oxytocin and Diabetes--Gestational

Very Early Pregnancy (< 15 years at delivery) is suggested as a risk factor for adverse pregnancy outcome including low birth weight (LBW), preterm birth (PTB), small for gestational age (SGA) infants, stillbirth, and neonatal mortality.. To systematically review the risk of an infant being born LBW/ PTB/SGA/stillbirth or neonatal mortality among patients < 15 years of age. Search strategy: Medline, Embase, CINAHL, and bibliographies of identified articles were searched for English language studies.. Selection criteria: Studies reporting birth outcomes to mothers < 15 years of age with an appropriate control group of older gravidas. Data collection and analysis: A single reviewer collected data and assessed the quality of the studies for biases in sample selection, correct age cohorts, confounder adjustment, analytical, outcome assessments, and attrition. Main results: Forty-six studies were located with very early adolescent pregnancy. Of these, only 21 papers had the correct age group (< 15 years) with a comparison cohort. The studies found in the very early adolescent pregnancy: Increased risk of SGA; Increased risk of LBW < 2,500 gms; Increased risk of PTD < 37 weeks; Decreased risk of DM; Decreased risk of cesarean section; Decreased risk of use of pitocin/active phase length; Conflicting risks for Preeclampsia/VLBW/Episiotomy/instrumental delivery rates.. Very early adolescent pregnancies (< 15 years) do not have universally grim outcomes as normally quoted. Very early adolescent pregnancies have decreased risk of cesarean delivery, DM, and of active phase disorders. Further, many of the adverse outcomes may be ameliorated with earlier, adolescent-focused, and improved antenatal care.

Topics: Adolescent; Cesarean Section; Diabetes, Gestational; Female; Humans; Infant, Low Birth Weight; Infant, Small for Gestational Age; Obstetrical Forceps; Oxytocics; Oxytocin; Pregnancy; Pregnancy Outcome; Premature Birth

Topics: Adult; Blood Transfusion; Combined Modality Therapy; Diabetes, Gestational; Female; Follow-Up Studies; Humans; Monitoring, Physiologic; Oxytocin; Postpartum Hemorrhage; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Third; Risk Assessment; Severity of Illness Index; Treatment Outcome; Ultrasonography; Uterine Balloon Tamponade; Uterine Inertia

The Gerard W. Ostheimer lecture is delivered at the Society for Obstetric Anesthesia and Perinatology Annual Meeting. The lecture provides a comprehensive review of the previous year's literature in obstetric anesthesia, obstetrics, perinatology, and health services research relevant for obstetric anesthesiologists. This article covers several of the major themes that emerged from the 2010 literature.

Topics: Anesthesia, Obstetrical; Anesthetics, Local; Diabetes, Gestational; Female; Humans; Obesity; Oxytocin; Patient Safety; Post-Dural Puncture Headache; Pregnancy

This article describes the use of a balloon catheter introduced via the femoral artery into the abdominal aorta without the use of fluoroscopy to stabilize six patients with life-threatening post-partum haemorrhage. The femoral artery was localized blindly or with the use of ultrasound. Immediate control of the bleeding was achieved in all patients, and the procedure was believed to be life saving for some patients. One patient with a narrow and fragile aorta had an aortic rupture necessitating surgical repair, which may have been caused by the balloon. In these six cases, the procedures were carried out by interventional radiologists. However, this procedure can also be performed by anaesthesiologists or surgeons who are trained in vascular access techniques.

Topics: Adult; Blood Pressure; Blood Substitutes; Cardiotonic Agents; Catheterization; Diabetes, Gestational; Embolization, Therapeutic; Erythrocyte Transfusion; Female; Glucose Intolerance; Humans; Hysterectomy; Infant, Newborn; Intra-Aortic Balloon Pumping; Misoprostol; Oxytocics; Oxytocin; Patient Care Team; Postpartum Hemorrhage; Pregnancy; Ultrasonography

Prevention of the permanent sequelae of fetal hyperinsulinemia, namely hypertension and obesity, in infants born to mothers with gestational diabetes mellitus (GDM) has remained unresolved. Efforts to reduce fetal macrosomia by attempting to maintain blood sugar within a certain range have certainly failed. We have tried to eliminate fetal macrosomia by accelerating fetal maturation and delivery before the 36th week.. Acceleration of fetal maturation was achieved by endogenous release of thyrotropin-releasing hormone brought about by periodic fluctuations in fetal oxygenation resulting from oxytocin-produced uterine contractions. Fifteen patients with GDM at 33-35 weeks, six of whom had previously given birth to a macrosomic fetus, agreed to participate in the study. Oxytocin was given for 6 h per day to produce regular contractions. In 13 patients it was given for 5 days, and in two patients for 7 days to reach a lecithin/sphingomyelin (L/S) ratio indicative of fetal maturity.. Eleven patients delivered vaginally after induction of labor and four delivered by Cesarean section. The mean Apgar score at 5 min was 9.13, and the mean birth weight was 2917 g (range 2100-3400 g). No newborn had respiratory difficulties, although four had short episodes of tachypnea. All were cared for in the regular nursery and all were discharged home with their mothers.. Acceleration of fetal maturation, and delivery between 34 and 36 weeks, appears to be a promising means to reduce or even eliminate the permanent sequelae of fetal hyperinsulinemia in pregnancies complicated by GDM.

