oxytocin and Acidosis

To determine labour management procedures associated with an increased risk of fetal heart rate anomalies and to assess the effectiveness of various intrauterine resuscitation techniques for fetal distress.. The literature search was carried out systematically on Medline and Cochrane database between 1980 and June 2007 was performed.. Early amniotomy and/or active management of labour reduce the duration of the first stage of labour without affecting the rate of caesarean section (level of evidence 1). Early amniotomy increases the frequency of severe variable fetal heart rate decelerations (level of evidence 1). High doses of oxytocin and decrease in the oxytocin-dosing interval for augmentation of labour both induce uterine hyperstimulation (level of evidence 1). Increased uterine activity is associated with a higher incidence of fetal heart rate abnormalities and neonatal acidosis (level of evidence 3). Fetal heart rate decelerations in supine position may disappear in the lateral position (level of evidence 3). In prophylactic maternal oxygenation administration abnormal cord blood pH values (less than 7.2) are more frequent in the oxygenation group than in the control group (level of evidence 2) and its efficacy in fetal distress is not evaluated until now. Amnioinfusion in the presence of thick meconium staining does not reduce the risk of perinatal death or meconium aspiration syndrome (level of evidence 1). Transcervical saline amnioinfusion might relieve variable decelerations during labour (level of evidence 3). Prophylactic amnioinfusion for intrapartum oligohydramnios reduces fetal heart rate abnormalities and overall rates of caesarean deliveries (level of evidence 2). Acute tocolysis may be helpful in cases of intrapartum fetal distress related to uterine hyperactivity (level of evidence 2).. Early amniotomy and high doses of oxytocin may both increase the risk of fetal heart rate anomalies, but are both useful for avoiding prolonged labour. More research is needed to attempt the impact of different labour managements and intrauterine resuscitation techniques on neonatal outcomes.

Topics: Acidosis; Amnion; Female; Fetal Blood; Fetal Distress; Fetal Monitoring; Heart Rate, Fetal; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Labor, Obstetric; Meconium Aspiration Syndrome; MEDLINE; Oligohydramnios; Oxytocin; Pregnancy; Sodium Chloride; Tocolysis; Uterine Contraction

Topics: Acidosis; Amniotic Fluid; Bicarbonates; Birth Weight; Carbon Dioxide; Estriol; Female; Fetal Diseases; Fetal Heart; Fetus; Growth; Heart Rate; Humans; Hydrogen-Ion Concentration; Hypoxia; Labor, Obstetric; Maternal-Fetal Exchange; Meconium; Muscle Contraction; Oxygen; Oxygen Consumption; Oxygen Inhalation Therapy; Oxytocin; Pregnancy; Pregnancy in Diabetics; Scalp; Ultrasonography; Uterus

To evaluate whether a high-dose oxytocin regimen reduces the risk for primary cesarean birth and other obstetric morbidities when compared with standard dosing.. 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.. 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.. 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.. ClinicalTrials.gov, NCT02487797.

Topics: Acidosis; Adult; Apgar Score; Cesarean Section; Chorioamnionitis; Double-Blind Method; Female; Fetal Blood; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Labor, Obstetric; Male; Oxytocics; Oxytocin; Parity; Patient Admission; Pregnancy; Time Factors; Umbilical Arteries

Oxytocin is effective in reducing labor duration, but can be associated with fetal and maternal complications such as neonatal acidosis and post-partum hemorrhage. When comparing discontinuing oxytocin in the active phase with continuing oxytocin infusion, previous studies were underpowered to show a reduction in neonatal morbidity. Thus, we aim at evaluating the impact of discontinuing oxytocin during the active phase of the first stage of labor on the neonatal morbidity rate.. STOPOXY is a multicenter, randomized, open-label, controlled trial conducted in 20 maternity units in France. The first participant was recruited January 17th 2020. The trial includes women with a live term (≥37 weeks) singleton, in cephalic presentation, receiving oxytocin before 4 cm, after an induced or spontaneous labor. Women aged < 18 years, with a lack of social security coverage, a scarred uterus, a multiple pregnancy, a fetal congenital malformation, a growth retardation <3rd percentile or an abnormal fetal heart rate at randomization are excluded. Women are randomized before 6 cm when oxytocin is either continued or discontinued. Randomization is stratified by center and parity. The primary outcome, neonatal morbidity is assessed using a composite variable defined by an umbilical arterial pH at birth < 7.10 and/or a base excess > 10 mmol/L and/or umbilical arterial lactates> 7 mmol/L and/or a 5 min Apgar score < 7 and/or admission in neonatal intensive care unit. The primary outcome will be compared between the two groups using a chi-square test with a p-value of 0.05. Secondary outcomes include neonatal complications, duration of active phase, mode of delivery, fetal and maternal complications during labor and delivery, including cesarean delivery rate and postpartum hemorrhage, and birth experience. We aim at including 2475 women based on a reduction in neonatal morbidity from 8% in the control group to 5% in the experimental group, with a power of 80% and an alpha risk of 5%.. Discontinuing oxytocin during the active phase of labor could improve both child health, by reducing moderate to severe neonatal morbidity, and maternal health by reducing cesarean delivery and postpartum hemorrhage rates.. Clinical trials NCT03991091 , registered June 19th, 2019.

