oxytocin and Streptococcal-Infections

To assess the effect of immediate induction versus expectant management on maternal and neonatal outcomes in case of term prelabor rupture of membranes.. We searched Medline Database, Cochrane Library and consulted international guidelines.. In case of term prelabor rupture of membranes, induction of labor is associated with shorter rupture of membranes to delivery intervals when compared to expectant management, if induction is conducted with oxytocin (LE2), prostaglandin E2 (LE2) or misoprostol (LE2), but not when induction is conducted with Foley® catheter (LE2), osmotic dilatator (LE2) or acupuncture (LE2). The strongest evidence to date comes from a large international randomized study, the TERMPROM study, which included over 5000 women between 1992 and 1995. This study compared immediate induction with oxytocin or prostaglandin E2 to expectant management up to 96hours, followed by induction by oxytocin or prostaglandin E2. Immediate induction was not associated with a decreased neonatal infection rate (LE1), even among women with a positive streptococcus B vaginal swab (LE2). Thus, expectant management can be offered without increasing the neonatal infection risk (Grade B). Induction with oxytocin was associated with a decreased risk of intra-uterine infection and postpartum fever in the TERMPROM study (LE2), however, this study had significant limitations concerning this outcome (unknown streptococcus B status and low rate of prophylactic antibiotics), and this association was not found in other smaller studies. This decrease was not observed with induction by prostaglandin E2. In the TERMPROM study, induction was not associated with an increase or decrease in the rate of cesarean section (LE2), whatever the parity (LE2) or Bishop score at admission (LE3). Induction can thus be proposed without increasing the cesarean section risk (Grade B). There is no study evaluating expectant management over 4 days.. In case of term prelabor rupture of membranes, induction can be offered without increasing the cesarean section risk (Grade B). Expectant management can be offered without increasing the neonatal infection risk (Grade B), even among women with a positive streptococcus B vaginal swab (Professional consensus). The optimal moment of induction will therefore be guided by the maternity wards organization and women's preference after having informed them of the risks and benefits associated with induction and expectant management (Professional consensus). In case of meconial fluid or term prelabor rupture of membranes>4 days, induction must be offered (Professional consensus).

Topics: Delivery, Obstetric; Dinoprostone; Female; Fetal Membranes, Premature Rupture; France; Humans; Infant, Newborn; Labor, Induced; MEDLINE; Misoprostol; Obstetrics; Oxytocics; Oxytocin; Pregnancy; Streptococcal Infections; Streptococcus agalactiae; Time Factors; Vagina

The clinical management of premature rupture of membranes (PROM) at term has been a matter of considerable controversy. Management options have included expectant management or induction of labor with oxytocin, dinoprostone (PGE2), or misoprostol. Early studies suggested that immediate oxytocin induction of labor might reduce maternal and neonatal infections while increasing risk for cesarean section. The definitive TermPROM study found no difference in neonatal infections between immediate and delayed induction with oxytocin and PGE2. However, neither PGE2 nor delayed induction resulted in fewer cesarean sections than immediate oxytocin. Misoprostol offers several theoretical advantages over oxytocin in the setting of PROM at term. However, randomized trials to date have found no significant advantage for misoprostol administration compared with other agents for women with PROM.

Topics: Cesarean Section; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Humans; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Physical Examination; Pregnancy; Randomized Controlled Trials as Topic; Streptococcal Infections

Topics: Adrenocorticotropic Hormone; Animals; Birth Order; Carbachol; Dexamethasone; Dichlorvos; Enterovirus Infections; Female; Fetal Death; Hemoglobins; Hypoxia; Leptospirosis; Obstetric Labor Complications; Oxytocin; Parvoviridae; Pregnancy; Prostaglandins; Rupture; Streptococcal Infections; Stress, Physiological; Swine; Swine Diseases; Umbilical Cord; Virus Diseases

Our purpose was to determine the effect of induction of labor on neonatal infection if mothers are group B streptococci positive and have prelabor rupture of membranes at term.. In the TermPROM study 5041 women were randomized to induction with intravenous oxytocin, induction with vaginal prostaglandin E2 gel, or expectant management with induction, if needed. Of these, 4834 women had vaginal or introital swabs for group B streptococci taken at entry. We used logistic regression to test for effects of treatment within group B streptococci subgroups.. Group B streptococci were predictive of neonatal infection for the induction with vaginal prostaglandin E2 gel and expectant groups but not for the induction with oxytocin group. For women positive for group B streptococci the rates of neonatal infection were 2.5% for the induction with oxytocin group and > 8% for all other groups.. Induction of labor with intravenous oxytocin may be preferable for group B streptococci-positive women with prelabor rupture of membranes at term.

