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Maeder AB, Bell AF, McFarlin BL, Park CG, Kominiarek MA, Toledo P, Carter CS, Nazarloo H, Vonderheid SC. Feasibility Study to Compare Oxytocin Function Between Body Mass Index Groups at Term Labor Induction. J Obstet Gynecol Neonatal Nurs 2024; 53:140-150. [PMID: 38012953 DOI: 10.1016/j.jogn.2023.11.003] [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] [Received: 06/09/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE To determine the feasibility of a protocol to examine the association between oxytocin system function and birth outcomes in women with and without obesity before induction of labor. DESIGN Prospective descriptive. SETTING Academic medical center in the U.S. Midwest. PARTICIPANTS Pregnant women scheduled for induction of labor at 40 weeks of gestation or greater (n = 15 normal weight; n = 15 obese). METHODS We collected blood samples and abstracted data by chart review. We used percentages to examine adherence to protocol. We used t tests and chi-square tests to describe differences in sample characteristics, oxytocin system function variables, and birth outcomes between the body mass index groups. RESULTS The recruitment rate was 85.7%, protocol adherence was 97.1%, and questionnaire completion was 80.0%. Mean plasma oxytocin concentration was higher in the obese group (M = 2774.4 pg/ml, SD = 797.4) than in the normal weight group (M = 2193.5 pg/ml, SD = 469.8). Oxytocin receptor DNA percentage methylation (CpG -934) was higher in the obese group than in the normal weight group. CONCLUSION Our protocol was feasible and can serve as a foundation for estimating sample sizes in forthcoming studies investigating the diversity in oxytocin system measurements and childbirth outcomes among pregnant women in different body mass index categories.
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Girault A, Sentilhes L, Desbrière R, Berveiller P, Korb D, Bertholdt C, Carrara J, Winer N, Verspyck E, Boudier E, Barjat T, Levy G, Roth GE, Kayem G, Massoud M, Bohec C, Guerby P, Azria E, Blanc J, Heckenroth H, Rousseau J, Garabedian C, Le Ray C. Impact of discontinuing oxytocin in active labour on neonatal morbidity: an open-label, multicentre, randomised trial. Lancet 2023; 402:2091-2100. [PMID: 37952548 DOI: 10.1016/s0140-6736(23)01803-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Oxytocin is effective in reducing labour duration but can be associated with fetal and maternal complications that could potentially be reduced by discontinuing the treatment during labour. We aimed to assess the impact of discontinuing oxytocin during active labour on neonatal morbidity. METHODS STOPOXY was a multicentre, randomised, open-label, controlled, superiority trial conducted in 21 maternity units in France. Participants who received oxytocin before 4 cm dilation were randomly assigned 1:1 to either discontinuous oxytocin (oxytocin infusion stopped beyond a cervical dilation equal to or greater than 6 cm) or continuous oxytocin (administration of oxytocin continued until delivery). Randomisation was stratified by centre and parity. The primary outcome, neonatal morbidity, was assessed at birth using a composite variable defined by an umbilical arterial pH at birth less than 7·10, a base excess greater than 10 mmol/L, umbilical arterial lactates greater than 7 mmol/L, a 5-min Apgar score less than 7, or admission to the neonatal intensive care unit. Efficacy and safety was assessed in participants who were randomly assigned (excluding those who withdrew consent or were deemed ineligible after randomisation) and had reached a cervical dilation of at least 6 cm. This trial is registered with ClinicalTrials.gov, NCT03991091. FINDINGS Of 2459 participants randomly assigned between Jan 13, 2020, and Jan 24, 2022, 2170 were eligible to receive the intervention and were included in the final modified intention-to-treat analysis. The primary outcome occurred for 102 (9·6%) of 1067 participants (95% CI 7·9 to 11·5) in the discontinuous oxytocin group and for 101 (9·2%) of 1103 participants (7·6 to 11·0) in the continuous oxytocin group; absolute difference 0·4% (95% CI -2·1 to 2·9); relative risk 1·0 (95% CI 0·8 to 1·4). There were no clinically significant differences in adverse events between the two groups of the safety population. INTERPRETATION Among participants receiving oxytocin in early labour, discontinuing oxytocin when the active phase is reached does not clinically or statistically significantly reduce neonatal morbidity compared with continuous oxytocin. FUNDING French Ministry of Health and the Département de la Recherche Clinique et du Développement de l'Assistance Publique-Hôpitaux de Paris.
