oxytocin and Infant--Newborn--Diseases

Oxytocin is widely used for induction and augmentation of labour, particularly in low- and middle-income countries (LMICs). In this systematic review and meta-analysis, we examined the effect of intra-partum Oxytocin use on neonatal encephalopathy.. The protocol for this study was registered with PROSPERO (ID: CRD42020165049). We searched Medline, Embase and Web of Science Core Collection databases for papers published between January 1970 and May 2021. We considered all studies involving term and near-term (≥36 weeks' gestation) primigravidae and multiparous women. We included all randomised, quasi-randomised clinical trials, retrospective studies and non-randomised prospective studies reporting intra-partum Oxytocin administration for induction and/or augmentation of labour. Our primary outcome was neonatal encephalopathy. Risk of bias was assessed in non-randomised studies using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. The RoB 2.0 tool was used for randomised studies. A Mantel-Haenszel statistical method and random effects analysis model were used for meta-analysis. Odds ratios were used to determine effect measure and reported with 95% confidence intervals.. We included data from seven studies (6 Case-control studies, 1 cluster-randomised trial) of which 3 took place in high-income countries (HICs) and 4 in LMICs. The pooled data included a total of 24,208 women giving birth at or after 36 weeks; 7642 had intra-partum Oxytocin for induction and/or augmentation of labour, and 16,566 did not receive intra-partum Oxytocin. Oxytocin use was associated with an increased prevalence of neonatal encephalopathy (Odds Ratio 2.19, 95% CI 1.58 to 3.04; p < 0.00001).. Intra-partum Oxytocin may increase the risk of neonatal encephalopathy. Future clinical trials of uterotonics should include neonatal encephalopathy as a key outcome.

Topics: Bias; Brain Diseases; Case-Control Studies; Developed Countries; Developing Countries; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor, Obstetric; Odds Ratio; Oxytocics; Oxytocin; Pregnancy

Topics: Amenorrhea; Breast Feeding; Cesarean Section; Colitis; Diet; Female; Humans; Immunity, Maternally-Acquired; Infant Care; Infant, Newborn; Infant, Newborn, Diseases; Jaundice, Neonatal; Lactation; Mastitis; Milk, Human; Nutritive Value; Obesity; Oxytocin; Postpartum Period; Pregnancy; Prolactin

Arginine vasotocin, arginine vasopressin, and oxytocin play a critical role in the stimulation of labor and delivery and in salt and water homeostasis in the newborn infant. The authors present information on their chemistry, secretion, and metabolism, and discuss the clinical effects upon target organs of their presence or absence.

Topics: Animals; Arginine Vasopressin; Diabetes Insipidus; Female; Fetus; Humans; Inappropriate ADH Syndrome; Infant, Newborn; Infant, Newborn, Diseases; Oxytocin; Pituitary Gland; Pituitary Gland, Posterior; Pituitary Hormones, Posterior; Pregnancy; Vasopressins; Vasotocin

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

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

Our purpose was to compare induction of labor with preterm rupture of membranes between 34 and 37 weeks' gestation with expectant management.. In this prospective investigation 120 gravid women at > or = 34 weeks 0 days and < 36 weeks 6 days of gestation were randomized to receive oxytocin induction (n = 57) or observation (n = 63).. Estimated gestational age at rupture of membranes (34.3 +/- 1.4 weeks vs 34.5 +/- 1.4 weeks) and ultrasonographically estimated fetal weight (2230 +/- 321 gm vs 2297 +/- 365 gm) were equivalent between groups (not significant). Chorioamnionitis occurred more often (16% vs 2%, p = 0.007), and maternal hospital stay (5.2 +/- 6.8 days vs 2.6 +/- 1.6 days, p = 0.006) was significantly longer in the control group. Neonatal sepsis was also more common in the observation group (n = 3) than among induction patients (n = 0), but the difference was not statistically significant.. Aggressive management of preterm premature rupture of the membranes at > or = 34 weeks 0 days of gestation by induction of labor is safe for the infant in our population and avoids maternal-neonatal infectious complications.

