oxytocin and Fetal-Death

Guidance for postabortion care (PAC) is established for the first trimester but limited in the second trimester.. To establish evidence-based recommendations for PAC in the second trimester.. Medline, POPLINE, and the Cochrane Central Register of Controlled Trials were searched with terms related to second-trimester PAC, including fetal demise, ruptured membranes, and incomplete abortion. The reference lists of retrieved articles were also searched.. Clinical trials and comparative studies of women presenting in the second trimester (12-28weeks) were included if more than 50% of participants met PAC criteria or if outcomes for PAC were analyzed separately.. Data were extracted from included studies. When interventions in at least two articles were comparable, a meta-analysis was performed.. Overall, 17 studies of 1419 women met inclusion criteria. Misoprostol given vaginally, sublingually, or buccally was associated with shorter expulsion times than was oral misoprostol. Additionally, 200μg of misoprostol was more effective than lower doses. Pretreatment with mifepristone decreased expulsion time. Misoprostol was more effective than oxytocin.. Misoprostol with or without mifepristone is an effective treatment for second-trimester PAC. The minimum misoprostol dose is 200μg vaginally, sublingually, or buccally every 6-12hours.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Incomplete; Aftercare; Cohort Studies; Female; Fetal Death; Fetal Membranes, Premature Rupture; Humans; Mifepristone; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Pregnancy Trimester, Second; Randomized Controlled Trials as Topic

This review of vaginal birth after caesarean (VBAC) focuses on practical issues that will be useful for the physician in training and the obstetrician in clinical practice. Although VBAC has long been a common practice in many European nations, the same has not been true in North America. As recently as 1970 essentially all hospitals in the United States maintained a policy that women with a history of previous caesarean delivery would undergo repeat caesarean operations for any and all subsequent births. Although VBAC rates in many nations increased dramatically in the 1980s and 1990s, many aspects of trial of labour (also known as trial of scar) remain controversial at the dawn of the 21st century.

Topics: Female; Fetal Death; Humans; Informed Consent; Maternal Mortality; Oxytocin; Parity; Patient Education as Topic; Placenta Accreta; Placenta Previa; Pregnancy; Prostaglandins; Risk Factors; Trial of Labor; Uterine Rupture; Vaginal Birth after Cesarean

In addition to questions raised about the efficacy of many tocolytics, appropriate concern has been voiced about the safety of these potent drugs. Although some degree of risk for adverse effects with drugs promising a strong therapeutic effect can be accepted, caution needs to be exercised when benefits are marginal or unproven. Unfortunately, some of the tocolytics, most notably the betamimetics and magnesium sulfate, have been found to have considerable potential for adverse maternal cardiovascular and respiratory effects. Although less clearly established, the use of indomethacin appears to be associated with increased fetal and neonatal risks. Concerning magnesium sulfate, in addition to the well-known maternal effects, the accumulating evidence showing an increased frequency of adverse outcomes in the fetus and neonate has led to the recommendations to abandon its use entirely as a tocolytic. Given the limitations of our current state of knowledge, nifedipine would appear to be among the more efficacious and safer tocolytics available to use when properly indicated.

Topics: Adrenergic beta-Agonists; Calcium Channel Blockers; Cyclooxygenase Inhibitors; Female; Fetal Death; Fetal Diseases; Humans; Magnesium Sulfate; Obstetric Labor, Premature; Oxytocin; Pregnancy; Randomized Controlled Trials as Topic; Tocolytic Agents; Vasotocin

The labour-inducing activity of RU486 (mifepristone) in different species including the human is relatively low in advanced stages of pregnancy. However, it increases myometrial responsiveness to prostaglandins and oxytocin and it also induces cervical ripening. The labour-inducing and labour-conditioning activities of various progesterone antagonists (antiprogestins) and the progesterone synthase inhibitor epostane were analysed at the pre-term period of pregnancy in various animal models. In guinea pigs and Tupaja belangeri (species showing no spontaneous progesterone withdrawal prior to parturition) onapristone, which is a 'pure' progesterone receptor antagonist, effectively induced parturition at pre-term but not during mid-pregnancy. On the other hand, antiprogestins showing mixed agonist/antagonist activities (e.g. RU486, lilopristone, ZK 112993) and epostane were only partially effective in inducing pre-term parturition in both species. In guinea pigs, all anti-progestins increased myometrial responsiveness to oxytocin and prostaglandins, onapristone being approximately 10 times more effective than RU486. This effect was seen at doses of antiprogestins which alone did not induce labour at all. The increase in oxytocin response in onapristone-primed guinea pigs was not accompanied by an increase in myometrial oxytocin receptors, although a marked increase in myometrial gap junctions occurred. Antiprogestins induced a pronounced cervical ripening in pregnant and non-pregnant guinea pigs and rats independently of the action of prostaglandins. The infiltration of polymorphonuclear granulocytes, macrophages and mast cells into the cervix after antiprogestin treatment indicates that cytokines or other chemotactic agents may mediate this effect. In guinea pigs in late pregnancy, the cytokines interleukin (IL)-8 and IL-1 beta induced a cervical ripening morphologically similar to the antiprogestin effect. Our data indicate that progesterone may control uterine quiescence by reducing myometrial responsiveness, i.e. by down-regulating gap junctions and inhibiting cervical maturation, but not by suppressing the release of endogenous uterine stimulants which may be controlled by other factors. Antiprogestins may be used to prepare the uterus for oxytocin- and prostaglandin-induction of labour without influencing uterine motor function. Onapristone may be a preferable antiprogestin as an adjunct to labour and delivery at term because it has high labour-conditio

Topics: Abortion, Induced; Animals; Cervix Uteri; Delivery, Obstetric; Double-Blind Method; Drug Interactions; Estrogen Antagonists; Female; Fetal Death; Hormone Antagonists; Humans; Labor, Induced; Mammals; Multicenter Studies as Topic; Oxytocin; Pregnancy; Pregnancy Trimester, Second; Pregnancy, Animal; Progesterone; Prostaglandins; Randomized Controlled Trials as Topic; Species Specificity; Uterine Contraction; Uterus

Topics: Administration, Intravaginal; Cervix Uteri; Dinoprost; Dinoprostone; Female; Fetal Death; Humans; Labor, Induced; Oxytocin; Pregnancy; Prostaglandins; Treatment Outcome; Uterine Contraction

Prostaglandin F2a was used for termination of pregnancy in two groups of patients. The first included eighteen patients with either missed abortion or intrauterine fetal death, and were treated by intrauterine-extraamniotic infusion of 20 mg prostaglandin F2a. The treatment was successful in 14 patients (mean induction-abortion interval 6.7 hours). Four patients, where the above method failed to induce labor, were given intravenously prostaglandin F2a or oxytocin simultaneously or separately; the expulsion time ranged from 12 to 48 hours. The second group included twelve patients who underwent a therapeutic abortion following either a diagnosis of fetal congenital abnormality or because of a maternal indication. The therapeutic abortion was performed using prostaglandin F2a (25-40 mg) via amniocentesis. The treatment was successful in all patients (mean induction-delivery interval 10.6 hours).

Topics: Abortion, Missed; Abortion, Therapeutic; Amniotic Fluid; Dinoprost; Drug Administration Schedule; Drug Evaluation; Drug Therapy, Combination; Female; Fetal Death; Humans; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Trimester, Second; Retrospective Studies; Time Factors

Injection of prostaglandin (PG) F-2 alpha or its analogues has provided a technique to induce parturition after Day 110 of gestation in the sow. The mean interval from PG injection to parturition ranges from 24 to 28 h, but only 50-60% of the sows farrow during an 8-10 h working day, and as many as 20% of sows may begin parturition before the injection of PG or less than 22 h after the injection. The duration of parturition is positively associated with the incidence of stillbirths and perinatal death so that techniques to reduce the duration of parturition may save piglets. Early parturition has been prevented by feeding sows progestagens, PG synthesis inhibitors and hypothalamic function inhibitors. These compounds were detrimental to piglet survival if they delayed parturition too long after the expected time of parturition. Parturition was delayed in sows up to 1.5 days by altrenogest, 1.6 days by meclofenamic acid, 2.7 days by indomethacin, and 3 days by methallibure without increased incidence of stillborn piglets compared with control sows. Injection of PG after administration of altrenogest or meclofenamic acid was successful in experiments with sows; parturition could be confined to a 5-day working week with no increase in stillborn piglets compared with control sows. Relaxin injected at 48 and 24 h before or only 24 h before injection of PG increased the proportion of sows farrowing 22-32 h after PG to 86.2% compared with sows injected only with PG (53.3%, P less than 0.01). Oxytocin injected 20 h after injection of PG increased the proportion of sows farrowing 20-28 h after PG to 90.4% compared with sows injected only with PG (49.2%, P less than 0.005). Injection of 25-60 i.u. ACTH on Day 110 of gestation did not shorten the length of gestation, but did decrease the incidence of still born piglets by 0.2 piglets/litter (P less than 0.05). An injection of the beta-adrenergic antagonist, carazolol, during labour before the birth of the first piglet decreased the duration of parturition and the incidence of stillborn piglets particularly in primiparous sows (P less than 0.05). Carazolol injected with oxytocin 20 h after injection of PG decreased the interval from PG to parturition by 2 h compared with sows injected with only PG and oxytocin.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Adrenergic beta-Antagonists; Adrenocorticotropic Hormone; Animal Husbandry; Animals; Dinoprost; Female; Fetal Death; Gestational Age; Indomethacin; Labor, Obstetric; Meclofenamic Acid; Methallibure; Oxytocin; Pregnancy; Progesterone Congeners; Propanolamines; Prostaglandins F; Relaxin; Swine; Trenbolone Acetate

Topics: Anencephaly; Breech Presentation; Congenital Abnormalities; Craniotomy; Delivery, Obstetric; Dinoprostone; Female; Fetal Death; Humans; Hydrocephalus; Labor Presentation; Labor, Induced; Oxytocin; Pregnancy; Prostaglandins E

In the last third of pregnancy the unspecific bacterial diseases of placenta, umbilical cord and membranes differ from those in earlier months [154; 155; 85]. There is a parallel change in the localization of fetal organs affected. Pathologic anatomical clarification of this led to the conceptual definition of the rare extra-amnial placental-fetal path of infection on the one hand and of primary intra-amnial infection with secondary chorion-amnionitis on the other hand and to identification of the amniotic infection syndrome as a typical entity at the end of pregnancy [19]. While the amnionic sac is closed, unspecific fetal inflammation is rare. Generally this happens only after rupture of the membranes. Since the amniotic infection syndrome often produces only minor clinical symptoms and since fetal infection probably starts early, one searched for means of assessing the risk of infection independently from symptoms. In comparative series of investigations of pregnancies with and without premature rupture of the membranes, cases of neonatal death from infection were preceded by signs of inflammation in placenta, umbilical cord and membranes. Together with the fetal and maternal infections they depended on the length of time between rupture and the onset of labor. pns. The data now available give a clear picture of the development of the inflammatory processes in mature and premature children and suffice for the assessment of fetal and maternal risks.

Topics: Abortion, Septic; Amnion; Anti-Bacterial Agents; Cesarean Section; Female; Fetal Death; Fetal Diseases; Fetal Membranes, Premature Rupture; Humans; Hysterectomy; Infant, Newborn; Infant, Newborn, Diseases; Obstetric Labor Complications; Obstetric Labor, Premature; Oxytocin; Placenta Diseases; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Trimester, Third; Time Factors

Topics: Adrenocorticotropic Hormone; Animals; Birth Order; Carbachol; Dexamethasone; Dichlorvos; Enterovirus Infections; Female; Fetal Death; Hemoglobins; Hypoxia; Leptospirosis; Obstetric Labor Complications; Oxytocin; Parvoviridae; Pregnancy; Prostaglandins; Rupture; Streptococcal Infections; Stress, Physiological; Swine; Swine Diseases; Umbilical Cord; Virus Diseases

Topics: Acid-Base Equilibrium; Anesthesia, Epidural; Asphyxia Neonatorum; Blood Chemical Analysis; Blood Specimen Collection; Delivery, Obstetric; Echocardiography; Electrocardiography; Female; Fetal Death; Fetal Diseases; Fetal Heart; Heart Rate; Humans; Hydrogen-Ion Concentration; Hypotension; Infant Mortality; Infant, Newborn; Injections, Intravenous; Methods; Monitoring, Physiologic; Obstetric Labor Complications; Oxytocin; Phonocardiography; Pregnancy; Pregnancy Complications, Cardiovascular; Scalp; Uterus

Topics: Amniotic Fluid; Cephalometry; Deglutition; Estrogens; Female; Fetal Death; Fetal Diseases; Fetal Heart; Fetus; Growth; Heart Rate; Humans; Hypoxia; Infant, Newborn; Infant, Premature; Insulin; Leukocytes; Movement; Oxytocin; Phosphatidylcholines; Phospholipids; Placenta; Pregnancy; Sphingomyelins; Transferrin; Ultrasonography; Urea

Topics: Blood Coagulation Disorders; Cervix Uteri; Dilatation; Electricity; Female; Fetal Death; Humans; Hypertonic Solutions; Infant, Newborn; Jaundice, Neonatal; Labor, Induced; Labor, Obstetric; Oxytocin; Pregnancy; Prostaglandins; Regional Blood Flow; Sodium Chloride; Time Factors; Urination; Uterus; Water Intoxication

Topics: Amniotic Fluid; Blood Glucose; Dehydroepiandrosterone; Delivery, Obstetric; Diet, Diabetic; Embryonic and Fetal Development; Estriol; Estrogens; Female; Fetal Death; Fetal Diseases; Humans; Hypertension; Infant, Newborn; Insulin; Length of Stay; Nutritional Physiological Phenomena; Osmolar Concentration; Oxytocin; Pre-Eclampsia; Pregnancy; Pregnancy in Diabetics; Prenatal Care; Smoking

Topics: Abortion, Induced; Animals; Cell Nucleus; Female; Fetal Death; Gestational Age; Humans; Labor, Induced; Labor, Obstetric; Oxytocin; Phospholipids; Placenta; Pregnancy; Progesterone; Rabbits; Rats; Uterus

Topics: Abortion, Therapeutic; Amnion; Female; Fetal Death; Humans; Hypertonic Solutions; Labor, Induced; Methods; Oxytocin; Placenta; Pregnancy

To compare the success rate of vaginal misoprostol versus intravenous (IV) oxytocin in termination of pregnancy in the second trimester intrauterine fetal death (IUFD).. This was an open-label randomized controlled study for 106 women with second trimester IUFD. Patients were randomly divided into two groups: women given vaginal misoprostol (400 mcg every 6 h up to 48 h) versus those given IV oxytocin (starting with 50 units up to a maximum of 300 units). When the first-line treatment (as mentioned above) failed, treatment methods were replaced with each other. When the second-line treatment failed, the patients underwent dilation and evacuation.. The first-line treatment yielded the successful rate of 88.7% versus 73.7% for misoprostol versus oxytocin, respectively (p = 0.047). Among those with first-line treatment failure, the second-line treatment yielded success rate of 85.7% versus 83.3% for misoprostol versus oxytocin (p = 0.891). The mean duration of induction to delivery in women with successful response to first-line treatment was 28.72 and 20.55 h after initially receiving misoprostol versus oxytocin, respectively (p < 0.001). While during second-line treatment, this mean interval was not significantly different among those with misoprostol versus oxytocin (p = 0.128). No severe adverse events were observed.. Vaginal misoprostol was associated with higher termination rate than oxytocin without adverse events when used as the first-line treatment. Both methods yielded the same success rate when used as the second-line treatment.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Administration, Intravaginal; Female; Fetal Death; Humans; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Pregnancy Trimester, Second

The metabolic activity of endogenous nitric oxide (NO) and the medical use of nitrovasodilatory drugs like isosorbide dinitrate have been shown to be potential inducers inducers of cervical ripening prior to surgical evacuation of the uterus.. To assess the therapeutic efficacy and safety of combined isosorbide dinitrate-oxytocin in the management of intrauterine foetal death (IUFD).. Sixty women with IUFD after 20 weeks of gestation requesting uterine evacuation were randomly selected to receive isosorbide dinitrate gel solution (80 mg/1.5 mL; n = 30) or misoprostol gel solution (100 mcg/1.5 mL; n = 30) every 3 h with a maximum of four doses or until a Bishop score >7 was reached. Subsequently, patients received a high dose of intravenous oxytocin until complete uterus evacuation was achieved. Therapeutic efficacy was evaluated by mean the relative risk of the foetal expulsion based on comparison of event rates, and the proportion of women induced to labor at 7, 10 and 15 h after the administration of isosorbide dinitrate or misoprostol. Safety was assessed on the basis of woman´s vital signs and evaluation of adverse effects, including headache, abdominal pain, pelvic pain, lower back pain, nausea, dizziness and vomiting.. The foetal expulsion rate using the isosorbide dinitrate-oxytocin combination was approximately 4.4 times, and at least 2.1 times, the foetal expulsion rate with the misoprostol-oxytocin regimen at any given point in time. The proportion of women achieved vaginal delivery at 15 hours was 100% for the isosorbide dinitrate-oxytocin group and 86.7% for the misoprostol-oxytocin group. The average delivery induction interval was significantly lower when isosorbide dinitrate-oxytocin was used (8.7 ± 3.1 h) than when misoprostol-oxytocin (11.9 ± 3.1 h) was used. A total of 20% of patients in the isosorbide dinitrate-oxytocin group recorded headache, and no cases of uterine tachysystole, haemorrhage or coagulopathy were recorded.. This study indicates that intravaginal isosorbide dinitrate followed by intravenous oxytocin was more effective than the conventional method used to induce labour in the medical management of foetal death in pregnancies after 20 weeks of gestation.. Clinicaltrials.gov NCT02488642.

Topics: Administration, Intravaginal; Adult; Cervical Ripening; Delivery, Obstetric; Double-Blind Method; Female; Fetal Death; Humans; Infusions, Intravenous; Isosorbide Dinitrate; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Prospective Studies; Time Factors; Young Adult

The aim of this study was to compare vaginal misoprostol versus intravenous (i.v.) oxytocin in the management of pregnancies with second-trimester intrauterine fetal death (IUFD).. This randomized clinical trial was conducted on 85 pregnant women with IUFD and unripe cervix who were admitted for labor induction. Forty were randomly allocated to receive 200 mcg vaginal misoprostol every 12 h, and 45 were randomly assigned to receive high-dose i.v. oxytocin (starting from 6 mU/min to reach the maximum dose of 40 mU/min). This study is registered at www.irct.ir (IRCT201307159568N5).. The induction-to-delivery interval in the misoprostol group (10.5 ± 5.3 [range 4-27] h) was significantly lower than that in the oxytocin group (14 ± 6.8 [range 4-30] h) (P = 0.009). The total hospital stay in the misoprostol group (22.6 ± 9.5 [range 12-48] h) was significantly lower than that in the oxytocin group (35.3 ± 16.4 [range 12-72] h) (P = 0.000). Although the successful induction rate was higher in the misoprostol group, this was not significant (95% vs 86.7%, P = 0.1). Placenta retention occurred more in the oxytocin group (20% vs 5%, P = 0.03).. Both vaginal misoprostol and high-dose i.v. oxytocin are highly effective in labor induction in second-trimester pregnancies with IUFD and an unripe cervix. However, vaginal misoprostol seems to be superior to i.v. oxytocin.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Administration, Intravaginal; Adult; Female; Fetal Death; Humans; Infusions, Intravenous; Misoprostol; Outcome Assessment, Health Care; Oxytocics; Oxytocin; Pregnancy; Pregnancy Trimester, Second; Young Adult

To assess whether buccal misoprostol is effective for the treatment of intrauterine fetal death.. This double-blind randomized trial was conducted at five tertiary-level hospitals in the United States and Vietnam. One hundred fifty-three women with an intrauterine fetal death at 14-28 weeks of pregnancy received either 100 mcg buccal misoprostol or 200 mcg buccal misoprostol every 6 h for a maximum of 8 doses. The main outcome measure was the fetal-placental delivery rate within 48 hours of prostaglandin commencement without any additional intervention.. Most of the women (140/153) were recruited at the study site in Vietnam. Expulsion of both fetus and placenta within 48 hours of prostaglandin commencement without any additional interventions occurred in 61.8% (47/76) of women receiving misoprostol 100 mcg and 77.9% (60/77) of women receiving misoprostol 200 mcg. The 200 mcg dose was significantly more effective than the 100 mcg dose at expelling the fetus and placenta within 48 h [RR 0.68 (95% CI: 0.50-0.92; p=.03)]. The mean time to expulsion was significantly shorter using the 200 mcg dose (18.5±11.9 h) than the 100 mcg dose (23.9±12.5 h) (p=.02). Most women in both groups found the procedure satisfactory or very satisfactory (100 mcg: 76.7% (56/73); 200 mcg: 89.5% (68/76) [RR 0.86 (95% CI: 0.74-1.00)].. Buccal misoprostol is an effective method for medical induction of labor after intrauterine fetal demise. A 200 mcg dose is significantly more effective than 100 mcg for evacuating the uterus within 48h. The treatment is highly acceptable to women.. Administration of 200 mcg buccal misoprostol every six hours is an effective and acceptable method to effect the delivery of a demised fetus at 14-28 weeks that can be feasibly implemented in a wide variety of settings.