Topics: Administration, Intravaginal; Dinoprostone; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Labor, Induced; Logistic Models; Oxytocin; Pregnancy; Streptococcal Infections; Streptococcus agalactiae; Vagina

We conducted a prospective randomized study involving 317 patients with term gestations (greater than 36 weeks) and premature rupture of membranes (PROM). Eighty-five percent of the 167 patients managed conservatively began labor within 48 hours. The cesarean section rate in this group was 7% as opposed to 21% in the group managed by oxytocin induction. There were no neonatal infections, and the maternal intrauterine infection rate was lower in the group managed expectantly, 4% vs 12%. There was no difference in the average time of hospitalization for the two groups. Conservative management of patients with PROM at term will significantly reduce the incidence of cesarean section without placing the mother or infant at a higher risk of infection.

Topics: Cesarean Section; Endometritis; Female; Fetal Diseases; Fetal Distress; Fetal Membranes, Premature Rupture; Fetal Monitoring; Humans; Infant, Newborn; Labor, Induced; Labor, Obstetric; Oxytocin; Pregnancy; Prospective Studies; Random Allocation; Streptococcal Infections; Streptococcus agalactiae; Time Factors

To determine the management of patients with term prelabor rupture of membranes.. Synthesis of the literature from the PubMed and Cochrane databases and the recommendations of French and foreign societies and colleges.. Term prelabor rupture of membranes is considered a physiological process up to 12hours of rupture (Professional consensus). In case of expectant management and with a low rate of antibiotic prophylaxis, home care compared to hospitalization could be associated with an increase in neonatal infections (LE3), especially in case of group B streptococcus colonization (LE3). Home care is therefore not recommended (Grade C). In the absence of spontaneous labor within 12hours of rupture, antibiotic prophylaxis could reduce the risk of maternal intrauterine infection but not of neonatal infection (LE3). Its use after 12hours of rupture in term prelabor rupture of the membranes is therefore recommended (Grade C). When antibiotic prophylaxis is indicated, intravenous beta-lactams are recommended (Grade C). Induction of labor with oxytocin (LE1), prostaglandin E2 (LE1) or misoprostol (LE1), is associated with shorter rupture of membranes to delivery intervals when compared to expectant management. Compared with expectant management, immediate induction of labor is not associated with lower rates of neonatal infection (LE1), even among women with a positive streptococcus B vaginal swab (LE2). Thus, expectant management can be offered without increasing the risk of neonatal infection (Grade B). Induction of labor is not associated with an increase or decrease in the cesarean delivery rate (LE2), whatever parity (LE2) or Bishop score at admission (LE3). Induction can thus be proposed without increasing the risk of cesarean delivery (Grade B). No induction method (oxytocin, dinoprostone, misoprostol or Foley® catheter) has demonstrated superiority over another, whether to reduce rate of intrauterine or neonatal infection, rate of cesarean delivery or to shorten rupture of membranes to delivery intervals regardless of Bishop's score and parity.. Term prelabor rupture of membranes is a frequent event. A 12-hour delay without onset of spontaneous labor was chosen to differentiate a physiological condition from a potentially unsafe situation justifying an antibiotic prophylaxis. Expectant management or induction of labor can both be proposed, even in case of positive screening for streptococcus B, depending on the patient's wishes and maternity units' organization (Professional consensus).