Topics: Acidosis; Adult; Apgar Score; Drug Administration Schedule; Female; Fetal Blood; France; Heart Rate, Fetal; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Infusions, Intravenous; Labor, Induced; Morbidity; Muscle Contraction; Myometrium; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Severity of Illness Index; Treatment Outcome; Young Adult

Topics: Acid-Base Equilibrium; Acidosis; Anesthesia, Obstetrical; Atropine; Bicarbonates; Carbon Dioxide; Clinical Trials as Topic; Drug Interactions; Female; Histamine H1 Antagonists; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Injections, Intravenous; Maternal-Fetal Exchange; Oxytocin; Partial Pressure; Pregnancy; Propanidid; Time Factors

Delivery mode of term breech presentation is debated because of higher rate of neonatal acidosis (pH<7.15) in planned vaginal delivery than in planned caesarean section. The objective was to evaluate per-partum risk factors of neonatal acidosis in vaginal delivery for podalic fetuses.. It was a single-centre, case-control retrospective study that included planned vaginal delivery in singleton term breech presentation between 2012 and 2016. The "case" group defined by neonatal pH≤7.10 and the "control" group defined by neonatal pH≥7.20 were matched. The maternal, labor, and neonatal characteristics were noted.. One hundred and thirty-two patients were included: each of 44 patients in "case" group, has been matched according to breech type (legs position) to 2 patients in the "control" group, so 88. In multivariate analysis, significant risk factors identified were oxytocin use [ORa=5.663 (95% CI=1.844-17.397)], "high risk" fetal heart rate (FHR) abnormalities according to FIGO classification [ORa=10.997 (95% CI=1.864-64.866)] and FHR abnormalities during expulsion, Melchior 2 [ORa=8.088 (95% CI=1.192-54.875)] and Melchior 4 [ORa=12.705 (95% CI=1.157-139.541)].. These risk factors of neonatal acidemia have to be known to improve the labor management in case of breech planned vaginal delivery.

Topics: Acidosis; Adult; Breech Presentation; Case-Control Studies; Cesarean Section; Delivery, Obstetric; Female; Heart Rate, Fetal; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Oxytocin; Pregnancy; Retrospective Studies; Risk Factors

To assess the factors affecting neonatal acidemia, including occurrence of tachysystole/hypertonus in fetuses exposed to oxytocin during labour and with continuously-monitored fetal heart rate (FHR) tracings.. Prospective observational study of all women with term pregnancies who received oxytocin for induction/augmentation of labour. FHR tracings were prospectively classified using ACOG classification. Independent predictors of neonatal acidemia were identified using multivariate linear regression with p < 0.05 considered significant.. We included 430 women, 236 of whom (54.9%) had spontaneous onset of labour. The duration of active phase of the second stage of labour and the presence of abnormal FHR tracing during labour were significantly associated with UA pH (p < 0.001) and BE (p < 0.001), while maximum dose of oxytocin (p < 0.17; p < 0.7) and tachysystole (p < 0.9; p < 0.8) were not. At logistic regression, the duration of active phase of the second stage of labour was independently predictive of neonatal acidemia (p < 0.009) while abnormal FHR tracing approached significance (p < 0.088).. In women receiving oxytocin during labour, the duration of active phase of the second stage of labour correlates with neonatal acidemia, whereas maximum dose of oxytocin, duration of oxytocin administration and occurrence of tachysystole during labour do not.

Topics: Acidosis; Cardiotocography; Female; Fetus; Heart Rate, Fetal; Humans; Infant, Newborn; Labor Stage, Second; Labor, Induced; Logistic Models; Obstetric Labor Complications; Oxytocics; Oxytocin; Pregnancy; Prospective Studies; Risk Factors; Time Factors

