oxytocin and Hematoma

Topics: Cervix Uteri; Embolism, Amniotic Fluid; Episiotomy; Ergot Alkaloids; Female; Hematoma; Humans; Labor Stage, Third; Oxytocin; Placenta Accreta; Postpartum Hemorrhage; Pregnancy; Puerperal Disorders; Uterine Inertia; Uterine Rupture; Vagina

To assess both severe maternal and neonatal mortality and morbidity after attempted operative vaginal deliveries by residents under supervision and by attending obstetricians.. Secondary analysis of a 5-year prospective study with cross-sectional analysis including 2192 women with live singleton term fetuses in vertex presentation who underwent an attempted operative vaginal delivery in a tertiary care university hospital. Obstetricians who attempted or performed an operative vaginal delivery were classified into 2 groups according to their level of experience: attending obstetricians (who had 5 years or more of experience) and obstetric residents (who had less than 5 years of experience) under the supervision of an attending obstetrician. We used multivariate logistic regression and propensity score methods to compare outcomes associated with attending obstetricians and obstetric residents. Severe maternal morbidity was defined as third- or fourth-degree perineal laceration, perineal hematoma, cervical laceration, extended uterine incision for cesareans, postpartum hemorrhage >1500 mL, surgical hemostatic procedures, uterine artery embolization, blood transfusion, infection, thromboembolic events, admission to the intensive care unit, or maternal death; severe neonatal morbidity was defined as a 5-minute Apgar score <7, umbilical artery pH <7.00, need for resuscitation or intubation, neonatal trauma, intraventricular hemorrhage greater than grade 2, neonatal intensive care unit admission for more than 24 hours, convulsions, sepsis, or neonatal death.. High prepregnancy body mass index, high dose of oxytocin, manual rotation, persistent occiput posterior or transverse positions, operating room delivery, midpelvic delivery, forceps, and spatulas were significantly more frequent in deliveries managed by attending obstetricians than residents whereas a second-stage pushing phase longer than 30 minutes was significantly more frequent in deliveries managed by residents. The rate of severe maternal morbidity was 7.8% (115/1475) for residents vs 9.9% (48/484) for attending obstetricians; for severe neonatal morbidity, the rates were 8.3% (123/1475) vs 15.1% (73/484), respectively. In the univariate, multivariable, and sensitivity analyses, attempted operative vaginal delivery managed by a resident was significantly and inversely associated with severe neonatal but not maternal morbidity. After propensity score matching, delivery managed by a resident was not significantly associated with severe maternal morbidity (adjusted odds ratio, 0.74; 95% confidence interval, 0.39-1.38) and was no longer associated with neonatal morbidity (adjusted odds ratio, 0.51; 95% confidence interval, 0.25-1.04).. Management of attempted operative vaginal deliveries by residents under the supervision of attending obstetricians, compared with by the attending obstetricians themselves, does not appear to be associated with either maternal or neonatal morbidity. These reassuring results support the continued use of residency programs for training in operative vaginal deliveries under the supervision of attending obstetricians.

Topics: Adult; Apgar Score; Birth Injuries; Body Mass Index; Cesarean Section; Extraction, Obstetrical; Female; Hematoma; Humans; Hydrogen-Ion Concentration; Internship and Residency; Labor Stage, Second; Lacerations; Logistic Models; Medical Staff, Hospital; Obstetrics; Operating Rooms; Oxytocics; Oxytocin; Pregnancy; Propensity Score; Prospective Studies; Scalp; Umbilical Arteries; Vacuum Extraction, Obstetrical

Topics: Adult; Female; Hematoma; Humans; Labor, Induced; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Prostaglandins; Puerperal Disorders; Uterine Rupture

Prostaglandin F2alpha (PGF2alpha) was injected intraamniotically in 122 patients between 14 and 20 weeks' gestation in the dosage schedule recommended by the drug manufacturer to induce abortion. Significantly more multiparous (47.5%) than primagravida patients (21.5%) aborted within 16 hours, but the mean duration between PGF2alpha injection and abortion was not significantly different. Complications occurred in 52 (42.6%) patients and included: fall in hematocrit of more than 5 percentage points, failure to abort within 48 hours after injection, infection requiring antibiotic therapy, cervical laceration or fistula, and uterine rupture. The atypical dilatation and effacement of the cervix occurring with PGF2alpha-induced contractions may possibly lead to cervical incompetence with later pregnancies. Although the efficacy of PGF2alpha as an abortifacient is confirmed, the large complication rate with the procedure cannot be ignored.

Topics: Abortion, Induced; Adolescent; Adult; Amniotic Fluid; Child; Female; Hematocrit; Hematoma; Hemorrhage; Humans; Infections; Injections; Oxytocin; Parity; Pregnancy; Pregnancy Trimester, Second; Prostaglandins F; Time Factors; Uterine Cervical Diseases; Uterine Rupture

Topics: Abortion, Therapeutic; Female; Hematoma; Humans; Hypertonic Solutions; Infusions, Parenteral; Middle Aged; Oxytocin; Pregnancy; Pregnancy Complications; Retroperitoneal Neoplasms; Uterine Rupture; Uterus