oxytocin and Cicatrix

To evaluate the benefits and risks of labor induction in patients previously delivered by at least one low transverse cesarean section. To define how labor should be managed in patients attempting a vaginal birth after cesarean section (VBAC).. A literature search was performed using the Pubmed(®) and Cochrane(®) databases. Foreign societies guidelines were also consulted.. Labor induction is associated with an increased risk of uterine rupture that could be estimated at 1% with oxytocine and 2% with vaginal prostaglandins (Level 2). Mechanical methods have been insufficiently studied. Misoprostol seems to dramatically increase the risk of uterine rupture (Level 3). The routine use of intrauterine pressure catheter does not prevent uterine rupture (Professional agreement). A moderate increase of uterine rupture was also found with augmentation (Level 3). The risk of uterine rupture increases when cervical dilatation is arrested for 3 hours or more when a good uterine dynamic is obtained (Professional agreement). The use of epidural analgesia should be encouraged (Grade C). Routine digital exploration of the uterine scare postpartum is not necessary (Grade C).. Women attempting a VBAC should be aware of the modalities of labor management. When labor induction is warranted, women should also be informed of the indication and the increased risk of uterine rupture. The choice of labor induction method should take into consideration maternal and obstetrical characteristics.

Topics: Analgesia, Epidural; Cicatrix; Female; Humans; Labor Stage, First; Labor, Induced; Misoprostol; Obstetric Labor Complications; Oxytocics; Oxytocin; Pregnancy; Prostaglandins; Risk Factors; Uterine Diseases; Uterine Rupture; Vaginal Birth after Cesarean

Recent clinical attention has focused upon the rising rate of caesarean sections being performed and whether patients with a previous caesarean section should be allowed a vaginal delivery. In this paper, the worldwide trend of caesarean section and the role of trial of scar following single and multiple caesarean surgery is reviewed. The role of oxytocin and regional epidural analgesia is evaluated as well as perinatal and maternal mortality. On the basis of the available data, there is no justification for the current clinical practice of almost 99% prevalence of elective repeat caesarean section in some hospitals in the North America. Oxytocin and epidural analgesia, when carefully monitored, are safe and reasonable in these patients. Watchful waiting has always been an essential virtue in obstetric management and should not be replaced by hopeful expectancy. This aspect of the art of obstetrics would appear to require rejuvenation if we are to stem the rising tide of caesarean sections.

Topics: Analgesia, Epidural; Cesarean Section; Cicatrix; Female; Humans; Infant Mortality; Infant, Newborn; Labor, Obstetric; Oxytocin; Pregnancy; Vaginal Birth after Cesarean

The optimum time of labour induction among women with a previous caesarean without any pregnancy complication and eligible and willing for vaginal delivery is not specified. This study compares the vaginal birth rates between induction at 40 weeks and expectant management till 41 weeks.. We conducted this parallel design nonblinded, randomized controlled trial in a tertiary care teaching institution in South India on women with a previous lower segment caesarean section eligible for a trial of labour with singleton foetus without any pregnancy complication at recruitment. We screened 1886 women. Sixty women underwent block (of 6 each) randomization into two groups of thirty each at 40 weeks. We induced the women in the intervention group at 40 weeks with oxytocin or a single 24-hour application of a Foley catheter followed by oxytocin infusion and amniotomy. The expectant group underwent maternal and foetal surveillance and induction at 41 weeks with the same protocol if not delivered by then. We compared the primary outcome of the proportion of vaginal birth rate with a chi-square test.. Data from all sixty women were analyzed. Twenty (66.67%) in the induction compared to ten (33.33%) in the expectant group delivered vaginally. This difference was significant (RR 2.0, 95% CI: 1.13-3.52;

Topics: Birth Rate; Cesarean Section; Cicatrix; Female; Humans; Labor, Induced; Oxytocin; Pilot Projects; Pregnancy; Pregnancy Complications; Watchful Waiting

Inducing labour with a Foley balloon catheter rather than using oxytocin or prostaglandins is considered to be less risky if the uterus is scarred.

