oxytocin and Fetal-Distress

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

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

In the second half of the twentieth century, true antepartum fetal assessment became possible, mainly due to the advent of real-time ultrasound. Initially, the most widely used form of antepartum fetal assessment was electronic fetal heart rate monitoring, through the nonstress test or the oxytocin-induced contraction stress test. It was soon realized, however, that these forms of monitoring had significant limitations. The biophysical profile allows a more thorough evaluation of fetal well-being and has the potential to significantly reduce the false-positive rate of the nonstress test/contraction stress test.

Topics: Amniotic Fluid; Biophysical Phenomena; Exercise Test; Female; Fetal Distress; Fetal Monitoring; Fetal Movement; Heart Rate, Fetal; Humans; Oxytocics; Oxytocin; Pregnancy; Pregnancy, High-Risk; Risk Factors; Uterine Contraction

To determine labour management procedures associated with an increased risk of fetal heart rate anomalies and to assess the effectiveness of various intrauterine resuscitation techniques for fetal distress.. The literature search was carried out systematically on Medline and Cochrane database between 1980 and June 2007 was performed.. Early amniotomy and/or active management of labour reduce the duration of the first stage of labour without affecting the rate of caesarean section (level of evidence 1). Early amniotomy increases the frequency of severe variable fetal heart rate decelerations (level of evidence 1). High doses of oxytocin and decrease in the oxytocin-dosing interval for augmentation of labour both induce uterine hyperstimulation (level of evidence 1). Increased uterine activity is associated with a higher incidence of fetal heart rate abnormalities and neonatal acidosis (level of evidence 3). Fetal heart rate decelerations in supine position may disappear in the lateral position (level of evidence 3). In prophylactic maternal oxygenation administration abnormal cord blood pH values (less than 7.2) are more frequent in the oxygenation group than in the control group (level of evidence 2) and its efficacy in fetal distress is not evaluated until now. Amnioinfusion in the presence of thick meconium staining does not reduce the risk of perinatal death or meconium aspiration syndrome (level of evidence 1). Transcervical saline amnioinfusion might relieve variable decelerations during labour (level of evidence 3). Prophylactic amnioinfusion for intrapartum oligohydramnios reduces fetal heart rate abnormalities and overall rates of caesarean deliveries (level of evidence 2). Acute tocolysis may be helpful in cases of intrapartum fetal distress related to uterine hyperactivity (level of evidence 2).. Early amniotomy and high doses of oxytocin may both increase the risk of fetal heart rate anomalies, but are both useful for avoiding prolonged labour. More research is needed to attempt the impact of different labour managements and intrauterine resuscitation techniques on neonatal outcomes.

Topics: Acidosis; Amnion; Female; Fetal Blood; Fetal Distress; Fetal Monitoring; Heart Rate, Fetal; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Labor, Obstetric; Meconium Aspiration Syndrome; MEDLINE; Oligohydramnios; Oxytocin; Pregnancy; Sodium Chloride; Tocolysis; Uterine Contraction

Oxytocin is the most common pharmacologic agent used for the induction and augmentation of labor. Oxytocin protocols can be divided into high-dose and low-dose protocols depending on the initial dose and the amount and rate of sequential increase in dose. Despite the frequency with which oxytocin in used in clinical practice, there is little consensus regarding which protocol is most appropriate. The purpose of this chapter is to review the most current data concerning recommendations for the use of oxytocin in the induction of labor, including cases of intrauterine fetal demise and vaginal birth after cesarean.

Topics: Anesthesia, Epidural; Dose-Response Relationship, Drug; Female; Fetal Distress; Humans; Infusions, Intravenous; Labor, Induced; Oxytocics; Oxytocin; Pregnancy; Receptors, Oxytocin; RNA, Messenger; Vaginal Birth after Cesarean

The authors have studied the recent literature as well as the conclusions reached at the FIGO Congress in Berlin in 1985 to define rigorous criteria for interpreting the three principal methods that are carried out for antepartum monitoring. These are the non-stress test (NST), the oxytocin test (OCT) and the biophysical score (BPS). The point out the usefulness and the reliability of the NST as a screening technique for hypoxia in utero and also how necessary it is to use more sensitive tests like OCT ou BPS to work out the degree to which the fetus is affected. The way the cases should be handled clinically according to the results of these tests is described.

Topics: Female; Fetal Distress; Fetal Heart; Fetal Hypoxia; Fetal Monitoring; Fetal Movement; Fetus; Heart Rate; Humans; Oxytocin; Pregnancy; Risk

Both biophysical and biochemical techniques may be used to diagnose fetal distress. Fetal heart rate monitoring should be thought of as a screening technique to define a population at significant risk for fetal acidosis. The addition of fetal scalp blood sampling improves the clinician's diagnostic accuracy. The hallmark of treatment is to alleviate the stress on the fetus, to restore intervillous and cord blood flow, and, hence, to improve fetal oxygenation. This improvement may be accomplished by (1) discontinuing oxytocin, (2) correcting maternal hypotension, (3) administering oxygen to the mother, and (4) attempting to alleviate cord compression by changing the relationship of the fetal presenting part to the umbilical cord and pelvis.

Topics: Acid-Base Imbalance; Female; Fetal Blood; Fetal Distress; Fetal Heart; Fetal Monitoring; Heart Rate; Humans; Hydrogen-Ion Concentration; Maternal-Fetal Exchange; Oxytocin; Pregnancy

Topics: Anesthesia, Obstetrical; Cesarean Section; Female; Fetal Distress; Fetal Viability; Humans; Infant Mortality; Infant, Newborn; Infant, Premature; Infections; Jaundice, Neonatal; Labor, Induced; Mother-Child Relations; Obstetric Labor Complications; Obstetrical Forceps; Oxytocin; Pregnancy; Respiratory Distress Syndrome, Newborn; United Kingdom

Topics: Animals; Apgar Score; Blood Specimen Collection; Bradycardia; Delivery, Obstetric; Electrocardiography; Electrodes; Estradiol; Female; Fetal Distress; Fetal Heart; Heart Rate; Humans; Oxytocin; Phonocardiography; Pregnancy; Prenatal Diagnosis; Respiration; Tachycardia; Uterine Contraction

Delayed labour progress is common in nulliparous women, often leading to caesarean section despite augmentation of labour with synthetic oxytocin.. High- or low-dose oxytocin can be used for augmentation of delayed labour, but evidence for promoting high-dose is weak. Aim To ascertain the effect on caesarean section rate of high-dose versus low-dose oxytocin for augmentation of delayed labour in nulliparous women. Methods Multicentre parallel double-blind randomised controlled trial (ClinicalTrials.gov: NCT01587625) in six labour wards in Sweden. Healthy nulliparous women at term with singleton cephalic fetal presentation, spontaneous labour onset, confirmed delay in labour and ruptured membranes (n=1351) were randomised to labour augmentation with either high-dose (6.6 mU/minute) or low-dose (3.3 mU/minute) oxytocin infusion.. 1295 women were included in intention-to-treat analysis (high-dose n=647; low-dose n=648). Caesarean section rates did not differ between groups (12.4% and 12.3%, 95% Confidence Interval -3.7 to 3.8). Women with high-dose oxytocin had: shorter labours (-23.4min); more uterine tachysystole (43.2% versus 33.5%); similar rates of instrumental vaginal births, with more due to fetal distress (43.8% versus 22.7%) and fewer due to failure to progress (39.6% versus 58.8%). There were no differences in neonatal outcomes.. Our study could not confirm results of two systematic reviews indicating, with weak evidence, that use of high-dose oxytocin was associated with lower frequency of caesarean section.. We found no advantages for routine use of high-dose oxytocin in the management of delay in labour. Low-dose oxytocin regimen is recommended to avoid unnecessary events of tachysystole and fetal distress.

Topics: Adult; Cesarean Section; Double-Blind Method; Female; Fetal Distress; Humans; Labor Presentation; Labor, Induced; Oxytocics; Oxytocin; Pregnancy; Sweden; Treatment Outcome

The efficacy and safety of misoprostol for cervical ripening and labor induction in patients with oligohydramnios was investigated. 57 pregnancies with oligohydramnios and 58 cases with a normal amniotic fluid volume (controls) were enrolled in this prospective trial. All patients received 50 microg of intravaginal misoprostol every 5 h. Primary outcomes were: cesarean section rate; induction to delivery time; oxytocin augmentation; uterine hyperstimulation; meconium passage; fetal heart rate (FHR) changes; fetal distress requiring delivery, and Apgar scores. There were no differences in the mean time to delivery, cesarean section rate, oxytocin augmentation or Apgar scores. The mean induction to delivery time in oligohydramnios and control groups were, 11 h 43 min and 11 h 18 min, respectively (p > 0.05). FHR changes were observed in 26.3% of oligohydramnios group and 32.7% of control group (p > 0.05). There was no statistically significant difference in the cesarean section rate and the uterine hyperstimulation between the 2 groups. These data suggest that misoprostol can be used as an effective agent for cervical ripening and labor induction in pregnancies with oligohydramnios without increasing the risk for perinatal outcome, compared to those with normal amniotic fluid volumes.

