oxytocin and Chorioamnionitis

The latent phase of labor extends from the initiation of labor to the onset of the active phase. Because neither margin is always precisely identifiable, the duration of the latent phase often can only be estimated. During this phase, the cervix undergoes a process of rapid remodeling, which may have begun gradually weeks before. As a consequence of extensive changes in its collagen and ground substance, the cervix softens, becomes thinner and dramatically more compliant, and may dilate modestly. All of these changes prepare the cervix for the more rapid dilatation that will occur during the active phase to follow. For the clinician, it is important to recognize that the latent phase may normally extend for many hours. The normal limit for the duration of the latent phase should be considered to be approximately 20 hours in a nullipara and 14 hours in a multipara. Factors that have been associated with a prolonged latent phase include deficient prelabor or intrapartum cervical remodeling, excessive maternal analgesia or anesthesia, maternal obesity, and chorioamnionitis. Approximately 10% of women with a prolonged latent phase are actually in false labor, and their contractions eventually abate spontaneously. The management of a prolonged latent phase involves either augmenting uterine activity with oxytocin or providing a sedative-induced period of maternal rest. Both are equally effective in advancing the labor to active phase dilatation. A very long latent phase may be a harbinger of other labor dysfunctions.

Topics: Chorioamnionitis; Female; Humans; Labor Stage, First; Labor, Induced; Labor, Obstetric; Oxytocin; Pregnancy; Time Factors

This study aimed to evaluate the incidence of chorioamnionitis in women with singleton gestations with ≥36 weeks' prelabor rupture of membranes induced with oxytocin within or after 12 hours of prelabor rupture of membranes.. The search was conducted using MEDLINE, Web of Sciences, Scopus, ClinicalTrial.gov, OVID, and Cochrane Library as electronic databases from their inception to May 2020.. Randomized controlled trials of women with singleton cephalic gestations and prelabor rupture of membranes at ≥36 weeks comparing induction of labor with oxytocin either ≤12 hours after prelabor rupture of membranes or >12 hours after prelabor rupture of membranes (expectant management group).. The risk of bias in each included study was assessed using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. All analyses were done using an intention-to-treat approach, evaluating women according to the treatment group to which they were randomly allocated in the original trials. The primary outcome was the incidence of chorioamnionitis.. After exclusions, 9 randomized controlled trials including 3759 women were analyzed. Women with singleton cephalic gestations and prelabor rupture of membranes at ≥36 weeks who have induction of labor ≤12 hours after prelabor rupture of membranes have shorter time between prelabor rupture of membranes and delivery (-12.68 hours; 95% confidence interval, -16.15 to -9.21) and higher chance of delivering within 24 hours of prelabor rupture of membranes (91% vs 46%; relative risk, 1.93; 95% confidence interval, 1.59-2.35). Cesarean and operative vaginal deliveries were not significantly different between the groups. Induction of labor ≤12 hours after prelabor rupture of membranes was also associated with significantly fewer incidences of chorioamnionitis (5.3% vs 9.9%; relative risk, 0.62; 95% confidence interval, 0.40-0.97), endometritis (2.4% vs 4.2%; relative risk, 0.59; 95% confidence interval, 0.40-0.87), neonatal sepsis (6.1% vs 11.8%; relative risk, 0.46; 95% confidence interval, 0.27-0.79), and admission to neonatal intensive care unit (6.4% vs 12.0%; relative risk, 0.54; 95% confidence interval, 0.43-0.69) compared with women managed expectantly, usually at >24 hours. The subgroup analysis of 3323 women with induction of labor at ≤6 hours showed similar results, including similar significant reductions in chorioamnionitis, endometritis, neonatal sepsis, and admission to neonatal intensive care unit.. Women with symptoms of prelabor rupture of membranes at ≥36 weeks should be evaluated promptly, and if prelabor rupture of membranes is confirmed, they should have induction of labor within 12 hours and perhaps even within 6 hours since the first symptom of prelabor rupture of membranes. This management is associated with significantly less morbidity, especially in terms of infections, for both the mother and the baby, with no evidence of any harm.

Topics: Chorioamnionitis; Delivery, Obstetric; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Oxytocin; Pregnancy; Randomized Controlled Trials as Topic

Trial and meta-analysis data revealed a reduction in time to delivery for Foley and prostaglandins or Foley and oxytocin vs Foley alone. However, there are limited data for the comparison of the 2 combination methods against each other.. This study aimed to determine whether Foley and prostaglandins or Foley and oxytocin decrease the time to vaginal delivery using a network meta-analysis.. A network meta-analysis (PROSPERO CRD42018081948) was performed comparing Foley and prostaglandins (prostaglandin E1 or prostaglandin E2) vs Foley and oxytocin for cervical ripening. Foley alone and prostaglandins alone were used as nodes for indirect comparison. Database searches were performed from inception to March 2020 with data abstracted from published manuscripts. Eligibility criteria included randomized trials comparing Foley and oxytocin with Foley and prostaglandins (misoprostol or dinoprostone). Trials that compared Foley catheter or prostaglandins with a combination of Foley and prostaglandins or Foley and concurrent oxytocin were also included. Nulliparous and multiparous women were analyzed together. Foley catheters of any catheter material or size and >24 weeks' gestational age with a live fetus were included. Quasi-randomized, cohorts, and other combination methods for cervical ripening were not included. Prostaglandin E1 and prostaglandin E2 combined methods were analyzed separately in a planned subanalysis. The primary outcome was the mean time from induction to vaginal delivery in hours. Secondary outcomes included time from induction to delivery, delivery within 24 hours, cesarean delivery, chorioamnionitis, endometritis, epidural use, tachysystole, postpartum hemorrhage, meconium, neonatal intensive care unit admission, and 5-minute appearance, pulse, grimace, activity, and respiration score of <7. Data were analyzed as a network meta-analysis using multivariate meta-regression.. A total of 30 randomized controlled trials with a total of 6465 women were considered eligible for inclusion in this network meta-analysis. When compared with Foley alone, the use of Foley-oxytocin reduced the time to vaginal delivery by 4.2 hours (mean duration, -4.2 hours; 95% confidence interval, -6.5 to -1.9). Foley-prostaglandins reduced the time to vaginal delivery compared with Foley but did not meet statistical significance (mean duration, -2.9 hours; 95% confidence interval, -5.7 to 0.0; P=.05). When compared head-to-head, there was no difference in the time to vaginal delivery between Foley-prostaglandins and Foley-oxytocin (mean duration, 1.3 hours; 95% confidence interval, -2.0 to 4.7). There was no difference in the rate of cesarean delivery, chorioamnionitis, epidural, tachysystole, postpartum hemorrhage, meconium, neonatal intensive care unit admissions, or 5-minute appearance, pulse, grimace, activity, and respiration score of <7 for Foley-prostaglandins vs Foley-oxytocin, although the rate of endometritis was high for Foley-prostaglandins. In the subanalysis by prostaglandin type, there was no difference in the time to vaginal delivery for Foley-misoprostol vs Foley-dinoprostone vs Foley-oxytocin. However, Foley-dinoprostone had a definite trend toward longer time to all deliveries compared with that of both Foley-misoprostol and Foley-oxytocin (P=.05).. Time to vaginal delivery was similar when comparing Foley with combined misoprostol, combined dinoprostone, and combined oxytocin. Dinoprostone comparisons are limited by small sample size but suggest longer time to delivery compared with Foley and misoprostol or oxytocin. No significant differences were observed in maternal or neonatal adverse events except for endometritis, but this was limited by the sample size, varied reporting of studies used in the indirect comparisons, and definitions of infectious morbidity use in the studies.