Topics: Cervical Ripening; Cesarean Section; Cicatrix; Female; Humans; Labor, Induced; Oxytocics; Oxytocin; Pregnancy; Pregnancy Outcome; Urinary Catheterization; Uterine Contraction; Uterine Rupture; Vaginal Birth after Cesarean

Our purpose was to assess maternal and perinatal outcomes associated with a trial of labor and attempted vaginal birth after prior low-segment vertical cesarean delivery.. During a 10-year period in a single tertiary hospital, all patients with a prior low-segment uterine incision (whether vertical or transverse) were considered candidates for a trial of labor in the absence of other contraindications or patient refusal. Among the 1137 women who underwent low-segment vertical cesarean delivery, 262 were subsequently delivered of 322 live-born infants, and 174 (54%) of them were identified retrospectively as having attempted vaginal birth. The maternal and perinatal outcomes of patients who did or did not undergo a trial of labor were analyzed and compared.. No significant differences between the two patient groups were observed regarding demographic characteristics, antepartum complications, gestational age at delivery (mean 37.4 weeks), birth weight, and cord pH at delivery. Vaginal delivery was accomplished successfully in 144 of 174 (83%) patients who underwent a trial of labor. Abdominal delivery was necessary for 17 mothers with labor disorders and 13 with suspected fetal distress. Postpartum hemorrhage occurred more often in the trial of labor group (7/174 [4.0%] vs 2/148 [1.4%], p not significant), but endometritis developed significantly more often in patients with elective repeat cesarean delivery (16.9% vs 6.3%, p = 0.006). Rupture of the low-segment vertical cesarean scar occurred in 2 patients during a trial of labor (1.1%) versus none in the elective repeat cesarean group. Neither mother experienced fetal extrusion or adverse maternal or fetal sequelae. Frequency of serious neonatal complications (8.1% vs 10%) and neonatal mortality (1.7% vs 2.0%) were similar between groups. All neonatal deaths were a result of extreme prematurity or congenital anomalies.. Our experience indicates that a mother with a prior low-segment vertical cesarean delivery can undertake a trial of labor with relative maternal-perinatal safety. The likelihood of successful outcome and the incidence of complications are comparable to those of published experience with a trial of labor after a previous low-segment transverse incision.

Topics: Cesarean Section; Cesarean Section, Repeat; Cicatrix; Dinoprostone; Female; Humans; Oxytocin; Pregnancy; Pregnancy Outcome; Risk Factors; Trial of Labor; Uterine Rupture

To investigate the incidence, etiology, diagnosis, treatment and outcome of uterus rupture.. From January 1999 to May 2013, clinical data of 67 cases with uterine rupture in Woman's Hospital, School of Medicine, Zhejiang University were studied retrospectively.. A total of 67 cases of uterine rupture with 21(+2)-39(+2) gestational weeks out of 128 599 deliveries were recorded giving an incidence of uterine rupture was 0.052 1% (67/128 599) . Cesarean scar rupture were found in 59 cases (88%, 59/67) and noncesarean scar rupture were found in 8 cases (12%, 8/67). The causes of uterine rupture include 60 cases of scar uterus (59 cesarean scar cases and 1 myomyectomy scar case), 2 cases of assisted delivery operation trauma, 2 cases of malformed uterus, 3 cases of unknown causes (all with artificial abortion history).Non obstructive dystocia and improper oxytocin use were found to be related with uterine rupture.Fifty-two cases of cesarean scar spontaneous incomplete rupture were found and repaired during repeated cesarean delivery without maternal and fetal complications. The remaining 15 cases need emergency rescue operation for fetal distress or dead fetus, severe acute abdomen, prepartum or postpartum vaginal bleeding even maternal hypovolemia; 6/15 uterine rupture cases were diagnosed with the history, clinical symptoms and signs, 3/15 cases with ultrasonic found dead fetus in the peritoneal cavity before exploratory laparotomy and 6 cases were diagnosed just during laparotomy.Hysterectomy was done in 10/15 cases and uterine repair in 5/15 cases; there was no maternal death and 12 perinatal fetal death (5 cases of mid-late pregnancy termination for deformed fetus) of the 15 uterine rupture cases.One case with hysterectomy was complicated with stress pancreatitis and dysfunction of liver and kidney and discharged 20 days after operation, the remaining 14 cases were discharged 5-7 days postpartum.One case with repaired malformed uterus got pregnancy 4 years later and delivered a 2 000 g healthy baby by cesarean section at gestational age of 33(+4) weeks.. Uterine scar caused by caesarean section or other operations became the leading cause of uterine rupture, assisted delivery operations, history of intrauterine manipulation and uterine malformations were the predisposing risk factors of uterine rupture.