To determine the incidence of uterine tachysystole (UT) and its association with neonatal depression or metabolic acidemia (DEP).. This retrospective study comprised all 6234 women at ≥ 37 weeks' gestation who were monitored during the last 4 hours of tracings before birth in an academic community hospital. DEP was defined by an umbilical artery base deficit value ≥ 10 mmol/L or a 5-minute Apgar ≤ 6 and included 77 births. UT was defined by >15 contractions in 30 minutes.. The overall incidence of UT was 18.3% (1139/6234). In 4.2% (260/6234) UT persisted for >60 min. The rate of UT was similar in births with DEP (14.3%, 11/77) compared to those without DEP (18.3%, 1128/6157; p=0.45). In births with UT, only 1.0% (11/1139) developed DEP. The DEP group had more decelerations at almost every level of contractions and a higher cesarean rate of 49.4% (38/77) compared to 24.0% (1468/6124); p=<0.001 in the group without DEP.. UT was common, occasionally prolonged and almost always benign. Fetuses with DEP had no more UT than those without DEP. Many babies with DEP declared their vulnerability with decelerations at contraction rates below UT levels and the great majority of them never experienced UT.

Topics: Acidosis; Apgar Score; Female; Fetal Diseases; Humans; Infant, Newborn; Infant, Newborn, Diseases; Oxytocics; Oxytocin; Pregnancy; Retrospective Studies; Uterine Contraction; Young Adult

To determine the incidence of moderate to severe neonatal encephalopathy (NE) and neonatal seizures without encephalopathy, and the association with metabolic acidemia. Secondly, to investigate the occurrence of suboptimal intrapartum care and its impact on neonatal outcome.. Clinical audit.. Two university hospitals in Sweden.. Neonates ≥34 weeks with moderate or severe NE and neonatal seizures alone, i.e. without encephalopathy, from a population of 71 189 births, where umbilical blood gases were routinely analyzed.. Neonates were categorized depending on the presence of metabolic acidemia at birth by umbilical artery pH < 7.00, base deficit ≥12 mmol/L. Records were audited for suboptimal care and a decision was made on whether management was assessed to have impacted neonatal outcome.. Encephalopathy and seizures alone.. We identified 80 neonates with NE and 30 with seizures alone, of which 48 (60%) and none, respectively, had metabolic acidemia. Suboptimal care could be assessed in 77 and occurred in 28 (36%) NE cases and in one neonate with seizures alone (p < 0.001). In 47 NE cases with metabolic acidemia, suboptimal care occurred in 22 (47%) vs. 6/30 (20%) without metabolic acidemia (p = 0.02). Suboptimal care had an impact on outcome in 18/77 (23%) NE cases but in no cases with seizures alone.. Suboptimal care was commonly seen with NE, particularly in neonates with metabolic acidemia, and also affected neonatal outcome. No such associations were found in neonates with seizures alone.

Topics: Acidosis; Blood Gas Analysis; Cardiotocography; Cerebral Palsy; Child Behavior Disorders; Child, Preschool; Clinical Audit; Cognition Disorders; Fetal Blood; Humans; Incidence; Infant, Newborn; Intellectual Disability; Mental Disorders; Oxytocics; Oxytocin; Perinatal Care; Quality of Health Care; Retrospective Studies; Seizures; Speech Disorders; Sweden; Vacuum Extraction, Obstetrical

To evaluate the occurrence and nature of suboptimal intrapartum care in cases with metabolic acidosis in the newborn, and to estimate the degree to which this may be prevented.. Case-control study. Clinical audit. Setting Delivery units at two university hospitals in Sweden.. Out of 28 486 deliveries, 161 neonates > or =34 weeks of gestational age were born with metabolic acidosis.. Cases (n = 161): umbilical artery pH < 7.05 and base deficit > or =12 mmol/l. Controls (n = 322): pH > or = 7.05 and Apgar score > or =7 at 5 minutes. Obstetric characteristics and oxytocin administration were recorded. The last 2 hours of electronic fetal monitoring before delivery were evaluated blinded to outcome. Intrapartum management was analysed for suboptimal care by using predefined criteria.. Suboptimal intrapartum care.. Case and control comparisons displayed an occurrence of suboptimal care in 49.1% versus 13.0% (P < 0.001), oxytocin misuse in 46.6% versus 13.0% (P < 0.001), a failure to respond to a pathological cardiotocographic pattern in 19.9% versus 1.2% (P < 0.001) and suboptimal care related to vacuum deliveries in 3.1% versus 0.3% (P < 0.01) respectively.. Metabolic acidosis at birth is often associated with suboptimal intrapartum care. The high rate of suboptimal care with regard to oxytocin use and fetal surveillance illustrate a gap between guidelines and clinical practice. Metabolic acidosis and related neonatal morbidity could potentially be prevented in 40-50% of cases. The adherence to guidelines must be checked.

