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Soriano LP, Rollins MD, Barreto Chang OL. Case Report of Hyponatremic Seizures in a Term Neonate Attributed to Excessive Maternal Coconut Water Ingestion During Labor. A A Pract 2024; 18:e01815. [PMID: 38975685 DOI: 10.1213/xaa.0000000000001815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
We report the case of a term neonate who was somnolent at birth with ventilatory distress and experienced 2 seizures shortly after delivery. Laboratory tests revealed the neonate had a serum sodium of 113 mmol/L. The seizures stopped after treatment with midazolam, and the sodium was corrected slowly with 3% hypertonic saline without further sequelae. The severe neonatal hyponatremia and seizures were attributed to maternal consumption of excessive amounts of coconut water during labor. This case demonstrates the importance of careful consideration of both fluid volume and fluid electrolyte composition during labor to prevent adverse maternal and neonatal outcomes.
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Affiliation(s)
- Laura P Soriano
- From the Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California
| | - Mark D Rollins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Odmara L Barreto Chang
- From the Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California
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Hermesch AC, Kernberg AS, Layoun VR, Caughey AB. Oxytocin: physiology, pharmacology, and clinical application for labor management. Am J Obstet Gynecol 2024; 230:S729-S739. [PMID: 37460365 DOI: 10.1016/j.ajog.2023.06.041] [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: 09/28/2022] [Revised: 06/11/2023] [Accepted: 06/19/2023] [Indexed: 03/12/2024]
Abstract
Oxytocin is a peptide hormone that plays a key role in regulating the female reproductive system, including during labor and lactation. It is produced primarily in the hypothalamus and secreted by the posterior pituitary gland. Oxytocin can also be administered as a medication to initiate or augment uterine contractions. To study the effectiveness and safety of oxytocin, previous studies have randomized patients to low- and high-dose oxytocin infusion protocols either alone or as part of an active management of labor strategy along with other interventions. These randomized trials demonstrated that active management of labor and high-dose oxytocin regimens can shorten the length of labor and reduce the incidence of clinical chorioamnionitis. The safety of high-dose oxytocin regimens is also supported by no associated differences in fetal heart rate abnormalities, postpartum hemorrhage, low Apgar scores, neonatal intensive care unit admissions, and umbilical artery acidemia. Most studies reported no differences in the cesarean delivery rates with active management of labor or high-dose oxytocin regimens, thereby further validating its safety. Oxytocin does not have a predictable dose response, thus the pharmacologic effects and the amplitude and frequency of uterine contractions are used as physiological parameters for oxytocin infusion titration to achieve adequate contractions at appropriate intervals. Used in error, oxytocin can cause patient harm, highlighting the importance of precise administration using infusion pumps, institutional safety checklists, and trained nursing staff to closely monitor uterine activity and fetal heart rate changes. In this review, we summarize the physiology, pharmacology, infusion regimens, and associated risks of oxytocin.
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Affiliation(s)
- Amy C Hermesch
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR.
| | - Annessa S Kernberg
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
| | - Vanessa R Layoun
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
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Rashidi M, Maier E, Dekel S, Sütterlin M, Wolf RC, Ditzen B, Grinevich V, Herpertz SC. Peripartum effects of synthetic oxytocin: The good, the bad, and the unknown. Neurosci Biobehav Rev 2022; 141:104859. [PMID: 36087759 DOI: 10.1016/j.neubiorev.2022.104859] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/23/2022] [Accepted: 09/03/2022] [Indexed: 11/30/2022]
Abstract
The first clinical applications of oxytocin (OT) were in obstetrics as a hormone to start and speed up labor and to control postpartum hemorrhage. Discoveries in the 1960s and 1970s revealed that the effects of OT are not limited to its peripheral actions around birth and milk ejection. Indeed, OT also acts as a neuromodulator in the brain affecting fear memory, social attachment, and other forms of social behaviors. The peripheral and central effects of OT have been separately subject to extensive scrutiny. However, the effects of peripheral OT-particularly in the form of administration of synthetic OT (synOT) around birth-on the central nervous system are surprisingly understudied. Here, we provide a narrative review of the current evidence, suggest putative mechanisms of synOT action, and provide new directions and hypotheses for future studies to bridge the gaps between neuroscience, obstetrics, and psychiatry.