Topics: Administration, Intravaginal; Adult; Apgar Score; Cervical Ripening; Cesarean Section; Female; Fetal Distress; Gestational Age; Heart Rate, Fetal; Humans; Labor, Induced; Misoprostol; Oligohydramnios; Oxytocics; Oxytocin; Pregnancy; Prospective Studies; Risk Factors; Time Factors

To compare expectant management with early induction of labour in pregnant patients with prelabour rupture of membranes at term and unfavourable cervix.. A prospective, randomised study of 154 women with prelabour rupture of membranes at term of whom 80 had been managed expectantly, and 74 had undergone oxytocin induction at a rate of 2.5 mU/min. Digital examination was not performed before oxytocin infusion, and the first was delayed until 4 h (nulliparae), or 2 h (multiparae) of regular uterine contractions.. The mean period from rupture of membranes to delivery was significantly shorter in the induction group. The mean duration of labour was significantly shorter in the expectant group. Operative vaginal deliveries were more common in the induction group, and fetal distress was the most common cause of operative vaginal deliveries. The caesarean rates were low and similar in both groups. Maternal and neonatal infectious morbidity was similar and no difference was found in the length of hospitalisation.. Expectant management in patients with ruptured membranes at term is safe and reduces the frequency of operative vaginal deliveries.

Topics: Adult; Cesarean Section; Female; Fetal Distress; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Outcome; Prospective Studies

The purpose of this study was to compare prostaglandin E2 gel and a low-dose infusion of oxytocin for cervical ripening before labor induction.. A total of 158 women were randomized to receive either two intracervical doses of 0.5 mg prostaglandin E2 gel 6 hours apart or 12 hours of intravenous oxytocin up to 4 mlU/min. After cervical ripening labor was induced with high-dose oxytocin infusion and amniotomy.. There was no difference between the prostaglandin E2 and low-dose oxytocin groups in the likelihood of being in labor or having a Bishop score favorable for induction after ripening (64.2% vs 52.0%, p = 0.12) or in the incidence of vaginal delivery (75.9% vs 74.7%). Prostaglandin E2-treated patients were delivered sooner (20.2 +/- 8.1 hours vs 25.0 +/- 10.5 hours, p = 0.002). Among delivered patients the likelihood of vaginal delivery within 24 hours was greater with prostaglandin E2 ripening (63.7% vs 47.2%, p = 0.04), but there was no difference at 36 hours (76.2% vs 75.0%). Uterine hyperstimulation and fetal distress during ripening occurred only in the prostaglandin E2 group, at a rate of 4.8%.. After cervical ripening with prostaglandin E2 gel or low-dose oxytocin vaginal delivery can be expected in three fourths of patients within 24 to 36 hours. We recommend that patients with an unfavorable cervix who require delivery undergo cervical ripening and induction of labor rather than automatic delivery by cesarean section.

Topics: Adult; Cervix Uteri; Chi-Square Distribution; Dinoprostone; Drug Administration Schedule; Female; Fetal Distress; Gels; Humans; Labor, Induced; Oxytocin; Pregnancy; Time Factors; Uterine Contraction

In order to evaluate a dose-related response of cervical ripening and labor induction to a prostaglandin E2 (PGE2) gel, 110 women with uncomplicated postdate pregnancies and unripe cervices received intracervically 0.5 mg PGE2 (n = 40), 1.5 mg PGE2 (n = 35) or 2.5 mg PGE2 (n = 35). The failure rate in terms of cervical ripening was similar in all groups. Labor characteristics such as the duration of the latent phase as well as the total length of labor, the cesarean-section rate, instrumental deliveries and neonatal outcome were similar in all groups. The number of women who required oxytocin for labor augmentation was negatively correlated to the dose of PGE2 (p < 0.05). In addition, 3 out of 35 women in the 2.5-mg group presented hypertonic uterine activity. The increase in the dose of PGE2 gel did not increase the possibility for a vaginal delivery, but reduced the requirement for oxytocin while increasing hypertonic uterine action.

Topics: Administration, Intravaginal; Adult; Cervix Uteri; Dinoprostone; Dose-Response Relationship, Drug; Female; Fetal Distress; Fever; Humans; Labor, Induced; Oxytocin; Parity; Pregnancy; Pregnancy Outcome; Pregnancy, Prolonged; Uterine Contraction; Vaginal Creams, Foams, and Jellies

Seven hundred fifty-nine of 926 women in abnormal labor (82%) were entered into an open randomized trial to compare the effects of oxytocin and saline. Patients were classified as having either primary dysfunctional labor or secondary arrest of cervical dilatation. The end points chosen were an increase in the rate of cervical dilatation or a change in cervical dilatation. Patients who failed to respond to the initial solution were crossed over to the other solution. Oxytocin was significantly superior to saline in treating both labor abnormalities. Administration of oxytocin did not increase the need for cesarean delivery for fetal distress.

Topics: Cesarean Section; Female; Fetal Distress; Humans; Incidence; Labor Stage, First; Obstetric Labor Complications; Oxytocin; Parity; Pregnancy; Prognosis; Randomized Controlled Trials as Topic

We conducted a prospective randomized study involving 317 patients with term gestations (greater than 36 weeks) and premature rupture of membranes (PROM). Eighty-five percent of the 167 patients managed conservatively began labor within 48 hours. The cesarean section rate in this group was 7% as opposed to 21% in the group managed by oxytocin induction. There were no neonatal infections, and the maternal intrauterine infection rate was lower in the group managed expectantly, 4% vs 12%. There was no difference in the average time of hospitalization for the two groups. Conservative management of patients with PROM at term will significantly reduce the incidence of cesarean section without placing the mother or infant at a higher risk of infection.

Topics: Cesarean Section; Endometritis; Female; Fetal Diseases; Fetal Distress; Fetal Membranes, Premature Rupture; Fetal Monitoring; Humans; Infant, Newborn; Labor, Induced; Labor, Obstetric; Oxytocin; Pregnancy; Prospective Studies; Random Allocation; Streptococcal Infections; Streptococcus agalactiae; Time Factors

Prolonged pregnancy was rigorously defined in 180 gravid women without other complications. Patients were randomly assigned to be serially followed, either by amniocenteses or by oxytocin challenge tests (OCT's). Induction of labor, based upon only (1) a finding of meconium in the amniocentesis group or (2) a positive test in the OCT group, was nearly three times more frequent in the amniocentesis group. The incidence of meconium, which overall was 22% initially and 44% at delivery, as well as the frequencies of obstetric and perinatal complications, were similar in both management groups. Although meconium was significantly associated with abnormal labor progression, intrapartum fetal distress, and low 1 and 5 minute Apgar scores, induction of labor after discovery of meconium, when compared to nonintervention, did not improve perinatal outcome. It is concluded that a search for meconium is of little value in the management of prolonged pregnancy.

Topics: Amniocentesis; Amniotic Fluid; Apgar Score; Female; Fetal Distress; Fetal Monitoring; Humans; Infant, Newborn; Labor, Induced; Meconium; Obstetric Labor Complications; Oxytocin; Pregnancy; Pregnancy, Prolonged; Risk

Fear or anxiety could result in adverse consequences on the course of labour. To date, family members are still not permitted in the delivery rooms in the majority of hospitals in China, and continuous support from hospital professional staff is also limited. This study aimed to evaluate the benefits of continuous support by family members and hospital professional staff during labour in China.. In this Cross-Sectional study, 362 primiparous pregnancies who self-requested to receive continuous or one to one support with vaginal delivery and 362 primiparous pregnant women with routine hospital maternal care were included from a university teaching hospital. Data on the length of labour, postpartum haemorrhage (PPH), use of pain relief, use of oxytocin, fetal distress, emergency caesarean section and apgar score at 1 and 5 min were retrospectively collected from hospital medical data-base and compared between the two groups.. Multiple linear regressions adjusting for maternal age, BMI and birth weight, revealed the estimated length of labour for women with routine hospital maternal care was 2.03 times (95%CI 1.86 to 2.21) the duration of women with supportive care (median time, 3.05 h vs 1.5 h). In addition, Fisher's exact test showed the emergency caesarean section rate was significantly lower in women with supportive care compared to women with routine hospital maternal care (3.3% vs 24%).. Our results suggest that continuous support from family members together with hospital professional staff should be considered as part of intrapartum care in hospitals in China.