Topics: Acidosis; Cardiotocography; Case-Control Studies; Clinical Competence; Female; Humans; Infant, Newborn; Maternal Health Services; Medical Audit; Oxytocics; Oxytocin; Perinatal Care; Practice Guidelines as Topic; Pregnancy; Sweden

During the brain's innate immune response microglia, astroglia and ependymal cells resolve/repair damaged tissue and control infection. Released interleukin-1beta (IL-1beta) reaching cerebroventricles stimulates circumventricular organs (CVOs; subfornical organ, SFO; organum vasculosum lamina terminalis, OVLT), the median preoptic nucleus (MePO), and magnocellular and parvocellular neurons in the supraoptic (SON) and paraventricular (PVN) nuclei. Hypertonic saline (HS) also activates these osmosensory CVOs and neuroendocrine systems, but, in contrast to IL-1beta, inhibits the peripheral immune response. To examine whether the brain's innate immune response is attenuated by osmotic stimulation, sterile acidic perfusion fluid was microdialyzed (2 microl/min) in the SON area of conscious rats for 6 h with sterile HS (1.5 M NaCl) injected subcutaneously (15 ml/kg) at 5 h. Immunohistochemistry identified cytokine sources (IL-1beta(+); OX-42(+) microglia) and targets (IL-1R(+); inducible cyclooxygenase, COX-2(+); c-Fos(+)) near the probe, in CVOs, MePO, ependymal cells, periventricular hypothalamus, SON, and PVN. Inserting the probe stimulated magnocellular neurons (c-Fos(+); SON; PVN) via the MePO (c-Fos(+)), a response enhanced by HS. Microdialysis activated microglia (OX-42(+); amoeboid/hypertrophied; IL-1beta(+)) in the adjacent SON and bilaterally in perivascular areas of the PVN, periventricular hypothalamus and ependyma, coincident with c-Fos expression in ependymal cells and COX-2 in the vasculature. These microglial responses were attenuated by HS, coincident with activating parvocellular and magnocellular neuroendocrine systems and elevating circulating IL-1beta, oxytocin, and vasopressin. Acidosis-induced cellular injury from microdialysis activated the brain's innate immune response by a mechanism inhibited by peripheral osmotic stimulation.

Topics: Acidosis; Animals; Brain; Disease Models, Animal; Ependyma; Immunity, Innate; Interleukin-1beta; Male; Microdialysis; Microglia; Midline Thalamic Nuclei; Osmosis; Oxytocin; Rats; Rats, Sprague-Dawley; Saline Solution, Hypertonic; Supraoptic Nucleus; Vasopressins

Evaluate obstetric characteristics during the last two hours of labor in neonates born with acidemia.. Case-control study.. Delivery units at two university hospitals in Sweden.. Out of 28,486 deliveries during 1994-2004, 305 neonates had an umbilical artery pH value <7.05 at birth.. neonates with an umbilical artery pH < 7.05. Controls were neonates with pH > or = 7.05 and an Apgar score > or =7 at 5 minutes. Obstetric characteristics, cardiotocographic patterns and oxytocin treatment during the last two hours of labor were recorded.. In the univariate analysis, > or =6 contractions/10 minutes (odds ratio (OR) 4.94, 95% confidence interval (CI) 3.25-7.49), oxytocin use (OR 2.20, 95% CI 1.66-2.92), bearing down > or =45 minutes (OR 1.77, 95% CI 1.31-2.38) and occipito-posterior position (OR 2.18, 95% CI 1.19-3.98) were associated with acidemia at birth. In the multivariate analysis, only > or =6 contractions/10 minutes (OR 5.36, 95% CI 3.32-8.65) and oxytocin use (OR 1.89, 95% CI 1.21-2.97) were associated with acidemia at birth. Among cases with > or =6 contractions/10 minutes, 75% had been treated with oxytocin. Pathological cardiotocographic patterns occurred in 68.8% of cases and in 26.1% of controls (p<0.001).. A hyperactive uterine contraction pattern and oxytocin use are the most important risk factors for acidemia at birth. The increased uterine activity was related to overstimulation in the majority of cases. The duration of bearing down is less important when uterine contraction frequency has been considered.

Topics: Acidosis; Adult; Cardiotocography; Case-Control Studies; Female; Humans; Hydrogen-Ion Concentration; Labor Stage, Second; Multivariate Analysis; Oxytocics; Oxytocin; Pregnancy; Risk Factors; Umbilical Arteries; Umbilical Cord; Uterine Contraction