Topics: Adult; Diabetes, Gestational; Drug Administration Schedule; Female; Fetal Macrosomia; Fetal Organ Maturity; Humans; Infusions, Intravenous; Labor, Induced; Oxytocin; Pregnancy; Treatment Outcome; Uterine Contraction

Induction of labour is associated with increased risk for caesarean delivery among nulliparous women. The aims of this study were to evaluate the risk factors for caesarean delivery and to investigate the risk of maternal and neonatal infections in nulliparous women undergoing induction of labour by Foley catheter.. This clinical retrospective study of 432 nulliparous women with singleton pregnancy and intact amniotic membranes at or beyond 37 gestational weeks scheduled for induction of labour by Foley catheter was conducted over the course of one year, between January 2012 and January 2013, in Helsinki University Hospital. The main outcome measures were caesarean section rate and maternal and neonatal infections. Univariate and multivariate logistic regressions were used to estimate relative risks by odds ratios with 95% confidence intervals.. The caesarean section rate was 39.1% (n = 169). In multivariate regression analysis, the factors associated with caesarean section were the need for oxytocin for labour induction [OR 2.9 (95% CI 1.8-4.5) p < 0.001] and early epidural analgesia [OR 9.9 (95% CI 2.1-47.5), p = 0.004]. The maternal intrapartum infection rate was 6.3%, and the clinical neonatal infection rate was 2.8%. In multivariate analysis, gestational diabetes was associated with maternal intrapartum infection [OR 4.3 (95% CI 1.7-11.0, p = 0.002] and early epidural analgesia with neonatal clinical sepsis [OR 10.5 (95% CI 1.4-76), p = 0.02].. Oxytocin induction and early epidural analgesia were associated with caesarean delivery. Gestational diabetes and early epidural analgesia were associated with infectious morbidity. Since the first caesarean delivery has a major impact on subsequent pregnancies, optimising labour induction among nulliparous women is important.

Topics: Adult; Analgesia, Epidural; Analgesia, Obstetrical; Cesarean Section; Diabetes, Gestational; Female; Humans; Infant Health; Infant, Newborn; Labor, Induced; Multivariate Analysis; Obstetric Labor Complications; Oxytocics; Oxytocin; Parity; Pregnancy; Pregnancy Complications, Infectious; Retrospective Studies; Urinary Catheterization

The prevalence of births worldwide complicated by diabetes mellitus is increasing. In the UK, for example, <25% of diabetic women have a non-instrumental vaginal delivery. Strikingly, more than half the Caesarean sections (CS) in these patients are non-elective, but the reasons for this are not understood. We have tested the hypothesis that poor myometrial contractility as a consequence of the disease contributes to this high CS rate.. We compared spontaneous, high K depolarisation and oxytocin-induced contractions from diabetic and matched control patients having an elective CS. To investigate the mechanism of any differences we measured intracellular Ca, and performed western blotting and compared the tissues histologically.. There was significantly decreased contraction amplitude and duration in uteri from diabetic compared with control patients, even when possible confounders such as BMI were analysed. Reduced intracellular calcium signals and expression of calcium entry channels were found in uteruses from diabetic patients, which, along with a reduction in muscle content found on histological examination, could explain the reduced force. Myometrium from diabetic patients was responsive to oxytocin, but still did not reach the levels found in non-diabetic patients.. These are the first data investigating myometrium in diabetic patients and they support the hypothesis that there is poorer contractility even in the presence of oxytocin. The underlying mechanism is related to reduced Ca channel expression and intracellular calcium signals and a decrease in muscle mass. We conclude that these factors significantly contribute to the increased emergency CS rate in diabetic patients.

Topics: Adult; Body Mass Index; Calcium; Calcium Channels; Cesarean Section; Diabetes Complications; Diabetes Mellitus; Diabetes, Gestational; Female; Humans; Oxytocin; Pregnancy; Pregnancy Complications; Signal Transduction; Uterine Contraction