Topics: Adolescent; Adult; Analgesia, Obstetrical; Anxiety; Apgar Score; Cesarean Section; China; Cross-Sectional Studies; Delivery, Obstetric; Emergencies; Family; Fear; Female; Fetal Distress; Hospitals, Teaching; Hospitals, University; Humans; Labor, Obstetric; Midwifery; Nursing Staff, Hospital; Obstetric Nursing; Oxytocics; Oxytocin; Parturition; Postpartum Hemorrhage; Pregnancy; Retrospective Studies; Social Support; Time Factors; Young Adult

A protocol including judicious use of oxytocin augmentation was investigated to determine whether it would change how oxytocin was used and eventually influence labor and fetal outcomes.. The population of this cohort study comprised 20 227 delivering women with singleton pregnancies ≥37 weeks, cephalic presentation, spontaneous or induced onset of labor, without previous cesarean section. Women delivering from 2009 to 2013 at Stavanger University Hospital, Norway, were included. Data were collected prospectively. Before implementing the protocol in 2010, oxytocin augmentation was used if progression of labor was perceived as slow. After implementation, oxytocin could only be started when the cervical dilation had crossed the 4-h action line in the partograph.. The overall use of oxytocin augmentation was significantly reduced from 34.9% to 23.1% (p < 0.01). The overall frequency of emergency cesarean sections decreased from 6.9% to 5.3% (p < 0.05) and the frequency of emergency cesarean sections performed due to fetal distress was reduced from 3.2% to 2.0% (p = 0.01). The rate of women with duration of labor over 12 h increased from 4.4% to 8.5% (p < 0.01) and more women experienced severe estimated postpartum hemorrhage (2.6% vs. 3.7%; p = 0.01). The frequency of children with pH <7.1 in the umbilical artery was reduced from 4.7% to 3.2% (p < 0.01).. The frequency of emergency cesarean section was reduced after implementing judicious use of oxytocin augmentation. Our findings may be of interest in the ongoing discussion of how the balanced use of oxytocin for labor augmentation can best be achieved.

Topics: Adult; Anal Canal; Cesarean Section; Clinical Protocols; Dystocia; Emergencies; Female; Fetal Blood; Fetal Distress; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Labor, Obstetric; Lacerations; Norway; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Time Factors

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

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

To compare outcomes in small for gestational age neonates induced with misoprostol to other cervical ripening agents. We hypothesized that misoprostol use will demonstrate no significant difference in outcomes compared with alternative agents.. Small for gestational age neonates (<10th percentile for gestational age) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) sponsored Consortium on Safe Labor database were analyzed. Neonates induced with misoprostol ± oxytocin (n = 451) were compared with neonates induced with prostaglandin E2 ± oxytocin and/or mechanical dilation ± oxytocin (n = 663). Primary outcomes included intrapartum fetal distress, cesarean section for fetal distress, cesarean section for any reason, neonatal intensive care unit admission, low 5-minute Apgar, and composite neonatal morbidity. Multiple logistic regression was used to calculate adjusted odds ratios (aORs). Data were analyzed using SAS.. Small for gestational age neonates induced with misoprostol ± oxytocin compared with alternative agents had decreased low 5-minute Apgar scores (aOR 0.27 [0.10-0.71]). No significant differences were demonstrated among very small for gestational age neonates (<5th percentile for gestational age).. Our results suggest that misoprostol does not increase risk of adverse outcomes in small for gestational age neonates; however, prospective studies are warranted to further assess optimal cervical ripening agents in this population.

Topics: Adult; Apgar Score; Cesarean Section; Dilatation; Dinoprostone; Female; Fetal Distress; Humans; Infant, Newborn; Infant, Small for Gestational Age; Intensive Care Units, Neonatal; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Patient Admission; Pregnancy; Retrospective Studies; Young Adult

Intrauterine resuscitative measures are commonly initiated during labor when the fetal heart rate (FHR) pattern is indeterminate or abnormal. The most effective use of these measures is directed at the presumed underlying cause. However, some FHR patterns are nonspecific, while others are such that intrauterine resuscitation will not remedy the situation. The goals of intrauterine resuscitation during labor are, at its best, to reverse any hypoxia that might lead to further deterioration, and at the very least to avoid prolonged periods of indeterminate or abnormal FHR patterns, which may cause unnecessary concern for caregivers and patients and unnecessary operative intervention.

Topics: Erythrocyte Transfusion; Female; Fetal Distress; Fetal Hypoxia; Fetal Monitoring; Fluid Therapy; Heart Rate, Fetal; Humans; Labor, Obstetric; Obstetric Labor Complications; Oligohydramnios; Oxygen; Oxytocin; Pregnancy; Resuscitation; Tocolytic Agents

Acute coronary syndrome (ACS) during pregnancy and delivery is a rare event that is usually related to prior disease or family history. Factors that contribute to the appearance of ACS during delivery in women with healthy coronary arteries include high doses of drugs to suppress contractions or increase uterine muscle tone and cardiovascular instability of any kind. Clinical and electrocardiographic abnormalities (eg, ST segment depression) that are suggestive of ACS have been reported to occur during cesarean section but without subsequent enzyme or echocardiographic abnormalities.

Topics: Acute Coronary Syndrome; Adult; Analgesia, Epidural; Cesarean Section; Coronary Vasospasm; Female; Fetal Distress; Humans; Intraoperative Complications; Obstetric Labor Complications; Oxytocin; Pregnancy; Ritodrine; Tocolytic Agents

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

To determine whether, in a group of high-risk pregnancies undergoing an oxytocin challenge test (OCT), uterine artery Doppler velocimetry will identify fetuses at risk of distress during the provoked contractions.. Bilateral uterine artery Doppler velocimetry was performed simultaneously with electronic fetal heart rate (FHR) recordings in 67 high-risk pregnancies subjected to an OCT. Flow velocity waveforms (FVWs) were classified according to pulsatility index (PI), presence of diastolic notching and a novel classification of FVW shapes. The OCT was classified as negative (normal) or positive (late FHR decelerations). Only OCT-negative cases were allowed a trial of vaginal delivery. Non-parametric statistical methods were used to test for differences between the OCT groups.. There was no difference in prevalence of high PI or diastolic notching in OCT-positive (n = 10) and OCT-negative (n = 57) cases at basal (resting) measurements or between uterine contractions in either uterine artery (P > or = 0.3). During contractions the PI could not be used for assessment due to the biphasic shape of the FVWs, but there was no difference in distribution of FVW classes between the groups in either the placental side (P > or = 0.3) or contraplacental side (P > or = 0.6) uterine artery. No significant associations between PI or FVW class distribution and birth asphyxia or operative delivery for fetal distress in labor were found (P > or = 0.1).. During uterine contractions there is no difference in uterine artery FVW pattern between OCT-positive and OCT-negative cases. Recording of uterine artery FVWs during the OCT seems to be of limited clinical relevance.

Topics: Arteries; Blood Flow Velocity; Female; Fetal Distress; Humans; Laser-Doppler Flowmetry; Oxytocin; Pregnancy; Pregnancy, High-Risk; Ultrasonography, Prenatal; Uterine Contraction; Uterus

Misoprostol, the prostaglandin E1 analog, is increasingly used for cervical ripening and induction of labor. We evaluated our experience with misoprostol in an open-label setting.. Patients were selected for cervical ripening based on clinical profile. At 3 cm cervical dilation, misoprostol was discontinued and other means of labor augmentation were used. Over 13 months, 470 inductions of labor occurred, and 455 charts were available; 254 patients (56%) received misoprostol for cervical ripening, and 144 (32%) received dinoprostone (prostaglandin E2).. With misoprostol, mean time from beginning of contractions until delivery was 7 hours, 30 minutes; vaginal birth occurred in 85% of cases, and spontaneous labor occurred in 38%. Hyperstimulation occurred in 4 cases (1.6%) and precipitate labor in 7 (3%). All infants were discharged in excellent condition; one had a 5-minute Apgar score <7, and 33 (13%) had meconium, none with aspiration. Twenty-three patients who had had a previous cesarean section received misoprostol and delivered vaginally.. Misoprostol was found to be a safe and effective agent for cervical ripening as part of labor induction.