Topics: Abortifacient Agents, Nonsteroidal; Administration, Buccal; Adult; Delivery, Obstetric; Double-Blind Method; Female; Fetal Death; Gestational Age; Humans; Labor, Induced; Misoprostol; Oxytocin; Pregnancy; Treatment Outcome; United States; Vietnam

Oxytocin is used to induce and control parturition; nevertheless, an increase in uterine contractions decreases blood flow and gaseous exchange through the uterus predisposing to intra-partum mortality in pigs. The objective of the present study was to evaluate the effect of different oxytocin administration routes on myometrial activity, fetal intrauterine hypoxia and postnatal asphyxia in crated farrowing sows. Yorkshire x Landrace hybrid sows (n = 300), that were approaching the time of parturition, were randomly assigned into six groups. Each group included 50 sows, 10 for each of the parities from one to five. A 40-IU oxytocin dosage was administered by intramuscular (IM), or intravulvar (IVU) routes, or 20 IU was administered via intravenous (IV) route. Groups 1 (G1), 3 (G3) and 5 (G5) were administered 0.9% saline solution (NaCl) IM, IVU and IV, respectively, whereas groups 2 (G2), 4 (G4) and 6 (G6) were treated with oxytocin IM, IVU and IV, respectively. There was a significantly (P < 0.05) greater number of intra-partum stillbirths (IPS) for the oxytocin treatments, as compared with the control groups, especially with the IVU and IV routes; a lesser number of IPS and lesser IPS with broken umbilical cords was observed with the IM administration route. Oxytocin and control IV administration resulted in longer farrowing durations. Administration of IV-oxytocin resulted in a greater number (P < 0.05) of intrauterine distressed neonates compared with its corresponding control and interpreted through dips II, a fetal cardiac frequency deceleration which determines acute fetal suffering. Independent of the route of oxytocin administration, the treatments resulted in twice as many dips II compared with the respective control groups. The use of the cardiotocograph proved to be an excellent tool for establishing the oxytocin response dose in farrowing sows. A greater number of piglets born alive, which had undergone bradycardia, also showed severe acidosis and greater meconium staining in oxytocin-treated sows, indicating that the administration time (at birth of the first piglet) as well as the dosage used were not adequate treatment regimens in the present study. Further studies will be conducted to evaluate different dosages and oxytocin administration timing to determine the most desirable treatment regimen to increase myometrial contractibility without compromising fetal welfare and neonatal survival.

Topics: Animals; Animals, Newborn; Asphyxia; Female; Fetal Death; Fetal Hypoxia; Fetal Monitoring; Fetus; Injections, Intramuscular; Injections, Intravenous; Oxytocics; Oxytocin; Pregnancy; Swine

The objective of the present study was to evaluate in penned sows the effect of two commercial oxytocin products on umbilical cord pathology, degree of asphyxia and intra-partum mortality. This study included 120 sows divided in three groups of 40 animals with eight animals for parities one to five per subgroup, respectively. Group 1 (G(1)) or control received saline solution while oxytocin groups (G(2)) and (G(3)) were injected at the onset of fetal expulsion with two oxytocin products. The doses of oxytocin were as follow: Primiparous sows weighing less than 130 kg received 20 IU; multiparous sows weighing 130-180 g received 30 IU, and those above 250 kg, 40 IU. Piglets born alive and/or dead were classified at birth using a subjective scale based on the degree of meconium staining on skin. Umbilical cords of intra-partum stillbirths (IPS) were classified as adhered or ruptured and subdivided into four categories: without pathological changes, edematous, congested and hemorrhagic. Result analyses revealed significant differences (P < 0.01) between groups 1 and 2, and 1 and 3 regarding the following traits: expulsion interval (min) (X: G(1) 27.7; G(2) 22.6; G(3) 22.2), IPS with a severe stain degree (X: G(1) 0.10; G(2) 0.45; G(3) 0.50), IPS with ruptured umbilical cords (X: G(1) 0.07; G(2) 0.42; G(3) 0.47), and detectable heartbeats in IPS (X: G(1) 0.27; G(2) 0.25; G(3) 0.22). Treatment with oxytocin reduced the duration of the expulsion of the fetus, increased the number of IPS with ruptured umbilical cords and with severe meconium-stain degree and reduced the number of fetuses with inspiration attempts. Furthermore, the use of this hormone increased the need for obstetric assistance due to increased frequency of dystocia.

Topics: Animals; Animals, Newborn; Dystocia; Female; Fetal Death; Fetal Hypoxia; Housing, Animal; Oxytocin; Parity; Pregnancy; Pregnancy Outcome; Rupture, Spontaneous; Swine; Swine Diseases; Umbilical Cord

Intrauterine fetal death is a major problem in obstetrics particularly in developing countries such as Uganda. Induction of labour in cases of fetal death using the available method of oxytocin is often difficult, expensive and frustrating.. To compare the effectiveness of vaginal misoprostol and intravenous oxytocin in induction of labour in women with intrauterine fetal death.. One hundred and twenty mothers were allocated in a randomised controlled way to one of the two induction groups. Oxytocin infusion was titrated based on patient response. The starting dose was 50 mcg (1/4 tablet) in misoprostol group and the dose was doubled every six hours till effective contractions were achieved. The two groups were compared for induction to delivery intervals, costs of the drugs and their safety during induction.. The success rate within 48 hours of induction was 100% in the misoprostol group and 96.7% in oxytocin group. The mean induction to delivery time was significantly longer in the oxytocin group compared with the misoprostol group (23.3 versus 12.4 hours; p= 0.004). In the gestational age before 28 weeks, the induction to delivery interval in oxytocin group, was more than twice that used in misoprostol. However beyond 28 weeks, there was no significant difference. Women with intact membranes had induction to delivery interval of 27.9 hours in the oxytocin group and 14.7 hours in the misoprostol group (p=0.002). When the membranes were ruptured, the values were 10.5 and 8.5 hours respectively (p=0.6). The induction to delivery time in cases with Bishop's score < 6 was 29.8 hours in the oxytocin group and 15.9 hours in misoprostol group (p=0.001). The corresponding values for Bishop's scores > 6 were 10 and 7.9 hours respectively (p=0.6). The majority of patients in misoprostol group (62%), required less than one tablet for successful induction. Misoprostol was cheaper (0.65 US dollars than oxytocin (7.86 US dollars) Retained placenta occurred in only 3.3% of the patients in the misoprostol group. There were no cases of ruptured uterus in both groups.. Intravaginal misoprostol is more effective and cheaper than intravenous oxytocin for inducing labour in patients with intrauterine fetal death.

Topics: Abortifacient Agents, Nonsteroidal; Adult; Female; Fetal Death; Humans; Infant, Newborn; Infusions, Intravenous; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Pregnancy Outcome; Time Factors; Treatment Outcome; Uganda

To study the complications and compare the success rate and abortion time between the live and the dead fetuses in second-trimester pregnancy termination with intracervicovaginal misoprostol.. A prospective comparative study.. A total of 89 pregnant women between 14 and 28 weeks of gestation with obstetric, medical, or genetic reasons for termination of pregnancy were recruited to receive 200 micrograms misoprostol inserted intracervicovaginally every 12 hours.. The rates of successful abortions within 12, 24 and 48 hours in live fetuses were 15.1%, 54.7% and 92.5%, respectively, while in dead fetuses were 50.0%, 83.3% and 97.2%, respectively. The success rates within 12 and 24 hours in live-fetus group were significantly lower than those of the dead-fetus group 9p = 0.0009 and p = 0.01, respectively). The mean abortion time of the live-fetus group (27.1 hours) was significantly more than that of the dead-fetus group (15 hours, p = 0.001). No serious complications occurred in terms of hemorrhage, febrile morbidity diarrhea, nausea and vomiting.. Intracervicovaginal misoprostol is an effective and safe method for second-trimester pregnancy termination. The success rate is higher and the abortion time is less in dead-fetus pregnancy than those in the live-fetus pregnancy.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Administration, Intravaginal; Adult; Analgesia; Cohort Studies; Female; Fetal Death; Fetus; Gels; Humans; Misoprostol; Oxytocin; Pelvic Pain; Pregnancy; Pregnancy Trimester, Second; Prospective Studies; Time Factors

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 the efficacy of methods for second trimester pregnancy termination.. A prospective randomized study of women undergoing pregnancy termination between 14 and 28 weeks gestation. Three hundred and forty patients with poor cervical condition (Bishop score < or = 4) in whom one of five termination methods were used were assessed: (i) extraamniotic administration of ethacridine lactate (82 patients); (ii) intracervical prostaglandin (PG) E2 gel (100 patients); (iii) intravenous infusion of concentrated oxytocin (36 patients); (iv) vaginal misoprostol (49 patients); and (v) balloon insertion (73 patients). Oxytocin infusion was used in all but concentrated oxytocin group to augment labor, when necessary. Patients in whom effective uterine contractions and cervical dilatation was not obtained within 48 h with the primary termination method were registered as failures.. The efficacy of each method were evaluated in terms of abortion within time. Abortion within 48 h were achieved in 98.8% (81/82) of the patients in ethacridine group; 97.3% (35/36) of the patients in concentrated oxytocin group; 90.0% (90/100) of the patients in PGE2 group; 97.2% (71/73) of the patients in balloon group; 77.5% (38/49) of the patients in misoprostol group (P = 0.000, P < 0.01, Wilcoxon (Gehan) statistic). The overall median induction-abortion interval +/- S.D. (in h) in each group were as follows: ethacridine lactate: 15.7 +/- 9.6, PGE2 gel: 20.0 +/- 14.5, concentrated oxytocin: 12.2 +/- 14.4, misoprostol: 24.0 +/- 22.2, balloon: 16.0 +/- 15.4 (one way ANOVA, P = 0.003, P < 0.01).. In comparison with the five methods, the use of extraamniotic ethacridine, intravenous concentrated oxytocin, and balloon was found to provide more effective treatment than intracervical PGE2 and misoprostol in terms of achievement of abortion within 24 and 48 h.. The efficacy of 5 methods of second-trimester pregnancy termination was compared in a prospective, randomized study of 340 women admitted to a High Risk Pregnancy Unit in Ankara, Turkey, with an unfavorable cervical state. The women were between 14 and 28 weeks' gestation. Termination methods assessed included: extra-amniotic administration of ethacridine lactate (82 women), cervical ripening through use of prostaglandin (PG) E2 gel (100 women), intravenous infusion of concentrated oxytocin (36 women), intravaginal misoprostol (49 women), and balloon insertion (73 women). Oxytocin infusion was used to augment labor, where necessary, in all but the concentrated oxytocin group. The main indications for pregnancy termination were fetal death (50%) and fetal anomaly (25%). Abortion within 48 hours was achieved in 98.8% of women in the ethacridine group, 97.3% of those in the concentrated oxytocin group, 90.0% of women in the PGE2 group, 97.2% of patients in the balloon group, and 77.5% of those in the misoprostol group. The median induction-abortion intervals were: ethacridine lactate, 15.7 +or- 9.6 hours; PGE2 gel, 20.0 +or- 14.5 hours; concentrated oxytocin, 12.2 +or- 14.4 hours; misoprostol, 24.0 +or- 22.2 hours; and balloon, 16.0 +or- 15.4 hours. Overall, these results suggest that mid-trimester induced abortion with extraamniotic ethacridine, balloon application, or intravenous concentrated oxytocin are the most effective techniques and should be considered as alternatives to misoprostol and PGE2.

Topics: Abortifacient Agents; Abortion, Induced; Administration, Intravaginal; Adult; Catheterization; Dinoprostone; Ethacridine; Female; Fetal Death; Humans; Infusions, Intravenous; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Pregnancy Trimester, Second; Prospective Studies

Induction of labor in women with late fetal death is often difficult in settings with scarce resources. The purpose of this study was to assess the value of vaginal misoprostol for induction of labor in women with such fetal death.. In Maputo 156 women with late fetal death were allotted in a non-randomised way to either vaginal misoprostol or intravenous infusion of oxytocin. Treatment outcomes were compared as to cost-effectiveness and safety. In the misoprostol group none received more than 800 micrograms. Oxytocin infusion followed an established routine. Statistical analyses were performed by EPI Info software.. In cases with Bishop's score < 6 the induction-to-delivery interval averaged 14.8 hours in the misoprostol group and 31.0 hours in the oxytocin group (p = 0.001). The corresponding values for women with Bishop's score > or = 6 were 6.6 and 8.7 hours, respectively (p = 0.4). Women with intact membranes had an induction-to-delivery interval of 13.8 hours in the misoprostol group and 26.9 hours in the oxytocin group (p = 0.002). The corresponding values in women with ruptured membranes were 7.8 and 10.5 hours, respectively (p = 0.6). Successful induction was achieved in 81% of misoprostol-treated women at a dose of 100 micrograms or less.. Vaginal misoprostol is a safe, low-cost drug particularly suitable in women of high average parity having late, fetal death.

Topics: Administration, Intravaginal; Adult; Developing Countries; Female; Fetal Death; Humans; Infusions, Intravenous; Labor, Induced; Misoprostol; Mozambique; Oxytocin; Pregnancy; Time Factors; Treatment Outcome

To induce abortion in women with intra-uterine foetal death (IUFD), during a two-year period (August 1990 to October 1992), at Yekatit 12 Hospital, Addis Abeba, Ethiopia, condom-Foley catheter method (CFCM) with oxytocin, and oxytocin infusion alone were compared. All 25 pregnant women randomly assigned to the CFCM aborted within 24 hr, a 100% success rate with an induction-abortion time interval of 14.6 hr (p < 0.001), whereas among 20 patients who were treated with oxytocin infusion alone, induction failed in all. Repeated induction in the second group resulted in a marked delay of abortion; these patients were crossed over to either combined medical and surgical induction or to the CFCM depending on their cervical status. The rapid cervical dilatation and safe abortion in pregnant women with IUFD make the CFCM a superior procedure to induction of abortion with oxytocin infusion alone. In places where there is no experience with the use of prostaglandins and the agent, which may have undesirable side-effects, is unavailable, the CFCM is a simple cost-effective technique which could be used safely.. In the Department of Obstetrics and Gynecology, Yekatit 12 Hospital, Addis Ababa, Ethiopia, during August 1990-October 1992, pregnant women at 20-28 weeks of gestation who presented with intra-uterine fetal death (IUFD) were enrolled in a comparative study after giving verbal consent. Patients were randomly assigned to two groups. In the first group, abortion was induced in the conventional method by oxytocin infusion alone. In the second group, in addition to oxytocin infusion, the condom-Foley catheter method (CFCM) was employed. All 25 patients with the CFCM aborted within 24 hours, yielding an induction abortion time interval (IATI) of 14.60 +or- 5.27 hours. In contrast, induction failed twice among the 20 patients getting oxytocin infusion alone, and 5 patients were submitted to combined medical and surgical induction (CMSI) (IATI of 59.4 +or- 8.7 hours), as they had an appropriate cervix, and they expelled the fetus within 48 hours. Among the remaining 15 patients induction failure occurred for the third time, and 8 of them had developed an appropriate cervix (Bishop scone = 4-6), but the other 7 patients did not show any cervical change. Those with the appropriate cervix were submitted to CMSI, and those whose cervical state was unchanged were transferred to the CFCM. Both groups aborted within 72 hours; the respective IATIs were 93.5 +or- 12.0 hours and 86.7 +or- 4.8 hours. In 48.9% of the patients, the cause of the IUFD was preeclampsia/eclampsia (2 patients had eclampsia). One patient was positive for syphilis and another was diabetic, both received treatment before admission. There was no abnormal bleeding or any signs of infection. Blunt curettage was performed in 37.8% of patients between 20 and 26 weeks of gestation after the expulsion of the fetus in the oxytocin group. 53.3% of the patients in the CFCM group also received this treatment.

Topics: Abortion, Induced; Adolescent; Adult; Combined Modality Therapy; Cost-Benefit Analysis; Female; Fetal Death; Humans; Infusions, Intravenous; Oxytocin; Pregnancy; Prospective Studies; Treatment Failure; Urinary Catheterization

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

In established intrauterine fetal death, 20 patients were treated with prostaglandin E2 gel administered extraamniotically. The results were compared with those of another group of 20 patients who had received combined treatment. In this group, one or more of the following agents had been administered :- i.v. oxytocin, 20% NaCl solution or Premarin instilled intraamniotically, introduction of a balloon catheter or Rivanol administered extraamniotically. Average induction-abortion interval for the PG group was about 12 hours while for the second group it was about 30 hours. The side effects observed were slight in both groups. The results show that administration of PG-gel can be used with advantage in fetal demise because of the relatively short induction-abortion intervals obtained, the insignificant side effects and the low dose of PG required.

Topics: Abortion, Induced; Adult; Clinical Trials as Topic; Drug Evaluation; Female; Fetal Death; Gels; Humans; Middle Aged; Oxytocin; Pregnancy; Prostaglandins E; Saline Solution, Hypertonic; Time Factors

Topics: Adult; Cesarean Section; Clinical Trials as Topic; Drug Evaluation; Female; Fetal Death; Humans; Oxytocin; Pregnancy; Pregnancy Trimester, Third; Pregnancy, Ectopic

Termination of pregnancy in missed abortion and intra-uterine fetal death was accomplished using vaginal suppositories of 20 mg PGE2 in 31 cases and the results were compared with oxytocin induction (with or without estrogen pre-treatment) in 17 cases at the doses routinely used in our hospital. The PG suppositories proved much more superior (96.7%) than oxytocin (47.7%), but induced a higher rate of side effects. The latter were not serious and were generally tolerated by the patients. There was a positive correlation between duration of fetal retention in utero and the induction expulsion time. The over all patient acceptance of the method was quite favourable and the approach appears to be a definite advance towards management of these cases.

Topics: Abortion, Missed; Drug Evaluation; Female; Fetal Death; Humans; Labor, Induced; Oxytocin; Pregnancy; Prostaglandins E; Suppositories; Time Factors

In a prospective, randomised trial, 111 obstetrically normal pregnant women, who had elective induction of labour performed between 39 and 40 weeks, were compared with 117 controls who were managed expectantly until 41 weeks. Compared with the controls, the patients who had elective induction of labour had significantly less meconium staining in labour and a smaller blood-loss after delivery. The mean length of labour, the amount of pethidine used, and the Apgar scores at 1 minute were similar in the two groups. In the electively induced group, the caesarean-section rate was lower and the use of epidural analgesia more common than in the controls, but the differences were mot statistically signficant. The hour of delivery was similar in the two groups, suggesting that convenience to medical and nursing staff would not be greatly changed by elective induction of labour. There was no evidence that the hazards to mother and child were increased by elective induction, and its use might improve perinatal mortality by reducing the number of unexplained mature stillbirths.