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Affiliation(s)
- Mahmoud Rashidi
- Department of General Psychiatry, Heidelberg University, Heidelberg, Germany.
| | - Eduard Maier
- Department of Neuropeptide Research in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Sharon Dekel
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Marc Sütterlin
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Robert C Wolf
- Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Valery Grinevich
- Department of Neuropeptide Research in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
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Shanmugharaj Y, Schut V, Syed R, Zakaryan A. Overconsumption of fluids during labour leading to water intoxication and a tonic-clonic seizure in a healthy labourer. BMJ Case Rep 2021; 14:e242674. [PMID: 34162617 PMCID: PMC8230979 DOI: 10.1136/bcr-2021-242674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 11/03/2022] Open
Abstract
A 33-year-old woman in her first pregnancy with no significant medical history had a tonic-clonic seizure one hour after delivery due to acute hyponatraemia caused by excess intake of fluids. She was admitted to a birthing centre as a low-risk labourer where she spent 19 hours including 4 hours in the second stage of labour. Throughout the labour, she was encouraged to drink as per her own initiative and thirst. However, there was no monitoring of fluid intake. In spite of initial confusion about the cause of the seizure, a multidisciplinary approach helped with diagnosis of an underlying pathology and allowed timely treatment to avoid adverse outcomes in this patient. We would like to increase awareness of a possibility, however rare, of water intoxication due to fluid overconsumption by patients in labour and encourage production of information guidance for monitoring of fluid intake of women in labour.
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Affiliation(s)
- Yogita Shanmugharaj
- GKT School of Medical Education, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Viktorie Schut
- GKT School of Medical Education, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Rifat Syed
- Department of Obstetrics and Gynaecology, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK
| | - Anahit Zakaryan
- Department of Obstetrics and Gynaecology, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK
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Alake O, Rana R, Jain A, Chakkarapani E. Therapeutic hypothermia and outcome in hyponatraemic encephalopathy secondary to maternal water intoxication. BMJ Case Rep 2021; 14:e237213. [PMID: 33731399 PMCID: PMC7978085 DOI: 10.1136/bcr-2020-237213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2021] [Indexed: 11/03/2022] Open
Abstract
Misguided encouragement to consume large volumes of water during labour for pain relief results in dilutional hyponatraemia in mothers and their babies presenting with neurological dysfunction. We report three babies who were encephalopathic with seizures in the background of hyponatraemia secondary to maternal ingestion of large volumes of water and mild perinatal asphyxia. All babies underwent therapeutic hypothermia in addition to sodium supplementation with fluid restriction. Their neurodevelopment was appropriate for age. This case series highlights the dilemma that could arise with hyponatraemic encephalopathy and mild perinatal asphyxia in the first 6 hours of life, which is the window of opportunity for therapeutic hypothermia for hypoxic-ischaemic encephalopathy. It is important to educate pregnant mothers in labour on the adverse effects of excessive fluid ingestion.
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Affiliation(s)
- Oluwaseyi Alake
- Regional Neonatal Intensive Care Unit, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Reena Rana
- Regional Neonatal Intensive Care Unit, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Anoo Jain
- Regional Neonatal Intensive Care Unit, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Ela Chakkarapani
- Regional Neonatal Intensive Care Unit, St Michael's Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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Poon L.C, Yang H, Dumont S, Lee JCS, Copel JA, Danneels L, Wright A, Costa FDS, Leung TY, Zhang Y, Chen D, Prefumo F. ISUOG Interim Guidance on coronavirus disease 2019 (COVID-19) during pregnancy and puerperium: information for healthcare professionals - an update. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:848-862. [PMID: 32356590 PMCID: PMC7267438 DOI: 10.1002/uog.22061] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Affiliation(s)
- L. . C. Poon
- Department of Obstetrics and GynaecologyThe Chinese University of Hong KongHong Kong SAR
| | - H. Yang
- Department of Obstetrics and GynecologyPeking University First HospitalBeijingChina
| | - S. Dumont
- Department of Gynaecology and ObstetricsUniversity Hospitals Leuven, Leuven, Belgium; and Department of GynaecologyAZ Delta, RoeselareBelgium
| | - J. C. S. Lee
- Division of Obstetrics and GynaecologyKK Women's and Children's HospitalSingapore
| | - J. A. Copel
- Department of Obstetrics, Gynecology & Reproductive SciencesYale School of MedicineNew HavenCTUSA
| | - L. Danneels