Topics: Anesthesia, Epidural; Apgar Score; Catheters; Cervical Ripening; Cervix Uteri; Cesarean Section; Chorioamnionitis; Delivery, Obstetric; Dinoprostone; Endometritis; Female; Humans; Intensive Care Units, Neonatal; Labor, Induced; Misoprostol; Network Meta-Analysis; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Time Factors

In most Western countries, obstetricians and midwives induce labour in about 25% of pregnant women. Oxytocin is an effective drug for this purpose, but associated with serious adverse effects of which uterine tachysystole, fetal distress and the need for immediate delivery are the most common. Various administration regimens such as reduced or pulsatile dosing have been suggested to minimise these. Discontinuation in the active phase of labour, i.e. when contractions are well-established and the cervix is dilated at least 5 cm is another method which may reduce adverse effects.. To assess whether birth outcomes can be improved by discontinuation of intravenous (IV) oxytocin, initiated in the latent phase of induced labour, once active phase of labour is established.. We searched Cochrane Pregnancy and Childbirth's Trials Register (31 January 2018), Scopus, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) (23 January 2018) together with reference checking, citation searching, and contact with study authors to identify additional studies.. Randomised controlled trials (RCTs) comparing discontinued IV with continuous IV oxytocin in the active phase of induced labour.No exclusion criteria were applied in terms of parity, maternal age, ethnicity, co-morbidity status, labour setting, gestational age, and prior caesarean delivery.Studies comparing different dosage regimens are outside the scope of this review.. We used standard Cochrane methods.. We found 10 completed RCTs involving 1888 women. One additional trial is ongoing. The included trials were conducted in hospital settings between February 1998 and January 2016, two in Europe (Denmark, and Greece), two in Turkey, and one each in Israel, Iran, USA, Bangladesh, India, and Thailand. Most trials included full-term singleton pregnancies with a fetus in vertex presentation. Some excluded women with cervical priming prior to induction and some excluded women with a history of prior caesarean delivery. When reported, the average age of the women ranged from 22 to 31 years, nulliparity from 45% to 68%, and pre-pregnancy body mass index from 22 to 32.Many of the included trials had design limitations and were judged to be at either high or unclear risk of bias across a number of 'Risk of bias' domains.Four trials included a Consort flow diagram. In three, this gave details of participants delivered before the active phase of labour, and treatment compliance for those who reached that stage. One Consort diagram only provided the latter information. The data in many of the trials without such a flow diagram were implausibly compliant with treatment allocation, suggesting that there had been silent post randomisation exclusions of women delivered before the active phase of labour. We therefore conducted a secondary analysis (not in our protocol) of caesarean section among women who reached the active phase of labour and were therefore eligible for the intervention.Our analysis by 'intention-to-treat' found that, compared with continuation of IV oxytocin stimulation, discontinuation of IV oxytocin may reduce the caesarean delivery rate, risk ratio (RR) 0.69, 95% confidence interval (CI) 0.56 to 0.86, 9 trials, 1784 women, low-level certainty. However, restricting our analysis to women who reached the active phase of labour (using 'reached active phase' as our denominator) suggests there is probably little or no difference between groups (RR 0.92, 95% CI 0.65 to 1.29, 4 trials, 787 women, moderate-certainty evidence).Discontinuation of IV oxytocin probably reduces the risk ofuterine tachysystole combined with abnormal fetal heart rate (FHR) compared with continued IV oxytocin (RR 0.15, 95% CI 0.05 to 0.46, 3 trials, 486 women, moderate-level certainty). We are uncertain about whether or not discontinuation increases the risk of chorioamnionitis (average RR 2.32, 95% CI 0.99 to 5.45, 1 trial, 252 women, very low-level certainty). Discontinuation of IV ox. Discontinuing IV oxytocin stimulation after the active phase of labour has been established may reduce caesarean delivery but the evidence for this was low certainty. When restricting our analysis to those trials that separately reported participants who reached the active phase of labour, our results showed there is probably little or no difference between groups. Discontinuing IV oxytocin may reduce uterine tachysystole combined with abnormal FHR.Most of the trials had 'Risk of bias' concerns which means that these results should be interpreted with caution. Our GRADE assessments ranged from very low certainty to moderate certainty. Downgrading decisions were based on study limitations, imprecision and indirectness.Future research could account for all women randomised and, in particular, note those who delivered before the point at which they would be eligible for the intervention (i.e. those who had caesareans in the latent phase), or because labour was so rapid that the infusion could not be stopped in time.Future trials could adopt the outcomes listed in this review including maternal and neonatal mortality, maternal satisfaction, and breastfeeding.

Topics: Administration, Intravenous; Adult; Cardiotocography; Cesarean Section; Chorioamnionitis; Female; Fetal Distress; Humans; Intention to Treat Analysis; Labor Stage, Third; Labor, Induced; Oxytocics; Oxytocin; Pregnancy; Randomized Controlled Trials as Topic; Withholding Treatment; Young Adult

Topics: Adrenal Cortex Hormones; Catecholamines; Chorioamnionitis; Female; Humans; Neuromuscular Junction; Obstetric Labor, Premature; Oxytocin; Pregnancy; Prostaglandins; Psychophysiologic Disorders; Single Person; Stress, Psychological; Synaptic Transmission; Uterine Contraction