Topics: Adolescent; Adult; Anesthesia, Epidural; Anesthesia, Obstetrical; Apgar Score; Birth Weight; Body Height; Clinical Trials as Topic; Delivery, Obstetric; Evaluation Studies as Topic; Female; Fetal Death; Gestational Age; Humans; Infant, Newborn; Jaundice, Neonatal; Labor, Induced; Maternal Age; Oxytocin; Parity; Pregnancy; Prospective Studies; Respiratory Distress Syndrome, Newborn; Time Factors

Complete uterine rupture is a rare peripartum complication associated with a catastrophic outcome. Because of its rarity, knowledge about its risk factors is not very accurate. Most previous studies were small and over a limited time interval. Moreover, international diagnostic coding was used in most studies. These codes are not able to differentiate between the catastrophic complete type and less catastrophic partial type. Complete uterine rupture is expected to increase as the rate of cesarean delivery increases. Thus, we need more accurate knowledge about the risk factors for this complication.. The objective of the study was to estimate the incidence and risk factors for complete uterine rupture during childbirth in Norway.. This population-based study included women that gave birth after starting labor in 1967-2008. Data were from the Medical Birth Registry of Norway and Patient Administration System, complemented with information from medical records. We included 1,317,967 women without previous cesarean delivery and 57,859 with previous cesarean delivery. The outcome was complete uterine rupture (tearing of all uterine wall layers, including serosa and membranes). Risk factors were parameters related to demographics, pregnancy, and labor. Odds ratios for complete uterine rupture were computed with crude logistic regressions for each risk factor. Separate multivariable logistic regressions were performed to calculate the adjusted odds ratios and 95% confidence intervals.. Complete uterine rupture occurred in 51 cases without previous cesarean delivery (0.38 per 10,000) and 122 with previous cesarean delivery (21.1 per 10,000). The strongest risk factor was sequential labor induction with prostaglandins and oxytocin, compared with spontaneous labor, in those without previous cesarean delivery (adjusted odds ratio, 48.0, 95% confidence interval, 20.5-112.3) and those with previous cesarean delivery (adjusted odds ratio, 16.1, 95% confidence interval, 8.6-29.9). Other significant risk factors for those without and with previous cesarean delivery, respectively, included labor augmentation with oxytocin (adjusted odds ratio, 22.5, 95% confidence interval, 10.9-41.2; adjusted odds ratio, 4.4, 95% confidence interval, 2.9-6.6), antepartum fetal death (adjusted odds ratio, 15.0, 95% confidence interval, 6.2-36.6; adjusted odds ratio, 4.0, 95% confidence interval, 1.1-14.2), and previous first-trimester miscarriages (adjusted odds ratio, 9.6, 95% confidence interval, 5.7-17.4; adjusted odds ratio, 5.00, 95% confidence interval, 3.4-7.3). After a previous cesarean delivery, the risk of rupture was increased by an interdelivery interval <16 months (adjusted odds ratio, 2.3; 95% confidence interval, 1.1-5.4) and a previous cesarean delivery with severe postpartum hemorrhage (adjusted odds ratio, 5.6; 95% confidence interval, 2.4-13.2).. Sequential labor induction with prostaglandins and oxytocin and augmentation of labor with oxytocin are important risk factors for complete uterine rupture in intact and scarred uteri.

Topics: Abortion, Spontaneous; Adult; Birth Intervals; Female; Fetal Death; Humans; Incidence; Labor, Induced; Logistic Models; Maternal Age; Multivariate Analysis; Norway; Odds Ratio; Oxytocics; Oxytocin; Pregnancy; Pregnancy Trimester, First; Prostaglandins; Risk Factors; Uterine Rupture; Vaginal Birth after Cesarean

This study examines the peripartum anesthetic management and outcomes of women with dilated cardiomyopathy in a large university medical centre over a seven-year period.. Twenty-five women were included in this series, 18 with a new diagnosis of cardiomyopathy and seven with a history of cardiomyopathy. Sixteen patients (64%) identified themselves as African American, seven (28%) were Caucasian, and two patients (8%) were Hispanic. The median (range) gestational age at the time of a new diagnosis of cardiomyopathy was 29 (7-38) weeks. Eight women (32%) had New York Heart Association class III/IV symptoms at the time of delivery or in the immediate postpartum period. A multidisciplinary team of obstetricians, anesthesiologists, cardiologists, and pediatricians were involved in the care of these women. The median (range) gestational age at the time of delivery was 33.5 (30-40) weeks. There were nine vaginal deliveries and 15 operative deliveries. One patient had fetal loss at 19 weeks gestation. Twelve women had labour induced with an intravenous infusion of oxytocin at a rate of 0.001-0.02 IU·min(-1). An oxytocin infusion at a variable rate with a maximum dose of 0.05 IU·min(-1) was administered after vaginal delivery to maintain uterine tone. Epidural analgesia was initiated prior to induction of labour or in the latent phase of labour. Seven Cesarean deliveries were performed under combined spinal-epidural anesthesia, five were performed under epidural anesthesia, and three women had general anesthesia. Oxytocin was administered via an intravenous infusion at a rate of 0.05-0.2 IU·min(-1) after operative delivery. One patient had a cardiac arrest on induction of general anesthesia and was successfully resuscitated. There were no maternal or neonatal deaths. Ten women were followed up at our institution and at six months postpartum; 50% of these patients were still symptomatic.. We report favourable outcomes in 25 pregnant women with dilated cardiomyopathy who were managed by a multidisciplinary team.

Topics: Academic Medical Centers; Adult; Anesthesia, Epidural; Anesthesia, General; Anesthesia, Obstetrical; Anesthesia, Spinal; Cardiomyopathy, Dilated; Delivery, Obstetric; Female; Fetal Death; Heart Arrest; Humans; Labor, Obstetric; Outcome and Process Assessment, Health Care; Oxytocics; Oxytocin; Pregnancy; Pregnancy Complications, Cardiovascular

Over the years, multiple forms and doses of pharmacologic agents have been used for cervical ripening and labor induction. This chapter will review potential criteria and article situations for choosing a particular pharmacologic agent. The discussion in this chapter will be limited to comparisons between pharmacologic agents; direct comparisons between mechanical agents and pharmacologic agents will largely be reviewed in the accompanying article: Methods of cervical ripening and labor induction: mechanical. For the purposes of this discussion, the term labor induction will be limited to patients with a "favorable cervix" by Bishop's score <6, whereas the term cervical ripening will be limited to patients with an unfavorable cervix and includes subsequent induction or augmentation of labor. Although the pharmacologic agent used for the initial cervical ripening process is the focus of this discussion, subsequent treatment with oxytocin may or may not be required for delivery.

Topics: Abortifacient Agents, Nonsteroidal; Cervical Ripening; Cesarean Section; Dinoprostone; Female; Fetal Death; Humans; Hyaluronoglucosaminidase; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Patient Satisfaction; Pregnancy

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

Acute myocardial infarction is a rare event in pregnant patients. Mechanical valves are naturally thrombogenic and require careful anticoagulation. Pregnancy produces a hypercoagulable situation and necessitates close follow-up in pregnant patients with mechanical heart valves. We present a 34-year-old pregnant woman who had mitral and aortic valve prosthesis. She developed resistant pulmonary oedema in the post-partum period after myocardial infarction. Oxytocin was used in this patient to induce midterm labour and prevent post-partum bleeding. Issues surrounding management of pulmonary oedema and use of oxytocin therapy during pregnancy are discussed. We emphasize the need for awareness of this condition and call attention to the risk of pulmonary oedema during labour.

Topics: Adult; Anticoagulants; Electrocardiography; Fatal Outcome; Female; Fetal Death; Heart Valve Prosthesis Implantation; Humans; Labor, Induced; Myocardial Infarction; Oxytocics; Oxytocin; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Trimester, Second; Pulmonary Edema

Maternal intrapartum fever has been associated with an increased incidence of neonatal morbidity. In this retrospective cohort study, we evaluated whether intravenous oxytocin has a fever-inducing effect. Oxytocin augments secretion of prostaglandins E(2) and F(2α) which are inflammatory mediators known to elevate body temperature.. Between January 2005 and June 2008, 279 patients were admitted with mid-trimester fetal demise. Patients meeting inclusion criteria included 34 women who received a high-dose intravenous oxytocin regimen and 29 patients who delivered after spontaneous labor without the need for augmentation. Oral temperatures were measured on admission and at delivery.. The median length of oxytocin infusion was 5.3h. The calculated temperature change was -0.14°C in the oxytocin group and +0.12°C in the control group. These findings were confirmed in a model adjusted for patients' white blood cell count and duration of labor. We did not observe an effect of analgesia type, epidural versus intravenous analgesia, on duration of labor.. Based on this comparative analysis of pregnant women who received high-doses of oxytocin, we found insufficient evidence to support that high-dose intravenous oxytocin elevates intrapartum maternal temperature.

Topics: Adult; Body Temperature; Cohort Studies; Female; Fetal Death; Fever; Humans; Infusions, Intravenous; Leukocyte Count; Linear Models; Oxytocics; Oxytocin; Pregnancy; Pregnancy Trimester, Second; Retrospective Studies

Topics: Dystocia; Female; Fetal Death; Humans; Lymphangioma; Oxytocin; Pregnancy; Shoulder; Uterine Rupture; Young Adult

Sixty hybrid Yorkshire-Landrace penned sows, 30 with eutocic farrowing and 30 experiencing a dystocic parturition, were studied to evaluate the obstetric and neonatal outcomes to low doses of oxytocin administered at advanced stages of parturition. Animals in each group were randomly subdivided into 2 subgroups: 15 eutocic and 15 dystocic sows received oxytocin 0.083 IU/kg (equivalent to 1 IU/12 kg body weight), administered intramuscularly after the delivery of the 5th piglet; the other 15 eutocic and 15 dystocic sows received saline solution intramuscularly at the same time. Oxytocin decreased the number of intrapartum deaths by approximately 50% (P = 0.002). No piglet was born dead from the saline- and oxytocin-treated eutocic sows. The highest viability score was observed among piglets born to eutocic sows treated with oxytocin. In summary, this dose schedule would help to decrease the number of stillbirths in both eutocic and dystocic farrowing sows.

Topics: Animals; Animals, Newborn; Dystocia; Female; Fetal Death; Fetus; Injections, Intramuscular; Oxytocics; Oxytocin; Parturition; Pregnancy; Pregnancy Outcome; Random Allocation; Swine

Alterations in RCAS1 (a receptor-binding cancer antigen expressed on SiSo cells) expression in the placenta and decidua may be related to the regulation of the process of maternal immune tolerance against fetal antigens. Moreover, it has been demonstrated that the occurrence of the spontaneous beginning of stillbirth is related to a decrease in the placental expression of RCAS1. There are no data currently available on the immune processes in decidua during stillbirth. The aim of this study was to evaluate the RCAS1 immunoreactivity level in decidua and to identify the cytotoxic immune cells present during labor, induced after intrauterine fetal death either with a combination of oxytocin (OT) and prostaglandins or with OT alone; a further objective was to assess the potential impact of these molecular alterations on the effectiveness of stillbirth induction.. The immunoreactivity of RCAS1, CD3, CD56, CD69, and CD25 was assessed by immunohistochemistry in 31 decidual samples derived from patients in whom the stillbirth occurred before the onset of labor.. The RCAS1 immunoreactivity level was higher in a statistically significant manner in decidual tissue samples derived from patients in whom OT alone proved insufficient to induce labor after the diagnosis of intrauterine fetal death but required additionally the use of prostaglandins when compared with samples from women in whom stillbirth was induced successfully with OT alone. However, we did not observe any differences either in CD56 and CD3 positive cell presence or in CD25 and CD69 antigen immunoreactivity in the respective decidua of these two groups of patients.. The level of RCAS1 in decidua seems to influence the effectiveness of stillbirth induction.

Topics: Adult; Antigens, Neoplasm; Cells, Cultured; Decidua; Female; Fetal Death; Fetal Diseases; Humans; Oxytocin; Pregnancy; Prostaglandins; Stillbirth

In this study, the effects of oxytocin and an analog of prostaglandin (cloprostenol) on the uterine involution and pregnancy rates were investigated. Mares received 3 ml of 0.9% NaCl in Group C (n=10), 30 IU/mare of oxytocin in Group O (n=10) and 250 microg/mare of cloprostenol in Group P (n=10) within 12h after parturition. The gravid uterine horn's cross-sectional diameter was measured by ultrasonography. The mean uterine diameters did not differ significantly between the treatment (O and P) and the control (C) groups (p>0.05). The difference between the postpartum ovulation periods (Group C: 12.6+/-0.72 days, Group O: 15+/-1.33 days, Group P: 14.6+/-1.11 days), the pregnancy rates at foal heat (Group C: 60%, Group O: 60%, Group P: 80%) and the embryonic death rates at foal heat (Group C: 33.3%, Group O: 16%, Group P: 25%) were not found to be statistically significant between the treatment and the control groups. The mean progesterone concentrations were similar in all groups and decreased continuously from parturition to until foal heat (Group C: from 2.43+/-0.24 to 0.66 ng/ml, Group O: from 3.07+/-0.6 to 0.27+/-0.27 ng/ml and Group P: from 2.8+/-0.44 to 0 ng/ml) (p>0.05). In conclusion, it was decided that the oxytocin and PGF2alpha treatments performed on the mares with the purpose of stimulating involution had no effect on the duration of parturition-first ovulation, the shrinkage of the uterus diameter, the pregnancy and embryonic death rates.

Topics: Animals; Animals, Newborn; Female; Fetal Death; Horses; Male; Ovulation; Oxytocin; Postpartum Period; Pregnancy; Progesterone; Random Allocation; Ultrasonography; Uterus

The objective of this study was to analyse the motives behind disciplinary action in obstetric malpractice cases concerning delivery, and to evaluate the frequency of inappropriate oxytocin use in these cases.. An analysis of all malpractice claims resulting in disciplinary action against physicians and midwives during the period 1996-2003. Investigations and decisions made by the Board of Medical Responsibility were reviewed with special focus on the use of oxytocin.. Of 77 cases, 60 regarded patients in labour. In the majority, there had been a normal pregnancy and spontaneous start of labour (78%). At the beginning of labour, 87% showed a normal fetal heart rate (FHR) pattern, indicating fetal well-being. In 70%, there was adverse fetal outcome with brain damage or death. The most common reason for disciplinary action was improper interpretation of fetal monitor tracings and corresponding failure to recognise fetal distress (76%). Injudicious use of oxytocin was common (68.5%), and was the primary reason for disciplinary action in 33% of the cases.. In a Swedish setting, a few common clinical problems pervade; interpretation of FHR patterns and the use of oxytocin account for the majority of rulings of negligence in malpractice cases regarding delivery. Analysis of the cases suggests that the adverse fetal outcomes could possibly have been prevented.

Topics: Cerebral Palsy; Delivery, Obstetric; Female; Fetal Death; Fetal Distress; Fetal Monitoring; Humans; Hypoxia, Brain; Labor, Obstetric; Malpractice; Midwifery; Oxytocics; Oxytocin; Physicians; Pregnancy; Pregnancy, High-Risk; Sweden

This study compared the course of midtrimester termination of pregnancies with fetal demise and those with a viable fetuses by extra-amniotic prostaglandin (PG) E(2). A total of 275 women who underwent second trimester abortion with extra-amniotic PGE2(2) were divided into two groups: 95 patients (35%) with fetal demise and 180 women (65%) with a live fetuses. Extra-amniotic PGE2(2) was administered in doses of 200 micro g every 2 h up to 20 doses. Bumm curettage was performed in the majority of the patients. We compared the duration and complication rate between the groups. The median induction to abortion interval was significantly shorter in the fetal demise group (13 vs. 21 h) than in the live fetus group. Mean gestational ages and complication rates were similar. Midtrimester termination of pregnancy with extra-amniotic PGE2(2) is a safe method with a low complication rate. In cases of pregnancy with fetal demise extra-amniotic PGE2(2) is associated with a significantly shorter induction to abortion interval than with a live fetus.

Topics: Abortion, Induced; Adult; Curettage; Dinoprostone; Female; Fetal Death; Gestational Age; Humans; Oxytocin; Pregnancy; Pregnancy Trimester, Second; Time Factors

Topics: Animals; Animals, Newborn; Cesarean Section; Dogs; Female; Fetal Death; Oxytocin; Pregnancy; Time Factors

To evaluate retrospectively pre-term induction; with Prostaglandin (PG) E(2)-gel and i.v. oxtytocin, respectively.. Fifty pre-term women with a gestational age between 28 + 0 and 36 + 6 and medical indications for labor induction were compared with the two next induced at term and post-term. The obstetric end points were numbers of PGE(2)-gel applications, failed inductions, instrumental delivery and heavy bleeding after partus (>1000 ml). The neonatal outcome was registered as operative delivery for fetal distress (ODFD) or Apgar score <7 at 5'.. The number of PGE(2)-gel applications did not differ. The duration of labor was shorter in the pre-term group (P = 0.043). A five-fold higher risk of heavy postpartum bleeding (>1000 ml) was noticed in the post-term group compared to the pre-term. The incidence of low Apgar scores were similar in the three groups.. Safe vaginal labor induction and delivery can be anticipated pre-term with PGE(2)-gel.

Topics: Administration, Intravaginal; Adult; Cervical Ripening; Cervix Uteri; Delivery, Obstetric; Dinoprostone; Female; Fetal Death; Fetal Growth Retardation; Gels; Gestational Age; Humans; Labor, Induced; Oxytocin; Postpartum Hemorrhage; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Retrospective Studies

To evaluate the effect of 2 oxytocin products administered to sows at the onset of fetal expulsion on the integrity of umbilical cords, meconium staining, and piglet mortality.. 2099 neonatal pigs.. 180 parturient sows were randomly assigned to 3 stratified groups of 60 sows each. Two groups of sows were injected IM at the onset of fetal expulsion with 1 of 2 oxytocin commercial products (20, 40, or 50 U for sows weighing 120 to 150 kg, 151 to 250 kg, or > or = 251 kg, respectively). Control sows were treated IM with saline (0.9% NaCI) solution. Farrowing time, expulsion intervals, and numbers of stillborn and liveborn piglets were recorded for each sow. Piglets were evaluated for inspiratory effort, heart rates, and degree of meconium staining of skin (nonstained, and moderately or severely stained). Umbilical cords were classified as normal in appearance, edematous, congested, hemorrhagic, or ruptured.. Oxytocin-treated sows had a significant decrease in farrowing time and expulsion intervals and also had a significantly higher number of stillborn piglets per litter, compared with control sows. The number of piglets per litter with ruptured and hemorrhagic umbilical cords was significantly greater in oxytocin-treated sows, compared with control sows. In near-death stillborn piglets, oxytocin treatment significantly decreased inspiratory efforts at birth and increased the rate and severity of meconium staining, compared with saline treatment.. Oxytocin given to sows at the onset of fetal expulsion significantly increases the rate of fetal distress, anoxia, and intrapartum death in piglets.

Topics: Animal Husbandry; Animals; Animals, Newborn; Female; Fetal Death; Heart Rate; Meconium; Oxytocin; Pregnancy; Random Allocation; Swine; Umbilical Cord

We evaluated stillbirth risk factors in two commercial swine farms of the Rio Grande do Sul State (south of Brazil). The study was conducted during 1 month in Farm A and during 2 months in Farm B, both during 1999. Data for all farrowings that occurred during the study period were recorded (101 for Farm A and 373 for Farm B), without interference in the farm management. In Farm A, 39% of all litters born during the period of interest had stillborn piglets and the stillborn risk for piglets was 12%. In Farm B, 25% of all litters had stillborn piglets whereas the stillborn risk was 2%. Variables considered as potential risk factors for stillbirths were: parity (1, 2-3, 4+); breed (purebred or crossbred); sow body-condition (normal or fat); use of oxytocin during parturition (yes or no); obstetric intervention through vaginal palpation (yes or no); farrowing duration (<4 or > or =4h); mummified fetuses (yes or no); total litter size (<12 or > or =12 piglets); and litter birth weight (<11 or > or =11kg). All stillborn piglets had their classification validated by necropsy. In multivariable logistic-regressions, the cases were the litters having at least one stillborn piglet. In Farm A, litters having at least 12 pigs and in which oxytocin was used during the parturition had 20.8-times-higher odds of stillborn occurrence. In Farm B, litters from sows having parity > or =4 had 2.2-times-higher odds of stillborn occurrence than litters from parity 2 to 3 females, litters having > or =12 pigs had 2.0-times-higher odds of a stillborn piglet than smaller litters and farrowings in which vaginal palpation was performed had 8.0-times-higher odds. Farrowing room management to minimize stillborn risk should target higher-parity females, large litters and optimization of practices of obstetric interventions.

