oxytocin and Birth-Injuries

Most allegations in obstetric lawsuits against obstetrician-gynecologists relate in some manner to the management of labor and delivery; few solely involve perceived flaws in prenatal or postpartum care. Although many of these cases accuse the defendant of not having properly monitored the fetus during labor for signs of oxygen deprivation, there is in most cases an underlying allegation regarding proper decision making about the timing and route of delivery. A perspective on accusations relating to the failure to identify or to act on intrapartum asphyxia has been presented elsewhere in this issue. This article focuses on legal allegations that arise from the conduct of labor and the timing of delivery, independent of those related to fetal monitoring.

Topics: Algorithms; Birth Injuries; Brachial Plexus Neuropathies; Cesarean Section; Documentation; Female; Humans; Malpractice; Medical Records; Obstetric Labor Complications; Oxytocics; Oxytocin; Pregnancy; Vaginal Birth after Cesarean

Synthetic oxytocin offers a safe and effective means of producing regular uterine activity and has a fairly large therapeutic index; however, the mild antidiuretic and vasoactive properties of oxytocin increase the risk of water intoxication and hypotension. The issue of reduction in cesarean section rates through the use of an active management protocol is being studied actively in the United States and Canada at this time. The authors recommend infusion protocols for the augmentation and induction of labor that use low doses of dilute oxytocin, increased at intervals no more than 40 minutes. Pharmacokinetic and clinical studies support the use of oxytocin in the physiologic range as efficacious and prudent. The longer induction to delivery time demonstrated by some, but not all authors, in our opinion, is a reasonable alternative to avoidable uterine hyperstimulation with the potential for fetal and maternal injury. We advocate the use of the lowest dose necessary to produce adequate uterine contractility and cervical change.

Topics: Birth Injuries; Cervix Uteri; Contraindications; Delivery, Obstetric; Female; Humans; Labor, Induced; Oxytocics; Oxytocin; Pregnancy; Time Factors; Uterine Contraction

Topics: Birth Injuries; Clinical Trials as Topic; Extraction, Obstetrical; Female; Humans; Labor, Induced; Oxytocin; Pregnancy

To assess both severe maternal and neonatal mortality and morbidity after attempted operative vaginal deliveries by residents under supervision and by attending obstetricians.. Secondary analysis of a 5-year prospective study with cross-sectional analysis including 2192 women with live singleton term fetuses in vertex presentation who underwent an attempted operative vaginal delivery in a tertiary care university hospital. Obstetricians who attempted or performed an operative vaginal delivery were classified into 2 groups according to their level of experience: attending obstetricians (who had 5 years or more of experience) and obstetric residents (who had less than 5 years of experience) under the supervision of an attending obstetrician. We used multivariate logistic regression and propensity score methods to compare outcomes associated with attending obstetricians and obstetric residents. Severe maternal morbidity was defined as third- or fourth-degree perineal laceration, perineal hematoma, cervical laceration, extended uterine incision for cesareans, postpartum hemorrhage >1500 mL, surgical hemostatic procedures, uterine artery embolization, blood transfusion, infection, thromboembolic events, admission to the intensive care unit, or maternal death; severe neonatal morbidity was defined as a 5-minute Apgar score <7, umbilical artery pH <7.00, need for resuscitation or intubation, neonatal trauma, intraventricular hemorrhage greater than grade 2, neonatal intensive care unit admission for more than 24 hours, convulsions, sepsis, or neonatal death.. High prepregnancy body mass index, high dose of oxytocin, manual rotation, persistent occiput posterior or transverse positions, operating room delivery, midpelvic delivery, forceps, and spatulas were significantly more frequent in deliveries managed by attending obstetricians than residents whereas a second-stage pushing phase longer than 30 minutes was significantly more frequent in deliveries managed by residents. The rate of severe maternal morbidity was 7.8% (115/1475) for residents vs 9.9% (48/484) for attending obstetricians; for severe neonatal morbidity, the rates were 8.3% (123/1475) vs 15.1% (73/484), respectively. In the univariate, multivariable, and sensitivity analyses, attempted operative vaginal delivery managed by a resident was significantly and inversely associated with severe neonatal but not maternal morbidity. After propensity score matching, delivery managed by a resident was not significantly associated with severe maternal morbidity (adjusted odds ratio, 0.74; 95% confidence interval, 0.39-1.38) and was no longer associated with neonatal morbidity (adjusted odds ratio, 0.51; 95% confidence interval, 0.25-1.04).. Management of attempted operative vaginal deliveries by residents under the supervision of attending obstetricians, compared with by the attending obstetricians themselves, does not appear to be associated with either maternal or neonatal morbidity. These reassuring results support the continued use of residency programs for training in operative vaginal deliveries under the supervision of attending obstetricians.