Topics: Antibiotic Prophylaxis; beta-Lactams; Dinoprostone; Female; Fetal Membranes, Premature Rupture; France; Humans; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Streptococcal Infections; Streptococcus agalactiae

Antibiotic regimens (intramammary antibiotic, penicillin-based parenteral treatment) and intramuscular oxytocin were tested for effectiveness against experimental infection by Streptococcus uberis with the following results from 54 animals: a) no treatment led to deterioration of infected quarters, requiring intervention within 48 h for cow health; b) aggressive intramammary antibiotic at every milking achieved 70% clinical cure in 3 d and 100% cure within 6 d; overall bacteriological cure was 80%; c) parenteral treatment alone used about 14 times as much antibiotic with 18% clinical cure in 3 d and 91% within 6 d; overall bacteriological cure was 80%; d) combination of aggressive intramammary and parenteral treatments achieved 61% clinical cure in 3 d and 100% within 6 d; overall bacteriological cure was 72%; e) intramammary antibiotic at labeled rates (1x for 3 d) achieved 27% clinical cure in 3 d but 91% within 6 d of treatment; overall bacteriological cure was 64%; f) use of oxytocin alone for 3 d failed to achieve clinical improvement with an increase in the severity of mastitis; g) combining oxytocin with labeled use of intramammary antibiotic (1x for 3 d) was unsuccessful: 0% clinical cures in 3 d, 10% in 6 d; significantly poorer than intramammary antibiotic alone. Extended treatment periods with parenteral or intramammary antibiotics resulted in positive inhibitory tests for milk from individual quarters up to 8 d after treatment. Aggressive intramammary antibiotic was the most effective treatment for fastest cure clinically and bacteriologically using least antibiotic.

Topics: Animals; Anti-Bacterial Agents; Cattle; Dose-Response Relationship, Drug; Female; Mastitis, Bovine; Milk; Oxytocin; Streptococcal Infections; Streptococcus; Time Factors; Treatment Outcome

Maternal fever is associated with chorioamnionitis and has been linked to labour epidural analgesia (LEA). The purpose of this study was to determine possible associations between LEA and chorioamnionitis, maternal fever, operative delivery rate, and neonatal outcome.. Data from 14,073 patients were entered into a database over a two-year period. From this database, 62 nulliparous parturients with clinical chorioamnionitis (amnionitis), but without LEA were identified (Group I). Two other groups who received LEA were matched for parity and gestation: Group II - LEA with concomitant amnionitis (n=50) and, Group III - LEA without concomitant amnionitis (n=201). The diagnosis of chorioamnionitis was confirmed by histologic examination. Results are expressed as mean +/- SD and analyzed at P <0.05 using ANOVA or Chi-square.. No differences were noted among the groups in the operative delivery rate or Apgar scores at five minutes. The percentage of patients with maternal fever during labour (38.0 degrees C) with amnionitis was significantly less in Group III compared to the other groups (100% in both Groups I and II vs 1.0% in Group III; P=0.000). Likewise, Group III had a lower percentage of neonates with Apgar scores <7 at one minute (35.5% in Group I, 20.0% in Group II, 17.4% in Group III; P=0.010). The percentage of histologic chorioamnionitis was significantly higher in both amnionitis groups compared to Group III (67.7% in Group I, 56.0% in Group II, 4.0% in Group III; P=0.000).. LEA without chorioamnionitis is not associated with maternal fever (38.0 degrees C), increased operative delivery rates or low Apgar scores.

Topics: Adult; Analgesia, Epidural; Analgesia, Obstetrical; Chorioamnionitis; Databases, Factual; Female; Fever; Humans; Infant, Newborn; Obstetric Labor Complications; Oxytocics; Oxytocin; Pregnancy; Pregnancy Outcome; Retrospective Studies; Streptococcal Infections

Mastitis was induced in dairy cows by infusion of 500 cfu of Streptococcus uberis into the mammary gland. Most infections developed to clinical disease, and the majority were predicted by changes in the electrical conductivity of the foremilk. The benefits of clinical prognosis and bacteriological cure were determined for cases that were treated when predicted to develop into clinical mastitis and compared with cases that were allowed to develop until milk clotted or until pyrexia before intramammary antibiotic treatment was used. Treatment prior to clinical mastitis included use of intramammary antibiotic or intramuscular oxytocin to allow stripping of residual milk to remove bacteria. All infections in which treatment was delayed resulted in clinical mastitis that was cured clinically and bacteriologically by sustained treatment using a broad-spectrum intramammary antibiotic preparation once daily but requiring a mean treatment time of 10 d. It was possible to prevent clinical mastitis from developing and to eliminate all infections in cows that were treated early when the developing disease was predicted by changes in the electrical conductivity of quarter foremilk and was treated aggressively by administering an intramammary antibiotic at each milking for 3 d. Treatment of 20 IU of oxytocin at six successive milkings of cows that were predicted to develop disease eliminated 25% of the infections, but 75% of the cows developed clinical mastitis. Those cases were resolved by sustained daily treatment using the same intramammary antibiotic. Elimination (100% clinical and bacteriological cure) of all infections caused by Strep. uberis was possible with early and aggressive or sustained use of the intramammary antibiotic. The early intervention using an intramammary antibiotic, when infection was first indicated by changes in the electrical conductivity of milk, was the most efficient method to achieve cure and led to quicker recovery of milk quality to a saleable standard.

