Neonatal jaundice after labour induced or stimulated by prostaglandin E2 or oxytocin

The effect of oxytocin infusion and misoprostol on neonatal bilirubin levels

PURPOSE

To investigate the association of neonatal bilirubin levels with oxytocin and misoprostol use for labour induction.

METHODS

A total of 100 neonates were included in the study. The first group consisted of 50 healthy babies of women who had received oxytocin infusion and the second group consisted of 50 healthy babies of women who had received 25 μg misoprostol every 4 h placed in the posterior fornix for labour induction. Bilirubin and haematocrit levels were measured in all on days 1 and 4 of the neonatal period.

RESULTS

The levels of bilirubin in the oxytocin group were significantly higher than those in the misoprostol group on day 1 [4.42 ± 0.27 mg/dl versus 3.55 ± 0.28 mg/dl (P = 0.035)] while they were higher also on day 4 but was not significantly so [7.47 ± 0.63 mg/dl versus 6.86 ± 0.65 mg/dl (P = 0.525)]. The mean haematocrit levels on day 1 were 50.62 ± 1.23 and 58.04 ± 1.30 in groups 1 and 2, respectively, with a significant difference between them. The levels were 52.31 ± 1.27 and 58.96 ± 1.14 on day 4 and the difference was again significant. P < 0.05 indicated statistical significance.

CONCLUSIONS

Labour induction with misoprostol and oxytocin does not seem to have harmful effects on bilirubin levels in the neonate.

The effect of oxytocin infusion and misoprostol on neonatal bilirubin levels

PURPOSE

To investigate the association of neonatal bilirubin levels with oxytocin and misoprostol use for labour induction.

METHODS

A total of 100 neonates were included in the study. The first group consisted of 50 healthy babies of women who had received oxytocin infusion, and the second group consisted of 50 healthy babies of women who had received 25 microg misoprostol every 4 h placed in the posterior fornix for labour induction. Bilirubin and haematocrit levels were measured in all on days 1 and 4 of the neonatal period.

RESULTS

The levels of bilirubin in the oxytocin group were significantly higher than those in the misoprostol group on day 1 [4.42 +/- 0.27 vs. 3.55 +/- 0.28 mg/dl (P = 0.035)] while they were higher also on day 4 but not significantly so [7.47 +/- 0.63 vs. 6.86 +/- 0.65 mg/dl (P = 0.525)]. The mean haematocrit levels on day 1 were 50.62 +/- 1.23 and 58.04 +/- 1.30 in groups 1 and 2, respectively, with a significant difference between them. The levels were 52.31 +/- 1.27 and 58.96 +/- 1.14 on day 4 and the difference was again significant. P < 0.05 indicated statistical significance.

CONCLUSIONS

Labour induction with misoprostol and oxytocin does not seem to have harmful effects on bilirubin levels in the neonate.

Drotaverine hydrochloride vs. valethamate bromide in acceleration of labor

OBJECTIVES

To compare the efficacy and safety of drotaverine hydrochloride and valethamate bromide in shortening the duration of labor.

METHODS

In a randomized controlled trial of 150 nulliparous women in established labor with cervical dilation of 4 cm, 50 women were given drotaverine (group I), 50 women were given valethamate (group II) and another 50 women were not given any medication (group III). Duration of labor, mode of delivery, side effects, and neonatal outcome were measured in all cases. Appropriate non-parametric tests and chi(2) tests were used for assessment of statistical significance.

RESULTS

In the three groups, 100%, 96% and 46% women delivered within 6 h, respectively. The injection-to-delivery interval was significantly reduced in the drotaverine group (193.96 min) in contrast to the valethamate group (220.68 min) and control group (412.84 min). The rate of cervical dilation was highest in the drotaverine group (2.04 cm/h) compared with the valethamate bromide group (1.86 cm/h) and control group (1.01 cm/h). There were no major maternal or fetal adverse effects in any group, but minor side effects were more common in the valethamate group.

CONCLUSION

Both intramuscular drotaverine hydrochloride and valethamate bromide are effective in acceleration of labor; however, drotaverine accelerates labor more rapidly and is associated with less side effects.

Oral prostaglandin E2 for induction of labour

BACKGROUND

This is one of a series of reviews of methods of cervical ripening and labour induction using standardised methodology.

OBJECTIVES

To determine the effects of oral prostaglandin E2 for third trimester induction of labour.