1. Diabetes is one of the most frequent complications of gestation, affecting approximately 7% of pregnancies. However, little is known about its effects on electrically and pharmacologically stimulated myometrial contractility. The aim of the present study was to investigate the consequences of streptozotocin (STZ)-induced diabetes on: (i) electrical field stimulation (EFS)-evoked contraction of isolated uterine rings as a function of gestational age; and (ii) the uterotonic and tocolytic actions of α- and β-adrenoceptor stimulation, respectively. The effects of oxytocin in late pregnancy were also investigated. 2. During pregnancy, EFS-evoked contractions of isolated uterine rings from intact rats declined, whereas isolated uterine rings from diabetic rats exhibited continuously low sensitivity to EFS. 3. In non-pregnant rats, diabetes resulted in increased noradrenaline-mediated contractility and a decreased relaxation response to terbutaline. At the mRNA level, diabetes enhanced the expression of α1B-adrenoceptors in non-pregnant rats from 14.65 to 18.39 μg/mL (P < 0.05), whereas the expression of α1D-adrenoceptors decreased (from 42.87 to 35.67 μg/mL; P < 0.05). During pregnancy, the responses to these sympathomimetics did not differ between diabetic and intact rats. 4. In late pregnancy (on Days 15 and 21), oxytocin caused greater maximum contractility of uterine rings from diabetic rats without affecting the EC(50). In addition, on Day 15 of pregnancy, the expression of oxytocin receptors in the myometrium of diabetic rats was higher than that in intact rats. 5. The results of the present study indicate that experimental diabetes facilitates gestation-induced denervation and increases myometrial sensitivity to oxytocin in late pregnancy. If similar mechanisms operate in humans, this could contribute to a tendency to premature uterine contractions in diabetes-complicated pregnancies.

Topics: Adrenergic alpha-1 Receptor Agonists; Adrenergic beta-2 Receptor Agonists; Animals; Diabetes Mellitus, Experimental; Diabetes, Gestational; Dose-Response Relationship, Drug; Electric Stimulation; Female; Gestational Age; Muscle Relaxation; Myometrium; Norepinephrine; Oxytocics; Oxytocin; Pregnancy; Rats; Rats, Sprague-Dawley; Receptors, Adrenergic, alpha-1; Receptors, Adrenergic, beta-2; Receptors, Oxytocin; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger; Streptozocin; Terbutaline; Uterine Contraction

Postpartum haemorrhage may be a life threatening complication. Seven cases are described in which the B-Lynch surgical technique (a brace like suture over the uterus) was successful in obtaining haemostasis. In four cases, the B-Lynch technique was the first line of treatment. In three cases, the B-Lynch was used after, or in combination with artery or other vessel ligation.

Topics: Adult; Diabetes, Gestational; Erythrocyte Transfusion; Female; Gestational Age; Humans; Iliac Artery; Labor, Induced; Ligation; Obstetric Surgical Procedures; Oxytocin; Plasma; Platelet Transfusion; Postpartum Hemorrhage; Pregnancy

To evaluate the effect of early amniotomy in term gestation on the mode of delivery and pregnancy outcome in comparison with premature rupture of membranes (PROM) and oxytocin induction.. The study population consisted of 60 consecutive parturients induced by early amniotomy. The two comparison groups were 147 women admitted with term PROM and 65 patients induced by oxytocin. All study participants were evaluated prospectively and had unfavorable cervical scores.. The duration of the first stage of labor was significantly longer in the PROM group (987.8 +/- 572.3 min) as compared with the early amniotomy group (615.0 +/- 389.6 min) and the oxytocin induction group (650.9 +/- 349.5 min, P<0.001). Higher rates of CS were found in the study group (26.7%) as compared to the controls (11.6% in the PROM and 16.9% in the oxytocin groups, p=0.012). Neonatal outcome was similar in all groups. A stratified analysis comparing the risk of CS while controlling for a previous one did not show a significant difference between the early amniotomy and the oxytocin administration groups.. Early amniotomy is associated with a higher rate of CS. While controlling for a previous CS, both ways of induction were comparable. In order to decrease the CS rates, induction should probably start with cervical ripening techniques in order to improve the Bishop scores.

Topics: Adult; Amnion; Cesarean Section; Delivery, Obstetric; Diabetes, Gestational; Female; Fetal Membranes, Premature Rupture; Fetal Monitoring; Fetal Movement; Gestational Age; Heart Rate, Fetal; Humans; Hypertension; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Prospective Studies

The present study assessed the possible role of oxytocin in the deterioration of glucose tolerance in gestational diabetes. Plasma levels of oxytocin, insulin, glucagon and glucose were measured at the time of a 400-kcal breakfast meal tolerance test in 12 women with gestational diabetes and 12 normal pregnant women in the third trimester. The gestational diabetic women had higher basal levels of insulin and an enhanced, delayed and prolonged insulin response to the breakfast. The same differences occurred in the glucose levels. There was no significant difference in the glucagon levels between the two groups. In the normal pregnant women, a significant (p < 0.05) though small rise in glucagon levels occurred 30 min after the ingestion of the breakfast. Oxytocin levels were not affected by the breakfast, and there was no clear difference between the two groups. The metabolic differences between the normal pregnant and gestational diabetic women were not related to any differences in oxytocin levels. In conclusion, we found no evidence of a role of oxytocin in the alteration of glucose metabolism in women with gestational diabetes. However, since alterations in oxytocin levels of possible significance for an impaired glucose tolerance are found in type 1 diabetic and extremely obese patients, further studies are needed in women with gestational or manifest diabetes.

Topics: Adult; Blood Glucose; Diabetes, Gestational; Female; Glucagon; Glucose Tolerance Test; Humans; Insulin; Oxytocin; Pregnancy; Pregnancy Trimester, Third