Topics: Abortion, Induced; Cesarean Section; China; Cicatrix; Female; Fetal Death; Gestational Age; Humans; Hysterectomy; Incidence; Labor Presentation; Maternal Mortality; Obstetric Surgical Procedures; Oxytocin; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Retrospective Studies; Treatment Outcome; Uterine Rupture

Induction of labour after a previous caesarean section is still controversial. We aim to analyse, in a population of women who have a uterine scar, the maternal, foetal and neonatal complications in relation to the mode of labour and delivery.. Retrospective analysis of collected data from all the singleton deliveries of patients with a scarred uterus (N=798), admitted to the hospital between August 2006 and March 2009.. maternal and perinatal complications.. Among 798 singleton deliveries, 36.1% had a spontaneous labour, 12.6% a prostaglandin-induced labour and 2.9% an ocytocin-induced labour, and 48.4% had an elective caesarean section. The chance of delivering vaginally was respectively 84.4% for those who had a spontaneous labour, 75.2% for those who were induced using prostaglandin, 82.6% after induction using ocytocin. There were eight uterine ruptures, four after spontaneous labour (1.4%), two after prostaglandin induction (2%) and two at the time of an iterative caesarean section (0.5%). There were no differences between groups, except the risk of haemorrhage (17.4% after spontaneously induced labour, 34.8% after ocytocin, 17.8% after prostaglandin and 44.6% after iterative caesarean section; p<0.005) and the neonatal admissions when analysed by intention to treat only (8.3% after spontaneously induced labour, 9.1% after ocytocin, 12% after prostaglandin and 16.8% after iterative caesarean section; p<0.009).. Although no increase in maternal or perinatal outcome was observed in relation to prostaglandin-induced labour after caesarean section, this study is too underpowered to exclude an increased risk.

Topics: Adult; Cesarean Section; Chi-Square Distribution; Cicatrix; Female; Humans; Intensive Care, Neonatal; Intention to Treat Analysis; Labor, Induced; Labor, Obstetric; Logistic Models; Medical Audit; Obstetric Labor Complications; Oxytocics; Oxytocin; Postoperative Hemorrhage; Pregnancy; Prostaglandins; Retrospective Studies; Uterine Rupture; Uterus

(a) To review the cases of ruptured uterus over the last 25 years and analyze the causative factors with a view to its prevention (b) To analyze subsequent pregnancy outcome with a view to its safety.. The case notes were reviewed for all patients with ruptured uterus over a period of 25 years from January 1982 to January 2007. Relevant dates relating to the characteristics of labor, delivery, maternal, perinatal, and subsequent pregnancy outcomes were assessed.. The incidence of ruptured uteri was calculated to be 0.03%. Total deliveries included in the study were 152,426. There were 46 cases of ruptured uteri and 44 were available for study. Twenty-two (52%) ruptured uteri occurred in patients with previous caesarean scars, of which 10 occurred in women with previous four or more caesarean sections. In 12 cases (27%), uterine rupture occurred due to oxytocin; PGE2 and oxytocin were used in 3 of these 12 cases. Two (4.5%) ruptures occurred due to non-removal of cervical cerclage during labor. Two (4.5%) primigravidae ruptured their uterus following road traffic accident, resulting in maternal and fetal deaths. Malpresentation in labor resulted in eight (18%) ruptures. Rupture occurred at the fundus in 10 cases and in the lower segment in the remaining 34. Fetal heart abnormalities were observed in all cases in which the uterus ruptured during labor. Abdominal hysterectomy was performed in 20 cases (45%) of which 13 were subtotal and 7 (10%) were total. Of the remaining 24 (55%) patients, 10 had suture repair and in addition 14 patients underwent hypogastric artery ligation. Later, 22/24 (92%) women became pregnant. Twenty (91%) were delivered by planned caesarean section. There were no maternal or fetal complications. The remaining two women had previous classical scar, undetected malpresentation, and sparse antenatal care. Their uteri ruptured spontaneously at 32 and 35 weeks at home. They died intra-operatively due to intractable hemorrhage along with their fetus.. In the previous caesarean section, the indiscriminate use of oxytocin and malpresentation are the risk factors for uterine rupture. Child birth after uterine rupture is not to be recommended routinely. Most women with a previous uterine rupture with meticulous tertiary level antenatal care had a favorable outcome in subsequent pregnancies.