Topics: Adolescent; Adult; Apgar Score; Cervical Ripening; Cervix Uteri; Delivery, Obstetric; Dinoprostone; Female; Fetal Distress; Humans; Infant, Newborn; Labor, Induced; Labor, Obstetric; Meconium; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Pregnancy Outcome; Retrospective Studies; Safety; Time Factors; Treatment Outcome; Uterine Contraction; Vaginal Birth after Cesarean

Topics: Adult; Blood Gas Analysis; Diagnosis, Differential; Female; Fetal Blood; Fetal Distress; Fetal Monitoring; Humans; Infant, Newborn; Neonatal Nursing; Oxytocin; Pregnancy; Prenatal Diagnosis; Respiratory Distress Syndrome, Newborn

Our objective was to study uterine and umbilical artery flow resistance during the oxytocin challenge test (OCT). The study population was 21 women with suspected placental insufficiency; one woman was excluded because of a positive OCT with reactive fetal heart rate pattern. We carried out simultaneous electronic fetal heart rate monitoring and Doppler velocimetry of uterine and umbilical artery flow during the OCT. The uterine artery flow resistance increased significantly during contractions in both OCT-positive (n = 5) and OCT-negative (n = 15) cases compared with basal values, but the increase was significantly higher in positive cases. The umbilical artery flow resistance increased significantly during contractions in OCT-positive cases, but was almost unchanged in negative cases. During uterine inactivity, there were no differences between the groups for any vessel. This study showed that fetal heart rate decelerations during the OCT are associated with rapid and exaggerated increases of vascular resistance in both uterine and umbilical arteries. The causal relationship is unknown, but the findings indicate pathophysiological mechanisms revealed only during uterine contractions.

Topics: Blood Flow Velocity; Female; Fetal Distress; Heart Rate, Fetal; Humans; Oxytocin; Pregnancy; Regression Analysis; Ultrasonography, Doppler; Ultrasonography, Prenatal; Umbilical Arteries; Uterine Contraction; Uterus

Increases in cesarean section frequency may be dependent on institutional or individual practitioner characteristics. The purpose of this study was to examine whether the diagnosis of fetal distress was influenced by time of day or institutional factors.. Chart review was performed on a random sample of women stratified by month of delivery at each institution (N = 8647). All women who gave birth by elective cesarean section or whose labor was induced were excluded from analysis (n = 2207), leaving a total population of 6440 for study. Women were stratified based on risk status, and comparisons were made between the time of delivery, maternal socioeconomic factors, and obstetric variables for those who had a cesarean section for fetal distress compared with women who gave birth vaginally.. Large variations in rates of cesarean delivery for fetal distress were observed among the participating institutions (range 0.9% to 3.0% of all deliveries). Increased rates of cesarean delivery for fetal distress were observed in nonwhite women and those who had had a previous cesarean delivery. Also, a significant increase in rates of cesarean section for fetal distress was noted between the hours of 9:00 PM and 3:00 AM. When adjusted for risk status, previous cesarean delivery, race, use of pitocin augmentation, length of labor, and site, time of day was still a significant predictor (adjusted odds ratio = 1.56, 95% confidence interval 1.06 to 2.29) for cesarean delivery for fetal distress.. Cesarean delivery for the diagnosis of fetal distress appears to vary depending on institutional and other nonclinical factors. The observation that cesarean deliveries for fetal distress peak during nighttime hours raises the possibility that the interpretation of fetal monitor tracing is influenced by physician and patient fatigue or other clinical factors.

Topics: Adult; Cesarean Section; Dystocia; Female; Fetal Distress; Fetal Monitoring; Humans; Labor, Induced; Labor, Obstetric; Oxytocin; Pregnancy; Pregnancy, High-Risk; Reoperation; Retrospective Studies; Time

The purpose of this study was to investigate the elemental composition of myometrial cells from term parturient women with normal and dysfunctional labour. Myometrial biopsies were obtained from forty-four term pregnant women undergoing Cesarean section. The patients were categorized according to uterine activity as follows: before labour, normal labour, labour successfully augmented by oxytocin, oxytocin-resistant labour, and labour arrested by terbutaline. X-ray microanalysis of freeze-dried sections (16 mu m thick) of the myometrium was carried out. An increase in intracellular phosphorus level (p < .01) was noted in the normal labour group compared to before labour. In patients with normal labour, higher phosphorus (p < .009) and potassium (p < .005) were found compared to oxytocin resistant labour. Patients with oxytocin resistant labour had lower intracellular potassium (p < .0006) and phosphorus (p < .02), and higher chloride (p < .05) and sodium (p < .03) compared to levels found in patients who responded to oxytocin treatment. In dysfunctional (oxytocin-resistant) labour the ion distribution in the myometrial cells might be disturbed. The reduced level of potassium and phosphorus together with the high sodium and chloride levels found in patients with oxytocin resistant labour may be connected to an impairment in sodium-potassium pump and muscle dysfunction, clinically diagnosed as dystocia.

Topics: Biopsy; Calcium; Cesarean Section; Chlorides; Electron Probe Microanalysis; Female; Fetal Distress; Humans; Labor, Obstetric; Myometrium; Obstetric Labor Complications; Obstetric Labor, Premature; Oxytocin; Phosphorus; Potassium; Pregnancy; Sodium-Potassium-Exchanging ATPase; Terbutaline; Tocolytic Agents; Uterine Contraction

Topics: Female; Fetal Distress; History, 20th Century; Humans; Oxytocin; Pregnancy

We describe a case of uterine rupture during labor in a patient with a previous cesarean section and a unicornuate uterus. The case may encourage obstetricians to carry out elective repeated cesarean sections in cases with previous cesarean sections and uterine anomalies.

Topics: Adult; Apgar Score; Cesarean Section; Female; Fetal Distress; Humans; Infant, Newborn; Labor, Induced; Obstetric Labor Complications; Oxytocin; Pregnancy; Surgical Wound Dehiscence; Trial of Labor; Uterine Rupture; Uterus

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

The use of continuous fetal heart rate (FHR) and uterine pressure monitoring in the chimpanzee (Pan troglodytes) by external Doppler transducer and tocodynamometer is described in 1) the routine obstetrical assessment of fetal well-being, 2) oxytocin challenge (stress) testing (OCT) and non-stress testing (NST) for the diagnosis of in utero fetal distress, and 3) induction of labor by intravenous oxytocin infusion, by surgical rupture of the chorio-amniotic membranes (amniotomy), or by a combination of these techniques, as an alternative to Caesarean section for clinical, managemental, or experimental purposes. FHR traces were analyzed during a total of 57 term pregnancies for three basic characteristics: baseline rate, variability, and periodic pattern. Results indicated that continuous FHR monitoring in the chimpanzee can provide a valuable tool for fetal assessment and management of labor in any attempt to reduce the unacceptably high annual incidence of perinatal and neonatal infant mortality reported in the U.S.

Topics: Amnion; Animals; Cardiotocography; Female; Fetal Distress; Heart Rate, Fetal; Infusions, Intravenous; Labor, Induced; Oxytocin; Pan troglodytes; Pregnancy; Pregnancy, Animal; Reference Values; Uterine Contraction

This study was designed to address the effect of induced labor using pitocin iv drip in decreasing the incidence of perinatal complications and perinatal mortality of prolonged pregnancy. Induced labor was used in a study group which included 126 prolonged pregnant nullipara without complication. One hundred and twenty-eight prolonged pregnant nullipara in natural labor were defined as the control group. The perinatal mortality was 0 in the study group and 3.125% in the control. Also, the asphyxia rate was 8.7% in the study group and 13.3% in the control. The percentage of caesarean deliveries was the same in the both groups. The results of this study suggest that induced labor is safe, effective and practical in the management of prolonged pregnancies.

Topics: Asphyxia Neonatorum; Female; Fetal Distress; Humans; Infant Mortality; Infant, Newborn; Infusions, Intravenous; Labor, Induced; Oxytocin; Pregnancy; Pregnancy, Prolonged

Clinical features of a long contraction wave, lasting 3 minutes or more, recorded on an external tocodynamometer were studied. The long wave was observed in 50 out of 1,050 pregnant women. Clinical significance was not indicated by the shape of each wave which was either a long relaxing type or a fused type, but by the frequency of occurrence. Vaginal delivery and its close relation to oxytocin administration were significantly more frequent in the sporadic type, in which the long wave was observed once within a week, and fetal distress and a low Apgar score were more frequently observed in the frequent type, in which long waves occurred twice or more within a week. The results suggest that the obstetric prognosis is normal unless the long wave occurs sporadically and its recovery is good, and that it is ominous when long waves are observed twice or more within a week. Careful observation is needed in that case.

Topics: Adult; Age Factors; Cardiotocography; Female; Fetal Distress; Heart Rate, Fetal; Humans; Obstetric Labor Complications; Oxytocin; Pregnancy; Prognosis; Retrospective Studies; Uterine Contraction

In an attempt to reduce the caesarean section rate without an adverse effect on the obstetrical outcome, new guidelines for the management of dystocia, previous caesarean delivery, fetal distress, and breech presentation were introduced in September 1984 in a provincial hospital in Zimbabwe, Africa. Comparison of the two-year periods before and after September 1984 showed that the caesarean section rate had dropped from 16.8 to 8.0%, the maternal mortality rate from 2.0 to 0.5%, and the perinatal mortality rate from 71.9 to 56.2%. During the latter period use of oxytocin increased from 3.4 to 17.4%. These findings suggest that the adoption of strict guidelines can lead to a decrease of the caesarean section rate and an improvement of the obstetrical outcome in the absence of new technology.