- Department of Gynaecology, AZ DeltaRoeselareBelgium
| | - A. Wright
- Department of Obstetrics and GynaecologyRoyal Free Teaching Hospital Foundation TrustLondonUK
| | - F. Da Silva Costa
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil; and Department of Obstetrics and GynaecologyMonash UniversityMelbourneAustralia
| | - T. Y. Leung
- Department of Obstetrics and GynaecologyThe Chinese University of Hong KongHong Kong SAR
| | - Y. Zhang
- Department of Obstetrics and GynaecologyZhongnan Hospital of Wuhan UniversityWuhanChina
| | - D. Chen
- Department of Obstetrics and GynaecologyThe Third Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - F. Prefumo
- Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
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Effects of Prophylactic Oxytocin on Bleeding Outcomes in Women Undergoing Dilation and Evacuation: A Randomized Controlled Trial. Obstet Gynecol 2019; 133:484-491. [PMID: 30741801 DOI: 10.1097/aog.0000000000003104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate whether routine use of intravenous oxytocin decreases the frequency of interventions to control excess blood loss during dilation and evacuation (D&E). METHODS In this multisite, randomized, double-blind, placebo-controlled trial, women undergoing D&E at 18-24 weeks of gestation received 30 units of oxytocin in 500 mL of intravenous fluid or 500 mL of intravenous fluid alone initiated on speculum placement. The primary outcome was the frequency of interventions to control excess bleeding. A sample size of 75 patients per group was needed to detect a 15% decrease in intervention from 20% to 5% with 80% power and two-sided alpha 0.05. Secondary outcomes included measured blood loss, complications, procedure duration, postoperative pain, and patient satisfaction. RESULTS From November 2014 to February 2018, we screened 337 women and randomized 160 to receive prophylactic oxytocin (n=82) or placebo (n=78). Demographic characteristics were similar between groups. The frequency of interventions for bleeding, our primary outcome, was 7.3% in the oxytocin group vs 16.7% in the placebo group, difference of 9.4% (95% CI -21.0% to 1.9%). Interventions primarily included uterine massage and uterotonic administration. Among our secondary outcomes, median measured blood loss was lower in the oxytocin group at 152 (interquartile range 98-235) mL vs 317 (interquartile range 168-464) mL (95% CI 71.6-181.5). Frequency of hemorrhage, defined as blood loss of 500 mL or more and 1,000 mL or more, was lower in the oxytocin group at 3.7% vs 21.8%, difference of 18% (95% CI -29 to -6.9%) and 1.2% vs 10.3%, difference of 9.0% (95% CI -17 to -0.7%), respectively. Procedures were shorter in the oxytocin group at a median of 11.0 (interquartile range 8.0-14.0) vs 13.5 (interquartile range 10.0-19.0) minutes in the placebo group (95% CI 1.0-4.0). We found no differences in the frequency of nonhemorrhage complications, pain scores, or satisfaction scores between groups. CONCLUSION Prophylactic use of oxytocin during D&E at 18-24 weeks of gestation did not decrease the frequency of interventions to control bleeding. However, oxytocin did decrease blood loss and frequency of hemorrhage. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT02083809.
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Hernández López AB, Muriel Miguel C, Fernández-Cañadas Morillo A, López Lapeyrere C, Pérez Medina T, Salcedo Mariña Á, Fornet Ruiz I, Rubio González E, Solís Muñoz M. Efficacy of "optimal hydration" during labor: HYDRATA study protocol for a randomized clinical trial. Res Nurs Health 2019; 43:8-16. [PMID: 31793019 DOI: 10.1002/nur.21998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 11/13/2019] [Indexed: 12/23/2022]
Abstract
There is a lack of consensus in the international scientific community with respect to the most suitable hydration strategies when attending nulliparous women during low-risk births. This paper describes the protocol for a randomized controlled trial to compare two hydration strategies and their influence on maternal and neonatal morbidity. The study population consists of nulliparous women admitted to the obstetrics department of a University Hospital. The women are being randomized into two groups: the "optimal hydration" group, which will be guaranteed 300 ml/hr liquids (crystalloids and bottled mineral water) with a minimum diuresis of 35 ml/hr; and the "variability in hydration" group, which will receive intravenous (alternating normal saline, Ringer's lactate solution, glucose, or Voluven®) and clear (bottled mineral water or isotonic drinks [Aquarius®]) liquids, without any established perfusion rate, and without established minimum diuresis. Outcomes for mothers include duration of labor, cesarean section, fever, and dehydration. Outcomes for newborns are respiratory distress, hypoglycemia, hyponatremia, jaundice, weight loss over 48 hr, and breastfeeding difficulties. Analysis will be per-protocol. Administering optimal hydration may improve health and safety for mothers and their newborn and reduce maternal and neonatal morbidity. The study is registered at www.clinicaltrials.gov. The project received funding by the Ministry of Health of Spain and is approved by the Research Ethics Committee.