Topics: Animal Husbandry; Animals; Animals, Newborn; Birth Weight; Body Constitution; Body Weight; Brazil; Female; Fetal Death; Litter Size; Logistic Models; Oxytocin; Parity; Pregnancy; Pregnancy Complications; Risk Factors; Swine; Swine Diseases

Rupture of unscarred uterus during the second trimester is rare. There have been only 32 cases reported in the literature since 1968. A case of ruptured uterus in a grand multiparous woman is presented. To our knowledge, this might be the first reported case in the English literature of uterine rupture during second trimester termination of pregnancy using a prostaglandin E1 analogue (Misoprostol) and oxytocin.

Topics: Abdominal Pain; Abortifacient Agents; Abortion, Induced; Administration, Intravaginal; Adult; Female; Fetal Death; Gestational Age; Humans; Hysterectomy; Misoprostol; Oxytocin; Parity; Pregnancy; Uterine Rupture

This trial was conducted in a farrow-to-finish pig unit from November 1999 to February 2000. Since November 1998 an induction-of-parturition program was applied in gilts and sows with PGF2alpha (2 mL Dinolytic, i.m.) 113 d post service, followed by oxytocin (1 mL Intertocine-S, i.m.) 24 h later. This program resulted in a high proportion of animals farrowing within the working hours of the day. At mid December 1999 splay-legs and edematous swelling and reddening of the vulva started to be observed in newborn piglets. A concurrent decline of parameters related to parturition also was noticed. Mycotoxicological analyses of the feeds revealed a co-occurring contamination with deoxynivalenol and zearalenone. For a 4-week period, sows were divided into two groups: (a) an induction-of-parturition and (b) a non-induction-of-parturition group. Significant differences were found between the two groups relating to prevalence of dystocia (<.05) and pregnancy duration (<.05). Moreover, it was found that prevalence of splay-legs and swelling of the vulva were highly correlated (<.05) with reduction of percentage of sows farrowing within the working day and increase of pre-weaning mortality. It was concluded that such an induction-of-parturition program should be avoided during a Fusarium mycotoxicosis.

Topics: Animal Feed; Animal Husbandry; Animals; Dinoprost; Female; Fetal Death; Fusarium; Greece; Labor, Induced; Male; Mycotoxicosis; Mycotoxins; Oxytocin; Swine; Swine Diseases

It has been proposed that the rise in myometrial oxytocin receptor (OTR) concentrations at term triggers parturition. In the present study, we have shown that in vivo infusion of the beta2-adrenoceptor (beta2AR) antagonist ICI-118.551 in late pregnant rats prevents the rise in myometrial OTR binding normally seen during delivery. A reduced contractile responsiveness of uterine strips isolated from rats in labor when challenged with oxytocin (OT) and a slight shortening of gestation accompanied this effect. OTR mRNA levels were, however, unaltered after the treatment, suggesting that the effect of beta2AR blockade on myometrial OTR was posttranscriptional or due to influences on extra-myometrial tissue. Infusion of the OTR antagonist atosiban down-regulated OTR binding sites in the parturient myometrium and resulted in an impaired contractile response to OT without affecting gestational length. OTR gene expression did not change, as seen from unchanged OTR mRNA values. Neither atosiban nor ICI-118.551 infusions alone changed fetal mortality. A significant increase in the incidence of fetal deaths was found, however, when rats were treated with a combination of atosiban and ICI-118.551. This treatment also down-regulated myometrial OTR and weakened the contractile response to OT, but it did not change gestational length. We conclude that the timing and onset of a normal parturition as well as a favorable outcome seem to be independent of a rise in OTR. This fact cannot exclude the possibility that an increase in OTR is of importance in the genesis of preterm labor. We suggest that beta2 stimulation up-regulates OTR during delivery. This effect may partly be responsible for the tachyphylaxis seen after the use of beta2 agonists to control preterm labor. We further suggest that OTR stimulation up-regulates OTR during labor. The OTR down-regulation seen after atosiban treatment adds to the direct relaxing effect of atosiban on the myometrium. In view of this, atosiban may prove to be a more useful tocolytic than the traditionally used beta2 agonists.

Topics: Adrenergic beta-2 Receptor Antagonists; Adrenergic beta-Antagonists; Animals; Cell Membrane; Female; Fetal Death; Gestational Age; Hormone Antagonists; Myometrium; Oxytocin; Pregnancy; Pregnancy Outcome; Propanolamines; Rats; Receptors, Adrenergic, beta-2; Receptors, Oxytocin; RNA, Messenger; Uterine Contraction; Vasotocin

Topics: Cause of Death; Crisis Intervention; Female; Fetal Death; Humans; Labor, Obstetric; Mothers; Myometrium; Oxytocics; Oxytocin; Pregnancy; Prostaglandins, Synthetic

An experiment was performed to determine the effect of elevated prostaglandin F2 alpha (PGF2 alpha) on pregnancy rates of progestogen-treated bred cows in the presence or absence of luteal tissue. Ninety-one beef cows were bred (Day 0) and assigned randomly to receive either 3 mL saline (CON), 15 mg PGF2 alpha, or 15 mg PGF2 alpha + lutectomy (P + L) administered intramuscularly (i.m.) at 8 h intervals on either Days 5-8, 10-13, or 15-18 postbreeding. Lutectomies were performed by transrectal digital pressure before initiation of treatment on Day 5, 10, or 15 for the respective treatment groups. All cows were fed 4 mg/day of melengesterol acetate from two days prior to initiation of treatment until Day 30 postbreeding. Mean concentrations of 13,14-dihydro-15-keto-PGF2 alpha (PGFM) were increased in cows administered PGF2 alpha and P + L treatments (398 +/- 23 and 413 +/- 22 pg/ml, respectively; p < 0.01) compared to the CON group (80 +/- 29 pg/ml) regardless of treatment group. Mean concentrations of oxytocin (OT) were increased in cows given PGF2 alpha on Day 10 and 15 (p < or = 0.0001) and tended to be increased on d 5 when compared to CON and P + L treatment groups on Day 5. Pregnancy rates were reduced (p < or = 0.03) in the PGF2 alpha treatment group (23%) and by Day 5-8 compared to CON (72%). Lutectomy tended to improve pregnancy rate in P + L (5-8; 55%) compared to PGF2 alpha (5-8; p = 0.1). Pregnancy rates tended (p < or = 0.07) to increase in the PGF2 alpha treatment groups on Days 5-8 treatment (23%, 50%, and 60% for Days 5-8, 10-13, and 15-18, respectively). The later the treatments were initiated pregnancy rates did not differ between treatments given on Days 10-13 and 15-18. In conclusion, the most susceptible period of embryonic growth to the negative effects of PGF2 alpha was during morula to blastocyst development. Removal of luteal tissue diminishes the negative effects of PGF2 alpha through interruption of the luteal oxytocin-uterine PGF2 alpha feedback loop.

Topics: Abortion, Veterinary; Animals; Cattle; Corpus Luteum; Dinoprost; Drug Administration Schedule; Estradiol; Female; Fetal Death; Oxytocin; Pregnancy; Pregnancy, Animal; Progesterone; Progestins; Time Factors

We analyzed the clinical course and investigated possible pathophysiologic mechanisms of amniotic fluid embolism.. We carried out a retrospective review of medical records. Forty-six charts were analyzed for 121 separate clinical variables.. Amniotic fluid embolism occurred during labor in 70% of the women, after vaginal delivery in 11%, and during cesarean section after delivery of the infant in 19%. No correlation was seen with prolonged labor or oxytocin use. A significant relation was seen between amniotic fluid embolism and male fetal sex. Forty-one percent of patients gave a history of allergy or atopy. Maternal mortality was 61%, with neurologically intact survival seen in 15% of women. Of fetuses in utero at the time of the event, only 39% survived. Clinical and hemodynamic manifestations were similar to those manifest in anaphylaxis and septic shock.. Intact maternal or fetal survival with amniotic fluid embolism is rare. The striking similarities between clinical and hemodynamic findings in amniotic fluid embolism and both anaphylaxis and septic shock suggest a common pathophysiologic mechanism for all these conditions. Thus the term amniotic fluid embolism appears to be a misnomer.

Topics: Adolescent; Adult; Anaphylaxis; Chi-Square Distribution; Embolism, Amniotic Fluid; Female; Fetal Death; Fetus; Heart Rate, Fetal; Humans; Hypersensitivity; Male; Obstetric Labor Complications; Oxytocin; Pregnancy; Prognosis; Puerperal Disorders; Registries; Retrospective Studies; Sex Factors; Shock, Septic; Survival Rate; United States

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

Isotonic solution was administered extraamniotically to 41 pregnant patients with dead fetus of 24 to 40 weeks of gestational age. Vaginal deliveries occurred in 90% and 9,7% had complications.

Topics: Administration, Intravaginal; Adolescent; Adult; Catheterization; Female; Fetal Death; Fetal Viability; Humans; Isotonic Solutions; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Trimester, Second; Pregnancy Trimester, Third

A case of uterine rupture caused by extraovular PGE2 in a sequence with intravenous oxytocin during midtrimester termination of pregnancy is presented. It teaches us that when oxytocin is used after prostaglandins in patients having a scarred uterus, the lowest effective dose should be applied.

Topics: Abortion, Therapeutic; Adult; Dinoprostone; Female; Fetal Death; Humans; Oxytocin; Pregnancy; Pregnancy Trimester, Second; Uterine Rupture

Nineteen cases of induction of labour by Foley catheter and extra-amniotic perfusion of normal saline for fetal death in utero occurring more than 24 weeks after the LMP were collected in the La Rabta Maternity and Neonatology Centre, Tunis, during the final 6 months of 1987. The mean age of the women was 27.8 and their mean parity 2.9. Two patients had uterine scars. The mean duration of the pregnancy was 33.3 weeks and initial Bishop score was 4 or less. When the catheter fell out, after 26.4 hours on average, the Bishop score had improved by 4.5 points. Labour occurred spontaneously in 5 cases and required oxytocin stimulation in 5 cases. The interval between induction and fetal expulsion was 44.4 hours. Delivery was followed by routine manual evacuation of the uterus. Two complications were seen: one case of accidental rupture of the membranes and one of rupture of the uterus affecting a scarred uterus. The authors point out certain risk factors concerning rupture of the uterus which should be considered to be contraindications to the method. With the exception of these situations, this method of induction is recommended because of its advantages of efficacy, safety and low cost, in particular in developing countries.

Topics: Administration, Intravaginal; Adult; Amnion; Catheterization; Extraembryonic Membranes; Female; Fetal Death; Gestational Age; Humans; Isotonic Solutions; Labor, Induced; Middle Aged; Oxytocin; Parity; Pregnancy; Sodium Chloride; Time Factors; Uterine Rupture

In a single large pig production unit of 6000 breeding sows, seven groups of 100 sows each were formed at random on the 110th day of pregnancy. Each group was evaluated and divided according to body condition in three subgroups. The average parity in each subgroup was recorded. The groups were treated as follows: Group 1 received on the 113th day of pregnancy a 3 mg single intramuscular dose of alfaprostol. Group 2 received on the 113th day of pregnancy a 3 mg single intramuscular dose of alfaprostol, 24 hours later a single intramuscular dose of 10 IU of oxytocin. Group 3 received a single intramuscular dose of 10 IU of oxytocin after the birth of the first piglet. Group 4 received on the 113th day of pregnancy a 100 mg single intramuscular dose of prednisolone. Group 5 received on the 113th day of pregnancy a 0.2 mg single intramuscular dose of carbamylcholine. Group 6 received from the 110th day of pregnancy food consisting of 12% fiber, 3 kg per sow per day. Group 7 (control) received a 3 ml physiologic NaCl solution on the 114th day of pregnancy. The following parameter were evaluated: A: Number of live born piglets B: Number of intrapartum stillborn piglets As regard number of live born piglets no significant difference was seen between the experimental groups (1-6) and the control group (7). On the other hand showed the experimental group 1, 2, 5 and 6 significant lower incidence of intrapartum stillbirth when compared to the control (group 7). Within the groups the tendency was seen, that the sows with higher parity and body condition produced less numbers of live born and higher numbers of intrapartum stillborn piglets.

Topics: Animals; Carbachol; Female; Fetal Death; Nutritional Status; Oxytocin; Parity; Prednisolone; Pregnancy; Prostaglandins F; Swine; Swine Diseases

Parturition in rats is associated with an abrupt and marked increase in myometrial oxytocin (OT) receptor concentrations. In this study, we investigated the role of myometrial OT receptors in the initiation and the process of parturition. We produced chronic OT receptor blockade during the last 3 days of gestation by administration of a specific OT antagonist at 100 micrograms/day and 300 micrograms/day. We also suppressed OT receptor formation by inhibiting prostaglandin synthesis with naproxen sodium at 2 mg/day and 5 mg/day. We found that chronic blockade of OT receptors inhibited the uterotonic response to OT in Day 22 and Day 23 pregnant rats in a dose-dependent manner. OT antagonist treatment did not prolong the gestation period. However, the duration of parturition, fetal mortality, and the mortality incidence were increased in rats treated with the high dose of the OT antagonist compared to controls. Naproxen sodium at both dosage levels prolonged gestation by 24 h or longer, doubled the duration of parturition, and markedly increased fetal mortality and mortality incidence. Combined OT antagonist and naproxen treatment produced adverse outcomes similar to that produced by naproxen treatment alone. Myometrial OT receptor concentrations were markedly increased in all rats immediately postpartum, ranging from 210 to 425 fmol/mg protein compared to the 50 to 100 fmol/mg found in Day 21 and Day 22 pregnant rats. Correlation analyses between OT receptor concentrations and various parameters associated with gestation and parturition showed that there was a correlation between low OT receptor concentrations and long gestation period, prolonged parturition, and high fetal mortality rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Angiotensin Receptor Antagonists; Animals; Female; Fetal Death; Gestational Age; Labor, Obstetric; Myometrium; Oxytocin; Pregnancy; Prostaglandins; Rats; Rats, Inbred Strains; Receptors, Angiotensin; Receptors, Oxytocin; Uterine Contraction

Placental abruption resulting in fetal death may seriously affect maternal health, especially when clotting disorders arise. The prevailing view is that the clotting system will only normalize after the uterus has been evacuated and therefore prompt delivery, often by induction of labor, is advocated. Over a 3-year period, 16 cases (0.35%) of intra-uterine fetal death due to placental abruption occurred at Leiden University Hospital. Five cases were complicated by severe clotting disorders. All women delivered vaginally. No maternal deaths occurred. In contrast to most authors, we present data showing that in four out of five cases the clotting system started to normalize before the uterus was emptied. We suggest that an expectant approach until recovery of the coagulopathy is safer than aiming at a quick delivery. After stabilization of the clotting disorder, one may then consider evacuation of the uterus, if need be by induction of labor.

Topics: Abruptio Placentae; Adult; Blood Coagulation Disorders; Blood Component Transfusion; Cesarean Section; Female; Fetal Death; Humans; Oxytocin; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Complications, Hematologic; Pregnancy Trimester, Third; Prostaglandins; Uterine Hemorrhage

Vaginal delivery was successful in 76% of the 242 women who underwent a trial of labor after cesarean section in a prior pregnancy. Separation of the uterine scar occurred in four women (1.7%). Women whose prior cesarean section was for breech presentation had the highest rate of successful vaginal delivery (86%). The vaginal delivery rates were similar in women who delivered infants with birth weights > or = 4,000 g (73%) and < 4,000 g (76%). The use of epidural anesthesia and oxytocin may enhance the success of vaginal delivery in women undergoing a trial of labor following an earlier cesarean section.

Topics: Anesthesia, Epidural; Apgar Score; Birth Weight; Cesarean Section; Episiotomy; Female; Fetal Death; Humans; Oxytocin; Pregnancy; Retrospective Studies; Trial of Labor; Vaginal Birth after Cesarean

The course of labour in 22 patients with antepartum fetal death who received epidural anaesthesia was evaluated as compared to 22 controls matched for parity and gestational age, who received narcotic pain relief. Both groups had similar preinduction cervical dilatation and the induction was performed by amniotomy and oxytocin infusion. The mean first stage of labour was 5.4 hours in the epidural group, and 8.7 hours in the controls (p = 0.0192). The mean cervical dilatation rate was 3.3 cm/hour and 1.0 cm/hour respectively (p = 0.0142). The second stage was similar in both groups. We conclude, that parturients receiving epidural anaesthesia may benefit both emotionally and physically from excellent pain relief and a shorter delivery process when going through the distressing experience of delivering a dead fetus.

Topics: Amnion; Anesthesia, Epidural; Anesthesia, Intravenous; Anesthesia, Obstetrical; Bupivacaine; Female; Fetal Death; Gestational Age; Humans; Labor Stage, First; Labor, Induced; Lidocaine; Meperidine; Obstetric Labor Complications; Oxytocin; Parity; Pregnancy; Time Factors

We identified high rates of intrapartum and neonatal mortality among children born in a traditional indigenous community in rural Guatemala. To examine the potential association of maternal characteristics and obstetric and newborn care practices with this mortality, we conducted a retrospective case-control study. Case were infants born in 1986 and 1987 who died during birth or in the first month of life, as identified by civil records; for each case, the next child born who survived the first month of life was selected as control. In interviews with mothers of cases and controls standardized data were collected on demographic and socioeconomic characteristics of the mother, her general obstetric history, history of the pregnancy, labor, and delivery, condition and care of the infant at birth, and morbidity and treatments of the infant after birth. Sixty-one cases and their controls were included in the study. Based on clinical condition at birth, we subcategorized cases into infants stillborn or dying in the first 24 hours of life (intrapartum cases) and those dying in the first month after day 1 (neonatal cases). Factors significantly associated with both subcategories of cases were maternal illiteracy, primagravity, failure to use "modern" prenatal care, and inter-birth interval less than 14 months. Intramuscular injection of oxytocin by the midwife during labor, and performance of greater than or equal to 3 vaginal examinations by the midwife were each significantly associated only with the intrapartum subcategory of cases. Mother's estimate of infant size as "smaller than normal" was associated with neonatal, but not with intrapartum, cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Analysis of Variance; Birth Intervals; Birth Weight; Case-Control Studies; Educational Status; Female; Fetal Death; Guatemala; Humans; Infant Mortality; Infant, Newborn; Oxytocin; Pregnancy; Prenatal Care; Retrospective Studies; Risk Factors

Fear of uterine rupture has led to the widespread practice of 'Once a section, always a section'. Between 1972 and 1982, 1498 patients with one or more previous cesarean sections were delivered at University College Hospital, Galway. Trial of labor was undertaken in 844 patients, while the remaining 654 patients underwent repeat elective section because they had two or more prior sections. Eight true ruptures and 22 scar dehiscences were found. Regional analgesia and oxytocin did not significantly affect the rate of true rupture. The mean parity with uterine rupture was five, and it occurred most frequently in the initial trial of labor. There were four perinatal deaths associated with true rupture. Failure to detect the already compromised fetus before labor and delivery, rather than the method of delivery, was responsible for fetal demise in some instances. Five true ruptures were found in the trial of labor group (i.e. a ratio of 1:169), with the loss of three babies. A further baby was stillborn in a mother who ruptured a classical scar before labor. There were no maternal deaths in trial-of-labor patients and one in the elective section group. Two patients with true rupture had their uterus repaired, and were subsequently delivered by section. Another two patients with bloodless dehiscence and no repair, had two subsequent elective repeat sections each, and the unrepaired scar dehiscence was not evident.

Topics: Cesarean Section; Female; Fetal Death; Fetal Distress; Humans; Obstetric Labor Complications; Oxytocin; Pregnancy; Reoperation; Surgical Wound Dehiscence; Trial of Labor; Uterine Rupture; Uterus

In a single large pig production unit of 6,000 breeding sows, 3 Groups of 100 sows each were formed at random on the 110th day of pregnancy. Each Group was evaluated and divided according to body condition in three subgroups. The Groups were treated as follows: Group 1: received on the 113th day of pregnancy a 3 mg single intramuscular dose of Alfaprostol, 24 hours later a single intramuscular dose of 10 i.U. of Oxytocin. Group 2: received on the 113th day of pregnancy a 0.2 mg single intramuscular dose of Carbamylcholin. Group 3: received a 3 ml intramuscular dose of physiologic NaCl solution on the 113th day of pregnancy. The parameter "intrapartal dead piglets" was evaluated. Group 1 and 2, especially in Subgroups KK3, showed significant less intrapartal death when compared to Group 3.