Oxytocin is considered the drug of choice for the induction of labor, although the optimal protocol and infusion duration remain to be determined.. This study aimed to assess whether the duration of oxytocin infusion increases 24-hour delivery rates and affects the length of time-to-delivery and patient's experience.. A randomized controlled trial was performed at a single tertiary medical center, between January 1, 2020 and June 30, 2022. Nulliparous patients with a singleton pregnancy at a vertex presentation and a Bishop score ≥6 were randomly assigned to receive either continuous (16 hours, with a 4 hours pause in between infusions) or intermittent (8 hours, with a 4 hours pause in between infusions) oxytocin infusion, until delivery. In both groups, infusion was halted when signs of maternal or fetal compromise were observed. Randomization was conducted with a computer randomization sequence generation program. The primary outcome was delivery within 24 hours from the first oxytocin infusion and the secondary outcome included time-to-delivery, mode of delivery, and additional maternal and neonatal outcomes. Seventy-two patients per group were randomized to reach 80% statistical power with a 20% difference in the primary outcome according to previous studies.. A total of 153 patients were randomized, 72 to the continuous oxytocin infusion group and 81 to the intermittent infusion group. The total oxytocin infusion time was similar between the groups. Patients in the continuous arm were more likely to deliver within 24 hours from oxytocin initiation (79.73% vs 62.96%, P<.05), and had a shorter oxytocin-to-delivery time interval, compared with patients receiving intermittent treatment (9.3±3.7 hours vs 21±11.7 hours, P<.001). Furthermore, time from ruptured membranes to delivery was shorter (9.3±3.7 hours vs 21±11.7 hours; P<.0001) and chorioamnionitis was less frequent (9.46% vs 21%; P<.05) in the continuous compared with the intermittent arm. Cesarean delivery rate was 20% in both groups (P=.226). There was no difference in postpartum hemorrhage, or adverse neonatal outcomes between the groups. Patients receiving continuous oxytocin infusion were more satisfied with the birthing experience.. Continuous infusion of oxytocin for labor induction in nulliparous patients with a favorable cervix may be superior to intermittent oxytocin infusion, because it shortens time-to-delivery, decreases chorioamnionitis rate, and improves maternal satisfaction, without affecting adverse maternal or neonatal outcomes.

Topics: Cervical Ripening; Chorioamnionitis; Female; Humans; Infant, Newborn; Labor, Induced; Oxytocics; Oxytocin; Pregnancy

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

The optimal method for induction of labor for multiparous women with an unfavorable cervix is unknown.. We sought to determine if induction of labor with simultaneous use of oxytocin and a cervical ripening balloon, compared with sequential use, increases the likelihood of delivery within 24 hours in multiparous women.. We performed a randomized controlled trial from November 2014 through June 2017. Eligible participants were multiparous women with a vertex presenting, nonanomalous singleton gestation ≥34 weeks undergoing induction of labor. Women were excluded for admission cervical examination >2 cm, ruptured membranes, chorioamnionitis or evidence of systemic infection, placental abruption, low-lying placenta, >1 prior cesarean delivery, or contraindication to vaginal delivery. Patients were randomly allocated to the following cervical ripening groups: simultaneous (oxytocin with cervical ripening balloon) or sequential (oxytocin following cervical ripening balloon expulsion). The primary outcome was delivery within 24 hours of cervical ripening balloon placement. Secondary outcomes included induction-to-delivery interval, time to cervical ripening balloon expulsion, mode of delivery, and adverse maternal or neonatal outcomes.. In all, 180 patients were randomized (90 simultaneous, 90 sequential). Baseline demographic and obstetric characteristics were similar between study groups. Women in the simultaneous group were significantly more likely to deliver within 24 hours of cervical ripening balloon placement compared to the sequential group (87.8% vs 73.3%, P = .02). The simultaneous group also had a significantly shorter induction-to-delivery interval and greater cervical dilation at cervical ripening balloon expulsion. There were no differences in mode of delivery, chorioamnionitis, or adverse maternal or neonatal outcomes.. In multiparous women with an unfavorable cervix, the simultaneous use of cervical ripening balloon and oxytocin results in an increased frequency of delivery within 24 hours and a shorter induction-to-delivery interval.

Topics: Adult; Catheterization; Cervical Ripening; Cesarean Section; Chorioamnionitis; Delivery, Obstetric; Female; Humans; Labor, Induced; Oxytocics; Oxytocin; Parity; Pregnancy; Time Factors; Young Adult

The purpose of this study was to determine whether there is an increase in the cesarean delivery rate in women who undergo induction when oxytocin is discontinued in the active phase of labor.. We conducted a prospective randomized controlled trial of women who underwent induction of labor at term; they were assigned randomly to either routine oxytocin use (routine) or oxytocin discontinuation (DC) once in active labor. Analysis was by intention to treat.. Two hundred fifty-two patients were eligible for study analysis: 127 patients were assigned randomly to the routine group and 125 patients were assigned randomly to the DC group. Cesarean delivery rate was similar between the groups (routine, 25.2% [n = 32] vs the DC group, 19.2% [n = 24]; P = .25). There was a higher chorioamnionitis rate and slightly longer active phase in those women who were assigned to the DC group. In adjusted analysis, the rate of chorioamnionitis was not different by randomization group but was explained by the duration of membrane rupture and intrauterine pressure catheter placement.. Discontinuation of oxytocin in active labor after labor induction does not increase the cesarean delivery rate significantly.

Topics: Adult; Cesarean Section; Chorioamnionitis; Female; Humans; Labor Onset; Labor, Induced; Labor, Obstetric; Oxytocics; Oxytocin; Pregnancy; Prospective Studies; Young Adult

To compare the efficacy, side effects, and complications of high-dose vaginal misoprostol with concentrated intravenous oxytocin plus low-dose vaginal prostaglandin (PGE(2)) for second-trimester labor induction.. One hundred twenty-six consenting women with maternal or fetal indications for pregnancy termination and no prior cesarean delivery were randomly assigned to receive either vaginal misoprostol 600 microg 1x, 400 microg every 4 hours 5x (misoprostol group, n = 60) or escalating-dose concentrated oxytocin infusions (277-1,667 mU/min) plus vaginal PGE(2) 10 mg every 6 hours 4x (oxytocin group, n = 66). Both groups received concurrent extra-amniotic saline infusion for cervical ripening. Women who failed their assigned regimen received 20 mg of PGE(2) suppositories every 4 hours until delivery. Analysis was by intent to treat.. Demographic characteristics were similar between study groups. Median induction-to-delivery interval was significantly shorter in the misoprostol group (12 hours) than in the oxytocin group (17 hours; P <.001). There was a higher induction success rate at 24 hours in the misoprostol group (95%) than in the oxytocin group (85%; P =.06), although this difference did not reach statistical significance. The incidence of live birth (25% versus 17%), chorioamnionitis (5% versus 2%), and postpartum hemorrhage greater than 500 mL (3% versus 3%) were similar between the misoprostol and oxytocin groups, respectively. Diarrhea (2% versus 11%; P =.04), nausea/emesis (25% versus 42%; P =.04), and retained placenta requiring curettage (2% versus 15%; P =.008) were significantly less common in the misoprostol group when compared with the oxytocin group, respectively. Isolated intrapartum fever, however, was more frequent in the misoprostol group (67%) than in the oxytocin group (21%; P <.001).. Compared with concentrated oxytocin plus low-dose vaginal PGE(2), high-dose vaginal misoprostol is associated with significantly shorter induction-to-delivery intervals, fewer side effects, a lower incidence of retained placenta, and comparable incidence of live birth.