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Affiliation(s)
- Ana Belén Hernández López
- Departamento de Obstetricia y Ginecología, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España.,Grupo de Investigación en Enfermería y Salud, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Madrid, España
| | - Cristina Muriel Miguel
- Departamento de Obstetricia y Ginecología, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España
| | - Aurora Fernández-Cañadas Morillo
- Departamento de Obstetricia y Ginecología, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España.,Grupo de Investigación en Enfermería y Salud, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Madrid, España
| | - Carolina López Lapeyrere
- Grupo de Investigación en Enfermería y Salud, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Madrid, España.,Centro de Salud Valle de la Oliva, Madrid, España
| | - Tirso Pérez Medina
- Departamento de Obstetricia y Ginecología, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España.,Escuela de medicina, Universidad Autonoma de Madrid, Madrid, España.,Grupo de Investigación y Desarrollo de Nuevas Técnicas Quirúrgicas en Ginecología, Puerta de Hierro- Instituto de Investigación Sanitaria Segovia Arana, Madrid, España
| | - Ángel Salcedo Mariña
- Departamento de Obstetricia y Ginecología, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España
| | - Inocencia Fornet Ruiz
- Departamento de Obstetricia y Ginecología, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España
| | - Esther Rubio González
- Departamento de nefrología, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España
| | - Montserrat Solís Muñoz
- Grupo de Investigación en Enfermería y Salud, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Madrid, España.,Unidad de Investigación de Cuidados, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España
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Savarirayan R, Rossiter JP, Hoover-Fong JE, Irving M, Bompadre V, Goldberg MJ, Bober MB, Cho TJ, Kamps SE, Mackenzie WG, Raggio C, Spencer SS, White KK. Best practice guidelines regarding prenatal evaluation and delivery of patients with skeletal dysplasia. Am J Obstet Gynecol 2018; 219:545-562. [PMID: 30048634 DOI: 10.1016/j.ajog.2018.07.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/15/2018] [Accepted: 07/17/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Skeletal dysplasia comprises a heterogeneous and collectively common group of inherited disorders of development, growth, and maintenance of the human skeleton. There is potential for increased perinatal morbidity and mortality in pregnant women who themselves have skeletal dysplasia, and for affected fetuses where skeletal dysplasia is suspected in utero. OBJECTIVE We sought to establish guidelines for perinatal health care professionals who should be aware of these risks, to optimize maternal and child health pregnancy outcomes through best prenatal and delivery management practices. STUDY DESIGN A panel of 13 multidisciplinary international experts participated in a Delphi process, which comprised consideration of thorough literature review and a list of 54 possible care recommendations subject to 2 rounds of anonymous voting and a face-to-face meeting. Those recommendations with >80% agreement were considered as consensual. RESULTS During the first round, consensus was reached to support 30 out of the 54 statements. After the panel discussion, the group reached consensus on 40 statements. These statements include guidelines for the evaluation and treatment of pregnant women with skeletal dysplasia and for the unborn child with or suspected to have skeletal dysplasia. CONCLUSION Consensus-based best practice guidelines are provided as a minimum of standard care to minimize associated health risks, and improve clinical outcomes for patients with skeletal dysplasia.
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Solomon N, Many A, Orbach R, Mandel D, Shinar S. Maternal and neonatal hyponatremia during labor: a case series. J Matern Fetal Neonatal Med 2018. [PMID: 29526150 DOI: 10.1080/14767058.2018.1446517] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Hyponatremia during labor and delivery may result in severe maternal and neonatal sequelae. Our aim was to describe the direct effect of hyponatremia in labor on pregnancy outcome. METHODS A case series of parturients diagnosed with hyponatremia during labor and their neonates. Clinical presentation, laboratory workup, and maternal and neonatal outcomes are presented. RESULTS Four parturients and their corresponding six neonates were diagnosed with hyponatremia. Of these, two cases were caused by water intoxication and two were preeclampsia induced. While two were identified due to maternal or neonatal symptoms, two were diagnosed by routine laboratory testing. In all cases, low maternal sodium resulted in similarly low neonatal sodium. Neonatal symptoms included respiratory distress syndrome (RDS), lethargy, and jaundice. CONCLUSION Psychogenic drinking during labor and preeclampsia may predispose to maternal hyponatremia, resulting in neonatal hyponatremia. Early recognition and treatment can prevent further maternal deterioration and adverse neonatal sequelae.