Topics: Adult; Apgar Score; Birth Injuries; Body Mass Index; Cesarean Section; Extraction, Obstetrical; Female; Hematoma; Humans; Hydrogen-Ion Concentration; Internship and Residency; Labor Stage, Second; Lacerations; Logistic Models; Medical Staff, Hospital; Obstetrics; Operating Rooms; Oxytocics; Oxytocin; Pregnancy; Propensity Score; Prospective Studies; Scalp; Umbilical Arteries; Vacuum Extraction, Obstetrical

To provide evidence-based guidelines for safe and effective assisted vaginal birth.. Prerequisites, indications, contraindications, along with maternal and neonatal morbidity associated with assisted vaginal birth.. Medline database was searched for articles published from January 1, 1985, to February 28, 2018 using the key words "assisted vaginal birth," "instrumental vaginal birth," "operative vaginal delivery," "forceps delivery," "vacuum delivery," "ventouse delivery." The quality of evidence is described using the Evaluation of Evidence criteria outlined in the Report of the Canadian Task Force on Preventive Health Care.. These guidelines were approved by the Clinical Practice Obstetrics Committee and the Board of the Society of Obstetricians and Gynaecologists of Canada.

Topics: Analgesia, Epidural; Birth Injuries; Brachial Plexus; Canada; Cardiotocography; Clinical Competence; Episiotomy; Extraction, Obstetrical; Facial Injuries; Female; Humans; Labor Presentation; Labor Stage, Second; Lacerations; Obstetrical Forceps; Oxytocics; Oxytocin; Peripheral Nerve Injuries; Pregnancy; Puerperal Disorders; Scalp; Shoulder Dystocia; Soft Tissue Injuries; Stress Disorders, Post-Traumatic; Time Factors; Vacuum Extraction, Obstetrical; Version, Fetal

Management of extremely large birthweight infants presents challenges during the period of labour and delivery. We sought to examine outcomes in infants with extreme macrosomia (birthweight > 5000 g), at an institution where the management of labour is standardised.. This is a retrospective analysis of prospectively gathered data on all infants with a birthweight >5000 g delivered at a tertiary level institution from 2008 to 2012. Details of labour characteristics and outcomes were examined; these were compared according to parity.. During the study period, there were 46 128 deliveries at the hospital and 182 infants with a birthweight >5000 g, giving an incidence of 0.4%. The majority of women (133/182) were multiparous. Among nulliparas, 47% (23/49) had a vaginal delivery, while 53% (26/49) had a caesarean delivery. 86% (97/113) of multiparas had a vaginal delivery, and 14% (16/113) had a caesarean delivery. 43% (69/162) required induction of labour. This was more common in nulliparous compared with multiparous women (58% [29/49] vs 30% [40/133], P = 0.005, OR = 3.4, 95% CI = 1.7-6.6). A total of 30% (49/162) of women had their labour accelerated with oxytocin. There were higher rates of oxytocin use in nulliparas than in multiparas (55% [27/49] vs 16.5% [22/133], P < 0.0001, OR = 6.2, 95% CI = 3-12.8). Seventeen of the 120 infants delivered vaginally had a shoulder dystocia (14.2%), with three suffering an Erbs palsy, all of which had resolved before 6 months of age. One baby had a clavicular fracture.. Extreme macrosomia affects 0.4% of pregnancies in contemporary practice. Multiparas have a low rate of caesarean section. Infants delivered vaginally are at increased risk of shoulder dystocia and associated complications.