Topics: Adolescent; Adult; Cicatrix; Female; Fetal Mortality; Gynecologic Surgical Procedures; Humans; Incidence; Infant, Newborn; Labor Presentation; Middle Aged; Oxytocin; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Retrospective Studies; Risk Factors; Safety; Uterine Rupture; Young Adult

To assess the risk of uterine rupture of the scarred uterus according to mode of delivery in subsequent births recorded as spontaneous labour, labour induced by oxytocin, labour after ripening with prostaglandin E2, and planned cesarean section.. Retrospective study of 2,128 births with a low transversal scar after a previous cesarean section. The study population was realised in a level III university hospital from 1995 to 2003. The association between mode of delivery and uterine rupture was studied in a multivariate logistic regression model, and adjusted for specific antenatal confounding factors.. Over 9 years, we collected 22 cases (1%), including 11 asymptomatic ruptures in a population of 2,128 scarred uteri out of 28,248 deliveries. Uterine rupture occurred at a rate of 0.3 per 100 among women with repeated cesarean delivery without labour, 1 per 100 among women with spontaneous onset of labour, 1.4 per 100 among women with oxytocin-induced labour, and 2.2 per 100 among women with prostaglandin cervical ripening. Compared to women with a planned cesarean section, women with spontaneous onset of labour were more likely to have uterine rupture (OR: 4.0; 95% CI: 0.8-42.0). A greater relative risk was observed among women with oxytocin-induced labour (OR: 4.3; 95% CI: 0.3-60.0), and particularly those with prostaglandin-induced labour (OR: 8.7; 95% CI: 1.5-97.3, p=0.01).. In women with a scarred uterus, prostaglandin E2 induction of labour is a risk factor for uterine rupture. The practice of a systematic cesarean section in cases with Bishop score<3, appropriate induction procedure, and rigorous monitoring of the labour, could make for a safer delivery.

Topics: Adult; Cicatrix; Delivery, Obstetric; Dinoprostone; Female; France; Hospitals, University; Humans; Incidence; Labor, Induced; Logistic Models; Oxytocics; Oxytocin; Pregnancy; Retrospective Studies; Risk Factors; Uterine Rupture; Uterus; Vaginal Birth after Cesarean

To determine the incidence, aetiology, trend, management maternal and fetal outcome of uterine rupture at University of Ilorin Teaching Hospital, Ilorin, Nigeria. To compare the results with previous reports from this centre.. A prospective study of patients with ruptured uterus at the University of Ilorin Teaching Hospital, Ilorin, Nigeria between February, 1992 and December, 1999 was undertaken. The patients were initially assessed in the labour ward where the clinical presentation, relevant socio-demographic data, previous medical and surgical histories were noted. Necessary investigations and resuscitation were carried out before the operation. A structured questionnaire was also administered either before or after the operation. Two consecutive spontaneous vaginal deliveries following each case of uterine rupture served as control. Statistical analysis was done using the Genstat 32 package.. Of the 20,960 deliveries during the study period, there were 100 ruptured uteri giving a hospital incidence of 1 in 210 deliveries. Oxytocin use (39%), uterine scar (23%) and obstructed labour (16%) were the common associated factors. When compared with the controls, uterine rupture in the study group was significantly associated with low socio-economic status p < 0.001, lack of antenatal care p < 0.001, and high parity p < 0.012. A maternal age 40 years and above was also a risk factor. The anterior wall of the uterus was the commonest site affected and repair with tubal ligation was the surgical procedure in 36% of cases. Maternal mortality was 13%, while fetal mortality was 92%. When compared with the previous incidence of 1 in 298 deliveries, a slight increase is noted.. Ruptured uterus is still a common obstetric hazard in our environment and its incidence appears to be on the increase. The condition is significantly associated with advanced maternal age, grandmultiparity, lack of antenatal care and the low socio-economic status of the patients.