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Affiliation(s)
- Neta Solomon
- a Department of Obstetrics and Gynecology , Lis Maternity Hospital, Sourasky Medical Center , Tel Aviv , Israel
| | - Ariel Many
- a Department of Obstetrics and Gynecology , Lis Maternity Hospital, Sourasky Medical Center , Tel Aviv , Israel
| | - Rotem Orbach
- b Department of Neonatology , Dana Dwek Children's Hospital , Tel Aviv , Israel
| | - Dror Mandel
- b Department of Neonatology , Dana Dwek Children's Hospital , Tel Aviv , Israel
| | - Shiri Shinar
- a Department of Obstetrics and Gynecology , Lis Maternity Hospital, Sourasky Medical Center , Tel Aviv , Israel
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Torloni MR, Gomes Freitas C, Kartoglu UH, Metin Gülmezoglu A, Widmer M. Quality of oxytocin available in low- and middle-income countries: a systematic review of the literature. BJOG 2016; 123:2076-2086. [PMID: 27006180 DOI: 10.1111/1471-0528.13998] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Oxytocin is the drug of choice for preventing and treating postpartum haemorrhage, an important cause of maternal death. Oxytocin is widely available in low and middle-income countries (LMIC) but there are concerns about its quality. OBJECTIVE To identify, critically appraise and synthesise the findings of studies on the quality of oxytocin available in LMIC. SEARCH STRATEGY We searched seven electronic databases, without language restriction. SELECTION CRITERIA Studies reporting results of tests to assess quality of oxytocin samples from LMIC. DATA COLLECTION AND ANALYSIS Study selection, data extraction and quality assessment were performed in duplicate. Results are presented descriptively. MAIN RESULTS The search identified 2611 unique citations; eight studies, assessing 559 samples from 15 different countries were included. Most samples were collected from facility level settings (n = 509) and from the private sector (n = 321). The median prevalence of oxytocin samples that failed quality tests was 45.6% (range 0-80%), mostly due to insufficient amounts of active pharmacological ingredient. Over one-third of the samples (n = 204) had low (<90%) oxytocin content indicating substandard medicine; two samples had no active ingredient, suggesting possible counterfeit drugs. The proportion of low fails was higher in samples collected in Africa than in Asia or Latin America (57.5% versus 22.3% versus 0%, respectively, P < 0.0001), in private than in public sectors (34.0% versus 25.3%, P = 0.032) and in facilities than in central distributors (37.9% versus 22.0%, P = 0.030). CONCLUSION There is a high prevalence of poor-quality oxytocin samples in LMIC countries, mainly due to inadequate amounts of active ingredient. TWEETABLE ABSTRACT Systematic review points to problems with quality of oxytocin samples from low- and middle-income countries.
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Affiliation(s)
- M R Torloni
- Evidence Based Healthcare Post-Graduate Programme, Department of Internal Medicine, São Paulo Federal University, São Paulo, Brazil
| | - C Gomes Freitas
- Evidence Based Healthcare Post-Graduate Programme, Department of Internal Medicine, São Paulo Federal University, São Paulo, Brazil
| | - U H Kartoglu
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - A Metin Gülmezoglu
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - M Widmer
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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12
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Imitators of preeclampsia: A review. Pregnancy Hypertens 2016; 6:1-9. [DOI: 10.1016/j.preghy.2016.02.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 02/05/2016] [Accepted: 02/11/2016] [Indexed: 12/16/2022]
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13
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Munesue T, Nakamura H, Kikuchi M, Miura Y, Takeuchi N, Anme T, Nanba E, Adachi K, Tsubouchi K, Sai Y, Miyamoto KI, Horike SI, Yokoyama S, Nakatani H, Niida Y, Kosaka H, Minabe Y, Higashida H. Oxytocin for Male Subjects with Autism Spectrum Disorder and Comorbid Intellectual Disabilities: A Randomized Pilot Study. Front Psychiatry 2016; 7:2. [PMID: 26834651 PMCID: PMC4720778 DOI: 10.3389/fpsyt.2016.00002] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 01/05/2016] [Indexed: 12/27/2022] Open
Abstract
UNLABELLED Approximately half of autism spectrum disorder (ASD) individuals suffer from comorbid intellectual disabilities (IDs). Oxytocin (OXT) receptors are highly expressed in temporal lobe structures and are likely to play a modulatory role in excitatory/inhibitory balance, at least based on animal model findings. Thus, it is feasible that in the highly representative group of Kanner-type ASD subjects, OXT could have a beneficial effect on social communication and social interaction. The aim of this pilot study is to investigate the feasibility and adverse events, such as epilepsy, of the long-term administration of intranasal OXT for adolescent and adult ASD subjects with ID because such patients frequently have seizures. We also addressed the question on how to scale the OXT effects to the core symptoms of social deficits because of the relative difficulty in obtaining objective measurements. Twenty-nine males (aged 15-40 years old) participated in a randomized, double-blind, and placebo-controlled crossover study (each for 8 weeks) with OXT (16 IU/day). Except for seizures experienced by one participant, other serious adverse events did not occur. The primary and secondary outcomes measured using the Childhood Autism Rating Scale and several standard scales, respectively, revealed no difference between the OXT and placebo groups. Instead, in an exploratory analysis, the social interactions observed in the play sessions or in daily life were significantly more frequent in the initial half period in the OXT-first arm of the crossover trial. There were also significant correlations between the plasma OXT concentration and subscale scores for irritability on the Aberrant Behavior Checklist. In conclusion, this pilot study demonstrates that long-term administration of intranasal OXT is tolerable in a representative cohort of ASD individuals with ID and suggests that future multicenter trials of OXT are warranted and should include measurements of reciprocal social interactions based on daily life under closer surveillance for epilepsy. TRIAL REGISTRATION UMIN000007250.