Topics: Abortifacient Agents, Nonsteroidal; Administration, Intravaginal; Adult; Chorioamnionitis; Dinoprostone; Female; Hemorrhage; Humans; Infusions, Intravenous; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Pregnancy Trimester, Second; Puerperal Disorders; Suppositories; Time Factors

Our purpose was to compare induction of labor with preterm rupture of membranes between 34 and 37 weeks' gestation with expectant management.. In this prospective investigation 120 gravid women at > or = 34 weeks 0 days and < 36 weeks 6 days of gestation were randomized to receive oxytocin induction (n = 57) or observation (n = 63).. Estimated gestational age at rupture of membranes (34.3 +/- 1.4 weeks vs 34.5 +/- 1.4 weeks) and ultrasonographically estimated fetal weight (2230 +/- 321 gm vs 2297 +/- 365 gm) were equivalent between groups (not significant). Chorioamnionitis occurred more often (16% vs 2%, p = 0.007), and maternal hospital stay (5.2 +/- 6.8 days vs 2.6 +/- 1.6 days, p = 0.006) was significantly longer in the control group. Neonatal sepsis was also more common in the observation group (n = 3) than among induction patients (n = 0), but the difference was not statistically significant.. Aggressive management of preterm premature rupture of the membranes at > or = 34 weeks 0 days of gestation by induction of labor is safe for the infant in our population and avoids maternal-neonatal infectious complications.

Topics: Adolescent; Adult; Chorioamnionitis; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor, Induced; Length of Stay; Morbidity; Oxytocics; Oxytocin; Patient Care Management; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Third; Prospective Studies; Ultrasonography, Prenatal; Uterine Contraction

As the interval between rupture of the fetal membranes at term and delivery increases, so may the risk of fetal and maternal infection. It is not known whether inducing labor will reduce this risk or whether one method of induction is better then another.. We studied 5041 women with prelabor rupture of the membranes at term. The women were randomly assigned to induction of labor with intravenous oxytocin; induction of labor with vaginal prostaglandin E2 gel; or expectant management for up to four days, with labor induced with either intravenous oxytocin or vaginal prostaglandin E2 gel if complications developed. The primary outcome was neonatal infection. Secondary outcomes were the need for cesarean section and women's evaluations of their treatment.. The rates of neonatal infection and cesarean section were not significantly different among the study groups. The rates of neonatal infection were 2.0 percent for the induction-with-oxytocin group, 3.0 percent for the induction-with-prostaglandin group, 2.8 percent for the expectant-management (oxytocin) group, and 2.7 percent for the expectant-management (prostaglandin) group. The rates of cesarean section ranged from 9.6 to 10.9 percent. Clinical chorioamnionitis was less likely to develop in the women in the induction-with-oxytocin group than in those in the expectant-management (oxytocin) group (4.0 percent vs. 8.6 percent, P<0.001), as was postpartum fever (1.9 percent vs. 3.6 percent, P=0.008). Women in the induction groups were less likely to say they liked "nothing" about their treatment than those in the expectant-management groups.. In women with prelabor rupture of the membranes at term, induction of labor with oxytocin or prostaglandin E2 and expectant management result in similar rates of neonatal infection and cesarean section. Induction of labor with intravenous oxytocin results in a lower risk of maternal infection than does expectant management. Women view induction of labor more positively than expectant management.

Topics: Adult; Anti-Bacterial Agents; Cesarean Section; Chorioamnionitis; Dinoprostone; Female; Fetal Death; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Infections; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Outcome

To compare obstetric and perinatal outcome between two different expectant managements in women with prelabour rupture of the membranes (PROM).. A randomised study.. One thousand three hundred and eighty-five women with rupture of the membranes at 34 to 42 weeks without contractions.. Women without contractions 2 h after admission were randomised to early induction the following morning after PROM (early induction group) or induction two days later (late induction group). Women with contractions starting within 2 h after admission were included in the calculations as a short latency group. Digital examinations of the cervix were avoided until onset of active labour. Labour was induced with oxytocin in both groups if no spontaneous contractions occurred or if chorioamnionitis or fetal distress was detected.. The frequency of spontaneous deliveries, operative deliveries, maternal and neonatal infections.. In nulliparous women, a higher rate of spontaneous deliveries was found in the late induction group (89%) compared with the early induction group (81%) (P < 0.05). The ventouse extraction rate was 7% and 14% respectively (P < 0.05). A low (2-4%) caesarean section rate was recorded and did not differ between the groups. Endometritis was detected in six women after delivery. Sixty-one children were treated with antibiotics, and no difference could be detected between the groups.. A higher rate of spontaneous deliveries was found among nulliparous women with prolonged latency as compared with brief latency prior to induction. A protocol of no digital examination before labour was associated with infrequent maternal and fetal morbidity, regardless of latency.

Topics: Adult; Chorioamnionitis; Female; Fetal Membranes, Premature Rupture; Gestational Age; Heart Rate, Fetal; Humans; Labor, Induced; Oxytocin; Parity; Pregnancy; Pregnancy Outcome; Time Factors

To compare the rates of clinical amnionitis and endometritis in patients with premature rupture of membranes (PROM), using endocervical prostaglandin E2 (PGE2) gel for induction of labor versus immediate oxytocin induction of labor.. We randomized 118 patients to receive either endocervical 0.5 mg of PGE2 gel (study group) or immediate oxytocin induction of labor (control group). If labor was not established in the group receiving PGE2 gel in 24 hours, intravenous oxytocin was given in incremental doses. The rates of clinical amnionitis and endometritis in the two groups were analyzed. Also compared were hours of labor, duration of rupture of membranes and number of vaginal examinations. Student t test, chi 2, or Wilcoxon rank-sum test were used for statistical analysis, as appropriate. P < .05 was considered significant.. The rates of clinical amnionitis were 5.3% in the PGE2 group and 8% in the control group. Endometritis developed in 1.7% of PGE2 patients and 3.2% of controls. These differences in maternal infection rates were not statistically significant. The two groups were comparable with respect to age, parity, and antepartum group B streptococcal colonization. No significant differences in hours of labor, duration of ruptured membranes, or vaginal examinations were observed. Neonatal outcome data (mean birth weight, Apgar scores at 1 and 5 minutes, Apgar score less than 7 at 5 minutes) were not statistically significant.. Endocervical placement of 0.5 mg of PGE2 gel does not increase the incidence of clinical amnionitis and endometritis in patients with PROM at term when compared with immediate induction of labor with oxytocin.