Topics: Adult; Breech Presentation; Cesarean Section; Female; Fetal Distress; Humans; Infant Mortality; Infant, Newborn; Maternal Mortality; Oxytocin; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Zimbabwe

Topics: Administration, Intranasal; Adult; Cardiotocography; Cesarean Section; Female; Fetal Distress; Fetal Hypoxia; Heart Rate, Fetal; Humans; Infant, Newborn; Oxytocin; Pregnancy; Risk Factors; Uterine Contraction

Epidural analgesia in labor is generally accepted as safe and effective and therefore has become increasingly popular. However, little is known regarding the effect of epidural analgesia on the incidence of cesarean section for dystocia in nulliparous women. During the first 6 months of 1987 we studied 711 consecutive nulliparous women at term, with cephalic fetal presentations and spontaneous onset of labor. Comparison of 447 patients who received epidural analgesia in labor with 264 patients who received either narcotics or no analgesia was performed. The incidence of cesarean section for dystocia was significantly greater (p less than 0.005) in the epidural group (10.3%) than in the nonepidural group (3.8%). There remained a significantly increased incidence (p less than 0.005) of cesarean section for dystocia in the epidural group after selection bias was corrected and the following confounding variables were controlled by multivariate analysis: maternal age, race, gestational age, cervical dilatation on admission, use of oxytocin, duration of oxytocin use, maximum infusion rate of oxytocin, duration of labor, presence of meconium, and birth weight. The incidence of cesarean section for fetal distress was similar (p greater than 0.20) in both groups. There were no clinically significant differences in frequency of low Apgar scores at 5 minutes or cord arterial and venous blood gas parameters between the two groups. This study suggests that epidural analgesia in labor may increase the incidence of cesarean section for dystocia in nulliparous women.

Topics: Analgesia, Epidural; Anesthesia, Obstetrical; Cesarean Section; Dystocia; Female; Fetal Distress; Humans; Oxytocin; Pain; Parity; Pregnancy; Risk Factors

We measured the cord levels of gastrin, somatostatin and oxytocin with radioimmunoassay in plasma collected from the umbilical artery after vaginal delivery and after elective cesarean section. Maternal venous samples after the two labour modalities were also assayed for the same hormones. Fetal gastrin, somatostatin and oxytocin levels were significantly higher after vaginal delivery than after elective cesarean section. Independently of labour type, the fetal gastrin and somatostatin levels were always higher than the maternal levels. We suggest that the observed high levels of gastrin, somatostatin and oxytocin could be due to a stress-related stimulation of the oxytocin- as well as of the gastric gastrin- and somatostatin-producing cells, occurring particularly during vaginal delivery. The significant inverse correlation found between fetal pH and the recorded hormone levels is consistent with this hypothesis.

Topics: Acid-Base Equilibrium; Cesarean Section; Female; Fetal Blood; Fetal Distress; Gastrins; Humans; Infant, Newborn; Labor, Obstetric; Male; Maternal-Fetal Exchange; Oxytocin; Postpartum Period; Pregnancy; Radioimmunoassay; Somatostatin

The incidence of uterine hyperstimulation during oxytocin augmentation in labor and in breast-stimulated and oxytocin contraction stress tests showed a wide variation in a number of reported studies. One major reason is the lack of a standard definition of uterine hyperstimulation.

Topics: Female; Fetal Distress; Fetal Heart; Fetal Monitoring; Humans; Oxytocin; Pregnancy; Terminology as Topic; Time Factors; Uterine Contraction

The obstetric performance of patients admitted with spurious labor was evaluated. The incidence of fetal distress in labor was significantly higher in those who had spurious labor (16.7%) than in those who were established in labor within 24 hours of admission (3.8%). An equivocal or ominous fetal heart rate trace on admission was related to the occurrence of fetal distress in labor in both the spurious labor group and the normal labor group. Positive predictive value of a normal test was low in the spurious labor group. Obstetric interventions such as augmentation (35.7%) and operative deliveries (41.0%) were significantly higher in the spurious labor group than in the normal labor group (19.7% and 18.8%, respectively). The induction rate in the spurious labor group was 15.5%. The use of oxytocin for augmentation and induction of labor seems to contribute to the increased incidence of fetal distress and operative deliveries in the spurious labor group. The spurious labor group also had a higher incidence of fetal distress than the control group even among the patients who did not receive oxytocin. The results suggest that patients with an episode of spurious labor constitute a high-risk group with a considerable risk of fetal distress and obstetric interventions in subsequent labor.

Topics: Delivery, Obstetric; Female; Fetal Distress; Fetal Monitoring; Heart Rate, Fetal; Humans; Infant, Newborn; Labor, Induced; Obstetric Labor Complications; Oxytocin; Pregnancy; Risk; Uterine Contraction

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

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

Topics: Estetrol; Estriol; Female; Fetal Distress; Gestational Age; Humans; Maternal-Fetal Exchange; Oxytocin; Placental Function Tests; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics; Radioimmunoassay; Risk

The use of oxytocin in labor has the inherent danger of producing uterine hyperstimulation with resultant fetal distress. When produced by gradual titration of intravenous oxytocin, discontinuation of the medication is usually sufficient to reverse the process. However, the rapid administration of a large intravenous dose of oxytocin, as occurred in this patient, may result in hypertonic uterine contractions and fetal distress unresponsive to traditional measures. The rationale for using a tocolytic drug to reverse the uterine hypertonus, produce intrauterine fetal resuscitation, and prevent cesarean section is discussed in this report.

Topics: Adrenergic beta-Agonists; Adult; Female; Fetal Distress; Humans; Muscle Hypertonia; Oxytocin; Pregnancy; Ritodrine; Uterine Contraction

Topics: Female; Fetal Distress; Humans; Labor Onset; Labor, Induced; Labor, Obstetric; Oxytocin; Postpartum Hemorrhage; Pre-Eclampsia; Pregnancy

Topics: Bradycardia; Female; Fetal Distress; Fetal Heart; Humans; Infant, Newborn; Oxytocin; Pregnancy

Topics: Adult; Amniocentesis; Female; Fetal Distress; Humans; Labor Onset; Labor, Obstetric; Oxytocin; Pregnancy; Time Factors; Uterine Rupture

L-cystine aminopeptidase (CAP) activity in plasma was determined by spectrophotometry in 243 normal pregnant women in week 20-40 and 68 pregnant women with premature pains in week 28-37 of pregnancy. For significantly diminished CAP activity, pains and the subsequent premature birth correlated with infantile dystrophy, while in case of normal CAP activity the number of premature births was significantly less and newborns had eutrophic birth weights. In addition, radioimmunological measurements of oxytocin concentration in plasma were performed in ten pregnant women each of these groups. In women with premature pains, the oxytocin concentration was significantly higher than in normals. The present findings suggest that fetal oxytocin release might be the trigger signal for pains, thus causing premature birth. This signal might be chronically induced by a stress situation which manifests itself in hypotrophy of the newborns.

Topics: Aminopeptidases; Birth Weight; Cystinyl Aminopeptidase; Female; Fetal Distress; Gestational Age; Humans; Infant, Newborn; Maternal-Fetal Exchange; Obstetric Labor, Premature; Oxytocin; Pregnancy; Radioimmunoassay

Topics: Anesthesia, Epidural; Cesarean Section; Extraction, Obstetrical; Female; Fetal Distress; Humans; Infant, Newborn; Obstetric Labor Complications; Oxytocin; Pelvimetry; Postoperative Complications; Pregnancy; Pregnancy, Prolonged; Reoperation; Risk; Uterine Rupture

Topics: Cesarean Section; Extraction, Obstetrical; Female; Fetal Distress; Fetal Monitoring; Humans; Labor, Induced; Obstetric Labor Complications; Oxytocin; Pelvimetry; Pregnancy; Uterine Contraction

Topics: Anesthesia, Obstetrical; Cesarean Section; Emergencies; Female; Fetal Distress; Fetal Heart; Fetal Monitoring; Humans; Hydrogen-Ion Concentration; Obstetric Labor Complications; Oxygen Inhalation Therapy; Oxytocin; Posture; Pregnancy; Resuscitation; Uterine Contraction

Prostaglandin E2 vaginal pessaries (3 mg) were compared with conventional amniotomy and oxytocin infusion as a method of induction of labor in 160 patients in the study group compared with 160 in the control group. Each group consisted of 100 primigravidae and 60 multigravidae. When the features of labor, delivery and fetal status were analyzed for the study and the control groups, the patients who received PGE2 pessaries had a better outcome. The difference was more significant for those patients with a low Bishop score. Compared with controls, the PGE2-treated patients had fewer cesarean sections either for failed induction or fetal distress (P less than 0.01); the incidence of infants with low Apgar score was significantly less (P less than 0.05) and there were fewer postpartum haemorrhages (P less than 0.01).