Topics: Adult; Cicatrix; Dystocia; Female; Humans; Incidence; Nigeria; Oxytocin; Pregnancy; Pregnancy Outcome; Prenatal Care; Prospective Studies; Socioeconomic Factors; Uterine Rupture

A review of the medical records from two public hospitals in Sydney was undertaken to determine the incidence of this uncommon complication. Twenty-seven cases of uterine rupture were reported out of 31,115 deliveries with an incidence of 0.086% (versus 0.05% in the current literature). The incidence associated with previous caesarean section was 0.038% (versus 0.8% in the current literature). Predisposing and associated factors in this review were similar to those reported by others. There was no maternal mortality in our series but the fetal mortality rate was 5 out of 27 cases. Uterine ruptures in the midtrimester were associated with high rates of maternal morbidity and fetal loss. Forty-eight per cent of patients with uterine rupture received epidural analgesia. The associated factors and outcomes are discussed. The current literature is reviewed in relation to this high-risk group of patients.

Topics: Adult; Analgesia, Epidural; Analgesia, Obstetrical; Cesarean Section; Cicatrix; Contraindications; Female; Humans; Labor, Induced; Obstetric Labor Complications; Oxytocin; Pregnancy; Retrospective Studies; Risk Factors; Uterine Rupture

The aim of this paper is to determine the antecedent factors, clinical presentation, complications and management of uterine rupture in the context of modern obstetric practice in Singapore. We conducted a retrospective study of 26 proven cases of uterine rupture in Kandang Kerbau Hospital, Singapore between January 1983 to December 1992. These cases were analysed with regards to their past history, clinical presentation, complications, management and outcome. The incidence of uterine rupture was 1 in 6331 deliveries. The ratio of cases with scarred uteri against those with unscarred uteri was 3:1. The commonest antecedent factor was previous lower segment caesarean section for the scarred group and cephalo-pelvic disproportion in the unscarred group. Overall, 46.2% of the patients had augmentation with oxytocin. The major clinical presentations were abnormal cardiotocogram (25%) and blood-stained amniotic fluid (20%) in the scarred group, and postpartum haemorrhage (50%) and shock (33%) in the unscarred group. Repair of the uterus with or without tubal ligation was performed in 95% of the patients with scarred uteri, whereas 67% of the patients with unscarred uteri underwent total abdominal hysterectomy with or without salpingo-oophorectomy. There was 1 (3.8%) maternal death. Maternal morbidity included bladder injuries, broad ligament haematoma, disseminated intravascular coagulation and gastrointestinal bleeding. The overall incidence of fetal loss was 7.4%. When compared to a previous study on uterine rupture in the same hospital, there was an improvement in obstetric performance.

Topics: Adult; Amniotic Fluid; Blood; Cardiotocography; Cesarean Section; Cicatrix; Delivery, Obstetric; Fallopian Tubes; Female; Fetal Death; Humans; Hysterectomy; Incidence; Infant, Newborn; Maternal Mortality; Obstetric Labor Complications; Ovariectomy; Oxytocin; Postpartum Hemorrhage; Pregnancy; Retrospective Studies; Shock; Singapore; Sterilization, Tubal; Treatment Outcome; Uterine Diseases; Uterine Rupture

To evaluate the symptoms and signs of scar rupture with special reference to intrauterine pressure measurement a retrospective analysis of labour records of those women who had trial of labour with a previous Caesarean scar in the National University Hospital over a period of 6 years (1985-1990) was carried out. Known symptoms and signs associated with scar rupture, cardiotocographic tracings and fetal and maternal outcome in these patients were studied. Of the 1,018 women with previous Caesarean scar (4.2% of our pregnant population at term) 722 (70.9%) had trial of labour; 70% delivered vaginally. There were 4 (0.55%) incomplete and 5 (0.69%) complete scar ruptures. All 9 women had an oxytocin infusion; 3 were diagnosed postdelivery (all 3 had complete ruptures); 3 of the 6 who had rupture prior to delivery had sudden reduction in uterine activity, 1 had scar pain and prolonged bradycardia and 2 had no symptoms or signs. Continuous cardiotocography with intrauterine pressure measurements may help to identify scar rupture early and may be of value especially in those who have an oxytocin infusion.

Topics: Apgar Score; Birth Weight; Cardiotocography; Cesarean Section; Cicatrix; Female; Humans; Infant, Newborn; Obstetric Labor Complications; Oxytocin; Pregnancy; Retrospective Studies; Rupture, Spontaneous; Trial of Labor; Uterine Rupture; Vaginal Birth after Cesarean

A series of 12 trials of scar associated with scar rupture is reviewed. Uterine activity patterns were assessable in 10 of them. Clinical features and characteristics of the intrauterine pressure waveform and uterine activity are discussed in relation to the integrity of the scar.