SEARCH STRATEGY

The Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register and bibliographies of relevant papers. Date of last search: December 2000.

SELECTION CRITERIA

The criteria for inclusion included the following: (1) clinical trials comparing oral prostaglandin E2 used for third trimester cervical ripening or labour induction with placebo/no treatment or other methods listed above it on a predefined list of labour induction methods; (2) random allocation to the treatment or control group; (3) adequate allocation concealment; (4) violations of allocated management not sufficient to materially affect conclusions; (5) clinically meaningful outcome measures reported; (6) data available for analysis according to the random allocation; (7) missing data insufficient to materially affect the conclusions.

DATA COLLECTION AND ANALYSIS

A strategy has been developed to deal with the large volume and complexity of trial data relating to labour induction. This involves a two-stage method of data extraction. The initial data extraction is done centrally, and incorporated into a series of primary reviews arranged by methods of induction of labour, following a standardised methodology. The data will then be extracted from the primary reviews into a series of secondary reviews, arranged by category of woman. To avoid duplication of data in the primary reviews, the labour induction methods have been listed in a specific order, from one to 25. Each primary review includes comparisons between one of the methods (from two to 25) with only those methods above it on the list.

MAIN RESULTS

There were 19 studies included in the review. Of these 15 included a comparison using either oral or intravenous oxytocin with or without amniotomy. The quality of studies reviewed was not high. Only seven studies had clearly described allocation concealment. Only two studies stated that providers and/or participants were blinded to treatment group. For the outcome of vaginal delivery not achieved within 24 hours, in the composite comparison of oral PGE2 versus all oxytocin treatments (oral and intravenous, with and without amniotomy), there was a trend favoring oxytocin treatments (relative risk (RR) 1.97, 95% confidence interval (CI) 0.86 to 4.48). For the outcome of cesarean section, in the comparison of PGE2 versus no treatment or placebo, PGE2 was favored (relative risk (RR) 0.54, 95% confidence interval (CI) 0.29,0.98). Otherwise, there were no significant differences between groups for this outcome. Oral prostaglandin was associated with vomiting across all comparison groups.

REVIEWER'S CONCLUSIONS

Oral prostaglandin consistently resulted in more frequent gastrointestinal side effects, in particular vomiting, compared with the other treatments included in this review. There were no clear advantages to oral prostaglandin over other methods of induction of labour.

Massive perinatal hepatic necrosis from maternal oxytocin overdose

Review of clinical records regarding administration of oxytocin may provide clues to the etiology of hepatic infarction in the neonate. The authors present a case in which a large and rapid maternal overdose of oxytocin (17,300 mU over 20 min) during end-stage labor was associated with neonatal death and extensive hepatic infarction. These findings represent novel complications of oxytocin administration.

Risk factors and sib correlation in physiological neonatal jaundice

The effect of a number of explanatory variables on the degree of physiological jaundice in mature infants was evaluated by multiple regression analysis. The sampling was designed so that comparisons could be made between siblings. We found an effect of gestational age, gender, infant nutrition, ABO incompatibility and induction of labour. Taking these factors into account we still found a highly significant correlation between the peak bilirubin levels of siblings. Whether this correlation is genetically or environmentally determined is not clear.

Intrapartum infusion of aqueous glucose solution, transplacental hyponatraemia and risk of neonatal jaundice

Cord serum sodium levels in three groups of 278 singleton infants, born vaginally at term, were correlated with the incidence of jaundice (serum bilirubin greater than or equal to 85 mumol/1) in the first 3 days of life. Of the 278 infants, 87 were born to mothers who were given infusions of 5% or 10% glucose in water during labour (group I), 90 were born to mothers who received glucose solution as a vehicle for oxytocin (group II), and 101 to mothers who did not receive any intravenous fluid therapy (control group). Jaundice was seen significantly more frequently in groups I (28/87, 32%) and II infants (30/90, 33%) than in the control group (12/101, 12%) (P less than 0.01), but when analysed in relation to cord serum sodium levels, the prevalence of jaundice in the normonatraemic infants (serum sodium greater than or equal to 131 mmol/1) was similar in the three groups. On the other hand, in groups I and II jaundice occurred about 3.5 times more frequently in the hyponatraemic infants [group I (17/32, 53%) and II (20/39, 51%)] than in the normonatraemic infants (P less than 0.01). The difference was not associated with any other perinatal or neonatal characteristic.