The aim of this study was to analyze the blood gas values of umbilical cord blood in newborns of first vaginal deliveries with or without obstetric interventions.. In a prospective descriptive study conducted during the 6-month period from August 2003 through February 2004 at a university hospital, we analyzed the umbilical cord blood gas results of 80 term newborns delivered vaginally from healthy nulliparous women. Multivariate logistic analysis was used to evaluate the associations between fetal acidosis (pH<7.20) and any obstetric interventions.. The mean of umbilical cord blood arterial pH was 7.26 (standard deviation, 0.072). After controlling for the confounding factors with multivariate logistic regression, fetal acidosis (pH<7.20) was found to be significantly associated with oxytocin augmentation (odds ratio [OR], 16.48; 95% confidence interval [CI], 1.21-226.1) and vacuum extraction (OR, 10.76; 95% CI, 1.025-112.9). In contrast, there was no significant relationship between fetal acidosis with episiotomy (OR, 1.096; 95% CI, 0.07-16.6) or epidural anesthesia (OR, 0.074; 95% CI, 0.003-2.09).. Oxytocin augmentation and vacuum extraction were significantly related to low cord arterial pH values (pH<7.20), but there were no adverse effects to the newborns of first vaginal deliveries.

Topics: Acidosis; Adolescent; Adult; Anesthesia, Epidural; Delivery, Obstetric; Episiotomy; Female; Fetal Blood; Gestational Age; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Logistic Models; Multivariate Analysis; Oxytocin; Parity; Pregnancy; Umbilical Arteries; Umbilical Veins; Vacuum Extraction, Obstetrical

The use of maternal epidural analgesia in labor may be associated with non-reassuring fetal heart rate (FHR) patterns. We aimed to assess changes in fetal oxygen saturation (FSpO(2)) during epidural analgesia in labor.. This was a prospective observational study. Twenty healthy parturients were enrolled following the inclusion criteria. Informed consent was obtained. Mode of delivery, use of oxytocin, maternal blood pressure, umbilical cord blood analysis, Apgar score, and neonatal outcomes were evaluated. Ropivacaine at a low concentration of 0.1% (1 mg/mL) co-administered with an opioid (fentanyl 2.5 microg/mL) was used. The values of fetal oxygen saturation were registered continuously 10 minutes before the administration of the analgesic drug and during the following 30 minutes after administration. Pulse oximetry was used simultaneously with cardiotocography (CTG).. The average value for fetal oxygen saturation before the analgesic drug administration was 44.3 +/- 8.8%; during the first 10 minutes following administration it was 41.3 +/- 7.2% (p = 0.25) and during the following 20 minutes it was 43.05% +/- 6.9% (p = 0.63). There was no direct relationship between non-reassuring CTG pattern appearance and FSpO(2) <30% (RR = 1.11, 95% CI 0.76-1.64). No significant correlation was found between FSpO(2) values within the first 30 minutes of epidural analgesia and neonatal acidotic status (pH or=30%.

Topics: Acidosis; Adult; Analgesia, Epidural; Analgesia, Obstetrical; Analgesics, Opioid; Anesthetics, Local; Delivery, Obstetric; Dystocia; Female; Fetal Blood; Humans; Infant, Newborn; Oximetry; Oxygen; Oxytocics; Oxytocin; Pregnancy; Prospective Studies

The purpose of this study was to investigate the delivery outcome in relation to oxytocin use in labor.. We studied 106,755 deliveries from 1995 to 2002 in the Perinatal Revision South, a population-based register comprising information from 10 hospitals in southern Sweden.. Oxytocin use in labor increased from 27.6% in 1995/96 to 33.2% in 2001/02 (p<0.000006). Oxytocin was administered to 47.7% of the nulliparas and 18.5% of the multiparas. There were large differences between hospitals (range among nulliparas: 32.6-60.4%; among multiparas: 13.9-27.0%). After exclusion of deliveries with induction of labor and deliveries lasting >12 h, there was a significant association between oxytocin use and Apgar score < 7 at 5 min (OR 2.3; 95% CI 1.8-2.9), need for neonatal intensive care (OR 1.6; 95% CI 1.5-1.7), and operative delivery (OR 4.0; 95% CI 3.7-4.2).. In deliveries with relatively short duration (< or =12 h), a significant association was seen between oxytocin use and adverse outcome. Even though the results are difficult to interpret, the significant difference between the use of oxytocin in different hospitals, as well as the increase of oxytocin use over time, calls for a randomized controlled study to elucidate the advantages and disadvantages of oxytocin use during labor and delivery.

Topics: Acidosis; Adult; Apgar Score; Cesarean Section; Confidence Intervals; Delivery, Obstetric; Female; Gestational Age; Humans; Infant, Newborn; Intensive Care, Neonatal; Labor, Induced; Labor, Obstetric; Maternal Age; Odds Ratio; Oxytocics; Oxytocin; Parity; Pregnancy; Pregnancy Outcome; Sweden; Time Factors

Partus induction is an important integrative component of reproduction management in the swine industry. In this context, the question is to what extent the application of uterotonic substances may influence the vitality of piglets. The blood pH value is used as a laboratory objective diagnostic parameter of neonatal acidosis. This parameter of the acid-base balance was examined in piglets born spontaneously at the 115th to 116th day of gestation (group 1, n = 57) and after two different partus induction protocols starting at the 114th day of gestation (group 2: combination of 175 microg of cloprostenol and 20 IU of oxytocin, n = 55; group 3: 175 microg of cloprostenol and 35 microg of carbetocin, n = 56). Initial blood samples were taken from each piglet at birth and 2 h later. The results show that the different protocols have no negative influence on the initial pH value and the compensation of neonatal acidosis until the second hour post-natum.

