oxytocin and Stillbirth

Stillbirth is a common adverse outcome of pregnancy. Management should be individualized based on gestational age, maternal condition, prior uterine surgery, availability of skilled professionals, and maternal desires. This article discusses available data on management by gestational age and prior uterine surgery. Expectant management is a viable option for women and families who desire it and do not have any contraindications. In the second trimester, misoprostol induction and dilatation and evacuation are effective in the evacuation of the uterus. In the third trimester, induction of labor with prostaglandins, mechanical dilators, and augmentation with oxytocin is appropriate. Care should be taken with women with prior cesarean delivery; prostaglandins ideally should be avoided. Delivery by cesarean section should be performed selectively, i.e., when there is a maternal indication.

Topics: Abortion, Induced; Adult; Cesarean Section; Contraindications; Directive Counseling; Female; Gestational Age; Humans; Misoprostol; Mothers; Oxytocics; Oxytocin; Practice Guidelines as Topic; Pregnancy; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Prostaglandins; Stillbirth; Time Factors; Urinary Catheterization; Vaginal Birth after Cesarean

Oxytocin is extensively used to induce or augment uterine contractions, especially to facilitate the third stage of labor in humans. Administration of oxytocin to parturient sows reduces duration of labor whereas mortality of the offspring may remain unchanged. This study aimed to evaluate whether time of administration of oxytocin during parturition may alter the uterine response and fetal outcomes. Two hundred parturient sows were randomly assigned to intramuscularly receive either saline solution (control group) or oxytocin 0.083 IU/kg immediately after the delivery of the 1st, 4th or 8th piglet (groups O-1, 0-4 and 0-8, respectively). Uterine effects and fetal outcomes were registered in all groups. The duration of labor was 20-40 min shorter (P < 0.0001) and time interval between babies was reduced by 3-5 min (P < 0.0001) in the three groups receiving oxytocin. The duration and intensity of contractions, meconium-stained piglets and intrapartum deaths decreased as time at which oxytocin administered during labor was increased. In group 0-8, we observed approximately 70% less meconium-stained piglets and intrapartum deaths than in the control group. In conclusion, oxytocin administered at early phases of parturition to sows may increase duration and intensity of uterine contractions as well as adverse fetal outcomes.

Topics: Animals; Animals, Newborn; Dose-Response Relationship, Drug; Female; Myometrium; Oxytocics; Oxytocin; Parturition; Pregnancy; Stillbirth; Swine; Time Factors; Uterine Contraction

Stillbirth and perinatal mortality issues continue to receive inadequate policy attention in Ghana despite government efforts maternal health care policy intervention over the years. The development has raised concerns as to whether Ghana can achieve the World Health Organization target of 12 per 1000 live births by the year 2030.. In this study, we compared stillbirth and perinatal mortality between two groups of women who registered and benefitted from Ghana's 'free' maternal health care policy and those who did not. We further explored the contextual factors of utilization of maternal health care under the 'free' policy to find explanation to the quantitative findings.. The study adopted a mixed method approach, first using two rounds of Ghana Demographic and Health Survey data sets, 2008 and 2014 as baseline and end line respectively. We constructed outcome variables of stillbirth and perinatal mortality from the under 5 mortality variables (n = 487). We then analyzed for association using multiple logistics regression and checked for sensitivity and over dispersion using Poisson and negative binomial regression models, while adjusting for confounding. We also conducted 23 in-depth interviews and 8 focus group discussions for doctors, midwives and pregnant women and analyzed the contents of the transcripts thematically with verbatim quotes.. Stillbirth rate increased in 2014 by 2 per 1000 live births. On the other hand, perinatal mortality rate declined within the same period by 4 per 1000 live births. Newborns were 1.64 times more likely to be stillborn; aOR: 1.64; 95% [CI: 1.02, 2.65] and 2.04 times more likely to die before their 6th day of life; aOR: 2.04; 95% [CI: 1.28, 3.25] among the 'free' maternal health care policy group, compared to the no 'free' maternal health care policy group, and the differences were statistically significant, p< 0.041; p< 0.003, respectively. Routine medicines such as folic acid and multi-vitamins were intermittently in short supply forcing private purchase by pregnant women to augment their routine requirement. Also, pregnant women in labor took in local concoction as oxytocin, ostensibly to fast track the labor process and inadvertently leading to complications of uterine rapture thus, increasing the risk of stillbirths.. Even though perinatal mortality rate declined overall in 2014, the proportion of stillbirth and perinatal death is declining slowly despite the 'free' policy intervention. Shortage of medicine commodities, inadequate monitoring of labor process coupled with pregnant women intake of traditional herbs, perhaps explains the current rate of stillbirth and perinatal death.