Topics: Adolescent; Adult; Chorioamnionitis; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor, Induced; Length of Stay; Morbidity; Oxytocics; Oxytocin; Patient Care Management; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Third; Prospective Studies; Ultrasonography, Prenatal; Uterine Contraction

To compare the obstetric performance, perinatal outcome and risk of neonatal infection in labour following spontaneous (SROM) and artificial (AROM) rupture of membranes.. Prospective, non-randomised, comparative study during a one-month period in 1995. The study was approved by the ethics committee of the Faculty of Medicine, University of Colombo.. University Obstetrics Unit at De Soysa Hospital for Women, Colombo.. 324 women who were in early established labour after 37 weeks of gestation. 151 of these had SROM and 173 AROM. The AROM and SROM groups among primigravidae and multigravidae were considered separately.. Oxytocin use in multigravidae was significantly higher in the AROM group than in the SROM group (p < 0.001). The emergency caesarean section (LSCS) rate in primigravidae was significantly higher in the AROM group than the SROM group (p < 0.001). A significantly larger number of primigravid AROM women had abnormal fetal heart rate changes on auscultation (p < 0.05) and cardiotopographic (CTG) patterns (p < 0.001) when compared with primigravid SROM women. Choreoamnionitis and funisitis were commoner in the AROM group although the difference was not statistically significant.. AROM appears to be associated with a higher chance of fetal distress particularly in primigravidae. Both AROM and SROM are associated with a potential risk of infection at intrauterine sites.. Artificial rupture of the membranes during established labor is believed to augment labor progression, but this practice carries the risk of maternal and neonatal infection. A prospective study conducted at De Soysa Hospital for Women in Colombo, Ceylon, in 1995 compared the obstetric performance, perinatal outcome, and risk of neonatal infection in 151 women with spontaneous rupture of membranes (SROM) and 173 women with artificial rupture of membranes (AROM). The need for oxytocin was higher in both primi- and multigravidae in the AROM group (37.5% and 38.8%, respectively) than the SROM group (24.7% and 18.9%, respectively), but this association reached statistical significance only among multigravidae. Also higher in the AROM group than the SROM group, but not significantly, were the rates of instrumental delivery and emergency cesarean section. Compared with primigravid AROM women, a significantly larger number of primigravid AROM women had abnormal auscultated fetal heart rates and cardiotopographic patterns. The appearance of meconium in liquor and the occurrence of low Apgar scores were similar in both groups. There were no clinical maternal or neonatal infections, but the intrauterine sites showed evidence of inflammation soon after membrane rupture. 36.1% of women in the SROM group and 24.0% of those in the AROM group whose cord and membranes were evaluated had histologic evidence of inflammation. Choreoamnionitis and funisitis were slightly more common in the AROM group. The potential for infection at intrauterine sites had no linear relationship to the mean membrane rupture-delivery interval or the number of vaginal examinations.

Topics: Adult; Amnion; Bacterial Infections; Extraembryonic Membranes; Female; Heart Rate, Fetal; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor, Induced; Labor, Obstetric; Obstetrics; Oxytocin; Parity; Perinatal Care; Pregnancy; Pregnancy Outcome; Prospective Studies; Risk Factors; Sri Lanka

To determine the incidence of uterine tachysystole (UT) and its association with neonatal depression or metabolic acidemia (DEP).. This retrospective study comprised all 6234 women at ≥ 37 weeks' gestation who were monitored during the last 4 hours of tracings before birth in an academic community hospital. DEP was defined by an umbilical artery base deficit value ≥ 10 mmol/L or a 5-minute Apgar ≤ 6 and included 77 births. UT was defined by >15 contractions in 30 minutes.. The overall incidence of UT was 18.3% (1139/6234). In 4.2% (260/6234) UT persisted for >60 min. The rate of UT was similar in births with DEP (14.3%, 11/77) compared to those without DEP (18.3%, 1128/6157; p=0.45). In births with UT, only 1.0% (11/1139) developed DEP. The DEP group had more decelerations at almost every level of contractions and a higher cesarean rate of 49.4% (38/77) compared to 24.0% (1468/6124); p=<0.001 in the group without DEP.. UT was common, occasionally prolonged and almost always benign. Fetuses with DEP had no more UT than those without DEP. Many babies with DEP declared their vulnerability with decelerations at contraction rates below UT levels and the great majority of them never experienced UT.