Topics: Animals; Anti-Bacterial Agents; Cattle; Cell Count; Electric Conductivity; Female; Mastitis, Bovine; Milk; Oxytocin; Streptococcal Infections; Time Factors

A case-control study was used to (1) examine the intrapartum characteristics of term neonates with early-onset group B streptococcal sepsis and (2) determine what percentage of patients meet The American College of Obstetricians and Gynecologists guideline for intrapartum administration of antibiotics.. Twenty-one women delivered of term neonates who contracted early-onset group B streptococcal sepsis were matched with 63 mothers who were colonized with group B streptococci. The women were matched for race, age, parity, and gestational age. A Student t test and chi2 analysis were performed. Significance was defined as p < 0.05.. The attack rate was 2.1 instances of sepsis per 1000 live births. For both groups, the maternal demographics and the actual birth weights were similar. Case mothers compared with controls had longer labor (11.4 +/- 6.9 vs 5.8 +/- 4.3 hours, p < 0.0001), had longer time elapsed between rupture of membranes and delivery (10.3 +/- 6.4 vs 3.2 +/- 3.6 hours, p < 0.0001); required oxytocin more often (76% vs 32%, p < 0.001); required more pelvic examinations (6 or more; 71% vs 46%, p < 0.05); and had a significantly higher cesarean section rate (33% vs 3%; p < 0.001). Only 10% (2 of 21) of case mothers met The American College of Obstetricians and Gynecologists guideline for chemoprophylaxis.. The American College of Obstetricians and Gynecologists guideline for chemoprophylaxis identifies only 10% of women whose term newborns contract early-onset group B streptococcal sepsis.

Topics: Adult; Anti-Bacterial Agents; Cesarean Section; Delivery, Obstetric; Extraembryonic Membranes; Female; Humans; Infant, Newborn; Labor, Obstetric; Male; Oxytocin; Pregnancy; Sepsis; Streptococcal Infections; Time Factors

The aim of this field study was to examine the influence of the uterotonic substance oxytocin in 2 different therapeutic dosages of 15 and 25 i.u., respectively on the uterine drainage of oestrous mares and on their fertility. In addition endometrial biopsies of mares with and without intrauterine fluid accumulations around the time of ovulation were evaluated histomorphologically regarding the aetiology of susceptibility to uterine infection. A population of 59 Hanoverian Warmblood mares was used in this study. The mares were divided into Group A (mares with intrauterine fluid accumulations [n = 49]) and Group B (controls [n = 10]). Group A was further subdivided into 3 groups according to varying oxytocin administrations (none, 15 i.u., 25 i.u.). Prior to insemination, all mares were examined by rectal palpation, ultrasonography and vaginal inspection. In addition, hormone plasma concentrations were evaluated at the time of ovulation, namely oestradiol and progesterone concentrations. Endometrial biopsies were obtained from all mares. Endometrial samples for microbiological and cytological evaluation were taken from mares of Group A only. All mares were inseminated close to ovulation during the first cycle. This study shows that intravenous oxytocin treatment of mares with intrauterine fluid accumulations results in better pregnancy rates than no treatment.

Topics: Animals; Biopsy; Endometrium; Epithelial Cells; Epithelium; Escherichia coli; Escherichia coli Infections; Estradiol; Estrus; Female; Fertility; Horse Diseases; Horses; Ovulation; Oxytocin; Pregnancy; Pregnancy Rate; Progesterone; Staphylococcal Infections; Staphylococcus; Streptococcal Infections; Streptococcus; Uterus