oxytocin and Fetal-Macrosomia

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

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

To determine the odds of postpartum hemorrhage (PPH) in low-risk women who gave birth vaginally and were exposed to different durations and dosages of oxytocin across a range of labor durations during spontaneous or induced labor.. A retrospective cross-sectional analysis of data from the Consortium for Safe Labor.. Data were gathered from 12 clinical institutions across the United States from 2002 to 2008.. After exclusion of high-risk conditions associated with PPH, we examined data from 27,072 women who gave birth vaginally.. PPH was defined as estimated blood loss of greater than 500 ml at the time of birth and/or a diagnostic code for PPH before hospital discharge. We included covariates were if they were associated with oxytocin use and PPH and did not mediate oxytocin use. We used regression models to determine the likelihood of PPH overall and within the induced and spontaneous labor groups separately. We used subgroup analyses within specific durations of labor to clarify the findings.. The overall rate of PPH was 3.9%. Women with induced labor experienced PPH more frequently than women who labored spontaneously. Labor augmentation was associated with greater adjusted odds for PPH when oxytocin was infused for more than 4 hours. Longer duration of spontaneous labor and the second stage of labor did not change this association. Oxytocin use during labor induction increased the odds for PPH when administered for more than 7 hours. The odds further increased when induction lasted longer than 12 hours and/or the second stage of labor was longer than 3 hours.. Strategies for judicious oxytocin administration may help mitigate PPH in low-risk women having vaginal birth.

Topics: Adolescent; Adult; Body Mass Index; Cross-Sectional Studies; Female; Fetal Macrosomia; Gestational Age; Humans; Labor, Obstetric; Obstetric Labor Complications; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Retrospective Studies; United States

We analysed the efficacy and safety of double-balloon catheter for cervical ripening in women with a previous cesarean section and which were the most important variables associated with an increased risk of repeated cesarean delivery.. We designed an observational retrospective study of 418 women with unfavourable cervices (Bishop Score <5), a prior cesarean delivery, and induction of labour with a double-balloon catheter. Baseline maternal data and perinatal outcomes were recorded for a descriptive, bivariate, and multivariate analysis. A p value <0.05 was considered statistically significant.. Most women improved their initial Bishop Score (89.5%) although only a 20.8% of them went into spontaneous active labour. Finally, 51.4% of the women achieved a vaginal delivery. Five cases of intrapartum uterine rupture (1.2%) occurred. After multivariate analysis, main risk factors for repeated cesarean section were dystocia in the previous pregnancy (OR 1.744; CI 95% 1.066-2.846), the absence of previous vaginal delivery (OR 2.590; CI 95% 1.066-6.290), suspected fetal macrosomia (OR 2.410; CI 95% 0.959-6.054), and duration of oxytocin induction period (OR 1.005; CI 95% 1.004-1.006). The area under the curve was 0.789 (p < 0.001).. Double-balloon catheter seems to be safe and effective for cervical ripening in women with a previous cesarean delivery and unfavourable cervix. In our study, most women could have a vaginal delivery in spite of their risk factors for cesarean delivery. A multivariate model based on some clinical variables has moderate predictive value for intrapartum cesarean section.

Topics: Adult; Catheterization; Cervical Ripening; Cervix Uteri; Cesarean Section; Cesarean Section, Repeat; Delivery, Obstetric; Dystocia; Female; Fetal Macrosomia; Humans; Labor, Induced; Oxytocin; Parturition; Pregnancy; Retrospective Studies; Risk Factors; Trial of Labor; Uterine Rupture; Vaginal Birth after Cesarean; Young Adult

Management of extremely large birthweight infants presents challenges during the period of labour and delivery. We sought to examine outcomes in infants with extreme macrosomia (birthweight > 5000 g), at an institution where the management of labour is standardised.. This is a retrospective analysis of prospectively gathered data on all infants with a birthweight >5000 g delivered at a tertiary level institution from 2008 to 2012. Details of labour characteristics and outcomes were examined; these were compared according to parity.. During the study period, there were 46 128 deliveries at the hospital and 182 infants with a birthweight >5000 g, giving an incidence of 0.4%. The majority of women (133/182) were multiparous. Among nulliparas, 47% (23/49) had a vaginal delivery, while 53% (26/49) had a caesarean delivery. 86% (97/113) of multiparas had a vaginal delivery, and 14% (16/113) had a caesarean delivery. 43% (69/162) required induction of labour. This was more common in nulliparous compared with multiparous women (58% [29/49] vs 30% [40/133], P = 0.005, OR = 3.4, 95% CI = 1.7-6.6). A total of 30% (49/162) of women had their labour accelerated with oxytocin. There were higher rates of oxytocin use in nulliparas than in multiparas (55% [27/49] vs 16.5% [22/133], P < 0.0001, OR = 6.2, 95% CI = 3-12.8). Seventeen of the 120 infants delivered vaginally had a shoulder dystocia (14.2%), with three suffering an Erbs palsy, all of which had resolved before 6 months of age. One baby had a clavicular fracture.. Extreme macrosomia affects 0.4% of pregnancies in contemporary practice. Multiparas have a low rate of caesarean section. Infants delivered vaginally are at increased risk of shoulder dystocia and associated complications.