Topics: Female; Ghana; Health Policy; Humans; Infant, Newborn; Maternal Health; Oxytocin; Perinatal Death; Perinatal Mortality; Pregnancy; Stillbirth

This study sought to compare clinical outcomes of midwifery clients who had postdates induction of labour with oxytocin under midwifery care with those transferred to obstetrical care.. This was a retrospective cohort study using 2006-2009 Ontario Midwifery Program data. All low-risk Ontario midwifery clients who had postdates oxytocin induction were included. Groups were established according to the planned care provider at onset of induction. The primary outcome was Cesarean section (CS). The secondary outcome was a composite of stillbirth, neonatal death, or serious morbidity. Other outcomes included assisted vaginal delivery, pharmaceutical pain relief, and use of episiotomy. We stratified by parity and used logistic regression to conduct analyses controlling for maternal age (Canadian Task Force Classification II-2).. For nulliparas, postdates induction with oxytocin under midwifery care decreased the odds of interventions including assisted vaginal delivery (OR 0.68; 95% CI 0.48-0.97), episiotomy (OR 0.49; 95% CI 0.34-0.70), and pharmaceutical pain relief (OR 0.57; 95% CI 0.36-0.90), with no difference in odds of neonatal morbidity or mortality (OR 0.71; 95% CI 0.25-2.04) when compared with induction under obstetrical care. For multiparas, the use of pharmaceutical pain relief was significantly lower in the midwifery group (OR 0.65; 95% CI 0.44-0.96).. For low-risk midwifery clients at 41 weeks or more gestation, the odds of Caesarean section and neonatal morbidity and mortality are similar when induction of labour with oxytocin under the care of a midwife is compared with induction of labour under obstetrical care, and rates of intervention are decreased.

Topics: Adult; Analgesia, Obstetrical; Cesarean Section; Cohort Studies; Episiotomy; Extraction, Obstetrical; Female; Humans; Labor, Induced; Logistic Models; Midwifery; Obstetrics; Odds Ratio; Ontario; Oxytocics; Oxytocin; Parity; Patient Transfer; Perinatal Death; Pregnancy; Pregnancy, Prolonged; Retrospective Studies; Stillbirth; Young Adult

The effects of various parturition controlling measures in sows on the relevant parameters for parturition were investigated.. A total of 1975 study animals were divided into five groups: control group: A (n = 710); trial groups: B (n = 719), C (n = 180), D (n = 175), E (n = 191). The control group (A) included sows that spontaneously farrowed until day 114 of gestation. The remaining sows were administered a PGF2α-analogue (175 µg cloprostenol) on day 114. All sows that farrowed within 24 hours after prostaglandin-medication were summarised in trial group B. Dams that did not farrow until day 115 were either administered oxytocin (20 IU i. m., group C) or carbetocin in two different doses (70 µg, group D or 35 µg, group E). The sows were monitored during the peripartal period over 24 hours.. 83.8% of the farrowings were without any complications. The percentage of dystocia varied between the individual groups. Given a complication-free farrowing the expulsion stage began 13.0 hours (group B), 2.4 hours (group C), 1.6 hours (group D) and 1.4 hours (group E) after medication. The expulsion interval of the farrowing of two piglets decreased from 21.1 minutes with spontaneous farrowings (group A) to 18.6 minutes (group E) as a result of the administration of 35 µg carbetocin. The rate of stillborn piglets as well as the incidence of puerperal disorders and the losses of the suckling piglets also gradually, partly even significantly (p ≤ 0.05) decreased from group A to E.. The results of this study show that the use of the long-acting oxytocin carbetocin has advantages compared to oxytocin (e.   g. shortened duration of birth, reduction of stillbirths). The tested dosages of carbetocin (35 µg or 70 µg) proved to be equally effective. Administration of the lower dose is recommended, since this reduces use of the active ingredient.

Topics: Animals; Breeding; Cloprostenol; Estrus Synchronization; Female; Oxytocin; Parturition; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Stillbirth; Swine

