oxytocin and Proteinuria

PATH, an international nonprofit organization, assessed nearly 40 technologies for their potential to reduce maternal mortality from postpartum hemorrhage and preeclampsia and eclampsia in low-resource settings. The evaluation used a new Excel-based prioritization tool covering 22 criteria developed by PATH, the Maternal and Neonatal Directed Assessment of Technology (MANDATE) model, and consultations with experts. It identified five innovations with especially high potential: technologies to improve use of oxytocin, a uterine balloon tamponade, simplified dosing of magnesium sulfate, an improved proteinuria test, and better blood pressure measurement devices. Investments are needed to realize the potential of these technologies to reduce mortality.

Topics: Africa South of the Sahara; Asia; Blood Pressure Determination; Developing Countries; Diagnostic Techniques, Obstetrical and Gynecological; Eclampsia; Female; Humans; Inventions; Investments; Magnesium Sulfate; Maternal Death; Models, Theoretical; Organizations, Nonprofit; Oxytocin; Postpartum Hemorrhage; Pre-Eclampsia; Pregnancy; Proteinuria; Technology, Pharmaceutical; Uterine Balloon Tamponade

In a consecutive series of 1,201 singleton pregnancies with pre-eclampsia, the onset occurred during labour in 290 (24.1%). There was no difference between the primiparous and parous patient in this respect (25.9% v 20.7%; P less than 0.10). The tendency for pre-eclampsia to develop during labour increased with advancing maturity of the pregnancy and seldom occurred before 38 weeks of gestation; this was again equally true of the primiparous and parous patient, as was the incidence of severe hypertension (diastolic pressure greater than 110mm Hg) (36.1% v 34.1%). The high incidences of severe hypertension (35.5%), proteinuria (41.7%), and eclampsia (2.1%), and the 1 maternal death testified to the severity of the disease process and the need for aggressive management. After delivery, the clinical signs tended to subside rapidly, but the early third stage of labour was a time of maternal risk, irrespective of whether ergometrine or Syntocinon was the oxytocic agent administered. Analysis of perinatal results showed that the risk to the fetus was minimal.

Topics: Adult; Ergonovine; Female; Fetal Distress; Humans; Hypertension; Labor Stage, Third; Middle Aged; Obstetric Labor Complications; Oxytocin; Parity; Pre-Eclampsia; Pregnancy; Proteinuria; Risk

Concentrations of plasma angiotensin II (AII) have been measured in the second stage of labour or before delivery by elective Caesarean section in 134 women and some factors influencing the levels have been assessed. Plasma AII concentrations in the second stage of labour were higher than levels previously observed before the onset of labour in both primigravid and multiparous women. Markedly lower levels were found following delivery by elective Caesarean section than following vaginal delivery. Multiparae had higher AII concentrations than primigravidae both before the onset of labour and at delivery. Epidural analgesia was associated with significantly lower AII concentrations; in primigravidae receiving such analgesia a statistically significant relation was found between AII concentration and diastolic blood pressure at delivery. A similar relation was found in the nonproteinuric patients delivered by Caesarean section. The estimated duration of the second stage of labour was the major factor affecting AII concentration in normal multiparae. In both primigravid and multiparous women, AII concentrations were markedly raised in association with proteinuria.

Topics: Adult; Anesthesia, Epidural; Anesthesia, Obstetrical; Angiotensin II; Blood Pressure; Body Weight; Cesarean Section; Female; Humans; Labor, Obstetric; Maternal Age; Oxytocin; Parity; Pregnancy; Pregnancy Complications; Proteinuria; Time Factors