Topics: Acidosis; Apgar Score; Female; Fetal Diseases; Humans; Infant, Newborn; Infant, Newborn, Diseases; Oxytocics; Oxytocin; Pregnancy; Retrospective Studies; Uterine Contraction; Young Adult

Topics: Administration, Sublingual; Child; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Organizational Innovation; Oxytocics; Oxytocin; Postpartum Hemorrhage; Preventive Health Services; Research; South Africa; Tablets; Vaccines

To determine whether the use of an intrauterine catheter during labor is related to the occurrence of infection in mother or newborn during labor and up to 3 weeks postpartum.. We performed a follow-up study of 1435 women who participated in a previously published multicentre randomized controlled trial in the Netherlands that assigned women in whom labor was induced or augmented with intravenous oxytocin to internal or external tocodynamometry. In the present post hoc analysis, we assessed the risk for infection, defined as a composite measure of any clinical sign of infection, treatment with antibiotics or sepsis during labor or in the postpartum period up to 3 weeks in mother or newborn.. There were 64 cases with indication of infection in the intrauterine catheter group (8.8%) versus 74 cases in the external monitoring group (10.4%). Relative risk: 0.91, 95% confidence interval: 0.77-1.1, and p: 0.33.. Use of an intrauterine catheter during labor does not increase the risk of infection.

Topics: Administration, Intravaginal; Catheters, Indwelling; Female; Fetal Monitoring; Follow-Up Studies; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infections; Labor, Induced; Multicenter Studies as Topic; Netherlands; Oxytocin; Pregnancy; Pregnancy Complications, Infectious; Randomized Controlled Trials as Topic; Risk Factors; Up-Regulation; Uterine Monitoring; Uterus

To examine the effects and safety of high-dose (compared with low-dose) oxytocin regimen for labor augmentation on perinatal outcomes.. Data from the Consortium on Safe Labor were used. A total of 15,054 women from six hospitals were eligible for the analysis. Women were grouped based on their oxytocin starting dose and incremental dosing of 1, 2, and 4 milliunits/min. Duration of labor and a number of maternal and neonatal outcomes were compared among these three groups stratified by parity. Multivariable logistic regression and generalized linear mixed model were used to adjust for potential confounders.. Oxytocin regimen did not affect the rate of cesarean delivery or other perinatal outcomes. Compared with 1 milliunit/min, the regimens starting with 2 milliunits/min and 4 milliunits/min reduced the duration of first stage by 0.8 hours (95% confidence interval 0.5-1.1) and 1.3 hours (1.0-1.7), respectively, in nulliparous women. No effect was observed on the second stage of labor. Similar patterns were observed in multiparous women. High-dose regimen was associated with a reduced risk of meconium stain, chorioamnionitis, and newborn fever in multiparous women.. High-dose oxytocin regimen (starting dose at 4 milliunits/min and increment of 4 millliunits/min) is associated with a shorter duration of first-stage of labor for all parities without increasing the cesarean delivery rate or adversely affecting perinatal outcomes.. II.

Topics: Adult; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor Onset; Labor, Induced; Obstetric Labor Complications; Oxytocics; Oxytocin; Parity; Pregnancy; Pregnancy Outcome; Young Adult

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

From 1985 to 1988 we analyzed two hundred puerperas with term pregnancies and live newborns which pregnancy ended by vaginal route. One hundred of them received oxytocin during the labor and one hundred didn't receive it. The results showed that the use of oxytocin produces and increase in the cervical and vaginal tears; the Apgar score of the newborns was lower with a longer period in the incubator, and a high rate of complications regarding to respiratory distress and jaundice. These results were statistically significant according ti Chi square test with p less than 0.05.

Topics: Adult; Drug Utilization; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Obstetric Labor Complications; Oxytocin; Pregnancy; Prospective Studies

Topics: Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor, Obstetric; Oxytocin; Pregnancy; Seizures

Preparation for childbirth (Lamaze classes) is becoming an increasingly popular addition to patient education. This retrospective study investigates its effect on 64 primiparas in comparison with a control group who had not taken classes. The two groups were matched for age, antenatal risk scores, ethnic derivation, and socioeconomic status. No difference was found in the use of analgesia and anesthesia, the length of labor, type of delivery, incidence of fetal distress, infant birth weights, Apgar scores, or maternal and neonatal complications. However, there was a statistically significant increase in the use of oxytocin for augmentation of labor (P less than 0.01) in the prepared group.