Topics: Adolescent; Adult; Cesarean Section; Dinoprostone; Female; Fetal Distress; Humans; Labor, Induced; Oxytocin; Pessaries; Postpartum Hemorrhage; Pregnancy; Prostaglandins E; Vagina

Topics: Evaluation Studies as Topic; Female; Fetal Distress; Fetal Heart; Fetal Monitoring; History, 19th Century; History, 20th Century; Humans; Obstetrics; Oxytocin; Pregnancy; Uterine Contraction

Modern beta-receptor agonists are potent inhibitors of uterine activity, both spontaneous and induced, and there are several indications for therapy, such as preterm labor, abnormal uterine activity during labor (with or without concomitant fetal distress), complicated cesarean sections, and others. In recent years the widespread use of beta-receptor agonists for preterm labor has been criticized and the efficacy of these drugs has been questioned, since the rate of preterm deliveries (before week 37) has remained unchanged. However, an analysis of preterm births in Sweden from 1973 to 1979 shows that the number of both preterm births before week 32 and of infants with birthweight below 1 500 g is declining, which is more interesting in terms of fetal outcome than is the crude preterm figure (before week 37). The introduction of routine use of beta-receptor agonists for preterm labor coincides with this decrease. It is concluded that these drugs can be of great value in many obstetrical situations.

Topics: Adrenergic beta-Agonists; Cesarean Section; Female; Fetal Distress; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Obstetric Labor, Premature; Oxytocin; Pregnancy; Sweden; Uterine Contraction

The results of unstressed and oxytocin-stressed cardiotocograms recorded in 222 high-risk pregnancies within 48 h of delivery were compared with signs of fetal distress in labour and Apgar scores. Thirty-nine (18%) developed a late deceleration pattern in labour and 18 newborn (8%) had Apgar scores of less than 7 at 1 min. A direct comparison of the predictive value of unstressed and stressed cardiotocograms, using Fisher's exact test, showed a very significant difference in favour of the stressed cardiotocogram for the prediction of both fetal compromise and fetal well-being. The exclusion, or very selective use, of the oxytocin-stressed cardiotocogram and reliance on the unstressed cardiotocogram for the antepartum investigation of high-risk pregnancies sacrifices accuracy for convenience.

Topics: Adolescent; Adult; Apgar Score; Female; Fetal Distress; Fetal Monitoring; Heart Rate; Humans; Infant, Newborn; Labor, Obstetric; Oxytocin; Pregnancy; Prognosis

The nonstress test (NST) and the contraction stress test (CST) have had wide application to term pregnancies, but little has been reported of use in the management of preterm fetuses. Seventy-two of 438 high-risk gravidas, receiving both tests between 25 and 34 weeks' gestation, delivered singleton infants before completion of their 34th week. On the basis of the last NST and CST preceding delivery, the 72 fetuses could be divided into reactive-negative and nonreactive-positive groups. Nonreactive-positive fetuses experienced greater perinatal mortality and significantly higher rates of intrapartum fetal distress, neonatal depression, respiratory distress syndrome (RDS), intrauterine growth retardation, and cesarean section. Pulmonary complications in nonreactive-positive fetuses, regardless of the lecithin: sphingomyelin ratio, were significantly increased if intrapartum fetal distress had preceded delivery. Most neonatal deaths stemmed from RDS-related complications, 86% preceding the 31st week of gestation; however, nearly half of the perinatal deaths before the 30th week followed reactive NSTs. The data suggest that for clinical management of preterm pregnancy, fetal heart rate testing should be initiated after the 29th week; earlier, test significance is less clear and infant survival less likely. Maternal estriol determinations aid little in the management of nonreactive-positive fetuses. Rather, the care of these selected pregnancies should be temporized through the 30th week; when delivery is then elected, intrapartum fetal distress should be avoided through liberal use of cesarean section in the nonreactive-positive group.

Topics: Estriol; Female; Fetal Distress; Fetal Heart; Heart Rate; Humans; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Obstetric Labor, Premature; Oxytocin; Pregnancy; Prenatal Diagnosis; Risk; Uterine Contraction

In a consecutive series of 1,201 singleton pregnancies with pre-eclampsia, the onset occurred during labour in 290 (24.1%). There was no difference between the primiparous and parous patient in this respect (25.9% v 20.7%; P less than 0.10). The tendency for pre-eclampsia to develop during labour increased with advancing maturity of the pregnancy and seldom occurred before 38 weeks of gestation; this was again equally true of the primiparous and parous patient, as was the incidence of severe hypertension (diastolic pressure greater than 110mm Hg) (36.1% v 34.1%). The high incidences of severe hypertension (35.5%), proteinuria (41.7%), and eclampsia (2.1%), and the 1 maternal death testified to the severity of the disease process and the need for aggressive management. After delivery, the clinical signs tended to subside rapidly, but the early third stage of labour was a time of maternal risk, irrespective of whether ergometrine or Syntocinon was the oxytocic agent administered. Analysis of perinatal results showed that the risk to the fetus was minimal.

Topics: Adult; Ergonovine; Female; Fetal Distress; Humans; Hypertension; Labor Stage, Third; Middle Aged; Obstetric Labor Complications; Oxytocin; Parity; Pre-Eclampsia; Pregnancy; Proteinuria; Risk

Fetal heart rate was studied during the antepartum period in 246 patients, yielding a total of 1964 recordings. The following parameters were evaluated and correlated: --the semi-quantitative assessment of fetal heart rate instability (as expressed by the percentage of duration of flat traces); --the presence of decelerations and their relationship to the presence or absence of uterine contractions; --the neonatal condition. Overall, 50% of the patients exhibited uterine contractions while 30% contained decelerations patterns either occurring spontaneously or in association with uterine contractions. A definite relationship was observed between the presence of severe decelerations (irrespective of the time relationship with any uterine contraction) and poor neonatal outcome. A relationship does exist between the presence of severe decelerations and flattening in the recording, which, as demonstrated in the previous part of the paper also exhibited a strong positive relationship with the neonatal outcome. When one considers the different degrees of flattening, it appears that a further correlation between decelerations and neonatal state is demonstrable only in the case of a 10--50% flat recording. Here the probability of a distressed baby is 20% in the absence of decelerations, but 43.4% in the presence of decelerations. In other cases (i.e., less than a 10% or more than a 50% flat recording) the pronostic significance of the instability of the record is not significantly modified by he presence or absence of decelerations. These results indicate that consideration of decelerations is only advisable in these cases where instability is moderately affected (flattening in 10-50% of the record) and that the use of the oxytocin challenge test OCT may be reserved for such cases, when these are neither spontaneous contractions nor decelerations and not contraindications present.

Topics: Apgar Score; Female; Fetal Distress; Fetal Heart; Fetal Monitoring; Follow-Up Studies; Heart Rate; Humans; Infant, Newborn; Infant, Newborn, Diseases; Oxytocin; Pregnancy; Uterine Contraction

One hundred twenty-five postterm patients with reactive nonstress tests (NSTs) were studied between January, 1978, and September, 1979. Ten poor outcomes occurred for a false reactive rate of 8%. Included were four antepartum deaths, one neonatal death, one brain-damaged infant, and four cases of fetal distress on admission. The NST was misleading by giving false reassurance of fetal well-being. The major mechanism causing acute fetal distress was cord compression, which frequently occurred with uteroplacental insufficiency, but occasionally without it. The oxytocin challenge test (OCT) was useful in unmasking problems of cord compression and may be a more sensitive indicator of fetal well-being and distress in the postterm patient.

Topics: Adult; False Negative Reactions; Female; Fetal Distress; Humans; Oxytocin; Pregnancy; Pregnancy, Prolonged

External tocodynamometric transducer loaded by 800 g weight on its back was placed on the abdomen of pregnant estimated by contraction woman and uterine contraction during NST and OCT was index which was defined by 10 minutes' total of amplitude (g/cm2) multiplied by the duration (min) at the half amplitude. Observations of OCTs were similar to intrapartum ones. OCT was more useful than NST in the prediction of fetal distress during labor. The adequate contraction index for OCT was 65 to 70 min . g/cm2.

Topics: Adult; Female; Fetal Distress; Fetal Heart; Fetal Monitoring; Heart Rate; Humans; Labor Onset; Oxytocin; Pregnancy; Pregnancy Trimester, Third; Transducers, Pressure; Uterine Contraction

During an 18-month period 1328 nonstress tests (NST) and sequential contraction stress tests (CST) were performed on 566 patients. The criterion for reactivity was at least 2 accelerations associated with fetal movement during 20 minutes. The last test performed within 1 week of delivery was compared with perinatal outcome. A total of 1118 (84.2%) NSTs were reactive, and 210 (15.8%) were nonreactive. Of the CSTs 1249 (94.1%) were negative, 52 (3.9%) were positive, 16 (1.2%) were equivocal, and 11 (0.8%) were unsatisfactory. The correlation between a reactive NST and a negative CST was excellent (99.4%), whereas that between a nonreactive NST and a positive CST was poor (24.8%). Although the CST proved to be a better predictor of morbidity than the NST, both tests are highly significant predictors (P less than .001). Fetuses exhibiting both a nonreactive NST and a negative sequential CST are at no increased risk for morbidity. This study supports the concept that a precisely defined NST is an adequate screening tool for the evaluation of high-risk pregnancies.

