oxytocin and Meconium-Aspiration-Syndrome

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

To determine the effect of oral Misoprostol in labour induction with respect to ease of administration and induction-to-delivery time interval.. Observational study.. Gynaecology/Obstetrics Department, Holy Family Hospital, Rawalpindi, from March to August 2006.. Women with live singleton pregnancy of > 37 weeks gestation with cephalic presentation, with an indication for induction of labour were inducted. Oral misoprostol 50 microg to 400 microg was given in divided doses at 4 hours interval upto a maximum of 4 doses, till labour was induced. Fetomaternal outcome and induction to delivering time interval in hours was noted.. In 6 months duration, 250 mothers were recruited for the study. The main indication for labour induction was post date pregnancy (52%) and oxytocin was given in 50% cases. The majority (96%) of mothers went into labour but 4% (9) had failed induction. The majority (73%, n=176/241) of mothers delivered vaginally, 99% being delivered in the first 24 hours. Mean induction-delivery interval was 11+/-2.7 hours. Sixty five (27%) had to undergo emergency lower segment caesarean section, the major indication being fetal distress (41.5%, n=27) and meconium staining of liquor (40%, n=26). Again, a majority (95%) of the babies were delivered with good Apgar score. However, 10.8% developed meconium aspiration syndrome. Early neonatal deaths occurred in 0.8% (2) cases. Maternal hyper stimulation was seen in 1 case (0.4%).. Oral misoprostol as an agent for labour induction in term pregnancy was easy to administer and the majority of women (99%) delivered in the first 24 hours.

Topics: Abortifacient Agents, Nonsteroidal; Administration, Oral; Adolescent; Adult; Apgar Score; Dose-Response Relationship, Drug; Female; Humans; Infant, Newborn; Labor, Induced; Meconium Aspiration Syndrome; Misoprostol; Oxytocics; Oxytocin; Pakistan; Pregnancy; Pregnancy Trimester, Third; Prospective Studies; Prostaglandins; Term Birth; Time Factors; Young Adult

Our purpose was to compare the safety and efficacy of intravaginal misoprostol versus intracervical prostaglandin E2 (dinoprostone) gel for preinduction cervical ripening and induction of labor.. One hundred thirty-five patients with indications for induction of labor and unfavorable cervices were randomly assigned to receive either intravaginal misoprostol or intracervical dinoprostone. Fifty microgram tablets of misoprostol were placed in the posterior vaginal fornix every 3 hours for a maximum of six doses. Prostaglandin E2 in gel form, 0.5 mg, was placed into the endocervix every 6 hours for a maximum of three doses. Medication was not given after either spontaneous rupture of membranes or beginning of active labor.. Among 135 patients enrolled, 68 received misoprostol and 67 received dinoprostone. The average interval from start of induction to vaginal delivery was shorter in the misoprostol group (903.3 +/- 482.1 minutes) than in the dinoprostone group (1410.9 +/- 869.1 minutes) (p < 0.001). Oxytocin augmentation of labor occurred more often in the dinoprostone group (65.7%) than in the misoprostol group (33.8%) (p < 0.001). There were no significant differences between routes of delivery. Ten of the misoprostol-treated patients (14.7%) and 13 of the dinoprostone-treated patients (19.4%) had cesarean deliveries. There was a higher prevalence of tachysystole (six or more uterine contractions in a 10-minute window for two consecutive 10-minute periods) in the misoprostol group (36.7%) than in the dinoprostone group (11.9%) (p < 0.001). However, there were no significant differences in frequency of uterine hyperstimulation or hypertonus. There was a higher prevalence of meconium passage in the misoprostol group (27.9%) than in the dinoprostone group (10.5%) (p < 0.05). There was no significant difference in frequency of abnormal fetal heart rate tracings, 1- or 5-minute Apgar scores < 7, neonatal resuscitations, or admissions to the neonatal intensive care unit between the two groups.. Vaginally administered misoprostol is an effective agent for cervical ripening and induction of labor; however when given at this dosage, it is associated with a higher prevalence of tachysystole and meconium passage than is dinoprostone. Further studies to compare the safety of misoprostol to that of dinoprostone and to delineate an optimal dosing regimen for misoprostol are needed.

Topics: Adult; Cervix Uteri; Dinoprostone; Female; Heart Rate, Fetal; Humans; Hyperbilirubinemia; Infant, Newborn; Labor, Induced; Meconium Aspiration Syndrome; Misoprostol; Oxytocin; Pregnancy; Time Factors

Topics: Anti-Bacterial Agents; Birth Weight; Delivery, Obstetric; Female; Fetus; Humans; Infant, Newborn; Male; Meconium Aspiration Syndrome; Obstetric Labor Complications; Oxytocics; Oxytocin; Pregnancy; Pregnancy Outcome; Regression Analysis; Retrospective Studies; Sex Factors

The objective of this report was to study the effect of oxytocin augmentation in arrest disorders in the presence of thick meconium on meconium aspiration and fetal acidosis. We evaluated 3,321 singleton, term deliveries with cephalic presentation at our institution. Eight percent (253/3,321) had thick meconium in labor, and these patients comprised the study sample. Of the 253 women with thick meconium, 84 had an arrest disorder in the active phase of labor with normal fetal heart rate tracing at the time of diagnosis. Seventy-four percent (62/84) of the women with arrest were treated with oxytocin (group 1) and 26% (22/84) delivered by cesarean section without augmentation (group 2). There was a significant (p < 0.05) increase in the incidence of meconium aspiration (14.5 vs. 4.5%) and low (< 7.20) cord arterial pH (27.8 vs. 4.5%) in patients who received oxytocin compared to those who did not. Of the women who received oxytocin, 36 delivered vaginally, and 2 neonates had meconium aspiration. The remaining 26 women had cesarean sections following oxytocin augmentation and had a significantly higher (p < 0.05) frequency of meconium aspiration (26.9 vs. 4.5%) and low cord arterial pH (38.5 vs. 4.5%) compared to women who had cesarean sections without oxytocin augmentation. The findings suggest that oxytocin augmentation in arrest disorders in the presence of thick meconium may be associated with a higher risk of meconium aspiration and low umbilical cord arterial pH.

Topics: Adult; Female; Humans; Incidence; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Oxytocin; Pregnancy; Pregnancy Outcome; Uterine Inertia