Topics: Birth Injuries; Birth Weight; Brachial Plexus Neuropathies; Cesarean Section; Dystocia; Female; Fetal Macrosomia; Humans; Incidence; Ireland; Labor, Induced; Oxytocics; Oxytocin; Parity; Pregnancy; Retrospective Studies

The objective was to compare national guidelines regarding vaginal birth after cesarean. Along with the American College of Obstetricians and Gynecologists practice bulletin, guidelines from the Royal College of Obstetricians and Gynaecologists and the Society of Obstetricians and Gynecologists of Canada were reviewed and compared. Although the 3 organizations agree on most of the risk factors for uterine rupture and failed vaginal birth after cesarean (VBAC), there were some variances in the recommendations to women with 2 previous cesareans and those who required oxytocin augmentation. A disagreement was also present in regard to the availability and requirement of resources to allow a trial of labor after a previous cesarean. Although concerns could be raised about how the literature is synthesized, the 3 organizations recognized the potential biases in published reports and the lack of randomized trials.

Topics: Canada; Cesarean Section, Repeat; Female; Fetal Macrosomia; Fetal Monitoring; Humans; Labor, Induced; Oxytocin; Patient Satisfaction; Practice Guidelines as Topic; Pregnancy; Risk Factors; Societies, Medical; Treatment Failure; Trial of Labor; Twins; Uterine Rupture; Vaginal Birth after Cesarean

Pre-eclampsia is a serious obstetric complication associated with a high rate of maternal and fetal morbidity and mortality. We report the case of a woman with a medical history of insulin-dependent diabetes mellitus and seizures possibly related to hypoglycemia who was admitted for an emergency cesarian due to severe pre-eclampsia and macrosomic fetus. In the first hour after delivery she experienced loss of consciousness and seizure, with vaginal bleeding and hypovolemic shock. Maximum vigilance is required for a patient with several concomitant diseases and a high-risk pregnancy. All prophylactic measures to lower the risk to mother and fetus should be undertaken. We analyze preanesthetic assessment, differential diagnosis, and choice of anesthesia in relation to this case.

Topics: Adult; Cesarean Section; Diabetes Mellitus, Type 1; Diagnosis, Differential; Embolism, Amniotic Fluid; Emergencies; Epilepsy; Female; Fetal Macrosomia; Humans; Hypoglycemia; Hysterectomy; Infant, Newborn; Oxytocin; Postoperative Complications; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics; Pregnancy, High-Risk; Puerperal Disorders; Shock; Stroke; Uterine Hemorrhage

The purpose of this study was to evaluate prospectively the association between selected obstetric antecedents and symptoms of pelvic floor dysfunction in primiparous women up to 7 months after childbirth.. All nulliparous women who were delivered between June 1, 2000, and August 31, 2002, were eligible for a postpartum interview regarding symptoms of persistent pelvic floor dysfunction. Responses from all women who completed a survey at or before their 6-month contraceptive follow-up visit were analyzed. Obstetric antecedents to stress, urge, and anal incontinence were identified, and attributable risks for each factor were calculated.. During the study period, 3887 of 10,643 primiparous women (37%) returned within 219 days of delivery. Symptoms of stress and urge urinary incontinence, were significantly reduced (P < .01) in women who underwent a cesarean delivery. Symptoms of urge urinary incontinence doubled in women who underwent a forceps delivery (P = .04). Symptoms of anal incontinence were increased in women who were delivered of an infant who weighed >4000 g (P = .006) and more than doubled in those women who received oxytocin and had an episiotomy performed (P = .01).. The likelihood of symptoms of pelvic floor dysfunction up to 7 months after delivery was greater in women who received oxytocin, who underwent a forceps delivery, who were delivered of an infant who weighed >4000 g, or who had an episiotomy performed. Women who underwent a cesarean delivery had fewer symptoms of urge and stress urinary incontinence.

