a new labor curve and a dynamic guideline for labor progression based on contemporary research. The main aim of this trial is to evaluate whether adhering to Zhang’s guideline for labor progression, changes the intrapartum cesarean section rate in nulliparous women without jeopardising maternal and neonatal outcomes compared to a traditional guide line called the 4-h action line based on Friedman’s curve. Methods/design A multicenter cluster randomized trial including 14 birth care units in Norway is conducted. Seven units are randomized to use the 4-h action line guideline for labor progression and seven units are randomized to use Zhang’s new dynamic guideline for labor progression, for all nulliparous women with a singleton fetus in a cephalic presentation and spontaneous onset of labor at term. Clinical outcomes are compared between the groups. The determination of the sample size (number of clusters and individuals) is based on a power calculation of intrapartum cesarean section, which is 9.2% in the study population (p1). Further, we expect that the intrapartum cesarean section rate will be 6.7% (p2) which is a 25% reduction, when using the new guideline. With a chosen significance level of 0.05, a power of 80% and p1 = 9.2% and p2 = 6.9%, we should include at least 14 clusters and 6582 individuals. Discussion Clinical consequences when using the guideline by Zhang have, to the best of our knowledge, not been investigated earlier. The results will provide a strong basis to make a qualified decision on whether it is beneficial to introduce a dynamic labor progression curve in contemporary obstetrics both nationally and internationally. Trial registration Clinicaltrials, NCT02221427
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Affiliation(s)
- Stine Bernitz
- Department of Obstetrics and Gynecology, Østfold Hospital Trust, PO.box 300, 1714, Grålum, Norway. .,Department of Health, Nutrition and Management, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
| | - Rebecka Dalbye
- Department of Obstetrics and Gynecology, Østfold Hospital Trust, PO.box 300, 1714, Grålum, Norway
| | - Pål Øian
- Department of Obstetrics and Gynecology, The University Hospital of north Norway, Tromsø, Norway.,Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Jun Zhang
- Xinhua Hospital, Shanghai Jiaotong University School of Medicine Shanghai, China, National Center for Fetal Medicine, Shanghai, China
| | - Torbjørn Moe Eggebø
- Trondheim University Hospital (St Olavs Hospital), Trondheim, Norway.,Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ellen Blix
- Department of Health, Nutrition and Management, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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DeMaria AL, Sundstrom B, Moxley GE, Banks K, Bishop A, Rathbun L. Castor oil as a natural alternative to labor induction: A retrospective descriptive study. Women Birth 2017; 31:e99-e104. [PMID: 28838804 DOI: 10.1016/j.wombi.2017.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 07/08/2017] [Accepted: 08/01/2017] [Indexed: 12/20/2022]
Abstract
AIM To describe birthing outcomes among women who consumed castor oil cocktail as part of a freestanding birth center labor induction protocol. METHODS De-identified data from birth logs and electronic medical records were entered into SPSS Statistics 22.0 for analysis for all women who received the castor oil cocktail (n=323) to induce labor between January 2008 and May 2015 at a birth center in the United States. Descriptive statistics were analyzed for trends in safety and birthing outcomes. RESULTS Of the women who utilized the castor oil cocktail to stimulate labor, 293 (90.7%) birthed vaginally at the birth center or hospital. The incidence of maternal adverse effects (e.g., nausea, vomiting, extreme diarrhea) was less than 7%, and adverse effects of any kind were reported in less than 15% of births. An independent sample t-test revealed that parous women were more likely to birth vaginally at the birth center after using the castor oil cocktail than their nulliparous counterparts (p<.010), while gestational age (p=.26), woman's age (p=.23), and body mass index (p=.28) were not significantly associated. CONCLUSIONS Nearly 91% of women in the study who consumed the castor oil cocktail to induce labor were able to give birth vaginally with little to no maternal or fetal complications. Findings indicate further research is needed to compare the safety and effectiveness of natural labor induction methodologies, including castor oil, to commonly used labor induction techniques in a prospective study or clinical trial.
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Affiliation(s)
- Andrea L DeMaria
- College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA.