Topics: Birth Injuries; Birth Weight; Brachial Plexus Neuropathies; Cesarean Section; Dystocia; Female; Fetal Macrosomia; Humans; Incidence; Ireland; Labor, Induced; Oxytocics; Oxytocin; Parity; Pregnancy; Retrospective Studies

Topics: Attitude of Health Personnel; Birth Injuries; Breast Neoplasms; Cesarean Section; Female; Gynecology; Humans; Infant, Newborn; Liability, Legal; Obstetric Labor Complications; Obstetrics; Oxytocics; Oxytocin; Pregnancy; United States

To determine the effect of extreme macrosomia on perinatal outcome.. We conducted a retrospective review of all deliveries with birth weight > or = 5000 g in a tertiary centre from 1986 to 2000 and analyzed the method of delivery and perinatal outcome.. Extreme macrosomia (birth weight > or = 5000 g) was coded in 111 deliveries. There were 62 deliveries by Caesarean section (CS) (25 in labour and 37 elective). The 49 vaginal deliveries were complicated by 10 (20%) cases of shoulder dystocia and 3 (6%) of Erb's palsy. Permanent Erb's palsy was noted in only 1 of these 3 cases. Shoulder dystocia was associated with use of oxytocin and instrumental deliveries.. Implementing the 2002 guidelines from the American College of Obstetricians and Gynecologists (that is, recommending Caesarean delivery of fetuses with an estimated weight of at least 5000 g) would have a negligible effect on the CS rate while eliminating 10 cases of shoulder dystocia in 49 births. A policy eliminating the use of oxytocin and instrumental deliveries would have prevented most birth traumas in this group. Unfortunately, this high-risk group is difficult to identify in the antepartum period, complicating the implementation of these guidelines and probably leading to higher rates of CS. In addition, the effect of endorsing such a policy on overall neonatal and maternal morbidity is minimal, because most morbidity occurs in newborns weighing less than 4000 g.

Topics: Birth Injuries; Brachial Plexus Neuropathies; Cesarean Section; Delivery, Obstetric; Dystocia; Elective Surgical Procedures; Extraction, Obstetrical; Female; Fetal Macrosomia; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor Stage, First; Labor Stage, Second; Length of Stay; Ontario; Oxytocics; Oxytocin; Pregnancy; Retrospective Studies

The primary objective was to examine the effect of formal education and training on instrumental delivery with respect to its success rate and associated neonatal and maternal morbidity. The secondary objective was to determine factors that could influence the success rate of instrumental delivery.. Prospective case-control study with historical controls set in a teaching hospital in Sheffield. The prospective group included all women who had instrumental deliveries between 1 November 1999 and 29 February 2000. The control group included all women who delivered between 1 February 1997 and 1 February 1998. An educational package involving formal postgraduate training and self-directed learning were introduced in the time period between the prospective and the control groups. Medical notes were reviewed in the historical controls. For both the control and prospective groups, the following patient characteristics were recorded: maternal age, parity, whether or not onset of labour was induced, use of oxytocin in the second stage of labour, delay in the second stage, operator grade, vaginal findings at delivery and the use of epidural analgesia.. The overall failure rate was not different in the prospective group (16%) compared with the control group (18.5%). However, the introduction of an educational package was associated with significant decrease in maternal morbidity associated with cervical, severe labial and high vaginal tears (Odds Ratio (OR) 0.29, CI 0.09-0.97) and neonatal morbidity associated with admission to SCBU (OR 0.72, CI 0.02-0.60), severe neonatal scalp injury (OR 0.14, CI 0.02-0.98) and facial injuries (OR 0.02, CI 0.01-0.04). The factors identified to affect the success of instrumental deliveries were: OP and OT positions of the baby at delivery (OR 0.28, CI 0.17-0.44) and inexperienced operators (OR 0.11, CI 0.02-0.58).. In this study, formal education and training of medical staff did not influence the success rate of instrumental delivery but was associated with improved safety for both mother and baby.

Topics: Anal Canal; Analgesia, Epidural; Birth Injuries; Cervix Uteri; Cesarean Section; Delivery, Obstetric; Education, Medical, Graduate; Female; Humans; Infant, Newborn; Labor, Induced; Morbidity; Obstetrical Forceps; Obstetrics; Oxytocin; Pregnancy; Treatment Outcome; Vagina

Fetal macrosomia is a known intrapartum risk factor for fetal injury and maternal morbidity. The purpose of this study was to review our experience with macrosomic fetuses in nondiabetic pregnancies and compare perinatal outcomes between those whose labor had been spontaneous or induced. Between January 1989 and December 1991, the 186 pregnancies of infants with birthweights greater than 4000 g (4001 to 5131 g) underwent labor that had been induced (46) or spontaneous (140). Cesarean delivery was more common after induced than spontaneous labor (11 [23.9%] vs 14 [10.0%]; P < 0.03) regardless of parity or gestational age. Frequencies of shoulder dystocia, 1-minute Apgar scores less than 7, and abnormal umbilical blood gas determinations were not different between the two groups. We conclude that spontaneous rather than induced labor is associated with a lower chance of cesarean delivery among those fetuses with birthweights 4000 g or more.