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

Topics: Estriol; Female; Fetal Distress; Fetal Growth Retardation; Fetal Heart; Fetal Monitoring; Hemodynamics; Humans; Infant, Newborn; Oxytocin; Placental Insufficiency; Placental Lactogen; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics

Topics: Female; Fetal Distress; Fetal Heart; Fetal Monitoring; Fetus; Heart Rate; Humans; Movement; Oxytocin; Pregnancy; Pregnancy Complications; Risk; Uterine Contraction

The oxytocin challenge test (OCT) has been shown in other studies to be valuable in evaluating high-risk pregnancies. The purpose of this study was to show the relationship of various disease states and clinical conditions with OCT results and fetal performance in labor. Of a group of normal patients, 4% had positive OCTs or late decelerations (LDs) in labor. The incidence of positive OCTs or LDs in labor in patients with diabetes mellitus (DM) class B-R was 23.2%; in DM class A, 27.6%; in intrauterine growth retardation (IUGR), 26.2%; in pregnancy-induced hypertension (PIH), 27.6%; in chronic hypertension (CH), 13.6%; and in prolonged gestation, 10.8%. This study shows that DM of all classes, IUGR and PIH are the most likely conditions in which persistent LDs will occur.

Topics: Apgar Score; Female; Fetal Distress; Fetal Growth Retardation; Fetal Heart; Fetus; Heart Rate; Humans; Hypertension; Infant, Newborn; Labor, Obstetric; Oxytocin; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy in Diabetics; Pregnancy, Prolonged; Risk

Topics: Amnion; Cesarean Section; Female; Fetal Distress; Humans; Infant Mortality; Infant, Low Birth Weight; Infant, Newborn; Infusions, Parenteral; Labor, Induced; Netherlands; Oxytocin; Pregnancy; Pregnancy Complications; Punctures; Time Factors

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

A total of 435 oxytocin challenge tests (OCT) were performed on 217 high-risk pregnant patients, and the test results were blinded. The results were correlated with late decelerations of the fetal heart rate during labor, Apgar scores at 5 minutes, a neonatal morbidity score, and perinatal mortality. The incidence of late decelerations during labor was 17% in the negative group, 24% in the suspicious group, and 33% in the positive group. The correlation of OCT results and the various measures of fetal outcome indicated that an individual fetus at risk cannot be identified with a high degree of accuracy since 67% of the tests were false positive and 17% were false negative. Even when the OCT was positive, 61% of infants did not have late decelerations in labor, low Apgar scores, or significant neonatal morbidity. When elective delivery has been decided upon after consideration of all clinical information, induction of labor rather than primary cesarean section is usually indicated. In this study 78% of patients were delivered vaginally with no significant increase of cesarean sections in the positive and suspicious groups as compared with the negative group.

Topics: Apgar Score; False Negative Reactions; False Positive Reactions; Female; Fetal Distress; Fetal Heart; Heart Rate; Humans; Infant, Newborn; Infant, Newborn, Diseases; Oxytocin; Pregnancy; Prognosis; Risk

In a prospective study, infants of high-risk mothers delivered over a 1-year period were evaluated by clinical, biochemical, and behavioral methods. Of 67 newborns whose mothers had oxytocin challenge tests (OCTs), 54 were delivered after negative tests, and 13 after positive tests. Infants with positive OCTs had poor state organization and reflexive performance when compared with negative-OCT babies. These infants also showed evidence of intrauterine malnutrition, but did not have any greater asphyxiation than the negative OCT group. These results are consistent with the hypothesis that a positive OCT implies pathological placental respiratory insufficiency, which may be superimposed, in many instances, on impairment in utero of the placenta's nutritional function. The clinical manifestation of such dysfunction is the alteration in subtle neonatal neurobehavior.

Topics: Behavior; Central Nervous System; Congenital Abnormalities; Female; Fetal Distress; Fetal Heart; Heart Rate; Humans; Infant Nutrition Disorders; Infant, Newborn; Motor Activity; Oxytocin; Placental Insufficiency; Pregnancy; Reflex; Uterine Contraction

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

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

Ninety-seven postmature pregnancies were monitored by amnioscopy or amniocentesis (to determine presence or absence of meconium), oxytocin challenge tests (OCT), 24-hour urinary oestriol estimations and fetal movement counts. The colour of the amniotic fluid and the result of the OCT predicted almost all cases of fetal distress in labour and infants with low Apgar scores. Oestriol estimations and fetal movement counts predicted fetal distress only when combined with other positive tests. Of 50 patients with no abnormal test results, 49 had uneventful labours. The Caesarean section rate was not above average and all babies were liveborn.

Topics: Adolescent; Adult; Apgar Score; Estriol; Female; Fetal Distress; Fetoscopy; Fetus; Humans; Infant, Newborn; Infant, Postmature; Movement; Oxytocin; Pregnancy; Pregnancy, Prolonged; Uterine Contraction

Topics: Female; Fetal Distress; Fetal Heart; Fetal Monitoring; Humans; Oxytocin; Pregnancy; Stress, Physiological; Uterine Contraction

A study of labor induction in 325 patients is reported. Group I (77 patients with Bioshop's scores 0-6) and 2 (69 patients with Bishop's scores 7-12) were given 0.5 mg prostaglandin E2 every half hour (maximum 5 mg per day). Group 3 (87 patients with Bishop's scores 0-6) was givne 50 International units of buccal desaminooxytocin every half hour (maximum 500 International units per day). In Group 4 (92 patients with Bishop's scores 7-12), labor was induced by primary amniotomy and automatic oxytocin infusion by the Cardiff method. In groups 1, 2 and 3, 45 per cent, 74 per cent and 41 per cent delivered within 48 hours, while 100 per cent in group 4 delivered within 24 hours. No differences were found in either the frequency of cesarean section or the incidence of low Apgar scores. A higher, but not statistically significant frequency of vacuum extraction was found in the Cardiff group (25 per cent) than in the tablet-induced groups (15 per cent). There was, however, a significantly higheroccurrence of alterations in fetal heart rate which led to instrumental intervention to hasten delivery in the Cardiff group compared to the tablet-induced patients.

Topics: Administration, Oral; Cesarean Section; Female; Fetal Distress; Humans; Infant, Newborn; Infusions, Parenteral; Labor, Induced; Obstetric Labor Complications; Oxytocin; Pregnancy; Prostaglandins E; Tablets; Vacuum Extraction, Obstetrical

Topics: Adult; Anencephaly; Delivery, Obstetric; Female; Fetal Diseases; Fetal Distress; Humans; Hydrocortisone; Infant, Newborn; Labor, Induced; Labor, Obstetric; Oxytocin; Pregnancy; Prostaglandins F, Synthetic

Topics: Female; Fetal Distress; Fetal Heart; Fetal Monitoring; Heart Rate; Humans; Obstetric Labor Complications; Oxygen; Oxytocin; Placenta; Pregnancy; Prenatal Diagnosis; Uterine Contraction

The use of buccal pitocin in the performance of stressed antenatal cardiotocography was studied. Sixty-three tests were performed on 40 patients. All the patients were followed through labour and delivery. The results were evaluated and compared with those where an intravenous oxytocin infusion was used. Buccal pitocin produced comparable uterine contractions to those obtained by intravenous oxytocin, with similar test results. The avoidance of venepuncture and infusion was a positive advantage of this method of applying the stress.

Topics: Administration, Oral; Female; Fetal Distress; Fetal Heart; Fetal Monitoring; Heart Rate; Humans; Oxytocin; Pregnancy

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

Five hundred-seven passive tests (PT's) on 260 patients and 133 oxytocin challenge tests (OCT's) on 97 of these patients were reviewed. The tracings were categorized according to a proposed modified scoring system based on baseline fetal heart rate (FHR), variability, accelerations and decelerations of FHR, and fetal activity. The scoring system was compared with the usual criteria for fetal compromise currently employed in PT's and OCT's and was found to be superior in accuracy. The usefulness of antepartum FHR monitoring as evaluated throuth the scoring system is discussed. It is concluded that passive testing can largely replace the OCT.