Topics: Administration, Topical; Adult; Cervix Uteri; Chorioamnionitis; Dinoprostone; Endometritis; Female; Fetal Membranes, Premature Rupture; Gels; Humans; Infusions, Intravenous; Labor, Induced; Oxytocics; Oxytocin; Pregnancy; Prospective Studies; Risk Factors

Our purpose was to determine the impact of early and late amniotomy on labor induction with continuous oxytocin infusion at term.. A total of 209 women admitted for labor induction were randomized to early or late amniotomy. The early amniotomy group (n = 106) had membranes ruptured as soon as it was deemed safe and feasible. The late amniotomy group (n = 103) had membrane rupture performed at > or = 5 cm dilatation. The first 103 women received a continuous oxytocin infusion with incremental adjustments at 60-minute intervals as required. The next 106 women had adjustments every 30 minutes as required. Statistical analysis was confined to concurrent groups.. Early amniotomy was associated with shorter labor (13.3 vs 17.8 hours, p = 0.001), chorioamnionitis (22.6% vs 6.8%, p = 0.002), and significant fetal umbilical cord compression (12.3% vs 2.9%, p = 0.017). The benefit regarding shortening of labor was limited to women having oxytocin increments every 30 minutes as required (13.3 vs 17.8 hours, p = 0.001). Alternatively, the increase in chorioamnionitis was confined to the 60-minute group (39% vs 11%, p < 0.001), which also demonstrated a trend toward increased moderate and severe variable decelerations (19.6% vs 6.4%, p = 0.08).. When a protocol of 60-minute increments in oxytocin infusion rate is desired, amniotomy should be performed late in labor to reduce chorioamnionitis and significant umbilical cord compression. Alternatively, if early amniotomy is necessary, oxytocin should be adjusted every 30 minutes as tolerated.

Topics: Adolescent; Adult; Amnion; Chorioamnionitis; Female; Fetal Diseases; Humans; Incidence; Infusions, Intravenous; Labor, Induced; Oxytocin; Pregnancy; Prospective Studies; Time Factors; Umbilical Cord

To determine whether leaving the membranes intact in active-phase arrest would affect the cesarean delivery rate or the incidence of maternal morbidity secondary to infection.. We conducted a randomized trial of healthy, spontaneously laboring women at term with an intact chorioamnion and active-phase arrest (defined as 1 cm or less of cervical change over 2 hours in the active phase of labor). Patients were assigned to either oxytocin augmentation with intact chorioamnion or oxytocin augmentation with amniotomy and internal monitoring of the fetal heart rate and uterine contractions.. The intact group (n = 58) and the amniotomy group (n = 60) were similar with respect to maternal age, race, parity, labor epidural usage, gestational age, cervical dilatation at randomization, number of vaginal examinations, and infant birth weight. Four patients in the intact group and five in the amniotomy group underwent cesarean delivery (P = 1.0). No patient in the intact group and three in the amniotomy group were diagnosed with chorioamnionitis (P = .24). Endometritis did not occur in the intact group, whereas four cases occurred in the amniotomy group (P = .12). There were no cases of maternal infection in the intact group, versus seven in the amniotomy group (P = .01). The interval between randomization and vaginal delivery was 44 minutes longer in the intact group than in the amniotomy group (P = .11).. In women with active-phase arrest of labor and intact membranes, oxytocin augmentation with elective amniotomy and internal monitoring increases maternal infectious morbidity.

Topics: Adult; Amnion; Cesarean Section; Chorioamnionitis; Endometritis; Female; Fetal Monitoring; Humans; Labor, Induced; Obstetric Labor Complications; Oxytocin; Pregnancy; Pregnancy Outcome; Puerperal Infection

Our objective was to compare maternal and perinatal outcomes between two management schemes for women with preterm premature rupture of the membranes and documented fetal pulmonary maturity.. Of 164 women with preterm premature rupture of the membranes at 32 weeks to 36 weeks 6 days' gestation, 93 eligible and consenting women were randomly selected for either induction of labor (n = 46) or expectant management (n = 47). Expectant management included hospitalization, assessment for fetal heart rate abnormalities, chorioamnionitis, and labor. Digital cervical examinations were prohibited until progressive labor occurred. Follow-up was also done for the 71 women who did not participate.. The women in the induction of labor and expectant management groups had similar demographic characteristics and gestational ages (34.1 vs 34.3 weeks). Expectant management was associated with prolonged latencies to labor, delivery, and maternal hospitalization (p < 0.001), as well as increased hospitalization of infants at 2 to 5 days after delivery (p < 0.05). These patients had increased chorioamnionitis and fetal heart rate abnormalities before labor (p = 0.01, 0.03). Infants received more frequent (p < 0.001) and prolonged antimicrobial therapy after expectant management (p = 0.003) with no reduction in proven sepsis (6.8% vs 4.4%). These latter differences were influenced by the neonatologist's concern over potential neonatal infection.. Among women with preterm premature rupture of the membranes at 32 to 36 weeks with mature surfactant profiles, immediate induction of labor reduces the duration of hospitalization and infection in both mothers and neonates.

Topics: Adult; Chorioamnionitis; Female; Fetal Death; Fetal Membranes, Premature Rupture; Fetal Monitoring; Fetal Organ Maturity; Follow-Up Studies; Humans; Incidence; Infusions, Intravenous; Labor, Induced; Length of Stay; Lung; Morbidity; Oxytocin; Physical Examination; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy Trimester, Third; Prospective Studies; Tocolysis

The purpose of this prospective investigation was to evaluate a protocol for management of term patients with premature rupture of membranes (PROM) and a cervix unfavorable for induction of labor (Bishop score 4 or less). Patients initially were observed for 24 to 36 hours for the spontaneous onset of labor. If spontaneous contractions did not commence, labor was induced with oxytocin. Patients subsequently were divided into three groups: 44 who had spontaneous labor, 29 who had spontaneous labor but required oxytocin augmentation, and 39 women who had oxytocin induction. Patients who entered labor spontaneously had a significantly shorter mean latent period between rupture of membranes and onset of labor (16.0 versus 26.8 and 40.7 hours), shorter mean duration of labor (7.6 versus 12.1 and 13.1 hours), and shorter mean duration of rupture of membranes (23.6 versus 39.0 and 53.8 hours). These women also had a significant decrease in the frequency of chorioamnionitis (7 versus 14 and 33%), and their infants had fewer evaluations for sepsis (25.0 versus 34.5 and 53.8%). We conclude that term patients with PROM and an unfavorable cervix who require oxytocin augmentation or induction of labor are at increased risk for intrapartum and neonatal infection compared with those who progress through labor spontaneously.