Topics: Adult; Anesthesia, Obstetrical; Delivery, Obstetric; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor, Induced; Labor, Obstetric; Natural Childbirth; Obstetric Labor Complications; Oxytocin; Parity; Pregnancy; Pregnancy Complications; Puerperal Disorders; Retrospective Studies

Two hundred eighty-one high-risk gravida women undergoing a collective total of 661 nonstress tests entered a protocol to determine whether extending initially nonreactive tests improved the positive predictive value of this test modality. Reactivity required the occurrence of at least three fetal heart rate accelerations (15 bpm, 15 seconds' duration), associated with fetal movement during a 30-minute episode. Tests failing these criteria were extended by sequential 30-minute increments until a reactive 30-minute window appeared or 90 minutes had elapsed. After 90 minutes, a nonreactive test was followed by a contraction stress test. Reactive tracings occurred in 266 patients (95%) and in all cases were evident by the end of 70 minutes. Corrected perinatal mortality and morbidity in this group were 0% and 5.6%, respectively. Nonreactive fetuses not only produced abnormal (positive or persistently equivocal) contraction stress tests in nearly all cases (93.3%) but had mortality and morbidity rates of 6.7% and 93.3%, respectively. Furthermore, in five of 15 instances, the contraction stress test was associated with profound fetal heart rate decelerations necessitating emergency delivery. We conclude that prolonged nonreactivity, in the absence of significant immaturity, congenital abnormalities, or pharmacologic agents, identifies significant fetal jeopardy. Expeditious termination of pregnancy should be considered and, under these circumstances, a subsequent contraction stress test may be relatively contraindicated.

Topics: Congenital Abnormalities; Female; Fetal Diseases; Fetal Heart; Fetal Monitoring; Fetal Movement; Heart Rate; Humans; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Oxytocin; Pregnancy; Prospective Studies; Time Factors; Uterine Contraction

The elimination of indocyanin green (IGG) in selected mature newborn babies (n = 50) was investigated on the first postnatal day. The IGG dose was 2 mg/kg body weight. The half time (t1/2), the elimination constant (K2), the dye distribution volume (ml/kg), as well as the level of serum indirect bilirubin on the third postnatal day were measured and calculated. Healthy, mature newborns from spontaneous labor served as controls (n = 14): the two study groups consisted of either growth-retarded (n = 8) or acidotic (n = 8) neonates. According to the management of deliveries, they were spontaneous, assisted by oxytocin drop infusion (n = 10) or under lumbal peridural anaesthesia + oxytocin drop infusion (n = 8). In the acidotic neonates the elimination constant was significantly lower and the half time significantly longer. In the growth retarded newborn babies the difference was not significant. The increase of the level of indirect bilirubin in serum appearing in the acidotic group on the third postnatal day was significantly greater.

Topics: Acidosis; Bilirubin; Female; Fetal Growth Retardation; Humans; Indocyanine Green; Infant, Newborn; Infant, Newborn, Diseases; Labor, Induced; Oxytocin; Pregnancy

Topics: Female; Humans; Infant, Newborn, Diseases; Oxytocin; Pregnancy; Seizures

Topics: Delivery, Obstetric; Drug Evaluation; Female; Humans; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; Labor, Induced; Oxytocin; Pregnancy; Prospective Studies; Risk

From April 1, 1978 to March 31, 1979 199 patients with a high risk pregnancy and a Bishop score of less than 7 among a total number of deliveries of 2075 needed induction of labour for medical indications. In 143 patients oxytocin infusions were given, in 56 patients PGF2 alpha infusions were given. It was shown that PGF2 alpha by infusion showed no advantages over oxytocin infusions. The duration of labour and delivery was not shortened. The foetal morbidity was not decreased. The incidence of Caesarean section remained unchanged at a high 32% and the incidence of vaginal operative delivery remained high at 50%. The incidence of post-partum acidosis in the newborn remained at around 14%. Therefore induction of labour was tried on the unripe cervix in the following 12 months with the intra-cervical application of 0.4 mg. PGE2 gel in 202 patients. The same criteria of high risk pregnancies and unripe cervices were used in the following 12 months. In contradistinction to the induction of labour with oxytocin infusion or PGF2 alpha infusion statistically very significant differences in favor of PGE2 gel were found. The foetal morbidity during labour, the duration of labour, the mode of delivery, the neonatal morbidity and the post-partum maternal condition regarding haemoglobin and pyrexia were improved. The low incidence of Caesarean section at 8% and the low incidence of post-partum acidosis in the newborn was especially noteworthy in the PGE2 gel group. Although excellence of prenatal care is essential for the improvement of obstetric results the timely termination of a high risk pregnancy is the second important step to reduce maternal and foetal morbidity. PGE2 gel intracervically improves this second step.