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Affiliation(s)
- Toshio Munesue
- Research Center for Child Mental Development, Kanazawa University , Kanazawa , Japan
| | - Hiroyuki Nakamura
- Department of Environmental and Preventive Medicine, Graduate School of Medical Sciences, Kanazawa University , Kanazawa , Japan
| | - Mitsuru Kikuchi
- Research Center for Child Mental Development, Kanazawa University , Kanazawa , Japan
| | - Yui Miura
- Research Center for Child Mental Development, Kanazawa University , Kanazawa , Japan
| | - Noriyuki Takeuchi
- Research Center for Child Mental Development, Kanazawa University , Kanazawa , Japan
| | - Tokie Anme
- International Community Care and Lifespan Development, Empowerment Sciences, Faculty of Medicine, University of Tsukuba , Tsukuba , Japan
| | - Eiji Nanba
- Division of Functional Genomics, Research Center for Bioscience and Technology, Tottori University , Yonago , Japan
| | - Kaori Adachi
- Division of Functional Genomics, Research Center for Bioscience and Technology, Tottori University , Yonago , Japan
| | | | - Yoshimichi Sai
- Department of Pharmacy, Kanazawa University Hospital , Kanazawa , Japan
| | - Ken-Ichi Miyamoto
- Department of Pharmacy, Kanazawa University Hospital , Kanazawa , Japan
| | - Shin-Ichi Horike
- Advanced Science Research Center, Kanazawa University , Kanazawa , Japan
| | - Shigeru Yokoyama
- Research Center for Child Mental Development, Kanazawa University , Kanazawa , Japan
| | - Hideo Nakatani
- Research Center for Child Mental Development, Kanazawa University, Kanazawa, Japan; Department of Psychiatry and Neurobiology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yo Niida
- Research Center for Child Mental Development, Kanazawa University, Kanazawa, Japan; Division of Genomic Medicine, Department of Advanced Medicine, Medical Research Institute, Kanazawa Medical University, Uchinada, Japan
| | - Hirotaka Kosaka
- Research Center for Child Mental Development, University of Fukui , Fukui , Japan
| | - Yoshio Minabe
- Research Center for Child Mental Development, Kanazawa University, Kanazawa, Japan; Department of Psychiatry and Neurobiology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Haruhiro Higashida
- Research Center for Child Mental Development, Kanazawa University , Kanazawa , Japan
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Handa D, Barclay N, Rehrauer D, Lakshminrusimha S. Case 2: Early Neonatal Seizures. Neoreviews 2015; 16:e645. [PMID: 27004045 PMCID: PMC4798245 DOI: 10.1542/neo.16-11-e645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Deepali Handa
- Department of Pediatrics, University at Buffalo, State University of New York and Neonatal Intensive Care Unit, Women and Children's Hospital of Buffalo, NY
| | - Nancy Barclay
- Department of Pediatrics, University at Buffalo, State University of New York and Neonatal Intensive Care Unit, Women and Children's Hospital of Buffalo, NY
| | - David Rehrauer
- Department of Pediatrics, University at Buffalo, State University of New York and Neonatal Intensive Care Unit, Women and Children's Hospital of Buffalo, NY
| | - Satyan Lakshminrusimha
- Department of Pediatrics, University at Buffalo, State University of New York and Neonatal Intensive Care Unit, Women and Children's Hospital of Buffalo, NY
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15
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Risberg A, Sjöquist M, Wedenberg K, Olsson U, Larsson A. Water balance during parturition and early puerperium: A prospective open trial. Clin Biochem 2015; 48:837-42. [DOI: 10.1016/j.clinbiochem.2015.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 06/09/2015] [Accepted: 06/11/2015] [Indexed: 10/23/2022]
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16
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Paul SP, Basude S, Smith-Collins AP. Maternal over-hydration in labor can cause dilutional hyponatremia in neonates. Indian J Pediatr 2014; 81:637-8. [PMID: 24248987 DOI: 10.1007/s12098-013-1282-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 10/21/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Siba Prosad Paul
- Department of Pediatric Gastroenterology, Bristol Royal Hospital for Children, Paul O'Gorman Building, Upper Maudlin Street, Bristol, BS2 8BJ, UK,
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17
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Mulder PJ, Gardner SE. The healthy newborn hydration model: a new model for understanding newborn hydration immediately after birth. Biol Res Nurs 2014; 17:94-9. [PMID: 25504955 DOI: 10.1177/1099800414529362] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The normal small volume of breast milk produced in the first 2 days following birth may raise concerns about adequate hydration in breast-fed newborns. These concerns are further magnified when breast-fed infants lose ≥7% of their birth weight within 2 days postnatally. Weight loss following birth is presumably mostly water loss that could result in hypohydration and subsequent hypernatremic dehydration. However, excess fluid loss immediately following birth is a normal and necessary