Topics: Animals; Carbachol; Drug Therapy, Combination; Female; Fetal Death; Health Status; Oxytocin; Pregnancy; Prostaglandins F; Swine; Swine Diseases

The particulars of 78 patients with fetal demise of the last 14 years were evaluated retrospectively. The most important reason of fetal death was hypoxaemia or anoxaemia. 31 patients were delivered by cesarean section or had spontaneous uterine contractions. Induction of 47 abortions were started with oxytocin or prostaglandins. Within 12 hours 54% of the oxytocin and 67% of the prostaglandin group succeeded in spontaneous delivery. In both groups there were 5 management failure of therapy, so that alternative medication or a cesarean section lead to delivery.

Topics: Cesarean Section; Delivery, Obstetric; Female; Fetal Death; Fetal Hypoxia; Humans; Labor, Induced; Oxytocin; Parity; Pregnancy; Prostaglandins

2635 prenatal cardiotocographic recordings were correlated with perinatal mortality in 1000 patients. In some cases, there were extenuating circumstances which, when combined with obstetrical intervention, resulted in an increase in mortality. These included congenital malformations, poor maternal conditions for surgery, a hypertensive crisis, and a delay in surgery. The correlated perinatal mortality was 9x1000. (author's modified)

Topics: Cardiotocography; Female; Fetal Death; Fetal Diseases; Humans; Infant Mortality; Infant, Newborn; Oxytocin; Pregnancy; Pregnancy Complications; Pregnancy Trimester, Third; Risk Factors

Topics: Delivery, Obstetric; Dinoprostone; Emotions; Female; Fetal Death; Gestational Age; Grief; Heparin; Humans; Labor, Induced; Oxytocin; Postpartum Period; Pregnancy; Prostaglandins E; Prostaglandins E, Synthetic; Saline Solution, Hypertonic

A case of oxytocin induced rupture of an unscarred uterus during the second trimester is presented. While rupture of the uterus by oxytocic agents in the second trimester has previously been documented, this case is unusual in that fetal parts were palpable through the cervical os, delaying diagnosis and definitive management. Digital palpation of fetal parts through the cervix does not preclude the diagnosis of fetal extrusion secondary to uterine rupture.

Topics: Adult; Female; Fetal Death; Humans; Infant, Newborn; Oxytocin; Pregnancy; Pregnancy Trimester, Second; Ultrasonography; Uterine Rupture

Serum bilirubin concentrations were investigated in neonatal rats. High concentrations were found on day 1 falling to adult values by day 4. Oxytocin (500 IU/kg) given subcutaneously to the dams on day 22 of pregnancy increased bilirubin concentrations in neonatal rats. This dose of oxytocin shortened gestational length but increased the neonatal death rate. Oxytocin (500 IU/kg) also increased uterine contractions on day 22 of pregnancy, measured using intrauterine balloons inserted on day 19 of pregnancy. Rats delivered by Caesarian section at the same gestational age as the oxytocin-treated group did not exhibit hyperbilirubinaemia. Prostaglandin F2 alpha (300 micrograms/kg) administered intramuscularly on day 20 of pregnancy was found to advance parturition and produced a small rise in serum bilirubin concentrations in neonatal rats. The rat could serve as a model for investigating the mechanisms of neonatal hyperbilirubinaemia which has been suggested to occur after the use of oxytocin or prostaglandins in the human.

Topics: Animals; Animals, Newborn; Bilirubin; Dinoprost; Female; Fetal Death; Gestational Age; Maternal-Fetal Exchange; Oxytocin; Pregnancy; Prostaglandins F; Rats; Rats, Inbred Strains; Spectrophotometry

Topics: Adolescent; Adult; Female; Fetal Death; Fetal Growth Retardation; Fetal Monitoring; Hormones; Humans; Oxytocin; Pregnancy; Risk

Topics: Abortion, Induced; Adolescent; Adult; Electric Stimulation Therapy; Female; Fetal Death; Humans; Middle Aged; Oxytocin; Pregnancy; Uterine Contraction

Topics: Adult; Dinoprost; Female; Fetal Death; Humans; Labor, Induced; Oxytocin; Pregnancy; Prostaglandins F

Topics: Abortion, Missed; Abortion, Therapeutic; Adult; Dinoprost; Female; Fetal Death; Humans; Labor, Induced; Oxytocin; Pregnancy; Prostaglandins F

Topics: Abortion, Induced; Anencephaly; Dinoprost; Female; Fetal Death; Gels; Humans; Oxytocin; Pregnancy; Prostaglandins F

Topics: Female; Fetal Death; Fetal Heart; Fetal Monitoring; Heart Rate; Humans; Hypertension; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; Multi-Institutional Systems; Oxytocin; Pre-Eclampsia; Pregnancy; Pregnancy in Diabetics; Prospective Studies; Risk; Uterine Contraction

This study includes, 1,542 patients who underwent nonstress tests (NSTs) for primary fetal surveillance and 4,626 patients who underwent contraction stress tests (CSTs) for primary fetal surveillance. All pregnancies were at increased risk for uteroplacental insufficiency. The results showed that the two groups were comparable according to maternal diagnostic criteria for testing. Those patients who underwent NSTs as primary surveillance had a 2.9% incidence of intervention because of abnormal test results while the CST group had a 4.5% incidence of intervention because of abnormal test results ( p less than 0.05). The NST group had significantly more respiratory distress syndrome, intrauterine growth retardation, birth weight less than 2,500 gm, and 5-minute Apgar scores less than 7. The antenatal death rate was nearly eight times higher in the NST group (7.8/1,000 versus 1.1/1,000 in the CST group) (p less than 0.05). After correction for congenital anomalies and unrelated causes, the NST group had an antenatal death rate of 3.2/1,000 versus 0.4/1,000 in the CST group (p less than 0.05); there was still an antenatal death ratio of 8:1.

Topics: Apgar Score; Birth Weight; Female; Fetal Death; Fetal Growth Retardation; Fetal Heart; Fetal Monitoring; Heart Rate; Humans; Hypertension; Infant, Newborn; Multi-Institutional Systems; Oxytocin; Pre-Eclampsia; Pregnancy; Pregnancy in Diabetics; Prospective Studies; Respiratory Distress Syndrome, Newborn; Risk; Uterine Contraction

From a study of 2000 consecutive labours, the outcome of 847 multigravid patients admitted in spontaneous labour was examined. Labour was classified according to the cervimetric pattern, and response to oxytocin given according to a strict protocol with the use of a nomogram and partogram. The mean 'observed first stage' was 3.4 h, and the caesarean section rate 1.4%. Normal labour occurred in 88.5%, with a vaginal delivery rate of 99.5% in this group. Stimulation was indicated in 98 patients (11.6%), augmentation improving the rate of progress in 86 (87.8%) of these, with vaginal delivery occurring in all but one. Successful accelerated labour was not associated with any increase in neonatal morbidity as judged by Apgar scores, intubation or transfer to the special care baby unit. Twelve patients did not have improvement following augmentation and seven were delivered by caesarean section, including one following a potentially preventable uterine rupture. The greatest neonatal morbidity was in the group with primary dysfunctional labour that did not improve with augmentation. It may be that this was related to the mode of delivery rather than augmentation, as there was no significant difference in neonatal condition between normal and abnormal labour if vaginal delivery occurred.

Topics: Apgar Score; Cervix Uteri; Female; Fetal Death; Humans; Labor, Obstetric; Obstetric Labor Complications; Oxytocin; Parity; Pregnancy

Topics: Adult; Female; Fetal Death; Fetal Heart; Fetal Monitoring; Humans; Oxytocin; Pregnancy; Ultrasonography; Uterine Contraction

Topics: Female; Fetal Death; Humans; Oxytocin; Pregnancy

Topics: Adult; Female; Fetal Death; Humans; Labor, Induced; Oxytocin; Pregnancy; Uterine Rupture; Uterus

A protocol for antepartum supervision which included "non stress fetal monitoring" (NSFM) and the "oxytocin Challenge Test" (OCT) was followed in a series of 640 high-risk pregnancies. The perinatal mortality in this group was compared with that obtained in a group of 3,049 non-selected deliveries which occurred during the same period of time and which were not monitored in the same way. The perinatal mortality which could be attributed to placental insufficiency in the first group (the supervised group) was at 4.68 per 1000, about half that of the non-supervised group (8.72 per 1000) in spite of the low number of high risk cases in the second group. When NSFM was normal in the week before delivery there was no single perinatal death due to placental insufficiency. When the NSFM was normal and the OCT was pathological the OCT Test was probably wrong. When the NSFM test was non-reactive placental insufficiency could be predicted in only 28 per cent of the cases although a combination of NSFM with a positive OCT Test predicted correctly 91.3 per cent of the cases of placental insufficiency. We consider that there is fetal distress due to placental insufficiency when having found signs indicative of fetal distress in delivery (a pH of less than 7.25, recent passage of meconium, the Apgar score less than 7 in the first minute, and pathological fetal heart rhythm (RFC) we can find no other cause to explain the signs such as a short cord, prematurity, obstetrical trauma, prolonged pregnancy and malformations, etc.

Topics: Female; Fetal Death; Fetal Heart; Fetal Monitoring; Humans; Infant, Newborn; Oxytocin; Placental Insufficiency; Pregnancy; Risk

Topics: Apgar Score; Female; Fetal Death; Fetal Heart; Fetal Monitoring; Heart Rate; Humans; Infant, Newborn; Oxytocin; Placental Insufficiency; Pregnancy; Risk

Three hundred sixty-two pregnant patients at risk for placental insufficiency were evaluated with the oxytocin challenge test (OCT) and urinary estriol determinations. The perinatal mortality in patients with positive tests was 6 times higher than the perinatal mortality in patients with negative tests. Expectant treatment of patients with a positive OCT was associated with a perinatal mortality 6 times higher than if immediate delivery was accomplished. A negative stress test was reassuring, as the risk of death in utero within a week of a negative test was only 0.3%. The combination of low estriol levels and positive OCT was quite ominous, while the presence of normal estriol levels provided reassurance of good perinatal outcome when expectant treatment of a patient with a positive OCT was undertaken. The overall perinatal mortality of the patients in this study was not different from that in the general obstetric population.

Topics: Cesarean Section; Estriol; Female; Fetal Death; Humans; Oxytocin; Placenta Diseases; Placental Function Tests; Placental Insufficiency; Pregnancy; Pregnancy Complications

Based on analyses of the oxytocin challenge test (OCT) in 293 cases, an OCT-reactivity classification is proposed to improve the predictive value of OCT for fetal outcome. All of the 6 perinatal deaths occurred in the 2 groups associated with nonreactive pattern. The positive nonreactive test had 90% accuracy of predicting a sick infant, and the negative reactive test assured good fetal outcome. A nonreactive pattern seems to reflect a compromised fetus, as a high incidence of this pattern was found in patients with pre-eclampsia-hypertension, intrauterine growth retardation (IUGR), low and falling estriol levels, and suspected fetal problems. A positive OCT seems to reflect the limits of fetoplacental reserve under the stressed condition. A high incidence of positive OCT was associated with IUGR, low estriol levels, and a small placenta.

Topics: Adult; Birth Weight; Estriol; Female; Fetal Death; Fetal Heart; Fetal Monitoring; Fetus; Gestational Age; Heart Rate; Humans; Organ Size; Oxytocin; Placenta; Pregnancy; Prenatal Diagnosis; Stress, Physiological

Stressed and non-stressed antenatal fetal monitoring was carried out 9 520 times in 5 932 high-risk patients. Intra-uterine death occurred in 48 patients. In 19 patients the fetus died within 1 week of monitoring but before the onset of labour; the results of monitoring had been normal in 14 of these. Abruptio placentae was the cause of 6 of these deaths. Many of the other causes of intra-uterine death were also acute complications such as haemorrhage due to placenta praevia, amniotic fluid infection, and cord prolapse. True false-negative test results were rare, and were seen most often in patients with preeclampsia, diabetes and haemolytic disease. Twin pregnancies also caused a problem, as double recording of the heart rate of the normal fetus could create a false sense of security.

Topics: Adolescent; Adult; Female; Fetal Death; Fetal Heart; Fetal Monitoring; Heart Rate; Humans; Oxytocin; Pregnancy; Uterine Contraction

The recent Food and Drug Administration's approval of prostaglandin E2 (PGE2) vaginal suppositories provides the clinician with a technique for the immediate management of missed abortion and intrauterine fetal death (IUFD). During a 4-year period at our institution, 78 of 80 patients with gestations ranging from 13 to 42 weeks had pregnancy successfully terminated with PGE2 suppositories with a dose schedule of 20 mg every 2 hours. The mean interval from induction to delivery of the fetus was 8.9 hours. Fifty percent of the patients spontaneously expelled the placenta; active intervention to remove the placenta within 2 hours of delivery of the fetus is recommended to avoid excessive vaginal bleeding. The most frequently encountered side effect was a temperature elevation, which was managed by less frequent administration of the prostaglandin. Gastrointestinal side effects were minimized by premedication with antidiarrheal and antiemetic agents, which also were administered during the induction period when indicated by the patient's symptoms. A concomitant oxytocin infusion was utilized in 38 patients. In gestations of less than 24 weeks the oxytocin was administered via intravenous drip at a rate of 10 U/hour. In the case of a patient with IUFD and a gestation of 24 weeks or more, oxytocin should be administered only with a constant-rate infusion pump starting at a dose schedule of 1 mU/minute with careful titration of the dose against the monitored uterine activity. The availability of the vaginal PGE2 suppositories for missed abortion and IUFD makes it important for the clinician to fully acquaint himself with the drug, its administration, effects, and side effects.

Topics: Abortion, Therapeutic; Adolescent; Adult; Drug Synergism; Drug Therapy, Combination; Female; Fetal Death; Fever; Gestational Age; Humans; Oxytocin; Pregnancy; Prostaglandins E; Suppositories; Time Factors; Vagina

Labor was induced in 64 women in the third trimester, after antepartum fetal death. In 26 patients, hypertonic saline solution was instilled into the uterus; in 24, surgical rupture of the membranes, followed by oxytocin, was tried, and in 14, induction was by amniotomy only. A definite advantage of the last two methods was shown, the mean induction delivery interval being 22.55, 8.96 and 7.20 hours, respectively. Considering also the possible dangers of hypertonic saline solution, the simple method of amniotomy is preferred.

Topics: Adult; Female; Fetal Death; Humans; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Trimester, Third; Saline Solution, Hypertonic

Topics: False Negative Reactions; Female; Fetal Death; Fetal Diseases; Humans; Oxytocin; Pregnancy

Sixty-six patients with chronic hypertension were cared for during a total of 72 pregnancies. Patients were treated at home primarily by greater than or equal to 4 hours of bed rest daily in the left recumbent position. Only patients whose diastolic blood pressures remained greater than 110 mmHg were treated with hydralazine (Apresoline, Ciba). With this plan of treatment there were only 3 perinatal deaths for an uncorrected perinatal mortality of 4.1% (1.4% corrected). Twenty-nine percent of the patients had babies that were small for gestational age, 13.8% had positive oxytocin challenge tests, and 36.8% developed superimposed preeclampsia. When compared with the outcome of previous pregnancies, the program of bed rest lowered perinatal mortality from 16.8 to 8.8%. Thus, it is suggested that bed rest together with the avoidance of diuretics and the judicious use of hydralazine results in the most favorable fetal outcome.

Topics: Bed Rest; Birth Weight; Chronic Disease; Female; Fetal Death; Humans; Hydralazine; Hypertension; Infant Mortality; Infant, Newborn; Infant, Small for Gestational Age; Meconium; Oxytocin; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Cardiovascular

Pregnancy was terminated with prostaglandin E2 in 65 women harboring a dead fetus for 3 days to 8 weeks. The study was designed to: (1) elucidate the mechanism of failed onset of labor in the presence of fetal death, (2) determine appropriate dose-response relationships, and (3) evaluate safety and efficacy of this new method of intervention. Results indicate that plasma progesterone levels from 12 to 40 weeks' gestation are in the lower normal statistical range as compared to those seen in pregnancy with a living fetus. Uterine size as estimated from fetal birth weight is also in the low normal range compared to that seen in a viable pregnancy. Hence the uterine volume-progesterone ratio is equal to or greater than that in normal pregnancy and thereby partially explanatory for the failed initiation of labor. The dosage required to produce delivery declined in each month's grouping from a mean of 56 +/- 26 (SD) mg at 12 to 15 weeks to 22 +/- 8.4 mg at 38 to 40 weeks. Dose-delivery response did not correlate with age, parity, or progesterone levels but did correlate with oxytocin response. Three unusual and serious complications occured.

Topics: Adult; Delivery, Obstetric; Dose-Response Relationship, Drug; Female; Fetal Death; Humans; Labor Onset; Labor, Induced; Oxytocin; Pregnancy; Pressure; Progesterone; Prostaglandins E; Suppositories; Uterine Contraction; Uterus

Two hundred seventy-eight high-risk patients were managed by a comprehensive assessment of the anatomic, biochemical, and functional environment of the fetoplacental unit utilizing predetermined guidelines. Decisions to terminate pregnancy were reserved for patients who demonstrated a positive OCT. Perinatal outcome in patients with positive OCT's was significantly worse than in patients who did not have a positive OCT. Patients with suspicious OCT's frequently had positive OCT's and were more likely to bear growth-retarded infants, whereas negative OCT's in general were associated with a favorable outcome. Correlation of estriol excretion with the OCT and perinatal outcome was inconsistent. There were a total of four prenatal deaths, all of which were considered unpreventable.

Topics: Congenital Abnormalities; Female; Fetal Death; Fetus; Humans; Labor, Induced; Oxytocin; Pregnancy; Risk; Uterine Contraction

A retrospective survey of surgical induction of labour has shown that induced patients had a lower perinatal mortality rate and a lower Caesarean section rate than non-induced women.

Topics: Cesarean Section; Female; Fetal Death; Humans; Infant, Newborn; Labor, Induced; Oxytocin; Pregnancy; Respiratory Distress Syndrome, Newborn; Retrospective Studies

Four cases of a rare atypical fetal heart pattern obtained during the oxytocin challenge test are described. In all cases, there were marked oligohydramnios and fetal growth retardation with a severely compromised fetus, and in 3 cases the fetuses died.

Topics: Female; Fetal Death; Fetal Growth Retardation; Fetal Heart; Fetal Monitoring; Heart Rate; Humans; Oxytocin; Pregnancy

In twelve cases of intrauterine fetal death labour was induced by combined treatment with an intra-cervical balloon and oxytocin infusion. The average induction-delivery time was approximately 11 hours. Acceptance of this method for induction of labour by the patients was satisfactory and the side effects were minor.

Topics: Adolescent; Adult; Female; Fetal Death; Humans; Labor, Induced; Oxytocin; Pregnancy; Time Factors

Topics: Female; Fetal Death; Humans; Labor, Induced; Oxytocin; Pregnancy

Topics: Apgar Score; Cesarean Section; Female; Fetal Death; Fetal Distress; Fetal Growth Retardation; Fetal Heart; Fetal Monitoring; Heart Rate; Humans; Infant Mortality; Infant, Newborn; Labor, Obstetric; Oxytocin; Pregnancy

Fifteen cases are reported of spontaneous rupture of the gravid uterus occurring at the Naval Regional Medical Center (NRMC), Portsmouth, Virginia, over a 21-year period. Forty-seven percent of the patients had previously undergone a cesarean section. Thirteen percent of the patients had received oxytocin prior to the rupture. Fetal mortality associated with these ruptures was 13%. No maternal deaths occurred. Forty percent of the patients had repair of the defect, with 60% undergoing some type of hysterectomy. Preventive measures, early diagnosis, and prompt treatment are emphasized.