Topics: Cervix Uteri; Chorioamnionitis; Endometritis; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Outcome; Prospective Studies; Risk Factors; Time Factors

Induction of labor in women with a previous cesarean section (CS) is associated with increased rates of uterine rupture and failed attempt for vaginal delivery. Prostaglandins use is contraindicated in this population, limiting available options for cervical ripening.. To evaluate the efficacy and safety of artificial rupture of membranes (AROM) as a mode of Induction of labor (IOL) in women with a previous cesarean section.. A retrospective cohort study conducted in a single tertiary care center between January 2015 and October 2020. Women with one previous cesarean section and a current singleton term pregnancy requiring IOL, with an unfavorable cervix, were included. The primary outcome was a successful vaginal delivery (VBAC); secondary outcomes were rates of chorioamnionitis, uterine rupture and low Apgar score (< 7).. Of the 665 women who met the inclusion criteria, 492 (74%) did not receive subsequent oxytocin and 173 (26%) did. There were significant differences in the baseline characteristics between these two groups, including maternal age, cervical dilation at presentation, parity, and a history of a previous VBAC. Among women who were induced solely by AROM the rate of a successful TOLAC was higher (81.3% vs 73.9%), total time of IOL was shorter (mean 8.7 h vs.16.1 h) and the risk of chorioamnionitis was lower (7.3% vs 18.4%). When subdividing the women who received oxytocin into early (< 12 h after AROM) vs late (> 12 h after AROM) administration, there were no significant changes in the rates of successful VBAC or of chorioamnionitis.. AROM as a single mode of IOL in women with a previous CS is a safe and efficient practice with high rates of successful VBAC. When spontaneous labor does not develop, there is no advantage to delay the administration of oxytocin.

Topics: Amniotomy; Cervical Ripening; Cesarean Section; Chorioamnionitis; Female; Humans; Labor, Induced; Oxytocin; Pregnancy; Retrospective Studies; Uterine Rupture

To assess the risk of chorioamnionitis in nulliparous, term, singleton, vertex (NTSV) pregnancies with premature rupture of membranes (PROM) and an unfavorable cervix undergoing labor induction with either prostaglandin E2 (PGE2) or oxytocin only.. Retrospective cohort of NTSV pregnancies presenting with PROM who underwent labor induction with either PGE2 (n=94) or oxytocin (n=181) between October 2015 and March 2019. The primary outcome of chorioamnionitis was compared between the two groups. Statistical analysis included Chi-squared and Wilcoxon rank-sum tests, as well as logistic regression. For time to delivery, a Cox proportional hazard regression was used to determine the hazard ratio (HR) and adjusted HR (aHR).. Baseline characteristics were similar between the two groups. Cervical ripening with PGE2 was associated with an increased rate of chorioamnionitis (18.1 vs. 6.1%; aOR 4.14, p=0.001), increased neonatal intensive care unit admissions (20.2 vs. 9.9%; aOR 2.4, p=0.02), longer time interval from PROM to delivery (24.4 vs. 17.9 h; aHR 0.56, p=<0.0001), and lower incidence of meconium (7.4 vs. 14.4%; aOR 0.26, p=0.01), compared to the oxytocin group.. Based on our data, the use of oxytocin appears both superior and safer compared to PGE2 in NTSV pregnancies with PROM undergoing labor induction.

Topics: Adult; Cervical Ripening; Chorioamnionitis; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Labor, Induced; Outcome and Process Assessment, Health Care; Oxytocics; Oxytocin; Pregnancy; Pregnancy Outcome; Prognosis; Retrospective Studies; Risk Assessment; United States

Chorioamnionitis is associated with an increased risk of cesarean delivery and uterine atony. We hypothesized that the onset of maternal fever is temporally associated with decreased uterine contractility.. Retrospective cohort.. Academic center.. Term participants who developed a fever in the setting of an intrauterine pressure catheter.. Montevideo units (MVUs) and oxytocin dose at time 0 (first oral temperature ≥38°C) and in the five 1--hour blocks preceding and following T0.. Montevideo units relative to the onset of fever. Results were adjusted for oxytocin dose and parity in a mixed-effects model.. One hundred participants were included. Uterine contractility was maintained for 2 hours after the onset of maternal fever but thereafter significantly and steadily declined by an average of 6.9 ± 3.2 MVU/h ( P = .03), despite the absence of a parallel decline in oxytocin exposure. Multiparas and nulliparas showed a similar pattern of waning uterine contractility. Patients who delivered vaginally maintained contractility, while those who delivered via cesarean had diminishing contractility ( P = .01). The postpartum hemorrhage (PPH) rate (postpartum bleeding requiring treatment) was 32%.. A decline in myometrial contractility occurs 2 hours following the onset of maternal fever. Increased risk of cesarean delivery appears to be directly associated with waning uterine contractility and decreased uterine responsiveness to oxytocin. Clinically, close attention should be given to maintaining adequate uterine contractions following a diagnosis of suspected chorioamnionitis. The likelihood of successful vaginal delivery may decrease over time, and the risk of PPH is clinically significant.

Topics: Adolescent; Adult; Cesarean Section; Chorioamnionitis; Female; Humans; Myometrium; Oxytocics; Oxytocin; Parity; Postpartum Hemorrhage; Pregnancy; Retrospective Studies; Risk Factors; Uterine Contraction; Young Adult