Topics: Berlin; Cervix Uteri; Cesarean Section; Female; Germany, West; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor, Induced; Oxytocin; Pregnancy; Prostaglandins E; Prostaglandins F; Risk; Uterine Cervical Incompetence

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

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

Topics: Accidents; Ergonovine; Humans; Infant, Newborn; Infant, Newborn, Diseases; Lung; Male; Oxytocin; Pulmonary Edema

Over five weeks 136 out of 246 deliveries were studied. Maternal plasma sodium concentrations were normal at admission. At delivery no significant difference was found between maternal and infant cord plasma sodium concentrations. Twenty-four of the 41 mothers who had received only oral fluids during labour had infants whose cord plasma sodium concentrations were normal. Of the 95 mothers who had been given intravenous fluids, however, only 14 infants with normal plasma sodium concentrations, 31 had a concentrations of 130 mmol (mEq)/1 or less and nine of these had a concentration of 125 mmol/1 or less. There was a highly significant inverse relation between cord plasma sodium concentration and rate of fluid administration, suggesting that hyponatraemia was due to intravenous treatment with predominantly sodium-free solutions. Endogenous antidiuretic activity probably increases during labour, and synthetic oxytocin in large doses has been shown to have an antidiuretic effect. The dose used in this study did not appear to have such an effect. Glucose solutions are often used as a vehicle for oxytocin; 83% of all fluid intake in this study was 5% or 10% glucose in water. Fluid balance in labour should be supervised closely, and oxytocin should be given in a more concentrated solution.

Topics: Birth Weight; Body Water; Female; Humans; Hyponatremia; Iatrogenic Disease; Infant, Newborn; Infant, Newborn, Diseases; Infusions, Parenteral; Obstetric Labor Complications; Oxytocin; Pregnancy; Prenatal Care; Prospective Studies; Sodium; Water Intoxication

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

The clinical course is described of an infant who accidentally received an adult dose of Syntometrine (synthetic oxytocin + ergometrine) at delivery. The infant soon became ill with convulsions and ventilatory failure, and later with water intoxication. Similar reported cases are reviewed and recommendations are given for the management of future cases.

Topics: Accidents; Drug Combinations; Ergonovine; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Oxytocin; Respiratory Insufficiency; Seizures; Water Intoxication

A retrospective study was made of the relation between the cord serum sodium levels and the intravenous administration to the mother of 5 per cent dextrose and oxytocin. Of the 203 mothers studied, 106 received intravenous fluid before delivery. The mean sodium levels of babies of mothers who had intravenous fluid (133 +/- 4.2 (SD) mkmol/l) was significantly lower than for babies of mothers who had not (138 +/- 4.3 (SD) mmol/l).

Topics: Female; Fetal Blood; Glucose; Humans; Hypernatremia; Infant, Newborn; Infant, Newborn, Diseases; Infusions, Parenteral; Labor, Obstetric; Maternal-Fetal Exchange; Oxytocin; Pregnancy; Retrospective Studies; Sodium; Water-Electrolyte Balance

The perinatal mortality and morbidity of 185 post-term pregnancies managed by weekly trial inductions starting at 42 weeks' gestation were compared to those of 119 post-term pregnancies with spontaneous labor before a trial induction was accomplished. One stillbirth occurred in the spontaneous labor group and one in the induced group. There was no statistical difference in the maternal or fetal morbidity in terms of bradycardia in labor, meconium-stained amniotic fluid, meconium aspiration, 1-minute Apgar scores less than 4, macrosomia (more than 4000 g), neonatal pneumonia, and the incidence of cesarean section. This retrospective analysis suggests that standard clinical management is sufficient to assure optimal perinatal outcome in post-term pregnancies.

Topics: Female; Fetal Diseases; Gestational Age; Humans; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; Labor, Induced; Labor, Obstetric; Oxytocin; Pregnancy; Pregnancy, Prolonged; Syndrome

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

Several authorities have recommended cesarean section for all intrapartum breech presentations. The present study documents that judiciously selected fetuses at term in breech presentation may be safely delivered vaginally by a selective management protocol that requires cesarean section when mandated criteria are not met. The outcome and performance of 6 years of vaginal breech deliveries were evaluated. Those in the control groups were delivered by spontaneous vertex vaginal and elective repeat cesarean section procedures. Morbidity was not different in the protocol breech vaginal delivery group and in the controls. Mortality was found only in the nonprotocol-managed breech vaginal delivery group, which also had a morbidity 5 times greater than that of controls. Approximately half the term breech presentations that are properly selected and managed may be safely delivered vaginally, thereby avoiding a significant number of cesarean sections and subsequent inherent risks.