Topics: Adult; Cesarean Section; Female; Fetal Death; Humans; Infant, Newborn; Labor, Induced; Maternal Mortality; Oxytocin; Pregnancy; Uterine Rupture; Virginia

Topics: Female; Fetal Death; Fetal Distress; Fetal Heart; Fetal Monitoring; Heart Rate; Humans; Oxytocin; Pregnancy

Topics: Adult; False Negative Reactions; Female; Fetal Death; Fetal Heart; Fetus; Heart Rate; Humans; Oxytocin; Pregnancy; Pregnancy, Abdominal; Prenatal Diagnosis; Uterine Contraction

On May 1, 1975, at Women's Hospital, Los Angeles County--University of Southern California Medical Center, a new antepartum fetal heart rate (AFHRT) protocol was put into clinical use. This included the widely used contraction stress test (CST) and a new concept of nonstress testing (NST). The NST was based on FHR response associated with fetal movements and was categorized as reactive (normal) or nonreactive (abnormal). The nonreactive fetus was then evaluated with a CST if not contraindicated. During the 24 months, May 1, 1975 to April 30, 1977, a total of 2,422 NST's were done in 1,169 patients with 1,547 (64 per cent) reactive and 829 (35 per cent) nonreactive. CST was done 939 times, with 851 (90.6 per cent) negative, 29 (3 per cent) positive, 13 (1.4 per cent) equivocal, and 46 (5.0 per cent) unsatisfactory. There were ten (3.3 per cent) perinatal deaths within one week of a negative CST, five (1.0 per cent) within one week of a reactive NST, and two (8.7 per cent) with a positive CST. A reactive NST was as predictive of good outcome as was a negative CST. Analysis of the nonreactive NST showed that two or more accelerations were not associated with abnormal CST's. Also, some nonreactive fetuses became reactive with oxytocin and had good outcome. These observations were utilized in the development of a newer, shorter NST which allows for fetal stimulation in an attempt to further define fetal well-being.

Topics: California; Female; Fetal Death; Fetal Diseases; Fetal Heart; Heart Rate; Humans; Infant Mortality; Oxytocin; Pregnancy; Prenatal Diagnosis; Stimulation, Chemical; Uterine Contraction

Topics: Adolescent; Adult; False Negative Reactions; Female; Fetal Death; Humans; Oxytocin; Pregnancy; Prenatal Diagnosis; Uterine Contraction

Topics: Adult; Anemia; Anticonvulsants; Epilepsy, Tonic-Clonic; Female; Fetal Death; Fetal Diseases; Humans; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Complications

Topics: Adult; False Negative Reactions; Female; Fetal Death; Fetal Distress; Humans; Labor, Induced; Oxytocin; Pregnancy; Prenatal Diagnosis

Topics: Birth Weight; Brazil; Developing Countries; Female; Fetal Death; Humans; Infant Mortality; Infant, Newborn; Oxytocin; Pregnancy; Pregnancy Complications, Cardiovascular

Topics: Adult; Female; Fetal Death; Fetal Diseases; Humans; Oxytocin; Pregnancy; Time Factors

The desired goals of the oxytocin challenge test (OCT) are preventing stillbirth and avoiding unnecessary premature intervention. To effectively reduce stillbirth the test should be done on a significant proportion of those fetuses who would subsequently succumb in utero. To analyze whether or not the OCT is achieving these goals. 5351 deliveries over a 2-year period at the University of California, Irvine, Medical Center were studied retrospectively. Four hundred and thirty of these patients had 823 OCTs performed. There were ten positive and 19 suspicious tests, and five neonatal deaths in these two groups. In patients who were studied with OCTs only one stillbirth occurred (in a patient who was noncompliant). During the same period, all stillbirths were reviewed. In the group in which stillbirth occurred, it was determined that 11 or 35% of the patients had indications for antepartum testing but were not tested. All 11 of these patients were transferred to the University hospital or had no prenatal care. It is suggested that these stillbirths may have been prevented had appropriate prenatal care allowed identification of patients for antepartum testing.

Topics: False Positive Reactions; Female; Fetal Death; Humans; Oxytocin; Pregnancy; Retrospective Studies; Time Factors

One hundred four postdate pregnancies were managed according to a well-defined protocol calling for weekly oxytocin challenge tests and urinary estriols three times per week. Although the perinatal mortality rate in these patients was not increased there was a significant increase in the incidence of neonatal morbidity and complications. The clinical syndrome of dysmaturity was seen in 20 per cent of the neonates. When meconium was present in the amniotic fluid the incidence of neonatal and fetal complications was higher. The cesarean section rate was twice the normal rate, with nonprogression of labor being the commonest indication. It is recommended that: (1) pregnancies carried beyond 42 weeks do not require termination simply because they are post dates; (2) all postdate patients should be monitored during labor; (3) trained personnel to initiate neonatal resuscitation should be present at each postdate delivery.

Topics: Amniocentesis; Cesarean Section; Estriol; Female; Fetal Death; Fetal Heart; Fetal Monitoring; Heart Rate; Humans; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; Labor, Obstetric; Meconium; Oxytocin; Placenta Diseases; Pregnancy; Pregnancy, Prolonged; Risk

Topics: Cervix Uteri; Dilatation; Female; Fetal Death; Fetal Monitoring; Humans; Infant Mortality; Infant, Newborn; Infusions, Parenteral; Labor, Induced; Monitoring, Physiologic; Oxytocin; Pelvimetry; Pregnancy; Pressure; Uterine Contraction

The hyperthermic effect of purified lipopolysaccharides (Pyrexal, Wander) was tested and analyzed in pregnant rabbits. The fever produced premature deliveries - probably caused by oxytocin, released from the posterior pituitary - in 50% of 40 tested rabbits on the 31st day of gestation. Injections of Syntocinon had a roughly equally strong effect. In control animals injection of saline did not accelerate delivery. The offspring of several animals, in which hyperthermia had been induced, were born dead. Fever during pregnancy thus can result in premature delivery and in injury to the fetus. Fever and febrile conditions occurring during pregnancy should therefore be treated as promptly and as effectively as possible.

Topics: Animals; Female; Fetal Death; Fever; Lipopolysaccharides; Obstetric Labor, Premature; Oxytocin; Pituitary Gland, Posterior; Pregnancy; Pregnancy Complications; Pyrogens; Rabbits; Sodium Chloride

Labor was successfully induced in 20 patients with a diagnosis of missed abortion or intrauterine fetal death (IUFD) by intravaginal administration of prostaglandin E2 suppositories. Fifteen patients delivered with the prostaglandin alone while a concomitant oxytocin infusion was employed to augment contractions in the other five patients. The mean induction-delivery time was 9.80 hours; nulliparous patients delivered in a mean time if 7.78 hours, parous patients in a mean time of 12.29 hours. The uterus appeared to be sensitive to the PGE2 stimulation in all patients and all were delivered completely without the need for surgical intervention. Fifty per cent of patients were delivered within 8 hours and 80 per cent by 12 hours. The side effects associated with prostaglandin administration--vomiting, diarrhea, and temperature elevation--were well tolerated and therapy did not have to be terminated in any patient. The administration of PGE2 vaginal suppositories offers an effective and safe technique for the induction of labor in patients with IUFD. Labor can be induced with PGE2 suppositories as soon as the diagnosis of IUFD is confirmed, which eliminates the need for waiting until spontaneous labor occurs.

Topics: Abortion, Missed; Adolescent; Adult; Female; Fetal Death; Humans; Labor, Induced; Oxytocin; Pregnancy; Prostaglandins E; Suppositories; Time Factors

Topics: Apgar Score; Estriol; Female; Fetal Death; Fetal Distress; Fetal Growth Retardation; Fetal Heart; Fetal Monitoring; Heart Rate; Humans; Infant Mortality; Oxytocin; Pregnancy; Uterine Contraction

Topics: Adult; Female; Fetal Death; Humans; Oxytocin; Placental Function Tests; Pregnancy; Pregnancy in Diabetics; Time Factors

The effect of modern antepartum and intrapartum fetal monitoring technics on the outcome of the pregnancy complicated with diabetes was studied by comparing the perinatal mortality of 2 groups of patients whose management differed primarily by the use of these tests. The perinatal death rate was halved to 9.2%, and when corrected for major congenital defects and referred fetal deaths it was 5.3%. Modern fetal diagnostic tests clearly add a degree of objectivity in the management of the diabetic pregnancy not previously available.

Topics: Amniocentesis; Delivery, Obstetric; Female; Fetal Death; Fetal Diseases; Fetus; Humans; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; Labor, Obstetric; Lung; Oxytocin; Placental Function Tests; Pregnancy; Pregnancy in Diabetics; Prenatal Diagnosis

A negative oxytocin challenge test has been considered a very reassuring finding in managing pregnancies in which the fetus is at risk from uteroplacental insufficency. In the case described here a fetal death in utero occurred 4 days after a negative oxytocin challenge test in a Class D diabetic patient, but in that period of time the patient's metabolic status deteriorated. A negative oxytocin challenge test does not protect the fetus from a subsequent acute event such as abruptio placentae, a cord accident, or diabetic ketoacidosis.

Topics: Adult; False Negative Reactions; Female; Fetal Death; Humans; Oxytocin; Pregnancy; Pregnancy in Diabetics

The oxytocin challenge test (OCT) was performed 537 times on 364 high-risk patients over a three-year period. It was shown that a positive test had a highly significant correlation with a worsened perinatal outcome as measured by stillbirth rate, fetal distress in labour, intrauterine growth retardation, Apgar scores and the need for neonatal resuscitation and intensive care. However, one-third of positive tests were falsely positive when tested by labour. A negative test proved reassuring for a further week of intrauterine life in 98.2 per cent of cases. The role of the OCT in antepartum fetal monitoring is discussed.

Topics: Female; Fetal Death; Fetal Distress; Fetal Heart; Humans; Oxytocin; Pregnancy; Prenatal Diagnosis

In a group of 16 women admitted for missed abortion, missed labor or antepartum fetal death, we induced abortion or labor by means of extraamniotic infusion of isotonic saline solution, using a Foley catheter inserted through the cervix. Eight patients also required parallel intravenous administration of 5-10 U of oxytocin drip. The average time from the onset of treatment until expulsion of the macerated fetus was 9.09 hours. No complications were recorded. This method is suggested in all such cases, especially when the classical methods are contraindicated.

Topics: Abortion, Induced; Abortion, Missed; Adult; Female; Fetal Death; Humans; Isotonic Solutions; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Complications; Sodium Chloride

Two groups of healthy women at term, who were not in labor 3 hours after premature rupture of the membranes, were studied. In one group labor induction with oral prostaglandin E2 (PGE2) was begun 3 hours after rupture, and in the other group intravenous oxytocin induction was begun 12 hours after rupture. PGE2 was successful in initiating active labor in 88% of women treated. Of the women who were observed for 12 hours, one-half began labor spontaneously during that time. Women in whom labor was induced with PGE2 given 3 hours after rupture of the membranes had a shorter interval of rupture to delivery, a lower cesarean section rate, and shorter postpartum hospitalization. Although significant bradycardia did not occur in fetuses of those women given PGE2, 10% of infants whose mothers were receiving oxytocin were delivered by cesarean section for this reason. It is concluded that oral PGE2 is safe and effective for induction of labor in women with premature membrane rupture. The benefits, to both mother and fetus, of a shorter latent period are discussed.

Topics: Adult; Extraembryonic Membranes; Female; Fetal Death; Fetal Heart; Fetal Membranes, Premature Rupture; Heart Rate; Humans; Labor, Induced; Labor, Obstetric; Maternal Mortality; Monitoring, Physiologic; Oxytocin; Pregnancy; Prostaglandins E; Puerperal Infection; Time Factors

Recently, the oxytocin challenge test (OCT) has gained increasing prominence in the management of high-risk pregnancies. 1 distinct advantage is its predictive value of intrauterine fetal well-being. Most authors agree that if a negative OCT is obtained the status of the fetus is relatively secure for 1 week. Even so, there have been reports of false negative OCTs. Dr. Freeman (Obstetrics and Gynecology 47: 8, 1976) reported 2 fetal deaths 6 and 7 days after negative OCTs, and Dr. Farahani (Obstetrics and Gynecology 47: 159, 1976) reported 1 fetal death 7 days following a negative OCT. In a Letter to the Editors (American Journal of Obstetrics and Gynecology 123: 106, 1975), Dr. Baskett related 2 additional fetal deaths in utero, preceded 6 1/2 days by negative OCTs. Dr. Klapholtz recorded the earliest fetal death occurring only 6 hours after a negative OCT (Journal of Reproductive Medicine 15: 169, 1975). Our experience of 255 negative OCTs in 140 high-risk patients favorably supports previous data. However, 1 exception has been noted. A primigravid patient with an uncomplicated pregnancy at 43 weeks' gestation by firm dates and third trimester ultrasound examination had initiation of monitoring by OCTs and triweekly estriol determinations. The 1st estriol level was low normal (12 mg/24 hours). An OCT that same evening was negative (data detailed in a figure). The cervix was considered unfavorable for induction of labor. A second 24-hour urinary collection for determination of estriol was begun. 13 hours after the OCT, fetal movement stopped and upon arrival at the hospital, 1 hour later, intrauterine death was confirmed. No fetal, placental, or cord abnormalities were identified after delivery of a normal female infant. (Cord entanglement was not present.) No signs of postmaturity were noted at postmortem examination. Squamous cells were present in the bronchi, and interstitial pulmonary hemorrhage was observed. (This case illustrates a negative OCT followed by fetal death within 14 hours. In contrast, most previously reported intrauterine deaths occurred near the end of the 1-week ''safe period.'') Despite this tragedy, the negative OCT remains as a remarkable indicator of fetal safety. However, it is still necessary to utilize all available aids and to explore new modes of detecting changes in intrauterine fetal status in the high-risk pregnancy.

Topics: False Negative Reactions; Female; Fetal Death; Humans; Oxytocin; Pregnancy; Prenatal Diagnosis

During a period of 16 months, 1 170 contraction stress tests (CST) were performed on 767 women who were at high risk of losing their babies. The tests were positive in 42 patients, of whom 29 were subsequently delivered by caesarean section. Fetal distress, which necessitated caesarean section, occurred in 5 of 6 cases of intra-uterine growth retardation in which labour was induced. Abruptio placentae caused the intra-uterine death of 4 fetuses, 3 of which died within 7 days of a negative CST. The low perinatal mortality rate of 13 demonstrates the reliability of the CST in the evaluation of placental function in obstetric patients who are at high risk.

Topics: Abruptio Placentae; Delivery, Obstetric; Female; Fetal Death; Fetal Heart; Heart Rate; Humans; Infant Mortality; Oxytocin; Placenta Diseases; Placental Function Tests; Placental Insufficiency; Pregnancy; Uterine Contraction

The oxytocin challenge test was used to evaluate the fetoplacental unit in 572 patients over a 5-year period. Four fetuses died in utero within 7 days of a negative test. None had periodic fetal heart rate decelerations of any type. All 4 showed periodic accelerations of the fetal heart rate (FHR) in association with fetal movement. Two had baseline changes in the fetal heart rate during the oxytocin challenge test.

Topics: Adult; Diagnostic Errors; Female; Fetal Death; Fetal Heart; Heart Rate; Humans; Oxytocin; Placental Insufficiency; Pregnancy; Pregnancy, Prolonged

The changes in unconjugated estradiol-17beta and estriol, progesterone and chorionic somatomammotropin (HCS) in peripheral plasma have been studied in 18 women at 30-minute intervals following intra-uterine prostaglandin E2 administration for therapeutic termination of second trimester pregnancy. The hormonal changes were related to the time of fetal death detected by the disappearance of fetal heart pulsations. Prostaglandin E2 was given by the intra-amniotic route with urea (5 patients) or with intravenous oxytocin (5 patients), or by the extra-amniotic route with intravenous oxytocin (8 patients). Fetal death occurred rapidly with intra-amniotic PGE2, but usually at a late stage with extra-amniotic PGE2. Three fetuses in the extra-amniotic group died at or just before abortion. A variety of fetal heart changes were noted and the time of fetal death did not appear to influence the time of abortion within each treatment subgroup. Estradiol and estriol showed a sligh but persistent fall over 24 hours prior to induction of abortion. A more rapid fall usually occurred after induction, with a consistent fall around the time of fetal death. Progesterone and HCS usually fell much less before and immediately after fetal death. A marked rise in estradiol sometimes occurred before fetal death, particularly in the intraamniotic PGE2 and urea subgroup. Estriol levels declined more rapidly before than after fetal death, whereas fetal death had less consistent effects on the other hormones. All hormones had usually fallen considerably at the time of abortion, and in some individuals marked fluctuations in hormone levels were seen.

Topics: Abortion, Induced; Amnion; Estradiol; Estriol; Female; Fetal Death; Fetal Heart; Humans; Injections; Injections, Intravenous; Oxytocin; Placental Lactogen; Pregnancy; Pregnancy Trimester, Second; Progesterone; Prostaglandins E; Urea

Alpha-fetoprotein (AFP) levels were measured in both plasma and amniotic fluid during 43 abortions induced with prostaglandin F2alpha (PGF2alpha) and their relationship to the induction-abortion interval and signs of fetal distress or intrauterine death examined. The mean plasma AFP levels showed a progressive rise after PGF2alpha administration but abnormally high levels were found infrequently until the time of delivery. Feto-maternal bleeding could explain the abnormally high plasma AFP levels which occurred early in a few cases. A shorter induction-abortion interval was found in patients with normal plasma AFP levels. Neither fetal distress nor intrauterine death were associated with abnormally high plasma AFP levels. No change in AFP levels in amniotic fluid was found.

Topics: Abortion, Induced; alpha-Fetoproteins; Amniotic Fluid; Female; Fetal Death; Fetal Distress; Fetal Proteins; Humans; Oxytocin; Pregnancy; Pregnancy Trimester, Second; Prostaglandins F; Time Factors

In a group of 84 women in the second trimester of pregnancy abortion was induced by intramniotic transabdominal instillation of 20 per cent NaCl. In a second group of 91 women the abortion was induced by means of extraamniotic physiological infusion of saline solution. The only complication observed in the first group was an increasing fever. In the second group there were better results. The fetus abortion was complete and in a shorter time. We assume that the new method is the method of choice because it gives no complications and may be easily performed. It may be used also in cases of missed abortion or intrauterine fetal death.. In a group of 84 women in the 2nd trimester of pregnancy, abortion was induced by intraamniotic transabdominal instillation of 20% NaCl. In a 2nd group of 91 women abortion was induced using extraamniotic physiological infusion of saline solution. The only complication observed in the 1st group was an increasing fever. In the 2nd group there were better results: fetus abortion was complete and in a shorter time. It is assumed that the new method is the method of choice because it gives no complications and may be easily performed. It may be used also in cases of missed abortion or intrauterine fetal death.

Topics: Abortion, Induced; Abortion, Missed; Adolescent; Adult; Female; Fetal Death; Fever; Humans; Oxytocin; Pregnancy; Pregnancy Trimester, Second; Saline Solution, Hypertonic; Sodium Chloride

A case of pregnancy in an unattached rudimentary uterine horn is presented. The pregnancy carried to term, ruptured without causing shock, resulted in fetal demise, and was discovered 6 weeks later at laparotomy. Some of the factors associated with rudimentary uterine horns are discussed.

Topics: Adult; Clindamycin; Female; Fetal Death; Humans; Oxytocin; Pregnancy; Pregnancy Complications, Infectious; Pregnancy, Ectopic; Prostaglandins E; Rupture, Spontaneous; Uterus

In of 707 pregnant women in the last five weeks of pregnancy a total of 1025 Oxytocin-Challenge Tests (OCT) were performed. Perinatal mortality in the toral material was 16,8% crude and 14,2% corrected. The results of the test were classified into three patterns: normal, borderline (or prepathological) and pathological. The main characteristics of these three patterns are described. Normal OCT was found in 84.9% of the tests and 83,7% of the cases. Borderline OCT was present in 8% of the tests and 7,7% of the cases. Finally pathological profiles were present in 7% and 8,4% respectively. The results of the OCT were compared with the perinatal mortality in the three groups and with the percentage of fetal distress intra partum. It is concluded that the OCT is perhaps the most accurate method to ascertain acute placental insufficiency pre partum. Even the more controversial borderline cases, have a clinical significance.