| | - Beth Sundstrom
- Department of Communication, College of Charleston, Charleston, SC, USA
| | - Grace E Moxley
- Emory University School of Medicine, Emory University, Atlanta, GA, USA
| | - Kendall Banks
- Belk College of Business, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Ashlan Bishop
- Honors College, College of Charleston, Charleston, SC, USA
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Montoya-Williams D, Lemas DJ, Spiryda L, Patel K, Neu J, Carson TL. What Are Optimal Cesarean Section Rates in the U.S. and How Do We Get There? A Review of Evidence-Based Recommendations and Interventions. J Womens Health (Larchmt) 2017; 26:1285-1291. [PMID: 28825512 DOI: 10.1089/jwh.2016.6188] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Cesarean sections (CSs) are the most commonly performed surgical procedures in the world today. Global epidemiological studies from the last decade suggest that the optimal CS rates in developed countries exist somewhere between 15% and 19%. Despite these findings, CS rates in the United States have remained stable at slightly over 32% over the past 10 years. Using primary and secondary literature published from 2010 to 2015, this review discusses how optimal CS rates were developed. In addition, we define a category of potentially avoidable CS (i.e., those conducted on nulliparous low-risk women who present with vertex infants at term) and explore how CS in this population appear to be one of the main drivers of high CS rates overall. The institutional, provider, and patient-related factors, which may be related to higher-than-recommended rates of CS, particularly those conducted in low-risk women, will be discussed. This review will then delve into clinician and patient-oriented interventions that have been shown to effectively reduce the rate of potentially avoidable CS. Our analysis showed that large-scale, multifaceted interventions that include audit and feedback cycles as well as peer review strategies were the most effective in decreasing rates of potentially avoidable CS. This review concludes with an agenda for future research into interventions that aim to achieve optimal CS rates.
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Affiliation(s)
- Diana Montoya-Williams
- 1 Division of Neonatology, Department of Pediatrics, University of Florida , Gainesville, Florida
| | - Dominick J Lemas
- 2 Department of Health Outcomes and Policy, University of Florida , Gainesville, Florida
| | - Lisa Spiryda
- 3 Department of Obstetrics and Gynecology, University of Florida , Gainesville, Florida
| | - Keval Patel
- 4 Department of Biology, College of Liberal Arts and Sciences, University of Florida, Gainesville, Florida
| | - Josef Neu
- 1 Division of Neonatology, Department of Pediatrics, University of Florida , Gainesville, Florida
| | - Tiffany L Carson
- 5 Division of Preventive Medicine, Department of Medicine, University of Alabama , Birmingham, Alabama
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Page K, McCool WF, Guidera M. Examination of the Pharmacology of Oxytocin and Clinical Guidelines for Use in Labor. J Midwifery Womens Health 2017; 62:425-433. [DOI: 10.1111/jmwh.12610] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/10/2017] [Accepted: 01/13/2017] [Indexed: 12/01/2022]
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Dias BAS, Santos ETD, Andrade MAC. Classification systems for avoidability of infant deaths: different methods, different repercussions? CAD SAUDE PUBLICA 2017; 33:e00125916. [PMID: 28614450 DOI: 10.1590/0102-311x00125916] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 02/06/2017] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to compare the avoidability of infant deaths according to different classification methods. This was a descriptive comparative study from 2006 to 2013 in Espírito Santo State, Brazil, focusing on the classification of 5,316 infant deaths according to five different methods. The methods of the International Collaborative Effort on Infant Mortality (ICE) and the SEADE Foundation correctly classified the highest proportions of deaths as avoidable versus unavoidable (94.6% and 94.4% correct classification, respectively). Most deaths resulted from quality problems in prenatal, childbirth, and postpartum care, regardless of which classification method was used. There were also considerable numbers of deaths from "ill-defined" causes according to all the methods, suggesting difficulty in access or precious care in health services. Avoidability methods provide an important instrument for diagnosis of quality problems in health services performance and orientation of measures to reduce avoidable infant deaths. Thus, strengthening maternal and child care and investment in training and capacity-building for health professionals and services are priorities for public policies to reduce infant mortality.
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Dupont C, Carayol M, Le Ray C, Deneux-Tharaux C, Riethmuller D. Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Guidelines short text. J Gynecol Obstet Hum Reprod 2017; 46:539-543. [DOI: 10.1016/j.jogoh.2017.04.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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50
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Dupont C, Carayol M, Le Ray C, Deneux-Tharaux C, Riethmuller D. Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Introduction and methodology. J Gynecol Obstet Hum Reprod 2017; 46:465-467. [PMID: 28473288 DOI: 10.1016/j.jogoh.2017.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- C Dupont
- AURORE perinatal network, 69004 Lyon, France; Pôle IMER, Lyon university hospital, 69003 Lyon, France; EA 7425, Health Services and Performance Research (HESPER), University Lyon, Claude-Bernard Lyon 1 University, 69008 Lyon, France.
| | - M Carayol
- Mother and child protection services, Paris Direction of Family and Early Childhood, Paris City Hall, 75196 Paris, France
| | - C Le Ray
- Port-Royal Maternity Unit, Cochin Hospital, AP-HP, DHU Risks in Pregnancy, Paris Descartes University, 75014 Paris, France; Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in pregnancy, Paris Descartes University, 75014 Paris, France
| | - C Deneux-Tharaux
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in pregnancy, Paris Descartes University, 75014 Paris, France
| | - D Riethmuller
- Besançon University Hospital, 3, boulevard Fleming, 25000 Besançon, France
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