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Affiliation(s)
- Aude Girault
- Université Paris Cité, Inserm UMR 1153, Equipe EPOPé, Paris, France; Department of Obstetrics and Gynecology, Port-Royal Maternity Hospital, AP-HP, Cochin Hospital, FHU PREMA, Paris, France.
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Raoul Desbrière
- Department of Obstetrics and Gynecology, Hôpital Saint Joseph, Marseille, France
| | - Paul Berveiller
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal de Poissy/Saint-Germain-en-Laye, Rue du Champ Gaillard, Poissy Cedex, France
| | - Diane Korb
- Department of Obstetrics and Gynecology, Robert Debré Hospital, AP-HP, Paris, France
| | - Charline Bertholdt
- University of Lorraine, CHRU NANCY, Obstetrics and Gynecology Department, NANCY, France
| | - Julie Carrara
- Department of Obstetrics and Gynecology, Antoine Béclère Hospital, AP-HP, Paris, France; Paris Saclay University, Paris, France
| | - Norbert Winer
- Department of Obstetrics and Gynecology, University Hospital of Nantes, Nantes, France
| | - Eric Verspyck
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Eric Boudier
- Department of Obstetrics and Gynecology, Les Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Tiphaine Barjat
- Department of Obstetrics and Gynecology, Saint Etienne University Hospital, Saint Etienne, France
| | - Gilles Levy
- Department of Obstetrics and Gynecology, Hôpital Nord Franche Comté, Belfort, France
| | - Georges Emmanuel Roth
- CHU de Strasbourg, Pôle de Gynécologie-Obstétrique et Fertilité, Université de Strasbourg, Strasbourg, France
| | - Gilles Kayem
- Université Paris Cité, Inserm UMR 1153, Equipe EPOPé, Paris, France; Department of Obstetrics and Gynecology, Trousseau Hospital, Sorbonne University, APHP, Paris, France
| | - Mona Massoud
- Hospices Civils de Lyon, Department of Obstetrics and Gynecology, Université Claude Bernard Lyon 1, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Caroline Bohec
- Department of Obstetrics and Gynecology, François Mitterrand Hospital, Pau, France
| | - Paul Guerby
- Department of Obstetrics and Gynecology, Infinity CNRS Inserm UMR 1291, CHU Toulouse, Toulouse, France
| | - Elie Azria
- Université Paris Cité, Inserm UMR 1153, Equipe EPOPé, Paris, France; Maternity Unit, Groupe Hospitalier Paris Saint Joseph, FHU PREMA, Paris, France
| | - Julie Blanc
- Department of Obstetrics and Gynecology, Nord Hospital, APHM, Marseille, France
| | - Hélène Heckenroth
- Department of Gynaecology and Obstetrics, Gynépole, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - Jessica Rousseau
- Clinical Research Unit, Center for Clinical Investigation P1419, AP-HP, Paris, France
| | - Charles Garabedian
- CHU Lille, Department of Obstetrics, Lille, France; Univ Lille, ULR 2694-METRICS, Lille, France
| | - Camille Le Ray
- Université Paris Cité, Inserm UMR 1153, Equipe EPOPé, Paris, France; Department of Obstetrics and Gynecology, Port-Royal Maternity Hospital, AP-HP, Cochin Hospital, FHU PREMA, Paris, France
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Racene L, Rostoka Z, Kise L, Kacerauskiene J, Rezeberga D. In-Depth Analysis of Caesarean Section Rate in the Largest Secondary Care-Level Maternity Hospital in Latvia. J Clin Med 2023; 12:6426. [PMID: 37835069 PMCID: PMC10573868 DOI: 10.3390/jcm12196426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
There is no surgical intervention without risk. A high rate of caesarean sections (CSs) impacts on maternal and newborn mortality and morbidity. For optimisation of the CS rate, regular monitoring is necessary. In 2015, the World Health Organization recommended the Robson classification as a global standard for assessing, monitoring, and comparing CS rates. We analysed all births in 2019 in the Riga Maternity Hospital-a secondary-level monodisciplinary perinatal care hospital in Latvia-according to the Robson classification, seeking to identify which groups make the biggest contribution to the overall CS rate. In total, 5835 women were included. The overall CS rate was 21.5%. In our study, the largest contributors to the overall CS rate were as follows: Group 5 (33.3%); Group 2 (20.8%); and Group 1 (15.6%). The results of our deeper analysis of individual groups (Group 1 and 5) from our study may help to develop targeted interventions for specific subgroups of the obstetric population, effectively reducing both the overall rate of CS and the number of unnecessary CSs performed. The CS rate reduction strategy should be based on decreasing CSs in Group 1 and encouraging VBAC, thus decreasing the number of women undergoing two or more CSs in future.