Topics: Apgar Score; Birth Weight; Female; Fetal Death; Fetal Distress; Fetal Heart; Heart Rate; Humans; Middle Aged; Myocardial Contraction; Oxytocin; Placenta Diseases; Placental Insufficiency; Pregnancy; Pregnancy Trimester, Third; Prenatal Diagnosis; Prognosis; Tachycardia

Three hundred and thirty-five patients with ruptured uterus were reviewed. The incidence of this condition is increasing, probably owing to poor antenatal care and lack of facilities. The most common site of rupture in the previously unscarred uterus was found to be longitudinal on the lateral aspects of the lower and upper segments. When the ruptures were in these areas, total hysterectomy proved to be best. Repair of the rupture should only be considered when the tear is simple, transverse in the lower segment, and in the absence of infection.

Topics: Adult; Broad Ligament; Drainage; Female; Fetal Death; Humans; Hysterectomy; Oxytocin; Parity; Pregnancy; Urinary Tract; Uterine Rupture

Topics: Adult; Age Factors; Delivery, Obstetric; Female; Fetal Death; Humans; Oxytocin; Parity; Pregnancy; Uterine Hemorrhage; Uterine Rupture

Sixty-six of 390 patients studied at LAC/USC Women's Hospital between 1970 and 1973 had positive oxytocin challenge tests (OCT). Twenty-four percent of patients who were allowed direct monitored labor after a positive OCT showed no late deceleration and must be assumed to have had false-positive tests. Patients with positive OCT's had significantly increased incidences of perinatal mord late deceleration in labor when compared to patients with no positive OCT. The combination of a positive OCT and abnormal 24-hour urinary estriol excretion should be considered ominous.

Topics: Evaluation Studies as Topic; Female; Fetal Death; Fetal Distress; Fetal Heart; Gestational Age; Heart Rate; Humans; Infant Mortality; Infant, Newborn; Monitoring, Physiologic; Oxytocin; Placental Insufficiency; Pregnancy; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Prenatal Diagnosis; Uterine Contraction

A simple hihg-risk pregnancy management protocol is presented. Three basic quantitative tests of fetal-placental function are utilized. The advantages and proper application and interpretation of these laboratory tools are discussed. Perinatal outcome is analyzed in the initial 225 high-risk pregnancies managed according to the protocol. Over 94% of the infants achieved 5 minute Apgar scores of 8 or above. The corrected perinatal mortality rate was only 8.8 per 1,000 live births.

Topics: Apgar Score; Birth Weight; Estriol; Female; Fetal Death; Fetal Diseases; Fetus; Gestational Age; Growth; Growth Disorders; Humans; Infant, Newborn; Maternal-Fetal Exchange; Oxytocin; Placental Insufficiency; Pregnancy; Pregnancy Complications; Risk; Ultrasonography

Topics: Female; Fetal Death; Humans; Labor, Induced; Oxytocin; Pregnancy

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

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

Three cases have been observed over the past 3 years at Los Angeles County-USC Medical Center, Women's Hospital, which have shown an unusual fetal heart rate response to induced uterine contractions during the antepartum period. All 3 cases resulted in perinatal death apparently due to asphyxia. This report describes this unusual pattern and presents a discussion of its possible significance.

Topics: Adult; Chronic Disease; Estriol; Female; Fetal Death; Fetal Heart; Fetus; Gestational Age; Growth; Heart Rate; Humans; Hypertension; Infant, Newborn; Oxytocin; Phonocardiography; Placenta Diseases; Placental Insufficiency; Polyhydramnios; Pregnancy; Pregnancy Complications, Cardiovascular

Medical induction of labor was attempted in 30 women after intrauterine death of the fetus. Labor was induced in 15 patients with oxytocin and in an additional 15 patients with prostaglandin E2. The results suggest that prostaglandin has some advantage over oxytocin in these circumstances, and that prostaglandins may be especially useful in this difficult clinical situation.

Topics: Adult; Erythroblastosis, Fetal; Female; Fetal Death; Fetal Diseases; Gestational Age; Humans; Labor, Induced; Oxytocin; Pregnancy; Prostaglandins; Time Factors

The author describes the history of 2 patients who experienced rupture of the uterus during prostaglandin-induced abortion. Both patients, aged 29 years (15 weeks gestational length, parity 2) and the other, 35 years old (24 weeks gestation, parity 6) presented with fetal death in utero. Both patients were managed with high doses of oxytocin as well as intravenous infusion of prostaglandins (PG) E2. Laparotomy and hysterectomy were performed on both patients. The 29-year old patient recovered uneventfully with the help of antibiotics. The 35-year old patient experienced a mild pelvic peritonitis which responded to penicillin and kanamycin. She recovered uneventfully but had to be readmitted to the hospital later because of pulmonary infarction. The infarction was successfully treated with intravenous heparin and later, warfarin. It is possible that uterine infection and multiparity predispose to rupture of the uterus although there was no evidence of old scarring in the excised uteri of the patients. The uterine rupture in both cases was associated with considerable morbidity from anemia, infection, and pulmonary infarction. It is possible that rupture of the uterus (very uncommon in midtrimester pregnancies) is a rare complication of prostaglandin-induced termination of pregnancies.

Topics: Abortion, Induced; Adult; Female; Fetal Death; Humans; Oxytocin; Pregnancy; Prostaglandins; Uterine Rupture; Uterus

The contraction stress test (CST) was used to attempt determination of fetal reserve prior to labor by evaluating the response of the fetal heart rate to spontaneous or induced uterine contractions. Testing was performed by using an external fetal heart rate monitor and tocograph. The CST was employed 189 times in 120 high-risk patients who either had hypertensive disorder of pregnancy or had completed at least 42 weeks of gestation. Testing was begun as early as 34 weeks' gestation and repeated at weekly intervals; it was not used in the clinical management of the patient. The maximum number of tests performed on one patient was 8. A negative CST appears to be a most reliable guide to the ability of the fetus to tolerate labor if it ensues within 1 week. A positive test suggests that the fetus is at increased risk, but death is not necessarily imminent. Results of the present study warrant use of the CST in controlled studies to determine its effect in improving perinatal outcome.

Topics: Apgar Score; Asphyxia Neonatorum; Female; Fetal Death; Fetal Diseases; Fetal Heart; Fetus; Heart Rate; Humans; Infant, Newborn; Monitoring, Physiologic; Oxytocin; Pregnancy; Pregnancy Complications; Prenatal Diagnosis; Stress, Physiological; Uterus

Over the last 4 years at Los Angeles County-University of Southern California Medical Center, Women's Hospital, clinical interest in antepartum fetal monitoring has increased considerably. As a result of approximately 1,500 tests in some 600 patients at high risk for placental insufficiency, we have reached several conclusions regarding the methods for antepartum fetal monitoring, criteria for interpretation of the results obtained, and the role of antepartum monitoring information in clinical management. In this paper, the results of "stress" monitoring (monitoring in the presence of uterine contractions) are presented. The term "oxytocin challenge test" is used in reference to "stressed" monitoring even though sometimes the contractions were spontaneous, or without oxytocin stimulation.

Topics: Cesarean Section; Electrocardiography; Estriol; Female; Fetal Death; Fetal Heart; Heart Rate; Hemoglobinopathies; Humans; Labor, Obstetric; Meconium; Monitoring, Physiologic; Obstetric Labor, Premature; Oxytocin; Phonocardiography; Placenta Diseases; Placenta Previa; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics; Pregnancy, Prolonged; Prenatal Diagnosis; Ultrasonography; Uterus

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

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

Routine electronic monitoring has been performed on 2411 labor patients at Booth Memorial Medical Center. Most recently, 88% of all patients delivered were monitored. As a direct result of this program, intrapartum stillbirths have been dramatically reduced from 1.2/1000 livebirths to 0.5/1000 livebirths. Perinatal mortality for fetuses over 1000 g has fallen to 8.8/1000 deliveries. Apgar scores below 6 at 5 minutes have decreased from a rate of 24/1000 to 14/1000 livebirths. No increase in cesarean sections for fetal distress has occurred although the primary cesarean section rate has increased over the past 10 years, apparently unrelated to fetal monitoring. It is strongly recommended that all patients in labor be monitored by currently available technics.

Topics: Apgar Score; Catheterization; Delivery, Obstetric; Electrodes; Female; Fetal Death; Fetal Heart; Heart Rate; Humans; Infant Mortality; Infant, Newborn; Labor, Induced; Labor, Obstetric; Monitoring, Physiologic; Oxytocin; Pregnancy; Scalp; Ultrasonography; Uterine Contraction; Uterus

Topics: Adolescent; Amniotic Fluid; Electrocardiography; Female; Fetal Death; Fetal Heart; Heart Rate; Humans; Labor, Obstetric; Meconium; Monitoring, Physiologic; Obstetric Labor Complications; Oxytocin; Pregnancy

Topics: Adolescent; Adult; Birth Weight; Female; Fetal Death; Humans; Infant Mortality; Infant, Newborn; Maternal Age; Middle Aged; Netherlands Antilles; Oxytocin; Parity; Pregnancy; Socioeconomic Factors

Topics: Adult; Diagnostic Errors; Female; Fetal Death; Fetal Distress; Humans; Hypertension; Infant, Newborn; Male; Oxytocin; Placental Insufficiency; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Trimester, Third; Prenatal Diagnosis

Extraamniotic administration of prostaglandins (PGs) for labor induction was studied. 69 patients took part in this study, 43 of whom were primigravid and 26 of whom were parous. 65 of the cases had a normally developed child and 4 fetuses were known to be anencephalic. Pregnancy maturity ranged from 26-41 weeks. PGE2 was administered as for midtrimester abortion, except that a catheter with a balloon capacity of 30-50 ml was used. PGE2 concentration of 50, 75, or 100 mcg/ml was infused continuously by a Palmer pump at a rate of 1.8 ml per hour. Labor was successfully induced in all cases, judging by the establishment of regular uterine activity and softening, effacement, and dilatation of the cervix. Mean time of PG infusion was 6.5 hours. Mean dose was .9 mg. Oxytocin was used as a supplement if necessary, and 3 of 4 women with anencephalic fetuses needed oxytocin treatment. 39% of primigravida required oxytocin, and 17% of parous women did. Mean induction-delivery interval in the normal fetus group was 14 hours 48 minutes for primigravida, and was 9 hours 35 minutes in parous women. 12 patients were delivered by Caesarean section. 3 of the 65 normal fetuses died during labor. Uterine hypertonus occurred in 1 mother. PGE2 is indicated for labor induction when avoidance of artificial rupture of membranes is wanted.

Topics: Amnion; Anencephaly; Apgar Score; Delivery, Obstetric; Extraembryonic Membranes; Female; Fetal Death; Fetal Diseases; Fetus; Gestational Age; Humans; Infusions, Parenteral; Injections; Labor, Induced; Oxytocin; Pregnancy; Prostaglandins; Time Factors; Uterus

Topics: Abortion, Induced; Female; Fetal Death; Humans; Infusions, Parenteral; Oxytocin; Pregnancy; Pregnancy Complications; Uterus

In a study of 32 patients, there were 29 cases of intra-uterine fetal death and 3 cases of hydatidiform mole. The intravenous administration of either prostaglandin E1, E2 or F2 successfully induced labor in 29 out of the 32 cases. 2 patients delivered following additional intravenous oxytocin and there was 1 failure due to the development of upper limb cyanosis. Side-effects included vomitng, phlebitis, facial flushing, rigors, pyrexia and uterine hypertonus. The method confirms the high success rates reported previously but the incidence of side-effects was disturbing. It is emphasized that prostaglandin E1 was used during this original research trial when prostaglandins were 1st investigated clinically. Prostaglandin E1 has not been made available commerically.

Topics: Abortion, Induced; Adolescent; Adult; Arm; Cyanosis; Female; Fetal Death; Humans; Hydatidiform Mole; Injections, Intravenous; Labor, Induced; Oxytocin; Phlebitis; Pregnancy; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Prostaglandins; Time Factors; Uterine Diseases

Topics: Cesarean Section; Chromatography, Gas; Creatinine; Estriol; Female; Fetal Death; Gestational Age; Glucose Tolerance Test; Humans; Hypertension; Infant, Newborn; Labor, Induced; Missouri; Oxytocin; Polyhydramnios; Pre-Eclampsia; Pregnancy; Pregnancy in Diabetics; Pregnancy, Prolonged; Retrospective Studies

Topics: Abortion, Missed; Acupuncture Therapy; Adult; Electric Stimulation; Female; Fetal Death; Humans; Labor, Induced; Labor, Obstetric; Methods; Needles; Oxytocin; Physical Stimulation; Pregnancy; Pregnancy, Prolonged; Rotation; Time Factors; Uterus

Topics: Abortion, Induced; Abortion, Missed; Blood Pressure; Female; Fetal Death; Fever; Gestational Age; Humans; Hydatidiform Mole; Infusions, Parenteral; Oxytocin; Pregnancy; Prostaglandins; Pulse; Ultrasonics

Topics: Adrenocorticotropic Hormone; Animals; Castration; Depression, Chemical; Estradiol; Estrogens; Female; Fetal Death; Labor, Obstetric; Lactation; Maternal Behavior; Ovary; Oxytocin; Pregnancy; Pregnancy, Animal; Prolactin; Rats; Time Factors; Uterus

Topics: Adult; Female; Fetal Death; Fetoscopy; Humans; Oxytocin; Pregnancy; Pregnancy, Tubal

Topics: Animals; Arteries; Diarrhea; Electrocardiography; Female; Fetal Death; Heart Rate; Humans; Intestine, Small; Muscle Tonus; Oxytocin; Pregnancy; Prostaglandins F; Rats; Time Factors; Uterine Contraction; Uterus

This study concerns the possibility that prostaglandins (PGs) produce their effects endogenously by releasing oxytocin from the maternal pituitary and the phenomena of "enhancement" and "potentiation" of the response of the human pregnant uterus to exogenous oxytocin after treatment with PGs. In the 1st study, PGE2 or PGF2alpha were infused to 22 women near term and to 2 men. Venous blood samples were collected and plasma oxytocin was extracted. Urine was collected during the infusion and oxytocin was assayed. The results of the infusion were: 1) oxytocin was detected in the plasma of 19 of 22 women, 2) 60 (43%) of 139 plasma samples showed oxytocin, 3) 11 of 16 urine samples showed oxytocin, 4) oxytocin release into plasma was intermittant, 5) oxytocin was present in the plasma of 2 of 3 women with intrauterine death of the fetus, and 6) the men showed plasma oxytocin levels during infusion similar to those in women in labor. PG infusion can directly stimulate oxytocin release from the maternal posterior pituitary gland. This release is similar to that found in late spontaneous labor. In the 2nd study, 7 patients in the midtrimester were infused with PGE2 to achieve an "enhanced" uterine response to subsequently infused oxytocin. 37 women were infused doses of oxytocin with either PGE2 or PGF2alpha in order to achieve the maximum potentiation of the drug effects. Results indicate that: 1) intraamniotic pressure tracing from a woman 16 weeks pregnant showed enhancement and potentiation, 2) only 1 patient was aborted by stopping the PGE2 infusion and reinforcing 90 minutes later, 3) PGF2alpha does not enhance the response to subsequently infused oxytocin in vitro, 4) 17 of the 37 women were given PGE2 or PGF2alpha, but only 1 aborted, and 5) of 20 women who received PGs in combination with oxytocin, 14 aborted successfully in 48 hours. These studies conclude that: 1) intact pregnant human uterus responds in the same way as the myometrial strips in that it exhibits an enhanced response to oxytocin after previous exposure to PGE2, and 2) PGE2 and PGF2alpha are poor abortifacients.

Topics: Abortion, Induced; Amniotic Fluid; Drug Synergism; Female; Fetal Death; Humans; Male; Oxytocin; Pregnancy; Pressure; Prostaglandins; Prostaglandins E; Prostaglandins F; Time Factors; Uterus

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

Topics: Amniotic Fluid; Chorionic Gonadotropin; Female; Fetal Death; Fetus; gamma-Globulins; Gestational Age; Growth Hormone; Half-Life; Humans; Infant, Newborn; Iodine Isotopes; Labor, Induced; Labor, Obstetric; Oxytocin; Pregnancy; Proteins; Serum Albumin; Serum Albumin, Radio-Iodinated; Time Factors; Transferrin

Topics: Amniotic Fluid; Estriol; Female; Fetal Death; Fetal Diseases; Fetal Heart; Gestational Age; Labor, Induced; Meconium; Oxytocin; Phosphatidylcholines; Pregnancy; Rh-Hr Blood-Group System; Sphingomyelins; Ultrasonography

Topics: Birth Weight; Cesarean Section; Female; Fetal Death; Fetal Diseases; Humans; Infant Mortality; Infant, Newborn; Labor, Induced; Oxytocin; Pregnancy; Pregnancy, Prolonged; Time Factors

Topics: Amnion; Apgar Score; Delivery, Obstetric; Female; Fetal Death; Fever; Gravitation; Humans; Infant Mortality; Infant, Newborn; Injections; Labor, Induced; Methods; Oxytocin; Postpartum Hemorrhage; Pregnancy; Prospective Studies; Puerperal Disorders; Time Factors

Topics: Alkaline Phosphatase; Chorionic Gonadotropin; Embryonic and Fetal Development; Estriol; Female; Fetal Death; Fetal Heart; Fetoscopy; Growth Disorders; Heart Rate; Humans; Oxytocin; Parietal Bone; Placenta Diseases; Placental Lactogen; Pregnancy; Pregnancy Complications; Ultrasonography

Topics: Apgar Score; Congenital Abnormalities; Estriol; Female; Fetal Death; Fetal Diseases; Fetal Heart; Humans; Infant, Newborn; Oxytocin; Pre-Eclampsia; Pregnancy; Pregnancy in Diabetics; Prognosis; Stimulation, Chemical

Topics: Animals; Delivery, Obstetric; Fallopian Tubes; Female; Fetal Death; Injections, Intravenous; Labor, Induced; Ligation; Methods; Muscle Contraction; Oxytocin; Pregnancy; Pregnancy, Animal; Rabbits; Time Factors; Uterus; Vasopressins

Plasma oxytocin levels were measured serially in 22 women receiving prostaglandin E(2) or F(2alpha) intravenously for the induction of labour. Oxytocin was detected in the plasma of 19 of the 22 women; positive levels were found in 60 (43%) of 139 plasma samples, an incidence similar to that in the late first stage of spontaneous labour. Oxytocin was found in the maternal plasma even when the fetus was dead, and in the plasma of two men receiving prostaglandin infusions. This indicates that prostaglandins stimulate the pituitary directly and suggests that this mechanism may play a part in the oxytocic action of infused prostaglandins.