Topics: Apgar Score; Breech Presentation; Cesarean Section; Delivery, Obstetric; Evaluation Studies as Topic; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor Presentation; New York City; Oxytocin; Patient Care Planning; Pregnancy; Risk

The main aim of the investigation was to study in which patients oxytocin stress test (OST) should be used. From 1071 patients routinely monitored with antenatal cardiotocography ( = non-stress test) 112 were selected for 151 OSTs for two reasons: 1) normal or suspect pathologic non-stress test (NST) 2) slight or severe pathologic NST regardless of risk classification. In the first group of 85 OSTs, only 2 proved positive. In the second group of 66 OSTs, 22 were positive. The oxytocin stress will give little additional information to the NST when the latter is normal; the OST could be restricted to the relatively few patients with pathologic NST.

Topics: Female; Fetal Diseases; Fetal Monitoring; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Small for Gestational Age; Oxytocin; Pregnancy; Pregnancy Complications

A very unusual observation of survival after surgical treatment of neonatal maceration of liver and spleen is reported. The patient had a normal birthweight and the only possible etiologic factor was a oxitocin-induced rapid delivery. The literature on this topic is reviewed.

Topics: Birth Injuries; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor, Induced; Liver; Male; Oxytocin; Pregnancy; Rupture; Splenic Rupture

Topics: Female; Humans; Hyponatremia; Infant, Newborn; Infant, Newborn, Diseases; Injections; Labor, Induced; Maternal-Fetal Exchange; Oxytocin; Pregnancy

Authors have studied in four groups of newborns the possible relationship between administration of oxitocyn to the mother during labor or during the pregnancy and appearance of neonatal jaundice, alterations of hematocrit and Na+ levels in the immediate hours post-partum. In the present study, with dosages of oxitocyn administered during true labor which never exceded 1,200 mUI, no significant differences appeared between levels of bilirubin present in newborns and those whose mothers did not receive this type of treatment (p greater than 0.05). Sodium levels in the first day of life did show significant difference when comparing control and problem series respectively (p less than 0.01).

Topics: Bilirubin; Erythrocytes; Female; Humans; Hyponatremia; Infant, Newborn; Infant, Newborn, Diseases; Jaundice, Neonatal; Labor, Induced; Male; Maternal-Fetal Exchange; Oxytocin; Pregnancy

Topics: Bilirubin; Female; Humans; Hyperbilirubinemia; Infant, Newborn; Infant, Newborn, Diseases; Labor, Induced; Oxytocin; Pregnancy; Prostaglandins F

A personal prospective study was made of some perinatal and postnatal problems associated with induction of labour by three different methods in primiparous women with unripe cervices. The methods of induction were: (A) amniotomy followed by intravenous oxytocin [49], (B) amniotomy followed by intravenous prostaglandin E2 [39], (C) prostaglandin E2 by the extra-amniotic route [42]. A spontaneous group (D) comprising 54 mother--infant pairs was also studied. Length of gestation was between 37 and 42 wk in all but 2 cases. There was no perinatal mortality, and no infant had hyaline membrane disease. A close association was found between method of delivery and method (or absence) or induction. The caesarean section rate was highest in group C and lowest in group D. The spontaneous vaginal delivery rate was lowest in group C and highest in group D. More infants in the three induction groups were admitted to the Special Care Baby Unit (SCBU) than in the spontaneous group. No significant associations were found between the severity of the conditions leading to induction and caesarean section rates, low Apgar scores, admissions to SCBU, or the favourability of the cervix before induction. Among those who intended to breast feed fewer infants in the spontaneous group changed from breast to bottle while in hospital and after discharge from hospital than in the combined induction groups. Success in breast-feeding was not significantly associated with method of delivery or whether the infant was admitted to SCBU or not.