Topics: Female; Fetal Distress; Fetal Heart; Fetal Monitoring; Fetus; Heart Rate; Humans; Oxytocin; Pregnancy; Prognosis; Risk

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

The reaction of the FHR to amniocentesis in 43 pregnancies is reported. In 10 pregnancies the FHR reacted with deceleration. Eight of the 10 patients underwent subsequent labor and all developed fetal distress requiring cesarean section. In 31 pregnancies the FHR reacted with an acceleration. Twenty-five of these patients subsequently underwent labor without evidencing fetal distress and the remainder were delivered by cesarean section without labor. In two pregnancies no FHR response occurred following amniocentesis. In both no evidence of fetal distress occurred during labor. The significance of this test as an indicator of fetal well-being is discussed.

Topics: Amniocentesis; Cesarean Section; Estriol; Female; Fetal Distress; Fetal Heart; Heart Rate; Humans; Infant, Newborn; Oxytocin; Pregnancy; Prenatal Diagnosis; Uterine Contraction

The perinatal prognostic significance of a type of Prepathological Oxytocin Stress Test, namely Transient Bradycardia coincident with a period of hyperdynamia in otherwise normal test, is analyzed. The 43 studied cases are compared to a group of 492 patients responding normally. The significantly higher incidence of intrapartum meconium and fetal distress, low Apgar Score and neurologically affected newborns seems to demonstrate that the Prepathological Test is a real entity. The possible fetal risk and the usefulness of the Oxytocin Test are discussed.

Topics: Bradycardia; Female; Fetal Distress; Fetal Heart; Humans; Oxytocin; Pregnancy; Uterus

Topics: Creatinine; Estrogens; Female; Fetal Distress; Fetal Monitoring; Humans; Oxytocin; Placental Lactogen; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics; Risk

Topics: Female; Fetal Blood; Fetal Distress; Fetal Heart; Heart Rate; Humans; Hydrogen-Ion Concentration; Labor, Obstetric; Monitoring, Physiologic; Oxytocin; Pregnancy; Prenatal Diagnosis; Uterine Contraction

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

Intrapartum fetal monitoring has provided a method by which the clinician can more accurately determine the status of the fetus during labor. More recently, investigations have been directed toward antepartum FHR monitoring studies to determine fetal well-being prior to the onset of labor. In this study, the results of "stress" monitoring are presented. The Authors have used three types of stress-tests: 1) oxytocin stress test 2) step-test 3) Oxygen stress test. The positive tests appears to correlate meaningfully with intrauterine compromise and neonatal status.

Topics: Adult; Echocardiography; Electrocardiography; Female; Fetal Distress; Fetal Heart; Fetal Monitoring; Heart Rate; Humans; Oxytocin; Phonocardiography; Pregnancy

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

Topics: Female; Fetal Distress; Humans; Oxytocin; Pregnancy; Pregnancy Complications

Advanced extrauterine pregnancy occurs rarely and may present diagnostic difficulty. Failure to induce uterine contractions during oxytocin infusion is a well-established diagnostic technic. The present case suggests that additional newer technics for fetal assessment, including sonography, unstressed monitoring of the fetal heart rate, uterine contractions, fetal movements, and serial urinary estriol determinations may also be useful in diagnosing and managing such complex cas-s.

Topics: Adult; Cesarean Section; Creatinine; Estriol; Female; Fetal Distress; Fetal Heart; Humans; Oxytocin; Pregnancy; Pregnancy, Abdominal; Ultrasonography; Uterine Contraction

This study reviews 27 patients with positive OCTs who were subsequently allowed a trial of directly monitored labor. Of these, 19 patients (70%) developed FHR signs of fetal distress and 8 (30%) tolerated labor without late decelerations. These patients were evaluated for signs of fetal reactivity (acceleration of the FHR associated with fetal movement of contractions) during the OCT. Those with a reactive pattern during the OCT (15 patients) uniformly had a good fetal outcome (unless there was birth trauma or premature delivery), but 8 of these 15 patients showed fetal distress during monitored labor. If the positive OCT was associated with a nonreactive baseline FHR recording, a trial of labor uniformly resulted in FHR signs of fetal distress. It is therefore concluded that a patient with a nonreactive positive OCT is unlikely to tolerate subsequent labor without fetal distress.

Topics: Apgar Score; Estriol; Female; Fetal Distress; Fetal Heart; Fetal Monitoring; Heart Rate; Humans; Labor, Obstetric; Meconium; Oxytocin; Pregnancy; Pregnancy Complications; Retrospective Studies

Topics: Adult; Anesthesia, Obstetrical; Female; Fetal Distress; Fetal Heart; Heart Rate; Humans; Labor, Obstetric; Monitoring, Physiologic; Obstetric Labor Complications; Oxytocin; Pregnancy; Uterine Contraction; Uterus

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

Fetal activity acceleration determination (FAD) was performed 462 times on a total of 410 patients for the evaluation of fetal reserve. Simultaneous oxytocin challenge test (OCT) was performed 324 times to evaluate the correlation between the two tests. In 308 instances, FAD was positive and OCT was either negative or probably negative. In 2 cases with inadequate FAD results the simultaneous OCT was suspicious and positive. In four instances of negative FAD the simultaneous OCT was positive. The correlation between the two tests was excellent. The outcome of all cases with positive FAD was also excellent. The result of the present study strongly suggests that the positive FAD indeed provides reassurance of fetal well-being. Only the inadequate or negative FAD requires the performance of an OCT for further evaluation of the fetal condition.

Topics: Delivery, Obstetric; Female; Fetal Distress; Fetal Heart; Fetus; Heart Rate; Humans; Monitoring, Physiologic; Oxytocin; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged; Prenatal Diagnosis; Uterine Contraction

The objective of management in the pregnant diabetic patient is to achieve physiologic glucose homeostasis through the use of diet and insulin. As outlined, the numerous ancillary tests developed during the past 15 years to assist the clinician in determining impending fetal death have left much to be desired, especially where metabolic homeostasis has not been achieved prior to the thirty-sixth week of gestation. The statistics from this institution indicate that the maintenance of the plasma glucose concentration below 100 mg. per cent throughout gestation, regardless of the severity of the diabetes, all but removes the risk of maternal-fetal complications due to diabetes. The management is uniform for all patients exhibiting an abnormality of carbohydrate metabolism, and, although it is rather difficult to accept, there have been minimal neonatal complications when the protocol outlined in this presentation has been followed.

Topics: Adolescent; Adult; Amniotic Fluid; Blood Glucose; Child; Diabetes Mellitus; Female; Fetal Distress; Glucose; Humans; Infant, Newborn; Infant, Newborn, Diseases; Insulin; Oxytocin; Placental Lactogen; Pregnancy; Pregnancy in Diabetics; Ultrasonography

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

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

Topics: Acute Disease; Chronic Disease; Estriol; Female; Fetal Distress; Fetal Heart; Fetal Hypoxia; Heart Rate; Humans; Maternal-Fetal Exchange; Oxygen Consumption; Oxytocin; Placenta Diseases; Pregnancy; Prenatal Diagnosis; Ultrasonography; Umbilical Cord

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

Topics: False Negative Reactions; Female; Fetal Distress; Humans; Oxytocin; Pregnancy

This study reviews the indications, interpretation, and practical application of the oxytocin challenge test (OCT) in 154 patients undergoing 375 tests. It emphasizes aspects of technique which may make the "challenge" nonphysiologic and the stress, therefore, nonquantifiable. Thirty-four positive or suspicious tests were obtained in 22 patients. These results are correlated with clinical complications of pregnancy; antepartum indices of fetal well-being (estriol, ultrasonic serial cephalometry, and the presence of meconium on amniocentesis); and subsequent intrapartum fetal heart rate response. Unsatisfactory (47 in 23 patients), false-positive, and false-negative tests are reviewed in detail. Since false-positive tests (47.9 per cent) are common whereas false-negative tests are rare (2.8 per cent), we conclude that the negative test is a reliable indication in high-risk pregnancies. Positive tests add to out data on the fetus and alert us to the need for a totally monitored labor.

Topics: False Negative Reactions; False Positive Reactions; Female; Fetal Distress; Fetal Heart; Heart Rate; Humans; Labor, Obstetric; Oxytocin; Pregnancy; Uterine Contraction

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

Topics: Adult; Female; Fetal Distress; Humans; Oxytocin; Placenta Diseases; Placental Lactogen; Pregnancy

Topics: Africa; Critical Care; Delivery, Obstetric; Female; Fetal Distress; Fetal Heart; Fetal Monitoring; Heart Rate; Humans; Intensive Care Units; Obstetric Labor Complications; Obstetrics and Gynecology Department, Hospital; Oxytocin; Patient Care Team; Posture; Pregnancy; Prenatal Care

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

Topics: Amniotic Fluid; Female; Fetal Diseases; Fetal Distress; Humans; Hypoxia; Labor, Obstetric; Oximetry; Oxygen; Oxytocin; Pregnancy