Topics: Female; Fetal Death; Humans; Injections, Intravenous; Labor, Induced; Male; Oxytocin; Pituitary Gland, Posterior; Pregnancy; Prostaglandins; Stimulation, Chemical

Topics: Abortion, Therapeutic; Amnion; Erythroblastosis, Fetal; Female; Fetal Death; Gestational Age; Humans; Labor, Induced; Oxytocin; Pregnancy; Puerperal Disorders

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: Anesthesia, General; Anesthesia, Obstetrical; Apgar Score; Body Weight; California; Cesarean Section; Extraction, Obstetrical; Extraembryonic Membranes; Female; Fetal Death; Fetus; Humans; Infant Mortality; Labor Presentation; Labor, Induced; Obstetric Labor Complications; Oxytocin; Parity; Pelvimetry; Pregnancy; Rupture

Topics: Amnion; Cervix Uteri; Cesarean Section; Dilatation; Female; Fetal Death; Fetal Heart; Humans; Labor, Induced; Labor, Obstetric; Obstetric Labor Complications; Oxytocin; Parity; Pregnancy; Pregnancy, Prolonged

Topics: Abortion, Therapeutic; Ethanol; Female; Fetal Death; Humans; Labor, Obstetric; Oxytocin; Pregnancy; Prostaglandin Antagonists; Prostaglandins; Time Factors; Uterus

Topics: Abortion, Habitual; Adult; Contraception; Electromyography; Female; Fetal Death; Hemorrhage; Humans; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Muscle Contraction; Muscular Dystrophies; Myotonia; Obstetric Labor Complications; Oxytocin; Pneumonia; Pregnancy; Pregnancy Complications; Procainamide; Uterus

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

Topics: Cervix Uteri; Female; Fetal Death; Humans; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics

Topics: Blood Gas Analysis; Cesarean Section; Extraction, Obstetrical; Female; Fetal Death; Humans; Labor, Induced; Labor, Obstetric; Methods; Obstetric Labor Complications; Oxytocin; Pregnancy; Pregnancy, Prolonged; Time Factors

Topics: Adult; Blood; Cesarean Section; Extraction, Obstetrical; Female; Fetal Death; Fetal Diseases; Glucose; Humans; Hydrogen-Ion Concentration; Hypertension; Hypoglycemia; Infant Mortality; Infant, Newborn; Labor, Obstetric; Monitoring, Physiologic; Natural Childbirth; Oxytocin; Pregnancy; Pregnancy Complications; Pregnancy Complications, Cardiovascular; Tachycardia

Topics: Cesarean Section; Female; Fetal Death; Gestational Age; Humans; Injections, Intravenous; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics; Time Factors

Topics: Amniotic Fluid; Estrogens; Female; Fetal Death; Humans; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Complications

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

Topics: Amniotic Fluid; Cesarean Section; Czechoslovakia; Female; Fetal Death; Humans; Infant Mortality; Injections, Intravenous; Labor, Induced; Oxytocin; Pregnancy

Topics: Aerosols; Apgar Score; Female; Fetal Death; Fetal Diseases; Hospitals, General; Humans; Infant, Newborn; Labor, Induced; Methods; Oxytocin; Parity; Pregnancy; Pregnancy Complications; Retrospective Studies; Solutions

Topics: Adult; Cesarean Section; Female; Fetal Death; Humans; Hysterectomy; Maternal Age; Maternal Mortality; Obstetric Labor Complications; Oxytocin; Parity; Pregnancy; Pregnancy Complications; Rupture, Spontaneous; Surgical Wound Dehiscence; Uterine Rupture; Uterus

Topics: Cervix Uteri; Cesarean Section; Delivery, Obstetric; Female; Fetal Death; Gestational Age; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor, Induced; Methods; Obstetric Labor Complications; Oxytocin; Parity; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Complications, Infectious; Pregnancy in Diabetics; Prospective Studies; Time Factors

Topics: Asphyxia Neonatorum; Female; Fetal Death; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor, Induced; Oxytocin; Pregnancy

Topics: Adult; Birth Weight; Body Height; Female; Fetal Death; Gestational Age; Humans; Infant Mortality; Labor Presentation; Obstetric Labor Complications; Oxytocin; Pregnancy; Pregnancy, Prolonged

Topics: Abruptio Placentae; Adult; Afibrinogenemia; Amnion; Antifibrinolytic Agents; Blood Transfusion; Cesarean Section; Delivery, Obstetric; Diagnosis, Differential; Female; Fetal Death; Hematocrit; Hemorrhage; Humans; Labor, Induced; Maternal Age; Oxytocin; Parity; Pregnancy; Pregnancy Complications; Puerperal Disorders; Time Factors

Topics: Anesthesia, Conduction; Cesarean Section; Delivery, Obstetric; Extraction, Obstetrical; Female; Fetal Death; Humans; Infant, Newborn; Labor Presentation; Methods; Obstetric Labor Complications; Oxytocin; Parity; Pregnancy; Prognosis

Topics: Adult; Female; Fetal Death; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Obstetric Labor Complications; Obstetric Labor, Premature; Oxytocin; Placenta; Pregnancy; Superfetation; Time Factors; Twins

Topics: Delivery, Obstetric; Embolism, Amniotic Fluid; Female; Fetal Death; Gestational Age; Humans; Infant Mortality; Infant, Newborn; Labor, Induced; Oxytocin; Parity; Pregnancy; Pregnancy Complications; Tablets

Topics: Delivery, Obstetric; Enzymes; Female; Fetal Death; Fetus; Humans; Infant, Newborn; Labor, Obstetric; Organ Size; Oxytocics; Oxytocin; Placenta; Postpartum Hemorrhage; Pregnancy; Time Factors

Topics: Abortion, Legal; Catheterization; Extraembryonic Membranes; Female; Fetal Death; Gestational Age; Humans; Labor, Induced; Methods; Oxytocin; Pregnancy; Uterus

Topics: Abortion, Legal; Abortion, Therapeutic; Female; Fetal Death; Humans; Labor, Induced; Oxytocin; Plants, Medicinal; Pregnancy; Pregnancy Complications

A prospective study of 1,000 consecutive primigravid deliveries has shown that active management in labour can ensure that every woman is delivered within 24 hours. Emphasis is laid on the importance of a correct initial diagnosis of labour based on objective criteria. Amniotomy followed by oxytocin infusion is advocated to simulate the progress of normal labour unless this is evident from an early stage.Oxytocin, the dose of which is limited only by foetal distress, cannot be used effectively unless three popular fallacies are rejected. Firstly, that prolonged labour is often an expression of cephalo-pelvic disproportion; secondly, that oxytocin may rupture the primigravid uterus; and, thirdly, that there is a valid therapeutic distinction between hypotonic and hypertonic uterine action.Stimulation, properly supervised, is safe to mother and child, it eliminates the problem of occipitoposterior position, results in a sharp decline in forceps delivery, and obviates the need for massive analgesia.

Topics: Amnion; Anesthesia, Obstetrical; Cesarean Section; Extraction, Obstetrical; Female; Fetal Death; Fetal Diseases; Humans; Infant, Newborn; Labor, Induced; Obstetric Labor Complications; Oxytocin; Pregnancy; Prospective Studies; Time Factors

Topics: Adult; Amnion; Cesarean Section; Female; Fetal Death; Fetal Diseases; Fetus; Humans; Infant, Newborn; Infusions, Parenteral; Labor, Induced; Labor, Obstetric; Oxytocin; Pregnancy

Topics: Accidents; Adult; Female; Fetal Death; Humans; India; Infant, Newborn; Labor Presentation; Maternal Mortality; Obstetric Labor Complications; Oxytocin; Pregnancy; Uterine Rupture

Topics: Extraembryonic Membranes; Female; Fetal Death; Humans; Injections, Intravenous; Labor, Induced; Methods; Obstetric Labor Complications; Oxytocin; Pregnancy; Pregnancy Complications; Time Factors

Topics: Adolescent; Adult; Amnion; Body Height; Cesarean Section; Delivery, Obstetric; England; Female; Fetal Death; Gestational Age; Humans; Infant Mortality; Infant, Newborn; Injections, Intravenous; Labor, Induced; Maternal Age; Oxytocin; Pregnancy; Pregnancy, Prolonged; Puerperal Disorders; Time Factors; Uterine Diseases

Topics: Bradycardia; Electrocardiography; Female; Fetal Death; Fetal Diseases; Fetal Heart; Heart Rate; Humans; Infant, Newborn; Oxytocin; Pregnancy; Pregnancy Complications

Topics: Adult; Asphyxia Neonatorum; Female; Fetal Death; Humans; Infant, Newborn; Labor, Induced; Oxytocin; Pregnancy; Thiopental

Topics: Female; Fetal Death; Fetal Diseases; Humans; Labor, Induced; Labor, Obstetric; Obstetric Labor, Premature; Oxytocin; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged; Uterine Inertia

Topics: Abruptio Placentae; Acute Kidney Injury; Afibrinogenemia; Blood Platelets; Female; Fetal Death; Fibrinogen; Hemoglobinometry; Humans; Oxytocin; Pregnancy

Topics: Adult; Birth Weight; Ethanol; Extraembryonic Membranes; Female; Fetal Death; Humans; Infant Mortality; Infant, Newborn; Lactation; Obstetric Labor, Premature; Oxytocin; Parity; Pituitary Gland, Posterior; Pregnancy

Topics: Abruptio Placentae; Adult; Afibrinogenemia; Blood Transfusion; Cesarean Section; Delivery, Obstetric; Diagnosis, Differential; Female; Fetal Death; Fetal Heart; Fibrinogen; Humans; Infusions, Parenteral; Oxytocin; Placenta Previa; Pregnancy; Prognosis; Uterine Hemorrhage

Topics: Adolescent; Adult; Anesthesia, Obstetrical; Female; Fetal Death; Humans; Maternal Mortality; Obstetric Labor Complications; Oxytocin; Pregnancy; Retrospective Studies; Uterine Rupture

Topics: Delivery, Obstetric; Female; Fetal Death; Humans; Infant Mortality; Infant, Newborn; Labor Presentation; Obstetric Labor, Premature; Oxytocin; Pregnancy; Pregnancy Complications; Retrospective Studies

Topics: Animals; Estradiol; Female; Fetal Death; Muscle Contraction; Oxytocin; Pituitary Hormones, Posterior; Pregnancy; Pregnancy, Animal; Rats

Topics: Chlorpromazine; Extraembryonic Membranes; Female; Fetal Death; Fetus; Histamine H1 Antagonists; Humans; Hypoxia; Labor Presentation; Labor, Obstetric; Maternal Mortality; Meperidine; Muscles; Natural Childbirth; Obstetric Labor, Premature; Oxytocin; Pregnancy; Uterine Inertia

Topics: Adolescent; Adult; Cesarean Section; Evaluation Studies as Topic; Female; Fetal Death; Humans; Labor Presentation; Maternal Mortality; Obstetric Labor Complications; Obstetrical Forceps; Oxytocin; Postpartum Hemorrhage; Pregnancy; Prenatal Injuries; Uterine Inertia

Topics: Adult; Amniotic Fluid; Female; Fetal Death; Humans; Hypertonic Solutions; Infusions, Parenteral; Labor, Induced; Oxytocin; Pregnancy; Sodium Chloride

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

Topics: Adolescent; Adult; Female; Fetal Death; Humans; Hypertension; Injections, Spinal; Labor, Induced; Oxytocin; Parity; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged; Uterine Rupture; Uterus

Topics: Adolescent; Adult; Amniotic Fluid; Animals; Female; Fetal Death; Humans; Labor, Induced; Labor, Obstetric; Muscle Contraction; Oxytocin; Placenta; Pregnancy; Pressure; Progesterone; Rabbits; Sodium Chloride; Uterus

Topics: Abortion, Therapeutic; Amnion; Congenital Abnormalities; Female; Fetal Death; Humans; Hypertonic Solutions; Labor, Induced; Oxytocin; Polyhydramnios; Pregnancy; Sodium Chloride

Topics: Animals; Female; Fetal Death; Fetus; Hemodynamics; Labor, Induced; Oxytocin; Pregnancy; Sheep; Uterus

Topics: Adult; Blood; Enzymes; Female; Fetal Death; Humans; Labor, Obstetric; Oxytocin; Pre-Eclampsia; Pregnancy; Pregnancy, Ectopic; Pregnancy, Multiple; Uterine Inertia

Topics: Abortion, Therapeutic; Enzymes; Female; Fetal Death; Humans; Oxytocin; Placenta; Pre-Eclampsia; Pregnancy; Pregnancy, Prolonged

Topics: Adult; Anencephaly; Diseases in Twins; Female; Fetal Death; Humans; Infant, Newborn; Labor, Induced; Oxytocin; Pregnancy

Topics: Drug Synergism; Estradiol; Female; Fetal Death; Humans; Oxytocin; Pregnancy; Uterus

Topics: Animals; Female; Fetal Death; Labor, Induced; Oxytocin; Pregnancy; Pregnancy, Animal; Rabbits

Topics: Abruptio Placentae; Blood Group Incompatibility; Dystocia; Female; Fetal Death; Humans; Labor, Induced; Muscles; Obstetric Labor, Premature; Oxytocin; Placenta Previa; Pregnancy; Pregnancy, Prolonged

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

Topics: Abnormalities, Drug-Induced; Asphyxia Neonatorum; Cesarean Section; Female; Fetal Death; Fetal Distress; Fetal Heart; Humans; Incidence; Infant, Newborn; Oxytocin; Pregnancy; Toxicology

Topics: Abortion, Threatened; Drug Therapy; Epinephrine; Ergonovine; Ethanolamines; Female; Fetal Death; Humans; Labor, Induced; Labor, Obstetric; Norepinephrine; Obstetric Labor, Premature; Oxytocin; Pharmacology; Polyhydramnios; Pre-Eclampsia; Pregnancy; Sympatholytics; Sympathomimetics; Toxicology; Uterus; Vasodilator Agents

Topics: Blood Pressure; Drug Therapy; Epinephrine; Ethanolamines; Female; Fetal Death; Heart Rate; Humans; Hydatidiform Mole; Norepinephrine; Oxytocin; Pharmacology; Pregnancy; Sympatholytics; Sympathomimetics; Uterus

Topics: Abruptio Placentae; Amniotic Fluid; Female; Fetal Death; Humans; Labor, Obstetric; Oxytocin; Pregnancy; Uterine Hemorrhage; Uterus

Topics: Female; Fetal Death; Humans; Labor, Induced; Oxytocin; Pregnancy; Statistics as Topic; Tablets

Topics: Abnormalities, Severe Teratoid; Amniotic Fluid; Electrophysiology; Estradiol; Female; Fetal Death; Humans; Labor, Induced; Labor, Obstetric; Oxytocin; Pharmacology; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged; Toxicology; Uterus

Topics: Aminopeptidases; Clinical Enzyme Tests; Cystinyl Aminopeptidase; Enzymes; Female; Fetal Death; Fetus; Humans; Leucine; Oxytocin; Placenta; Placental Insufficiency; Pregnancy; Pregnancy Complications

Topics: Aspartate Aminotransferases; Diagnosis, Differential; Female; Fetal Death; Humans; Hyperemesis Gravidarum; Labor, Induced; Labor, Obstetric; Oxytocin; Pre-Eclampsia; Pregnancy; Pregnancy, Prolonged

Topics: Female; Fetal Death; Humans; Infant Mortality; Infant, Newborn; Labor, Induced; Labor, Obstetric; Oxytocin; Pregnancy; Sparteine

Topics: Afibrinogenemia; Anti-Bacterial Agents; Australia; Blood Coagulation Disorders; Erythroblastosis, Fetal; Female; Fetal Death; Humans; Infant, Newborn; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Complications, Hematologic; Rh-Hr Blood-Group System; Stillbirth

Topics: Cesarean Section; Female; Fetal Death; Humans; Labor, Induced; Oxytocics; Oxytocin; Postpartum Hemorrhage; Postpartum Period; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged

Topics: Abruptio Placentae; Diabetes Mellitus; Drug Therapy; Female; Fetal Death; Humans; Labor, Induced; Oxytocin; Pre-Eclampsia; Pregnancy; Pregnancy in Diabetics; Pregnancy, Prolonged; Rh-Hr Blood-Group System

Topics: Asphyxia Neonatorum; Birth Weight; Female; Fetal Death; Follicle Stimulating Hormone; Humans; Infant, Newborn; Labor, Induced; Labor, Obstetric; Oxytocin; Pharmacology; Pregnancy; Puerperal Disorders; Puerperal Infection; Statistics as Topic

Topics: Female; Fetal Death; Humans; Infant Mortality; Infusions, Intravenous; Infusions, Parenteral; Injections, Intravenous; Labor, Induced; Labor, Obstetric; Oxytocin; Pregnancy

Topics: Acetylcholine; Animals; Animals, Newborn; Autonomic Nervous System; Blood Circulation; Carbachol; Choline; Dogs; Electric Stimulation; Estrogens; Female; Fetal Death; Ganglionic Blockers; Humans; Infant, Newborn; Neurosurgery; Neurotransmitter Agents; Oxytocin; Parasympathetic Nervous System; Pharmacology; Phentolamine; Physiology; Postpartum Period; Pregnancy; Pregnancy, Animal; Progesterone; Research; Sympathectomy; Uterus

Topics: Anesthesia; Anesthesia, General; Anesthesia, Obstetrical; Cesarean Section; Dystocia; Extraction, Obstetrical; Female; Fetal Death; Humans; Infant Mortality; Obstetrical Forceps; Oxytocics; Oxytocin; Pregnancy; Switzerland; Thiopental

Topics: Aerosols; Amnion; Cesarean Section; Eclampsia; Female; Fetal Death; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Labor, Induced; Obstetric Labor Complications; Oxytocin; Pregnancy; Pregnancy, Prolonged; Surgical Procedures, Operative; Uterine Hemorrhage

Topics: Acute Kidney Injury; Amniotic Fluid; Drug Therapy; Embolism, Amniotic Fluid; Female; Fetal Death; Glucose; Humans; Infusions, Parenteral; Labor, Induced; Labor, Obstetric; Oxytocin; Postpartum Hemorrhage; Postpartum Period; Pregnancy; Pregnancy in Diabetics; Renal Insufficiency

Topics: Female; Fetal Death; Humans; Hypertonic Solutions; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Complications; Saline Solution, Hypertonic; Statistics as Topic; Stillbirth

Topics: Female; Fetal Death; Humans; Labor, Induced; Labor, Obstetric; Obstetric Labor Complications; Oxytocin; Pregnancy; Statistics as Topic

Topics: Abnormalities, Severe Teratoid; Electrocardiography; Female; Fetal Death; Fetal Heart; Humans; Infant, Newborn; Obstetric Labor Complications; Oxytocin; Pharmacology; Pregnancy; Uterine Contraction; Uterus

Topics: Abortion, Induced; Abortion, Therapeutic; Adolescent; Female; Fetal Death; Humans; Hypertonic Solutions; Isotonic Solutions; Labor, Induced; Labor, Obstetric; Oxytocin; Physiology; Pregnancy; Sodium Chloride; Uterus

Topics: Blood Chemical Analysis; Cystinyl Aminopeptidase; Erythroblastosis, Fetal; Female; Fetal Death; Humans; Infant, Newborn; Labor, Induced; Labor, Obstetric; Oxytocin; Peptide Hydrolases; Placenta; Pre-Eclampsia; Pregnancy; Uterus

Topics: Abortion, Threatened; Diagnosis; Estrogens; Female; Fetal Death; Humans; Labor, Induced; Labor, Obstetric; Nephritis; Oxytocin; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged; Pregnanediol

Topics: Female; Fetal Death; Humans; Infant, Premature; Labor, Induced; Labor, Obstetric; Nephritis; Oxytocin; Pre-Eclampsia; Pregnancy; Pregnancy, Prolonged

Topics: Diethylstilbestrol; Erythroblastosis, Fetal; Estriol; Female; Fetal Death; Humans; Infant, Newborn; Infusions, Parenteral; Labor, Induced; Labor, Obstetric; Oxytocin; Polyhydramnios; Pre-Eclampsia; Pregnancy; Pregnancy in Diabetics; Pregnancy, Prolonged; Progesterone

Topics: Diabetes Mellitus; Estradiol; Female; Fetal Death; Humans; Infusions, Intravenous; Infusions, Parenteral; Oxytocin; Pharmacology; Pregnancy; Pregnancy in Diabetics; Progesterone; Relaxin; Uterus

Topics: Female; Fetal Death; Humans; Injections, Intramuscular; Labor, Induced; Labor, Obstetric; Oxytocics; Oxytocin; Placenta; Pregnancy

18 cases of missed abortion occurring during or after the 12th week of gestation in Professor Kellar's Unit of the Simpson Memorial Maternity Pavilion during the past 3 years were managed using intravenous high concentration oxytocin drips. Estimated duration of fetal death ranged from 3 to 14 weeks. A summary of the results of analysis is presented in Table 1. Delivery was achieved in the last 13 cases (except 2) within 24 hours of treatment. Of the 2 exceptions, 1 patient in whom the fetus had been dead for the longest time (14 weeks) took 31 1/4 hours to pass the fetus; the other patient took 21 1/4 hours to pass the fetus but as the placenta failed to follow, another drip was administered 11 hours later. The placenta was passed 50 minutes later. Surgical evacuation of the uterus was performed in 7 patients to complete the abortion process. No evidence of failure of clotting mechanism after delivery was observed, nor was the possibility of toxic substances being introduced into the maternal circulation from the placenta seen. It was concluded that the use of oxytocin drips is a reliable, rapid and safe method of managing missed abortion.

Topics: Abortifacient Agents; Abortion, Induced; Abortion, Missed; Abortion, Therapeutic; Age Factors; Biology; Contraception; Demography; Endocrine System; Family Planning Services; Female; Fetal Death; Hormones; Humans; Infusions, Intravenous; Mortality; Oxytocin; Physiology; Pituitary Hormones; Population; Population Dynamics; Pregnancy

Topics: Female; Fetal Death; Fetus; Humans; Injections, Intravenous; Labor, Induced; Labor, Obstetric; Muscle Relaxants, Central; Oxytocin; Parasympatholytics; Pregnancy; Stillbirth