Topics: Apgar Score; Breast Feeding; Cesarean Section; Critical Care; Delivery, Obstetric; Female; Fetal Viability; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor, Induced; Oxytocin; Pregnancy; Prostaglandins E

Topics: Female; Humans; Hyponatremia; Infant, Newborn; Infant, Newborn, Diseases; Labor, Induced; Maternal-Fetal Exchange; Oxytocin; Pregnancy; Water Intoxication

Topics: Adult; Asphyxia Neonatorum; Female; Humans; Hyponatremia; Infant, Newborn; Infant, Newborn, Diseases; Labor, Induced; Maternal-Fetal Exchange; Oxytocin; Pregnancy

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

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

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

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

A method is described of using matched pairs of index infants and controls to examine the hypothesis that induction or some other obstetric practice is associated with increased morbidity in the mature infant. All infants over 2250 g and 37 weeks gestation, without severe congenital defect or history of severe maternal disorder, born in the John Radcliffe and admitted to the Special Care Baby Unit in 1975 were identified. For each of these index infants a matched control was chosen using strict criteria. Contrast between the 109 matched pairs showed no significant differences between maternal characteristics, induction of labour, use of forceps or duration of labour. There was an excess of index infants born to mothers who had had epidural anaesthesia (P less than 0.05).

Topics: Extraction, Obstetrical; Female; Humans; Infant Care; Infant, Newborn; Infant, Newborn, Diseases; Labor, Induced; Male; Oxytocin; Pregnancy

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

Fatal myocardial infarction occurring in a neonate is reported. The patient presented with a clinical picture of cardiogenic shock simulating a hypoplastic left heart syndrome. Etiology of the myocardial infarction is uncertain for the coronary arteries were patent, anatomically and histologically normal, and there was no significant associated cardiac defect. The possible etiologies in relationship to myocardial infarction in the neonatal period are presented.

Topics: Acute Kidney Injury; Angiocardiography; Cardiac Catheterization; Diagnosis, Differential; Electrocardiography; Female; Heart Failure; Humans; Hypotension; Infant, Newborn; Infant, Newborn, Diseases; Myocardial Infarction; Myocardium; Oliguria; Oxytocin; Pregnancy; Shock, Cardiogenic; Wolff-Parkinson-White Syndrome

Topics: Apgar Score; Cesarean Section; Female; Fetal Heart; Fetus; Humans; Infant, Newborn; Infant, Newborn, Diseases; Injections, Intravenous; Labor, Induced; Methods; Muscle Contraction; Nausea; Oxytocin; Parity; Pregnancy; Prostaglandins; Time Factors; Uterus

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

Topics: Apgar Score; Cyanosis; Ergonovine; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intubation, Intratracheal; Medication Errors; Oxytocin; Positive-Pressure Respiration

Topics: Drug Combinations; Ergonovine; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Medication Errors; Oxytocin; Vitamin K

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

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

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

Topics: Czechoslovakia; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor Presentation; Labor, Induced; Oxytocin; Pregnancy; Retrospective Studies

Topics: Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Injections, Intravenous; Labor Presentation; Labor, Induced; Oxytocin; Pregnancy

Topics: Adult; Anesthesia, Obstetrical; Cesarean Section; Female; Fetal Diseases; Gestational Age; Humans; Infant, Newborn; Infant, Newborn, Diseases; Injections, Intravenous; Intensive Care Units; Labor, Induced; Oxytocin; Placenta; Placenta Diseases; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged; Terminology as Topic; Time Factors

Topics: Birth Weight; Cervix Uteri; Cytodiagnosis; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged; Vaginal Smears

Topics: Female; Fetal Diseases; Hematoma, Epidural, Cranial; Hemorrhage; Humans; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; Intellectual Disability; Labor, Induced; Muscles; Obstetric Labor Complications; Oxytocin; Perfusion; Pregnancy; Statistics as Topic

Topics: Amniotic Fluid; Bilirubin; Body Weight; Colposcopy; Cytodiagnosis; Delivery, Obstetric; Diagnosis, Differential; Fasting; Female; Germany, East; Humans; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; Labor, Induced; Oxytocin; Placenta; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged; Statistics as Topic; Uterus; Vaginal Smears

Topics: Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Kidney Cortex Necrosis; Kidney Diseases; Maternal-Fetal Exchange; Oxytocin; Pregnancy; Renal Artery Obstruction; Thrombosis

Topics: Amniotic Fluid; Delivery, Obstetric; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Oxytocin; Placenta; Pregnancy; Pregnancy, Prolonged

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

Topics: Anesthesia, Obstetrical; Anesthesia, Spinal; Blood Pressure; Female; Heart Rate; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor, Induced; Labor, Obstetric; Obstetric Labor Complications; Oxytocin; Pain; Pregnancy