While there are well-accepted standards for the diagnosis of arrested active-phase labor, the definition of a "failed" induction of labor remains less certain. One approach to diagnosing a failed induction is based on the duration of the latent phase. However, a standard for the minimum duration that the latent phase of a labor induction should continue, absent acute maternal or fetal indications for cesarean delivery, remains lacking.. The objective of this study was to determine the frequency of adverse maternal and perinatal outcomes as a function of the duration of the latent phase among nulliparous women undergoing labor induction.. This study is based on data from an obstetric cohort of women delivering at 25 US hospitals from 2008 through 2011. Nulliparous women who had a term singleton gestation in the cephalic presentation were eligible for this analysis if they underwent a labor induction. Consistent with prior studies, the latent phase was determined to begin once cervical ripening had ended, oxytocin was initiated, and rupture of membranes had occurred, and was determined to end once 5-cm dilation was achieved. The frequencies of cesarean delivery, as well as of adverse maternal (eg, postpartum hemorrhage, chorioamnionitis) and perinatal (eg, a composite frequency of seizures, sepsis, bone or nerve injury, encephalopathy, or death) outcomes, were compared as a function of the duration of the latent phase (analyzed with time both as a continuous measure and categorized in 3-hour increments).. A total of 10,677 women were available for analysis. In the vast majority (96.4%) of women, the active phase had been reached by 15 hours. The longer the duration of a woman's latent phase, the greater her chance of ultimately undergoing a cesarean delivery (P < .001, for time both as a continuous and categorical independent variable), although >40% of women whose latent phase lasted ≥18 hours still had a vaginal delivery. Several maternal morbidities, such as postpartum hemorrhage (P < .001) and chorioamnionitis (P < .001), increased in frequency as the length of latent phase increased. Conversely, the frequencies of most adverse perinatal outcomes were statistically stable over time.. The large majority of women undergoing labor induction will have entered the active phase by 15 hours after oxytocin has started and rupture of membranes has occurred. Maternal adverse outcomes become statistically more frequent with greater time in the latent phase, although the absolute increase in frequency is relatively small. These data suggest that cesarean delivery should not be undertaken during the latent phase prior to at least 15 hours after oxytocin and rupture of membranes have occurred. The decision to continue labor beyond this point should be individualized, and may take into account factors such as other evidence of labor progress.

Topics: Adult; Cervical Ripening; Cesarean Section; Chorioamnionitis; Cohort Studies; Female; Humans; Labor, Induced; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Time Factors; United States

To compare maternal and neonatal outcomes based on length of the latent phase during induction with rupture of membranes before 6 cm dilation.. This is a retrospective cohort study using data from the Consortium of Safe Labor study, including 9,763 nulliparous and 8,379 multiparous women with singleton, term pregnancies undergoing induction at 2 cm dilation or less with rupture of membranes before 6 cm dilation after which the latent phase ended. Outcomes were evaluated according to duration of oxytocin and rupture of membranes.. At time points from 6 to 18 hours of oxytocin and rupture of membranes, the rates of nulliparous women remaining in the latent phase declined (35.9-1.4%) and the rates of vaginal delivery for those remaining in the latent phase at these time periods decreased (54.1-29.9%) Nulliparous women remaining in the latent phase for 12 hours compared with women who had exited the latent phase had significantly increased rates of chorioamnionitis (12.1% compared with 4.1%) and endometritis (3.6% compared with 1.3%) and increased rates of neonatal intensive care unit admission (8.7% compared with 6.3%). Similar patterns were present for multiparous women at 15 hours.. Based on when neonatal morbidity increased, in an otherwise uncomplicated induction of labor with rupture of membranes, a latent phase after initiation of oxytocin of at least 12 hours for nulliparous women and 15 hours in multiparous women is a reasonable criterion for diagnosing a failed induction.

Topics: Adult; Chorioamnionitis; Endometritis; Extraembryonic Membranes; Female; Humans; Infant, Newborn; Intensive Care, Neonatal; Labor, Induced; Labor, Obstetric; Oxytocics; Oxytocin; Parity; Pregnancy; Retrospective Studies; Time Factors; Treatment Failure; Young Adult

Standardized oxytocin protocols have been used to improve the safety and quality of obstetric care. We examined rates of chorioamnionitis and labor dystocia requiring cesarean delivery as unintended consequences of the implementation of a low-dose, checklist-based oxytocin protocol.. We performed a retrospective cohort study of live singleton deliveries that underwent a trial of labor in two 15-month periods, comparing outcomes in those who delivered before to after protocol implementation. Patients and outcomes were identified using a combination of electronic medical records and International Classification of Diseases, 9th Revision, Clinical Modification codes. Time trend analysis was performed to evaluate for secular trends.. A total of 8,717 women were included; 5,077 received oxytocin. Despite an unchanged rate of cesarean deliveries from before to after initiation of the protocol (15.15 vs. 14.75%, p = 0.60), deliveries after protocol implementation were generally characterized by higher rates of chorioamnionitis (7.48 vs. 5.97%, p < 0.001), longer median time from admission to delivery (524 vs. 462 minutes, p < 0.001), more cesarean deliveries performed for labor dystocia (50.62 vs. 40.92%, p < 0.001), and fewer cesarean deliveries performed for fetal distress (32.52 vs. 38.67%, p = 0.02).. Low-dose oxytocin protocols are intended to increase safety, but they may have unintended consequences related to prolonged labor, and should be studied before widespread use.

Topics: Adult; Cesarean Section; Checklist; Chorioamnionitis; Clinical Protocols; Dystocia; Electronic Health Records; Female; Fetal Distress; Fetal Monitoring; Humans; International Classification of Diseases; Labor, Induced; Obstetric Labor Complications; Oxytocics; Oxytocin; Pregnancy; Retrospective Studies; Young Adult

To analyze outcomes after second-stage labor beyond 3 hours and determine if prolonged second stages were intentional.. Retrospective cohort analysis of maternal and neonatal outcomes in nulliparous women based on second-stage duration. Medical records were reviewed for management decisions in women with second stages ≥4 hours; all other outcomes were accessed via computerized obstetric database.. Second stage exceeding 3 hours occurred in 1489 (7%) of 21,991 pregnancies analyzed. Of the 427 (2%) with second stages ≥4 hours, 315 (74%) reached 4 hours unintentionally, after a decision for operative delivery had been made. Only 34 (8%) women were intentionally allowed to continue second-stage labor beyond 4 hours, and half of these ultimately required cesarean. Indices of maternal and neonatal morbidity were significantly increased when second stages exceeded 3 hours.. Most second stages reaching 4 hours are unintentional, occurring while awaiting an previously decided upon operative delivery. Maternal and neonatal morbidities are significantly increased with second stages beyond 3 hours.