Topics: Acid-Base Equilibrium; Acidosis; Aging; Animals; Animals, Newborn; Blood Gas Analysis; Cloprostenol; Female; Hydrogen-Ion Concentration; Labor, Induced; Labor, Obstetric; Male; Oxytocics; Oxytocin; Pregnancy; Random Allocation; Swine; Swine Diseases; Time Factors

The purpose of this study is to identify pregnancy and labor factors that place women at increased risk for symptomatic uterine rupture during trial of labor following cesarean section. The study population consisted of 16 women with uterine rupture after a trial of labor who were compared with 32 women without uterine rupture after a trial of labor. Using a case-control study design with a 1:2 match, we examined risk factors that might be associated with an increased risk of uterine rupture. Cases were more likely to have an induction of labor with the use of oxytocin and/or amniotomy (56 vs. 34%) and more likely to undergo augmentation with oxytocin (25 vs. 19%) in comparison with controls. In addition, cases were more likely to be given oxytocin (for either induction or augmentation) (75 vs. 50%) and cervical ripening agents (31 vs. 9%) versus controls. Neonates born after uterine rupture had a higher rate of significant acidosis (pH < 7.0, 57 vs. 0%, p = 0.0002) and lower Apgar scores. There was a significantly higher risk of maternal infection (36 vs. 3%, p = 0.003), transfusion (13 vs. 0%, p = 0.03), and longer length of stay in patients with uterine rupture. There is a trend for increased use of augmentation and induction agents to be associated with uterine rupture. Serious maternal and fetal morbidities are increased following uterine rupture.

Topics: Acidosis; Adolescent; Adult; Apgar Score; Case-Control Studies; Female; Humans; Labor, Induced; Oxytocics; Oxytocin; Pregnancy; Risk Factors; Trial of Labor; Uterine Rupture

To examine and compare the value of the nonstress test (NST), oxytocin challenge test (OCT), Doppler velocimetry (S/D ratio), and biophysical profile (BPP) in predicting fetal acidosis.. NST, OCT, S/D ratio and BPP were performed in 23 pregnancies with growth-retarded fetuses. The value of each parameter in predicting fetal acidosis (umbilical vein pH obtained by cordocentesis) was examined.. The NST, OCT and BPP were found to have the same positive predictive value of 57.1% in predicting fetal acidosis. The S/D ratio was found to have a very low positive predictive value (14.3%). The only combination of two parameters that showed improved positive predictive value, was that of OCT and NST (66.7%).. (1) The best indirect method in assessing fetal well-being is the combination of NST and OCT. (2) Since the positive predictive value of the indirect methods is still low, direct assessment of the fetal metabolic status is recommended in premature growth-retarded fetuses with an abnormal test.

Topics: Acidosis; Blood Flow Velocity; Cordocentesis; Female; Fetal Diseases; Fetal Growth Retardation; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Laser-Doppler Flowmetry; Oxytocin; Predictive Value of Tests; Pregnancy; Prospective Studies; Umbilical Arteries; Umbilical Veins

To determine the effect of early labour, maternal analgesia and fetal hypoxia on circulating fetal oxytocin concentrations.. Prospective observational study.. Delivery suite in a District General Hospital.. Fifty women at term who did not require oxytocin administration or more than one form of analgesia. Study groups: vaginal delivery with (1) no analgesia, (2) pethidine, or (3) epidural analgesia. Caesarean section under regional analgesia (4) prior to, and (5) after the onset of labour.. Samples of blood were collected from the umbilical artery (UA) and umbilical vein (UV) immediately after fetal delivery prior to placental separation or oxytocic administration.. Plasma oxytocin (OT) concentration, umbilical vein pH, cystine aminopeptidase activity.. The geometric mean UA-OT was significantly greater than UV-OT in all groups and was not altered by pethidine; however, epidural administration increased the UA-UV difference. The UA-UV difference at caesarean section was not significantly altered by the onset of labour. There was no correlation between UV pH and UA-UV plasma oxytocin. Cystine aminopeptidase activity was not detectable in UA and UV plasma.. Fetal OT production is increased by epidural but not by pethidine analgesia. It is not influenced by the onset of labour or fetal hypoxia.