Topics: Adult; Birth Injuries; Birth Weight; Case-Control Studies; Cesarean Section; Dinoprostone; Dystocia; Female; Fetal Macrosomia; Humans; Infant, Newborn; Labor, Induced; Labor, Obstetric; Male; Oxytocin; Pregnancy; Risk Factors

To determine the efficacy and safety of labor induction in patients previously delivered by at least one low transverse cesarean section, a retrospective review was done at a single tertiary perinatal center, the University of Florida Health Science Center, Jacksonville. All patients with a previous cesarean section who required labor induction from 1988 until the end of 1992 were identified. Duration and outcome of labor induction, including mode of delivery, maternal and perinatal morbidity, and birth trauma, were evaluated. Of 160 patients with a previous cesarean, 50 (31.3%) had a repeat operation compared to 18 (11.2%) in the no previous cesarean group (p = 0.001, odds ratio = 3.59; 95% confidence interval, 1.98, 6.49). Women in the cesarean group had a higher incidence of operative vaginal deliveries, prolonged duration of the first and second stages of labor, rate and maximum dose of oxytocin infusion. One patient in the previous cesarean group experienced uterine rupture. There was no difference in the rate of infants with low 5-minute Apgar scores or with cord pH values less than 7.20. Labor induction in women with previous low transverse cesarean sections results in an acceptable rate of vaginal delivery and appears safe for both mother and fetus.

Topics: Adult; Apgar Score; Birth Injuries; Cesarean Section; Delivery, Obstetric; Female; Humans; Infant, Newborn; Labor, Induced; Morbidity; Oxytocin; Pregnancy; Retrospective Studies; Trial of Labor

A very unusual observation of survival after surgical treatment of neonatal maceration of liver and spleen is reported. The patient had a normal birthweight and the only possible etiologic factor was a oxitocin-induced rapid delivery. The literature on this topic is reviewed.

Topics: Birth Injuries; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor, Induced; Liver; Male; Oxytocin; Pregnancy; Rupture; Splenic Rupture

Utilizing the Zatuchni-Andros Breech Scoring Index a prospective study of 290 consecutive term breech deliveries occurring at Evanston Hospital from Jan. 1, 1968, to Jan. 1, 1974, is reported. This paper represents a direct continuation of a retrospective study of 500 consecutive term breech deliveries reported by the authorsin 1970. The results indicate that this breech assessment method is a valid method and it is recommended that patients whose breech score is 3 or less be submitted to immediate cesarean section and, conversely, those with a breech score of 4 or more be allowed to labor with meticulous observation with a high confidence level that successful vaginal delivery will result. Also, cautious stimulation with intravenous oxytocin can be safely undertaken when necessary in patients with a breech score of 4 or more. By employment of the Zatuchni-Andros Breech Scoring Index, the authors submit, fetal mortality and morbidity rates are markedly diminished.

Topics: Adolescent; Adult; Apgar Score; Birth Injuries; Birth Weight; Breech Presentation; Cesarean Section; Female; Fetal Death; Humans; Illinois; Infant Mortality; Infant, Newborn; Labor Presentation; Labor, Induced; Methods; Obstetric Labor Complications; Oxytocin; Pregnancy; Prognosis; Prospective Studies; Resuscitation

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: Birth Injuries; Cesarean Section; Female; Humans; Labor, Induced; Obstetrical Forceps; Oxytocin

Topics: Birth Injuries; Brain Damage, Chronic; Cesarean Section; Female; Humans; Infant Mortality; Labor, Induced; Obstetric Labor Complications; Oxytocin; Pelvimetry; Pregnancy

Topics: Birth Injuries; Brain Injuries; Cesarean Section; Female; Fetal Death; Humans; Hyaline Membrane Disease; Hypoxia; Infant Mortality; Infant, Newborn; Labor Presentation; Obstetric Labor Complications; Oxytocin; Parity; Pregnancy; Pulmonary Atelectasis; Statistics as Topic; Vitamin K Deficiency Bleeding

Topics: Birth Injuries; Birth Weight; Breech Presentation; Cesarean Section; Delivery, Obstetric; Diagnosis; Female; Fetal Death; Humans; Infant Mortality; Infant, Newborn; Iowa; Labor Presentation; Obstetric Labor Complications; Oxytocin; Pelvimetry; Pregnancy; Statistics as Topic; Umbilical Cord