Labour induction should be performed where benefit outweighs potential harm, however epidemiology of induction in lower-income countries is not well described. We used the WHO Global Survey dataset to describe the epidemiology and outcomes of labour induction in 192,538 deliveries in 253 facilities across 16 countries in Africa and Asia.. Data was analyzed separately for Africa and Asia. Prevalence of indications, methods, success and characteristics associated with labour induction were determined. Multilevel logistic regression was used to determine the relationship between induction (with medical indication and elective) and maternal/perinatal outcomes.. Induction accounted for 4.4% (Africa) and 12.1% (Asia) of deliveries. Oxytocin alone was the most common method (45.9% and 37.5%) and success rates were generally over 80%. Medically indicated inductions were associated with increased adjusted odds of Apgar <7 at 5 minutes, low birthweight, NICU admission and fresh stillbirth in both regions. The odds of caesarean section in Africa were reduced (Adj OR 0.61, 95%CI 0.42-0.88). Elective induction was associated with increased adjusted odds of NICU (Africa) and ICU (Asia) admissions.. Induction was generally less common than in higher-income countries. Prostaglandin use was uncommon despite evidence supporting use. Induction for medical indications may be associated with poorer outcomes due to maternal baseline risks. Despite one-third of elective inductions occurring at <39 weeks, the risk of maternal, fetal and neonatal mortality was not elevated following elective inductions.

Topics: Adolescent; Adult; Africa; Asia; Elective Surgical Procedures; Female; Health Surveys; Humans; Infant; Infant Mortality; Infant, Low Birth Weight; Infant, Newborn; Labor, Induced; Labor, Obstetric; Live Birth; Maternal Welfare; Oxytocics; Oxytocin; Pregnancy; Stillbirth; World Health Organization

To describe the management of third-trimester stillbirth at a single institution, stratifying induction intervals and adverse outcomes by method.. Women diagnosed with fetal demise at 28weeks or later and admitted to an academic hospital between January 2007 and September 2010 were identified. A chart review extracted demographics, history, induction method, delivery interval, and adverse outcomes.. Seventy-four women were included, with a median gestational age of 35.5weeks (range, 28-40weeks). Ten women had undergone at least 1 prior cesarean. Induction methods included misoprostol alone or for cervical ripening; oxytocin and amniotomy; transcervical Foley catheter; and mifepristone. Overall, 88% of patients delivered within 24hours; median time to fetal delivery was 11hours 20minutes (range, 7minutes to 57hours 12minutes). Adverse outcomes included intrapartum fever and postpartum hemorrhage. In total, 98% of patients, including those with prior cesarean, had a successful vaginal delivery.. Regardless of third-trimester induction method for management of stillbirth, the majority of women experience safe delivery within 24hours. The descriptive data imply that misoprostol-only inductions might confer the shortest induction intervals; however, further prospective trials are needed to identify the optimal misoprostol regimen for women with third-trimester stillbirth.

Topics: Adolescent; Adult; Amnion; Cervical Ripening; Delivery, Obstetric; Female; Humans; Labor, Induced; Mifepristone; Misoprostol; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Pregnancy Trimester, Third; Retrospective Studies; Stillbirth; Time Factors; Urinary Catheterization; Young Adult

Despite the high prevalence of primary uterine inertia in whelping bitches, the underlying pathogenesis remains unclear. The objectives were to i) determine serum concentrations of total calcium, ionized calcium (iCa), parathyroid hormone (PTH), and blood pH in normally whelping bitches throughout the peri-parturient period; and ii) investigate relationships among iCa, PTH, and acid-base status, and the role that they and oxytocin may have in the underlying pathogenesis of canine uterine inertia. Bitches were randomly selected from a population of German Shepherd Dog bitches with a history of uncomplicated parturition (Group 1; n=10), and from a population of Labrador bitches with a clinical history of an increased incidence of uterine inertia and stillbirths (Group 2; n=20). Jugular blood samples were collected daily from -4 d to the onset of whelping (t=0 h), and then every 4h until the last pup was born. Overall, bitches from Group 2 had higher mean+/-SEM serum concentrations of PTH (4.72+/-2.45 pmol/L, P<0.001), lower iCa (1.31+/-0.08 pmol/L, P<0.05), and higher venous pH (7.41+/-0.03, P<0.005) than bitches from Group 1 (2.9+/-1.44 pmol/L, 1.38+/-0.06 mmol/L, and 7.33+/-0.02, respectively) during the periparturient period. However, there was no significant difference between Groups 1 and 2 for serum oxytocin concentrations during the periparturient period (45.5+/-40 and 65.5+/-82 pg/mL). We inferred that low iCa resulting from a rising pH and decreasing PTH during the periparturient period may have contributed to decreased uterine contractility and increased risk of stillbirths. Therefore, manipulating the cationic/anionic difference in diets of pregnant bitches, similar to the bovine model for hypocalcamia, may reduce the incidence of stillbirths in the bitch.