Topics: Adult; Cesarean Section; Delivery, Obstetric; Episiotomy; Fecal Incontinence; Female; Fetal Macrosomia; Humans; Likelihood Functions; Obstetrical Forceps; Odds Ratio; Oxytocin; Prospective Studies; Urinary Incontinence; Urinary Incontinence, Stress

To determine the effect of extreme macrosomia on perinatal outcome.. We conducted a retrospective review of all deliveries with birth weight > or = 5000 g in a tertiary centre from 1986 to 2000 and analyzed the method of delivery and perinatal outcome.. Extreme macrosomia (birth weight > or = 5000 g) was coded in 111 deliveries. There were 62 deliveries by Caesarean section (CS) (25 in labour and 37 elective). The 49 vaginal deliveries were complicated by 10 (20%) cases of shoulder dystocia and 3 (6%) of Erb's palsy. Permanent Erb's palsy was noted in only 1 of these 3 cases. Shoulder dystocia was associated with use of oxytocin and instrumental deliveries.. Implementing the 2002 guidelines from the American College of Obstetricians and Gynecologists (that is, recommending Caesarean delivery of fetuses with an estimated weight of at least 5000 g) would have a negligible effect on the CS rate while eliminating 10 cases of shoulder dystocia in 49 births. A policy eliminating the use of oxytocin and instrumental deliveries would have prevented most birth traumas in this group. Unfortunately, this high-risk group is difficult to identify in the antepartum period, complicating the implementation of these guidelines and probably leading to higher rates of CS. In addition, the effect of endorsing such a policy on overall neonatal and maternal morbidity is minimal, because most morbidity occurs in newborns weighing less than 4000 g.

Topics: Birth Injuries; Brachial Plexus Neuropathies; Cesarean Section; Delivery, Obstetric; Dystocia; Elective Surgical Procedures; Extraction, Obstetrical; Female; Fetal Macrosomia; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor Stage, First; Labor Stage, Second; Length of Stay; Ontario; Oxytocics; Oxytocin; Pregnancy; Retrospective Studies

Previous cesarean section, oxytocin administration, and fetal macrosomia increase the risk of uterine rupture or dehiscence (URD).. All 25,718 deliveries at Riverside Regional Medical Center from January 1990 to June 2000 were reviewed to describe complications and identify risk factors for URD.. Eleven uterine ruptures and 10 dehiscences occurred during this period (0.08%). One maternal death (5%) and three neonatal deaths (14%) occurred. Other complications included intrapartum nonreassuring fetal status (67%), 5-minute Apgar score < 7 (52%), maternal blood transfusion (24%), neonatal hypoxic injury (14%), hysterectomy (14%), and endometritis (10%). Uterine rupture/dehiscence was independently associated with fetal weight > or = 4,000 g, nonreassuring fetal status, use of oxytocin, and previous cesarean delivery; internal fetal monitoring reduced the risk of URD.. To reduce the risk of URD, a delivery plan should include assessment of cesarean history and fetal macrosomia,judicious use of oxytocin, and intrapartum monitoring for nonreassuring fetal status.

Topics: Adolescent; Adult; Apgar Score; Case-Control Studies; Cesarean Section; Female; Fetal Macrosomia; Fetal Monitoring; Fetal Weight; Humans; Infant, Newborn; Oxytocin; Pregnancy; Pregnancy Outcome; Risk Factors; Surgical Wound Dehiscence; Time Factors; Uterine Rupture

Fetal macrosomia is a known intrapartum risk factor for fetal injury and maternal morbidity. The purpose of this study was to review our experience with macrosomic fetuses in nondiabetic pregnancies and compare perinatal outcomes between those whose labor had been spontaneous or induced. Between January 1989 and December 1991, the 186 pregnancies of infants with birthweights greater than 4000 g (4001 to 5131 g) underwent labor that had been induced (46) or spontaneous (140). Cesarean delivery was more common after induced than spontaneous labor (11 [23.9%] vs 14 [10.0%]; P < 0.03) regardless of parity or gestational age. Frequencies of shoulder dystocia, 1-minute Apgar scores less than 7, and abnormal umbilical blood gas determinations were not different between the two groups. We conclude that spontaneous rather than induced labor is associated with a lower chance of cesarean delivery among those fetuses with birthweights 4000 g or more.

Topics: Adult; Birth Injuries; Birth Weight; Case-Control Studies; Cesarean Section; Dinoprostone; Dystocia; Female; Fetal Macrosomia; Humans; Infant, Newborn; Labor, Induced; Labor, Obstetric; Male; Oxytocin; Pregnancy; Risk Factors

Topics: Adult; Apgar Score; Cesarean Section; Female; Fetal Macrosomia; Humans; Infant, Newborn; Infant, Postmature; Labor, Induced; Oxytocin; Pregnancy; Pregnancy, Prolonged; Time Factors