Topics: Adolescent; Adult; Analgesia, Epidural; Analgesia, Obstetrical; Blood Transfusion; Cesarean Section; Chorioamnionitis; Cohort Studies; Female; Fetal Monitoring; Fever; Heart Rate, Fetal; Humans; Hypovolemia; Hysterectomy; Labor Stage, Second; Lacerations; Oxytocics; Oxytocin; Parity; Perineum; Pregnancy; Retrospective Studies; Time Factors; Young Adult

To generate contemporary uterine activity and labor progress data for oxytocin-augmented labor, and assess whether 2 hours of active phase labor arrest with at least 200 Montevideo units justifies cesarean delivery.. Five hundred and one consecutive spontaneously laboring term women with abnormally progressive labor were managed by a standardized protocol: oxytocin and intrauterine pressure catheter with an intent to sustain at least 200 Montevideo units for 4 hours or more before cesarean for labor arrest. Uterine activity was measured, and maternal and neonatal outcomes were evaluated. With a sample of this size, the upper 95% confidence interval limit for an event with an observed rate of 1% is below 3%.. During oxytocin augmentation, nulliparas who were delivered vaginally dilated at a median rate of 1.4 cm/hour versus 1.8 cm/hour for parous women. In both groups, the 5th percentile of cervical dilation rate was 0.5 cm/hour. Thirty-eight women experienced labor arrest for over 2 hours despite at least 200 sustained Montevideo units; 23 (61%) achieved a vaginal delivery. Rates of chorioamnionitis and endometritis for the 38 women were 26%. None of their infants sustained a serious complication, including brachial plexus injury, even though three of the 23 vaginal deliveries (13%) were complicated by shoulder dystocia.. These data demonstrate that oxytocin-augmented labor proceeds at substantially slower rates than spontaneous labor, and support our previous contention that the criteria of labor arrest for 2 hours, despite at least 200 sustained Montevideo units, are insufficiently rigorous for the performance of cesarean.

Topics: Adult; Cesarean Section; Chorioamnionitis; Confidence Intervals; Endometritis; Female; Humans; Infant, Newborn; Labor Stage, First; Labor, Induced; Obstetric Labor Complications; Oxytocin; Parity; Pregnancy; Pregnancy Outcome; Prospective Studies; Time Factors; Uterine Contraction; Uterine Monitoring

Maternal fever is associated with chorioamnionitis and has been linked to labour epidural analgesia (LEA). The purpose of this study was to determine possible associations between LEA and chorioamnionitis, maternal fever, operative delivery rate, and neonatal outcome.. Data from 14,073 patients were entered into a database over a two-year period. From this database, 62 nulliparous parturients with clinical chorioamnionitis (amnionitis), but without LEA were identified (Group I). Two other groups who received LEA were matched for parity and gestation: Group II - LEA with concomitant amnionitis (n=50) and, Group III - LEA without concomitant amnionitis (n=201). The diagnosis of chorioamnionitis was confirmed by histologic examination. Results are expressed as mean +/- SD and analyzed at P <0.05 using ANOVA or Chi-square.. No differences were noted among the groups in the operative delivery rate or Apgar scores at five minutes. The percentage of patients with maternal fever during labour (38.0 degrees C) with amnionitis was significantly less in Group III compared to the other groups (100% in both Groups I and II vs 1.0% in Group III; P=0.000). Likewise, Group III had a lower percentage of neonates with Apgar scores <7 at one minute (35.5% in Group I, 20.0% in Group II, 17.4% in Group III; P=0.010). The percentage of histologic chorioamnionitis was significantly higher in both amnionitis groups compared to Group III (67.7% in Group I, 56.0% in Group II, 4.0% in Group III; P=0.000).. LEA without chorioamnionitis is not associated with maternal fever (38.0 degrees C), increased operative delivery rates or low Apgar scores.

Topics: Adult; Analgesia, Epidural; Analgesia, Obstetrical; Chorioamnionitis; Databases, Factual; Female; Fever; Humans; Infant, Newborn; Obstetric Labor Complications; Oxytocics; Oxytocin; Pregnancy; Pregnancy Outcome; Retrospective Studies; Streptococcal Infections

To compare 12-hour and 72-hour expectant management of premature rupture of membranes (PROM) in singleton term pregnancies.. In a prospective, nonrandomized study, 566 low-risk women with singleton term pregnancies presenting with PROM were assigned to either 12-hour or 72-hour expectant management. Patients who had not entered labor at the end of the assigned period were induced with oxytocin. The pregnancy outcome of both methods was compared with regard to infectious complications and method of delivery.. There was no statistical difference in the rate of chorioamnionitis between the 12-hour and 72-hour expectant management groups (11.7 versus 12.7%; relative risk [RR] 0.9, 95% confidence interval [CI] 0.6-1.5; P = .83). Cesareans were performed to a similar degree in both groups (4.7 versus 6.7%; RR 0.7, 95% CI 0.3-1.4; P = .39). Fifty-five percent of the 12-hour group underwent oxytocin induction, compared with 17.5% of those in the 72-hour group (RR 5.8, 95% CI 3.9-8.5; P < .001). Women undergoing induction after 72-hour expectant management had an increased risk of cesarean delivery compared with those after a 12-hour wait (RR 5.9, 95% CI 2.3-15.1; P < .001). Overall, women in the 12-hour group had shorter admission-to-discharge times than the 72-hour group (5 versus 6 days, 95% CI of the difference 0.6-1.3; P < .01).. Regimens of 12-hour and 72-hour expectant management of PROM are comparable regarding infectious complications and pregnancy outcome. However, the longer wait prolongs the interval to delivery and increases hospitalization costs.

Topics: Adolescent; Adult; Cesarean Section; Chorioamnionitis; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Length of Stay; Oxytocin; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Third; Prospective Studies; Time Factors

The impact of chorioamnionitis on the course of labor is controversial. Some clinicians believe the infection has stimulatory effects, whereas others suspect inhibitory influences. Two hundred sixty-six pregnancies with chorioamnionitis requiring labor stimulation with oxytocin were matched to uninfected women for maternal age, race, parity, gestational age, oxytocin dosage regimen, indication for labor stimulation, type of labor stimulation, cervical dilatation at initiation of oxytocin, and time for rupture of membranes to initiation of labor stimulation. Chorioamnionitis diagnosed before oxytocin infusion was associated with shorter oxytocin initiation-to-delivery intervals (4.3 versus 5.6 hours; P = .04) and had no significant impact on the cesarean rate compared with matched controls. In contrast, pregnancies complicated by chorioamnionitis detected late in labor were associated with markedly longer oxytocin initiation-to-delivery intervals (12.6 versus 7.9 hours; P less than .0001) and a fourfold increase in cesarean for dystocia compared with matched controls (40 versus 10%; P less than .0001). Thus, the impact of chorioamnionitis on the course of labor can be divided into two clinical presentations. That diagnosed before labor stimulation does not increase the use of cesarean, whereas that diagnosed after oxytocin stimulation may be a sign of abnormal labor, as it was associated with a marked increase in abdominal delivery for dystocia.

Topics: Adult; Case-Control Studies; Cesarean Section; Chorioamnionitis; Dystocia; Female; Fetal Monitoring; Humans; Labor, Induced; Oxytocin; Pregnancy