Topics: Cardiotocography; Cesarean Section; Cicatrix; Female; Humans; Obstetric Labor Complications; Oxytocin; Pregnancy; Pressure; Retrospective Studies; Rupture; Trial of Labor; Uterine Contraction; Uterus; Vaginal Birth after Cesarean

A review of 393 patients undergoing trial of labor after one or more previous cesarean sections was performed. Three hundred patients had an unknown uterine scar, 88 patients had a documented low cervical transverse incision, and five patients had a prior low vertical incision. The rate of vaginal delivery and maternal and fetal morbidity was no different in those patients with an unknown prior uterine incision compared with those having a known prior low cervical transverse incision. In 66 of the patients with a documented low cervical transverse incision, the original operative record was reviewed in regard to single-layer closure of the uterine incision versus double-layer closure or imbricating technique. No patient with a double-layer uterine closure had a subsequent dehiscence, whereas three patients with a prior single-layer closure exhibited scar separation. These data suggest that neither an unknown scar nor a single-layer uterine closure places the mother or fetus at greater risk.

Topics: Cesarean Section; Cicatrix; Female; Humans; Infant, Newborn; Labor, Induced; Oxytocin; Pregnancy; Puerperal Infection; Trial of Labor; Uterine Rupture; Uterus

During the ten year study period, April 1972 to March 1982, there were 1,498 patients, with one or more prior caesarean section delivered at the Regional Hospital, University College, Galway. Trial of scar (TOS) was undertaken in 844 (56.34%) patients and the remaining 654 (43.66%) had a repeat elective caesarean section. There were 546 (64.69%) TOS patients who had some form of induction/augmentation and in 269 (49.26%) oxytocin was used, singularly and in combination with other induction methods and successful vaginal delivery was attained in 222 (82.52%) patients. There was no increased incidence of true rupture (TR) or bloodless dehiscence (BD) associated with the use of induction/augmentation or oxytocin in this series. There was a 50% perinatal mortality associated with TR, but there was no maternal death in TOS patients, with or without a successful trial. An incidence of TR of 1:169 patients is no justification for the "once a section, always a section" idiology, widely practiced in North America today.

Topics: Cesarean Section; Cicatrix; Extraction, Obstetrical; Female; Humans; Infant, Newborn; Labor, Induced; Oxytocin; Pregnancy; Reoperation; Retrospective Studies; Trial of Labor; Uterine Contraction; Uterus

Seventeen cases of uterine rupture in late pregnancy managed over an eight-year period in one hospital in Hong Kong were analysed. Labour was associated with rupture in 16 cases, including ten with one or more previous caesarean section scars. Rupture occurring in an unscarred uterus was associated with high fetal losses and all required hysterectomy. All of these patients had at least one previous vaginal delivery, in contrast to the patients with a scarred uterus. Labour should be closely monitored in multiparous patients with or without a uterine scar, and oxytocics should be used carefully. Patients with previous sections who are scheduled for repeat elective sections should be delivered before 39 weeks.

Topics: Cesarean Section; Cicatrix; Female; Humans; Hysterectomy; Labor, Induced; Obstetric Labor Complications; Oxytocin; Postoperative Complications; Pregnancy; Pregnancy Complications; Uterine Rupture

The American College of Obstetricians and Gynecologists has supported the concept of a trial of labor in patients with a previous lower uterine transverse cesarean section, and its safety is generally accepted. The purpose of this report was to present the results of a year-long, prospective study in which the indications for trial of labor were liberalized. Only patients with a previous classical incision or "T" incision on the uterus were excluded. Two hundred seventy-two patients elected to undergo a trial of labor. Vaginal delivery occurred in 216 patients (76.5%). Oxytocin was used as needed, and epidural anesthesia was used in all patients who requested it. One uterine rupture occurred in a patient with a single lower transverse scar. The results of this study suggest that a trial of labor is a safe alternative for patients with a previous single or multiple lower uterine transverse incision or a lower uterine vertical incision. In addition, the use of epidural anesthesia and oxytocin appears safe in patients undergoing a trial of labor.

