oxytocin and Oligohydramnios

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

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

This study aimed to evaluate the association of induction method on delivery mode in pregnancies complicated by oligohydramnios with and without fetal growth restriction (FGR).. This was a secondary analysis of a National Institutes of Health funded retrospective cohort study of singleton deliveries at a tertiary-care hospital between 2002 and 2013 with diabetes, mild hypertension, and/or FGR. Chart abstraction was performed by trained research nurses. Patients with a diagnosis of fetal oligohydramnios with and without FGR were identified. Our analytic cohort was further stratified into three groups per initial induction agent: prostaglandins (PGEs) alone, PGE plus mechanical ripening, or oxytocin only. Primary outcome was mode of delivery. Secondary outcomes included indications for cesarean delivery and neonatal morbidity.. Out of 4,929 patients in the original database, 546 subjects with fetal oligohydramnios were identified; of these, 270 were induced and included for analysis. Outcomes were compared between 171 patients who had fetuses with isolated oligohydramnios and 99 patients who had fetuses with oligohydramnios and FGR. There were no significant differences in demographic characteristics between the groups. Patients with fetuses with isolated oligohydramnios had similar rates of spontaneous vaginal delivery (SVD) when PGEs were used (. In patients with fetuses with oligohydramnios with and without FGR, most patients delivered by SVD regardless of induction method. In this population, PGE use was associated with a high chance of SVD in patients with fetuses with suspected placental insufficiency regardless of the presence of absence of FGR.. · The majority of fetuses with oligohydramnios with or without FGR deliver vaginally.. · The use of prostaglandins did not increase rates of cesarean for fetal distress in oligohydramnios.. · Prostaglandin use did not increase rate of neonatal intensive care unit admission among pregnancies with oligohydramnios..

Topics: Female; Fetal Growth Retardation; Humans; Infant, Newborn; Oligohydramnios; Oxytocics; Oxytocin; Placenta; Pregnancy; Prostaglandins; Retrospective Studies

The world's understanding of COVID-19 continues to evolve as the scientific community discovers unique presentations of this disease. This case report depicts an unexpected intraoperative coagulopathy during a cesarean section in an otherwise asymptomatic patient who was later found to have COVID-19. This case suggests that there may be a higher risk for intrapartum bleeding in the pregnant, largely asymptomatic COVID-positive patient with more abnormal COVID laboratory values.. The case patient displayed D-Dimer elevations beyond what is typically observed among this hospital's COVID-positive peripartum population and displayed significantly more oozing than expected intraoperatively, despite normal prothrombin time, international normalized ratio, fibrinogen, and platelets.. There is little published evidence on the association between D-Dimer and coagulopathy among the pregnant population infected with SARS-CoV-2. This case report contributes to the growing body of evidence on the effects of COVID-19 in pregnancy. A clinical picture concerning for intraoperative coagulopathy may be associated with SARS-CoV-2 infection during cesarean sections, and abnormal COVID laboratory tests, particularly D-Dimer, may help identify the patients in which this presentation occurs.

Topics: Adult; Antifibrinolytic Agents; Betacoronavirus; Blood Coagulation Disorders; Blood Loss, Surgical; Breech Presentation; C-Reactive Protein; Cautery; Cesarean Section; Coronavirus Infections; COVID-19; Female; Fibrin Fibrinogen Degradation Products; Fibrinogen; Hemostasis, Surgical; Humans; International Normalized Ratio; Methylergonovine; Oligohydramnios; Oxytocics; Oxytocin; Pandemics; Platelet Count; Pneumonia, Viral; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy Complications, Infectious; Prothrombin Time; SARS-CoV-2; Tranexamic Acid; Uterine Inertia

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

We report a case of previously healthy woman who suffered cerebral embolism after delivery. Echocardiography with contrast medium confirmed the patent foramen ovale (PFO). PFO may be a mechanism of paradoxical embolism causing a transient ischemic attack or stroke.

Topics: Adult; Anticoagulants; Apgar Score; Birth Weight; Echocardiography; Embolism, Paradoxical; Female; Heart Septal Defects, Atrial; Hematocrit; Hemoglobins; Heparin; Humans; Infant, Newborn; Maternal Age; Oligohydramnios; Oxytocin; Postpartum Period; Pregnancy; Pregnancy, High-Risk; Tomography, X-Ray Computed; Warfarin