process. Furthermore, newborns exposed to excess fluid intake during labor may need to lose ≥7% of birth weight in the first 2 days following birth in order to achieve euhydration. Normal newborn fluid loss following birth confounds the use of weight loss as the sole measure of newborn hydration. We thus propose the healthy newborn hydration model that highlights the normalcy of newborn weight loss immediately following birth and the healthy newborn's compensatory mechanisms for preserving adequate hydration. We also recommend the use of serum sodium to measure intravascular osmolarity in addition to monitoring weight loss to obtain a more comprehensive newborn hydration assessment. Research is necessary in healthy newborns to identify relationships among fluids received in utero, newborn weight loss, and hydration, as evaluated with laboratory measures, in the first 2 days following birth. This information will guide clinicians in correctly identifying newborns with inadequate hydration who are in need of supplementary fluids versus newborns with adequate hydration for whom exclusive breast-feeding can be supported and encouraged.
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Affiliation(s)
| | - Sue E Gardner
- College of Nursing, University of Iowa, Iowa City, IA, USA
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Abstract
INTRODUCTION Labor induction is now reported to occur in up to 30 - 40% of obstetrical patients. There are a number of pharmacological options available to facilitate labor induction, including oxytocin and analogues of prostaglandins E1 and E2, which have particular utility when labor induction necessitates cervical ripening, as when labor induction occurs in the context of an unfavorable cervix. AREAS COVERED This paper reviews acceptable pharmacological options for labor induction, especially when cervical ripening is required. These options include oxytocin and a number of prostaglandin formulations using dinoprostone and misoprostol. It also covers several analyses of published clinical trials (Phase-III) describing evidence of effectiveness. EXPERT OPINION Oxytocin is best used when labor needs to be induced in the context of a favorable cervix. When the cervix is not favorable, cervical ripening using prostaglandins should precede labor induction. Either dinoprostone or misoprostol are superior to oxytocin alone for cervical ripening. However, judicious, careful considerations need to be made at the outset of labor induction so as to balance maternal and fetal risks, and these should be guided by institutional policies that reflect the evidence-base.
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Affiliation(s)
- J Seth Hawkins
- University of Texas Southwestern School of Medicine, Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, 5323 Harry Hines Boulevard, Dallas, TX 75390-9032, USA
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19
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Marcialis MA, Dessi A, Pintus MC, Irmesi R, Fanos V. Neonatal hyponatremia: differential diagnosis and treatment. J Matern Fetal Neonatal Med 2012; 24 Suppl 1:75-9. [PMID: 21942597 DOI: 10.3109/14767058.2011.607667] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hyponatremia is very frequent in neonates, especially in VLBW. Recent data have shown that hyponatremia is not so benign as previously believed,and several clinical studies have indicated that preterms with mild to moderate chronic hyponatremia may experience poor growth and development retardation. The aim of this review is to present how to differentiate hypovolemic, euvolemic and hypervolemic hypernatremias, suggesting algorithms for practical management.
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Affiliation(s)
- Maria Antonietta Marcialis
- Department of Paediatrics, Section of Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, Azienda Mista and University of Cagliari, Italy.
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20
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Imoto S, Takeda A, Koyama K, Taguchi S, Horibe K, Nakamura H. Late occurrence of severe hyponatremia followed by extrapontine osmotic demyelination syndrome after successful conservative management of postpartum hemorrhage due to placenta accreta by uterine artery embolization. J Matern Fetal Neonatal Med 2010. [DOI: 10.3109/14767050903265097] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Abstract
Amniotic fluid embolism (AFE), an uncommon disorder with a high fatality rate, is an obstetric emergency that requires swift recognition and intervention to save both the mother's life and that of her child.The high mortality rate and varying theories as to its cause make it difficult to diagnose AFE, which can occur at any point during labor and delivery, including during cesarean birth. These factors make it important for perioperative nurses to understand and recognize AFE when it occurs in the OR. Rapid delivery of the fetus is imperative for the survival of both mother and child. Monitoring and aggressively providing respiratory and circulatory support interventions are required if the mother is to survive AFE.