Topics: Acidosis; Adult; Analgesia, Obstetrical; Cesarean Section; Female; Fetal Blood; Fetal Diseases; Humans; Meperidine; Obstetric Labor, Premature; Oxytocin; Pregnancy; Prospective Studies; Umbilical Arteries; Umbilical Veins

The effect of parity on intrapartum fetal scalp pH was investigated in 6466 patients in labour with a live fetus who were delivered in 1987. 350 (5.4%) required fetal scalp blood sampling for pH (FBS), 236 primigravidae (10.4%) and 114 multigravidae (2.7%) (P less than 0.001). Fetal acidosis (pH less than 7.20) was detected in 35 patients, 27 primigravidae (11.4%) and 8 multigravidae (7.0%) (P less than 0.001). The incidence of intrapartum acidosis in the 2275 primigravidae and the 4191 multigravidae was 1.2 and 0.2% respectively (P less than 0.001). The two deaths from birth asphyxia and three cases of neonatal seizures occurred in primigravidae. In primigravidae requiring FBS, fetal acidosis was not associated with the use of oxytocin or with increased duration of labour. Neonatal seizures were more common overall in primigravidae than in multigravidae and more common in patients requiring FBS than in those not requiring FBS (P less than 0.05). The higher incidence of FBS, fetal scalp acidosis and neonatal seizures in primigravidae has important implications for intrapartum fetal monitoring.

Topics: Acidosis; Female; Fetal Blood; Fetal Diseases; Humans; Hydrogen-Ion Concentration; Obstetric Labor Complications; Oxytocin; Parity; Pregnancy; Prospective Studies; Scalp; Time Factors

In 77 women (phi 41 week, less than 7 days before delivery) we compared the resistance index (RI) in the umbilical artery (UA), descending aorta (DA) and intracranial artery (ICA) with an oxytocin challenge test (OCT) and a non stress test (NST). Proof criterias were asphyxia resulting in operative deliveries and metabolic acidosis. The sensitivity in predicting metabolic acidosis was low in all tests, but a high and comparable specificity could be achieved in both the RI and OCT. In predicting fetal asphyxia the RI in the ICA had a high sensitivity, the RI in the UA and DA had the highest specificity of all tests. Centralisation and increased brain perfusion seem to detect fetal asphyxia as a result of placental insufficiency.

Topics: Acidosis; Asphyxia Neonatorum; Cerebrovascular Circulation; Cesarean Section; Female; Humans; Infant, Newborn; Muscle, Smooth, Vascular; Oxytocin; Pregnancy; Prenatal Diagnosis; Prospective Studies; Risk Factors; Ultrasonography; Vascular Resistance

The elimination of indocyanin green (IGG) in selected mature newborn babies (n = 50) was investigated on the first postnatal day. The IGG dose was 2 mg/kg body weight. The half time (t1/2), the elimination constant (K2), the dye distribution volume (ml/kg), as well as the level of serum indirect bilirubin on the third postnatal day were measured and calculated. Healthy, mature newborns from spontaneous labor served as controls (n = 14): the two study groups consisted of either growth-retarded (n = 8) or acidotic (n = 8) neonates. According to the management of deliveries, they were spontaneous, assisted by oxytocin drop infusion (n = 10) or under lumbal peridural anaesthesia + oxytocin drop infusion (n = 8). In the acidotic neonates the elimination constant was significantly lower and the half time significantly longer. In the growth retarded newborn babies the difference was not significant. The increase of the level of indirect bilirubin in serum appearing in the acidotic group on the third postnatal day was significantly greater.

Topics: Acidosis; Bilirubin; Female; Fetal Growth Retardation; Humans; Indocyanine Green; Infant, Newborn; Infant, Newborn, Diseases; Labor, Induced; Oxytocin; Pregnancy

Non-stress and oxytocin exposure tests were applied to 321 patients with hypertensive late gestoses for cardiotocographic monitoring of their high-risk pregnancies, over two years. No prenatal and intranatal deaths of newborns were recordable in cases in which non-stress tests were repeated in two-day intervals together with oxytocin exposure tests, where indicated. Thirty-minute recordings of cardiotocography in two-day intervals, with particular attention to foetal movements, are recommended for routine prepartal monitoring of high-risk pregnancies. Oxytocin exposure tests should not be used unless indicated.