Topics: Anesthesia, Epidural; Anesthesia, Obstetrical; Cesarean Section; Cicatrix; Female; Humans; Length of Stay; Oxytocin; Pregnancy; Reoperation; Trial of Labor; Uterine Rupture

Fifty-two patients who had had a single previous caesarean section were submitted to a trial of scar. Labour was monitored by internal tocography and direct fetal heart rate monitoring. Oxytocin infusion was employed when uterine work proved to be inadequate. The oxytocin-augmented and unstimulated groups were compared. Oxytocin augmentation improved uterine work and did not result in significant fetal or maternal morbidity or mortality. Internal tocography was found to be of value, but fetal heart rate monitoring was essential.

Topics: Asphyxia Neonatorum; Cesarean Section; Cicatrix; Female; Fetal Distress; Humans; Infant, Newborn; Labor, Obstetric; Oxytocin; Pregnancy; Uterine Contraction

The authors report on their experience delivering 87 women vaginally with previous cesarean sections. Epidural anesthesia does not appear to be contraindicated as long as the block is not higher than the level of the tenth thoracic dermatome. The use of an infusion of oxytocin should be accompanied by internal fetal heart monitoring. Furthermore, induction of labor with oxytocic agents appears preferable.

Topics: Anesthesia, Epidural; Anesthesia, Obstetrical; Cesarean Section; Cicatrix; Delivery, Obstetric; Female; Humans; Labor, Induced; Oxytocin; Pregnancy; Uterus

The hypothalamic magnocellular system of the rhesus monkey was studied with specific immunocytochemical techniques in animals that had undergone hypothalamic lesions. The results indicate that this system maintains a regenerative capacity even when its tracts are interrupted within the hypothalamus. New neurohemal units are reconstituted from newly formed vessels within the scar as well as from preexistent blood vessels, such as perforating and pial arterioles, and the vessels of the pars tuberalis of the pituitary gland, which normally do not contain neurosecretory terminals.

Topics: Animals; Brain Diseases; Cicatrix; Female; Fluorescent Antibody Technique; Haplorhini; Hypothalamus; Macaca mulatta; Neurophysins; Oxytocin; Regeneration; Vasopressins

Topics: Adult; Cesarean Section; Cicatrix; Female; Humans; Oxytocin; Pregnancy; Surgical Wound Dehiscence; Uterine Perforation; Uterine Rupture

Topics: Cesarean Section; Cicatrix; Female; Humans; Oxytocin; Pregnancy; Rupture, Spontaneous; Uterine Rupture

Topics: Abortion, Spontaneous; Adult; Cesarean Section; Cicatrix; Female; Gestational Age; Humans; Hysterosalpingography; Infusions, Parenteral; Oxytocin; Pregnancy; Time Factors; Uterine Rupture

In the absence of a recurring indication for caesarean section vaginal delivery in subsequent pregnancy is a "trial of scar," with potentially serious implications for mother and baby. Labour under caudal analgesia was carefully supervised for 75 women with a surgically scarred uterus-due to lower segment section in 72, abdominal hysterotomy in one, and transcavity myomectomy in two. Every caesarean scar was assessed digitally during labour and every uterus was examined after delivery. Caudal analgesia provided a painless labour and delivery and made scar assessment easy. Controlled intravenous Syntocinon infusion was given to 25 patients. One scar dehiscence occurred early in labour and one in the second stage. Seventy mothers had 71 vaginal deliveries with one pair of twins and one breech. There was one stillbirth and no neonatal death. There were five repeat sections.

Topics: Anesthesia, Obstetrical; Anesthesia, Spinal; Apgar Score; Blood Pressure Determination; Cesarean Section; Cicatrix; Delivery, Obstetric; Extraction, Obstetrical; Female; Fetal Death; Humans; Labor Presentation; Obstetric Labor Complications; Oxytocin; Pain; Pregnancy; Pulse; Uterus

Topics: Adolescent; Adult; Cesarean Section; Cicatrix; Female; Fetal Death; Humans; Hysterectomy; Maternal Age; Maternal Mortality; Oxytocin; Parity; Pregnancy; Uterine Rupture

Topics: Adult; Cesarean Section; Cicatrix; Delivery, Obstetric; Female; Humans; Labor Presentation; Labor, Obstetric; Oxytocin; Pregnancy; Rupture