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Affiliation(s)
- Laura Racene
- Department of Obstetrics and Gynaecology, Rīga Stradiņš University, LV-1007 Riga, Latvia; (Z.R.); (L.K.); (D.R.)
- Riga Maternity Hospital, LV-1013 Riga, Latvia
| | - Zane Rostoka
- Department of Obstetrics and Gynaecology, Rīga Stradiņš University, LV-1007 Riga, Latvia; (Z.R.); (L.K.); (D.R.)
- Riga Maternity Hospital, LV-1013 Riga, Latvia
| | - Liva Kise
- Department of Obstetrics and Gynaecology, Rīga Stradiņš University, LV-1007 Riga, Latvia; (Z.R.); (L.K.); (D.R.)
- Riga Maternity Hospital, LV-1013 Riga, Latvia
| | - Justina Kacerauskiene
- Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, 50167 Kaunas, Lithuania;
| | - Dace Rezeberga
- Department of Obstetrics and Gynaecology, Rīga Stradiņš University, LV-1007 Riga, Latvia; (Z.R.); (L.K.); (D.R.)
- Riga Maternity Hospital, LV-1013 Riga, Latvia
- Riga East Clinical University Hospital, LV-1038 Riga, Latvia
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Jiang D, Yang Y, Zhang X, Nie X. Continued versus discontinued oxytocin after the active phase of labor: An updated systematic review and meta-analysis. PLoS One 2022; 17:e0267461. [PMID: 35499990 PMCID: PMC9060379 DOI: 10.1371/journal.pone.0267461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 04/08/2022] [Indexed: 11/18/2022] Open
Abstract
Objective
To systematically assess the effect of discontinued vs continued oxytocin after active stage of labour is established.
Methods
Pubmed, Embase, and the Cochrane Library were systematically searched to 18 April 2021. The risk ratio or mean difference with corresponding 95% confidence interval were computed to investigate the effect of intervention or control on maternal and fetus outcomes. This review was registered in the International Prospective Register of Systematic Reviews: CRD42021249635.
Results
Discontinuing oxytocin when the active labour was established might decrease the risk of cesarean delivery [RR (95% CI): 0.84 (0.72–0.98), P = 0.02]. However, when we restricted our analysis to women who performed cesarean section after the active phase was reached, the difference was no longer significant [RR (95% CI): 0.82 (0.60–1.10), P = 0.19]. The incidence of uterine tachysystole [RR (95% CI): 0.36 (0.27–0.49)], postpartum hemorrhage [RR (95% CI): 0.78 (0.65–0.93)], and non-reassuring fetal heart rate [RR (95% CI): 0.66 (0.58–0.76)] were significantly lower in the oxytocin discontinuation group. We also found a possible decrease in the risk of chorioamnionitis in discontinued oxytocin group [RR (95% CI): 2.77 (1.02–5.08)]. An increased duration of active [MD (95% CI): 2.28 (2.86–41.71)] and second [MD (95% CI): 5.36 (3.18–7.54)] phase of labour was observed in discontinued oxytocin group, while the total delivery time was not significantly different [MD (95% CI): 20.17 (-24.92–65.26)].