Topics: Acidosis; Cesarean Section; Female; Fetal Monitoring; Humans; Hypertension; Infant, Low Birth Weight; Infant, Newborn; Oxytocin; Pre-Eclampsia; Pregnancy

The uterine contraction patterns and the changes in fetal heart rate (FHR) were studied in cardiotocographic recordings from 26 women in oxytocin-induced labour, 26 women in PGF2alpha-induced labour and 24 women during the later part of spontaneous labour. The contraction patterns and their effect on the FHR did not differ between the three groups. During the course of labour an increasing steepness of the upward slope of the contraction wave with increasing intensity of the contraction was found. High frequency of atypical contraction patterns, suggesting some degree of uterine incoordination was found during the active phase of labour in 10 patients, 8 of whom were primiparae. This incoordination could not be related to the effect of induction with either drug. Incoordinated contractions were associated with longer duration of labour and a tendency to more pronounced acidosis in the infant at birth, although mean values still fell in the normal range. Ominous FHR patterns were only seen in 2 cases of uterine hyperactivity during induction of labour.

Topics: Acidosis; Female; Fetal Heart; Heart Rate; Humans; Infant, Newborn; Labor, Induced; Labor, Obstetric; Oxytocin; Parity; Pregnancy; Prostaglandins F; Uterine Contraction

The role of hyperthermia in the absence of infection has been investigated in the pregnant baboon. Twenty-three near term animals were used. Catheters were placed in maternal and fetal arteries and thermocouples implanted in maternal colon and fetal esophagus. Maternal temperature was raised to between 41 and 42 degrees Centigrade (C.), by applying external heat. The temperature gradient between fetus and mother (delta T F-M) was 0.47 degree C. under steady-state conditions with maternal temperature at 38 degrees C. and rose to 0.75 degree C. at 42 degrees C. Hyperthermia caused a twofold increase in uterine activity; a metabolic acidosis developed in the mother and a profound acidosis and hypoxia developed in the fetus. There was also a marked fall in blood pressure and an increase in heart rate in both mother and fetus; late deceleration of the fetal heart rate occurred at a higher oxygen level and pHa than has been observed under normothermic conditions.

Topics: Acidosis; Animals; Arrhythmias, Cardiac; Body Temperature; Female; Fetal Death; Fetal Diseases; Fetal Heart; Fever; Haplorhini; Heart Rate; Hypotension; Hypoxia; Labor, Obstetric; Oxytocin; Papio; Pregnancy; Pregnancy Complications; Vasopressins

In our series of vaginal breech deliveries the morbidity from hypoxia and acidosis showed no difference to the same type of morbidity in our series of breech deliveries by Caesarean section. The correct selection of cases, intensive monitoring during labour and the management of the second stage of labour as outlined in our paper are the most important perequisites which permit to plan and justify a vaginal breech delivery in present obstetric practice.

Topics: Acidosis; Birth Injuries; Birth Weight; Breech Presentation; Cephalometry; Cesarean Section; Delivery, Obstetric; Dystocia; Extraction, Obstetrical; Female; Humans; Hypoxia; Infant Mortality; Infant, Newborn; Labor Presentation; Oxytocin; Paralysis, Obstetric; Pelvic Bones; Pelvimetry; Pregnancy; Radiography; Ultrasonography; Umbilical Cord

Topics: Acidosis; Anesthesia, Epidural; Anesthesia, Obstetrical; Apgar Score; Cervix Uteri; Dilatation; Extraction, Obstetrical; Female; Fetal Death; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor, Induced; Labor, Obstetric; London; Medical Records; Obstetric Labor Complications; Oxytocin; Pregnancy; Prospective Studies; Respiratory Distress Syndrome, Newborn; Retrospective Studies; Time Factors

Topics: Acidosis; Actinomycosis; Animals; Chronic Disease; Endometritis; Ergotism; Female; Hypocalcemia; Lactation Disorders; Mammary Glands, Animal; Mastitis; Necrosis; Obstetric Labor Complications; Oxytocin; Pregnancy; Swine; Swine Diseases

Topics: Acid-Base Equilibrium; Acidosis; Female; Fetal Diseases; Fetal Heart; Fetus; Heart Rate; Humans; Labor, Induced; Muscle Contraction; Oxytocin; Pregnancy; Pressure; Uterus

Topics: Acidosis; Amnion; Anesthesia, Obstetrical; Apgar Score; Cesarean Section; Delivery, Obstetric; Female; Fetal Death; Humans; Hypertension; Infant Mortality; Infant, Newborn; Labor, Induced; Obstetric Labor Complications; Oxytocin; Postpartum Hemorrhage; Pregnancy; Puerperal Infection; Time Factors

Topics: Acid-Base Equilibrium; Acidosis; Alkalosis; Anesthesia, Obstetrical; Bicarbonates; Carbon Dioxide; Female; Glucose; Humans; Hydrogen-Ion Concentration; Hyperventilation; Labor, Obstetric; Lactates; Maternal-Fetal Exchange; Muscle Contraction; Oxytocin; Parity; Partial Pressure; Pregnancy; Pyruvates; Starvation; Time Factors