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22
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Vercauteren M, Palit S, Soetens F, Jacquemyn Y, Alahuhta S. Anaesthesiological considerations on tocolytic and uterotonic therapy in obstetrics. Acta Anaesthesiol Scand 2009; 53:701-9. [PMID: 19397506 DOI: 10.1111/j.1399-6576.2009.01922.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Significant side effects of tocolytic and uterotonic substances may be of concern to the anaesthesiologist. Recently, new drugs have been introduced having less side effects for both the mother and the neonate. METHODS A literature search was undertaken mainly focusing on meta-analyses, to review the possible side effects that might affect the course of anaesthesia and to suggest which precautions should be considered to prevent the occurrence of significant interactions with anaesthetic manipulations and drugs. RESULTS Magnesium sulphate has a proven benefit in lowering systolic blood pressure and preventing the occurrence of eclampsia, but not as a tocolytic. beta-adrenergic agonists are being abandoned due to the availability of tocolytic agents causing less side effects. Calcium channel blockers (CCB) are frequently used but can cause major maternal cardiovascular complications. Nitroglycerin seems to be appreciated as an acute tocolytic rather than a routine substance during pre-term labour. Cyclo-oxygenase-2 inhibitors are still under investigation but their tocolytic benefit is questionable mainly due to foetal side effects. Atosiban is considered the first-choice tocolytic. With respect to oxytocic drugs, oxytocine, prostaglandines and methylergometrine may all cause serious side effects especially when combined. The cardiovascular side effects of prostaglandins and methylergometrine can be life-threatening. Both oxytocin and carbetocin have a rather low risk for maternal complications. CONCLUSION Atosiban and CCB are at least as effective tocolytic agents as beta-mimetics but have significantly less side effects. Magnesium sulphate can cause neuromuscular blockade, especially when combined with CCB. Concerning oxytocic agents, short-acting oxyctocin and long-acting carbetocin have the least side effects as compared with prostaglandins and methylergometrine.
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Affiliation(s)
- M Vercauteren
- Department of Anaesthesia, Antwerp University and University Hospital, Antwerp, Belgium.
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Bergum D, Lonnée H, Hakli TF. Oxytocin infusion: acute hyponatraemia, seizures and coma. Acta Anaesthesiol Scand 2009; 53:826-7. [PMID: 19397503 DOI: 10.1111/j.1399-6576.2009.01964.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Hyponatremia is not uncommon, serious cases can cause dangerous complications as seizures, brain damage and even death. We present a case of a young mother with post partum hemorrhage and some of the serious complications.
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Affiliation(s)
- D Bergum
- Department of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim, Norway.
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Moen V, Brudin L, Rundgren M, Irestedt L. Hyponatremia complicating labour--rare or unrecognised? A prospective observational study. BJOG 2009; 116:552-61. [PMID: 19175600 PMCID: PMC2675008 DOI: 10.1111/j.1471-0528.2008.02063.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objective The aim of this study was to investigate the occurrence of hyponatraemia following delivery, with a hypothesis that hyponatraemia has a high prevalence in labouring women. Design Prospective observational study. Setting Consultant-led delivery suite in County Hospital, Kalmar, Sweden. Sample A total of 287 pregnant women at term (37 full gestational weeks). Methods Oral fluids were allowed during labour. Blood samples were collected on admission, after delivery, and from the umbilical artery and vein. Main outcome measure Hyponatraemia defined as plasma sodium ≤130 mmol/l after delivery. Results Hyponatraemia was found in 16 (26%) of the 61 mothers who received more than 2500 ml of fluid during labour. Two-thirds of fluids were orally ingested. Decrease in plasma sodium concentration during labour correlated with duration of labour and the total fluid volume administered. Analysis by multivariate logistic regression showed that hyponatraemia was significantly correlated with fluid volume (P < 0.001) but not with oxytocin administration or epidural analgesia. Hyponatraemia correlated significantly with prolonged second stage of labour, instrumental delivery, and emergency caesarean section for failure to progress (P = 0.002). Conclusions Hyponatraemia is not uncommon following labour. Tolerance to a water load is diminished during labour; therefore, even moderate fluid volumes may cause hyponatraemia. Women should not be encouraged to drink excessively during labour. Oral fluids, when permitted, should be recorded, and intravenous administration of hypotonic fluids should be avoided. When abundant drinking is unrecognised or intravenous fluid administration liberal, life-threatening hyponatraemia may develop. The possibility that hyponatraemia may influence uterine contractility merits further investigation.
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Affiliation(s)
- V Moen
- Department of Anaesthesiology and Intensive Care, County Hospital, Kalmar, Sweden.
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