Topics: Animals; Blood Glucose; Calcium; Diet; Dog Diseases; Dogs; Female; Hydrogen-Ion Concentration; Oxytocin; Parathyroid Hormone; Parturition; Pregnancy; Stillbirth; Uterine Inertia

Alterations in RCAS1 (a receptor-binding cancer antigen expressed on SiSo cells) expression in the placenta and decidua may be related to the regulation of the process of maternal immune tolerance against fetal antigens. Moreover, it has been demonstrated that the occurrence of the spontaneous beginning of stillbirth is related to a decrease in the placental expression of RCAS1. There are no data currently available on the immune processes in decidua during stillbirth. The aim of this study was to evaluate the RCAS1 immunoreactivity level in decidua and to identify the cytotoxic immune cells present during labor, induced after intrauterine fetal death either with a combination of oxytocin (OT) and prostaglandins or with OT alone; a further objective was to assess the potential impact of these molecular alterations on the effectiveness of stillbirth induction.. The immunoreactivity of RCAS1, CD3, CD56, CD69, and CD25 was assessed by immunohistochemistry in 31 decidual samples derived from patients in whom the stillbirth occurred before the onset of labor.. The RCAS1 immunoreactivity level was higher in a statistically significant manner in decidual tissue samples derived from patients in whom OT alone proved insufficient to induce labor after the diagnosis of intrauterine fetal death but required additionally the use of prostaglandins when compared with samples from women in whom stillbirth was induced successfully with OT alone. However, we did not observe any differences either in CD56 and CD3 positive cell presence or in CD25 and CD69 antigen immunoreactivity in the respective decidua of these two groups of patients.. The level of RCAS1 in decidua seems to influence the effectiveness of stillbirth induction.

Topics: Adult; Antigens, Neoplasm; Cells, Cultured; Decidua; Female; Fetal Death; Fetal Diseases; Humans; Oxytocin; Pregnancy; Prostaglandins; Stillbirth

Topics: Adult; Antihypertensive Agents; Brain Diseases; Delivery, Obstetric; Eclampsia; Female; Follow-Up Studies; Gravidity; Humans; Magnesium Sulfate; Magnetic Resonance Imaging; Nifedipine; Oxytocics; Oxytocin; Paraparesis; Parietal Lobe; Pregnancy; Pregnancy Trimester, Second; Stillbirth; Time Factors; Tocolytic Agents; Tomography, X-Ray Computed; Treatment Outcome

Oxytocin and vetrabutin chlorhydrate (VC) are used to reduce the duration of farrowing in swine. The objective of the present study was to evaluate the use of these products on intra-partum stillbirth (IPS) rate and asphyxia. At the onset of parturition, sows (n=180) were allocated to receive 2 mL of saline (control group), oxytocin (40 IU i.m.) or 100mg of VC per 60 kg of body weight, with all treatments given i.m. Oytocin-treated sows had a higher number of IPS than the VC and Control groups (means, 1.2, 0.8 and 0.6, respectively; P<0.001), and the highest percentage of ruptured umbilical cords (76.0, 9.4 and 37.5%; P<0.003). There were differences among groups for duration of farrowing (means, 163.0, 211.2 and 306.9 min in the oxytocin, VC and control groups; P<0.001), interval between piglets (13.9, 19.2 and 28.1 min; P<0.001), and in IPS, the incidence of ruptured umbilical cords was 76.0, 9.4 and 37.5% (P<0.003) and absence of a fetal heartbeat was 53.3, 16.9 and 12.5% (P<0.05). Although oxytocin decreased both duration of farrowing and interval between piglets by approximately 50% relative to control sows, it resulted in a significantly higher rate of IPS, in association with a much higher incidence of ruptured umbilical cord and absence of a fetal heartbeat. Treatment with VC reduced farrowing duration by approximately 1.5h, with an IPS rate that was not significantly different from controls but significantly lower than that of oxytocin-treated sows.

Topics: Animals; Asphyxia; Female; Oxytocin; Parturition; Pregnancy; Rupture, Spontaneous; Stillbirth; Swine; Swine Diseases; Time Factors; Umbilical Cord; Uterine Contraction

Topics: Afibrinogenemia; Anti-Bacterial Agents; Australia; Blood Coagulation Disorders; Erythroblastosis, Fetal; Female; Fetal Death; Humans; Infant, Newborn; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Complications, Hematologic; Rh-Hr Blood-Group System; Stillbirth

Topics: Female; Fetal Death; Humans; Hypertonic Solutions; Labor, Induced; Oxytocin; Pregnancy; Pregnancy Complications; Saline Solution, Hypertonic; Statistics as Topic; Stillbirth

Topics: Abortion, Induced; Abortion, Spontaneous; Female; Humans; Moon; Oxytocin; Pregnancy; Stillbirth

Topics: Female; Fetal Death; Fetus; Humans; Injections, Intravenous; Labor, Induced; Labor, Obstetric; Muscle Relaxants, Central; Oxytocin; Parasympatholytics; Pregnancy; Stillbirth