Conclusion
After the active labor is reached, discontinuation of oxytocin could be considered a new recommendation for the improved maternal and fetal outcomes without delaying labour.
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Affiliation(s)
- Danni Jiang
- Graduate School, Dalian Medical University, Dalian, Liaoning, China
| | - Yang Yang
- Department of Gynecology, Shenyang Women’s and Children’s Hospital, Shenyang, Liaoning, China
| | - Xinxin Zhang
- Department of Gynecology, Shenyang Women’s and Children’s Hospital, Shenyang, Liaoning, China
| | - Xiaocui Nie
- Department of Gynecology, Shenyang Women’s and Children’s Hospital, Shenyang, Liaoning, China
- * E-mail:
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Cornthwaite K, Draycott T, Bahl R, Hotton E, Winter C, Lenguerrand E. Impacted fetal head: A retrospective cohort study of emergency caesarean section. Eur J Obstet Gynecol Reprod Biol 2021; 261:85-91. [PMID: 33901776 DOI: 10.1016/j.ejogrb.2021.04.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/13/2021] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate risk factors, management and outcomes of impacted fetal head (IFH) at caesarean section (CS). STUDY DESIGN This is a retrospective cohort study of all women with singleton, cephalic pregnancies who had an emergency CS during one-year (2016) at North Bristol NHS Trust, UK (n = 838). The incidence of caesarean section at full dilatation (CSFD) and IFH were calculated using the annual birth rate. To identify risk factors for IFH, maternal, perinatal and intrapartum characteristics were compared according to the presence or absence of IFH, and separately for first- and second-stage CS. Techniques employed to disimpact the fetal head were described. Univariable and multivariable comparisons of maternal and perinatal outcomes were made between cases with and without an IFH. Characteristics and outcomes were compared using modified Poisson regression. RESULTS CSFD accounted for 2.1 % of all births. IFH complicated 1.5 % of all births (11.3 % of emergency CS), with 55.8 % occurring prior to full cervical dilatation. Increased rates of IFH at CS were associated with: oxytocin augmentation (RR = 2.47 [1.61-3.80]), full cervical dilatation (RR = 4.24 [2.96-6.07], mid/low station (RR = 4.14 [2.72-6.32]), moulding (RR = 4.39 [2.55-7.54]) and caput (RR = 6.60 [3.09-14.10]). Junior operators documented IFH more than consultants (RR = 9.61 [1.35-68.2]). The strategies recorded for managing IFH included: tocolysis, reverse breech extraction and vaginal push up (33.7 %, 14.7 % and 11.6 % cases respectively) with two or more techniques used in 21.1 % cases. IFH at CS was independently associated with an increased risk of uterine extensions (RR = 3.09 [1.96-4.87]) and a composite adverse perinatal outcome (RR = 1.66 [1.21-2.28]). CONCLUSIONS IFH is a common and heterogeneous complication associated with increased complications for both mother and baby, independent of those of CSFD. Obstetricians must remain vigilant to the possibility of IFH at all emergency CS, particularly those at full cervical dilatation or with evidence of obstructed labour. There is an urgent need for a standardised management algorithm and training in evidence-based disimpaction techniques.
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Affiliation(s)
- Katie Cornthwaite
- Women's Health Department, North Bristol NHS Trust, UK; Translational Health Sciences, University of Bristol, UK.
| | - Tim Draycott
- Women's Health Department, North Bristol NHS Trust, UK
| | - Rachna Bahl
- Women's Health Department, University Hospital Bristol Foundation NHS Trust, UK
| | - Emily Hotton
- Women's Health Department, North Bristol NHS Trust, UK; Translational Health Sciences, University of Bristol, UK
| | - Cathy Winter
- Women's Health Department, North Bristol NHS Trust, UK
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