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Tenne Y, Kahalon R, Daari L, Preis H, Eisner M, Chen R, Mor P, Grisaru Granovsky S, Samueloff A, Benyamini Y. Is Oxytocin Administration During Childbirth Associated With Increased Risk for Postpartum Posttraumatic Stress Symptoms?: A Preliminary Investigation. J Perinat Neonatal Nurs 2023:00005237-990000000-00026. [PMID: 38050984 DOI: 10.1097/jpn.0000000000000760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Synthetic oxytocin is one of the most regularly administered medications to facilitate labor induction and augmentation. The present study examined the associations between oxytocin administration during childbirth and postpartum posttraumatic stress symptoms (PTSS). MATERIALS AND METHODS In a multicenter longitudinal study, women completed questionnaires during pregnancy and at 2 months postpartum (N = 386). PTSS were assessed with the Impact of Event Scale. Logistic regression was used to examine the difference in PTSS at Time 2 between women who received oxytocin and women who did not. RESULTS In comparison with women who did not receive oxytocin, women who received oxytocin induction were 3.20 times as likely to report substantial PTSS (P = .036, 95% confidence interval: 1.08-9.52), and women who received oxytocin augmentation were 3.29 times as likely to report substantial PTSS (P = .036, 95% confidence interval: 1.08-10.03), after controlling for being primiparous, preeclampsia, prior mental health diagnosis, mode of birth, postpartum hemorrhage, and satisfaction with staff. DISCUSSION Oxytocin administration was associated with a 3-fold increased risk of PTSS. The findings may reflect biological and psychological mechanisms related to postpartum mental health and call for future research to establish the causation of this relationship.
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Affiliation(s)
- Yaara Tenne
- Department of Pediatrics, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (Dr Tenne); The Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel (Drs Tenne, Preis, and Benyamini and Ms Daari); The Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel (Dr Kahalon); Department of Psychology, Stony Brook University, Stony Brook, New York (Dr Preis); Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Drs Eisner and Chen); Department of Obstetrics and Gynecology, Medical Genetics Institute, Shaare Zedek Medical Center, and Hebrew University Medical School of Jerusalem, Jerusalem, Israel (Dr Mor); and Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, and Hebrew University Medical School of Jerusalem, Jerusalem, Israel (Drs Grisaru Granovsky and Samueloff)
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Cormier J, Merrer J, Blondel B, Le Ray C. Influence of the maternity unit and region of delivery on episiotomy practice in France: a nationwide population-based study. Acta Obstet Gynecol Scand 2023; 102:438-449. [PMID: 36852493 PMCID: PMC10008350 DOI: 10.1111/aogs.14522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Our objective was to identify factors associated with episiotomy practice in France, in particular, characteristics of the maternity units and regions of delivery. MATERIAL AND METHODS We performed a national cross-sectional population-based study in all French maternity units in 2016 including 9284 women with vaginal delivery. Our outcome was the performance of an episiotomy. After stratification for parity, associations of episiotomy practice with individual and organizational characteristics and the region of delivery were estimated with multilevel logistic regression models. The variability in maternity unit episiotomy rates explained by the characteristics studied was estimated by the proportional change in variance. RESULTS A total of 19.9% of the women had an episiotomy. The principal factors associated with episiotomy practice were maternal and obstetric and delivery in a maternity unit with <2000 annual deliveries. After adjusting for individual, obstetric and organizational characteristics, the practice of episiotomy was strongly associated with women's region of delivery. Additionally, women's individual characteristics did not explain the significant variability in episiotomy rates between maternity units (P < 0.001) but maternity unit characteristics partly did (proportion of variance explained: 7.2% for primiparas and 13.6% for multiparas) and regional differences still more (18% and 30.7%, respectively). CONCLUSIONS Episiotomy practices in France in 2016 varied strongly between maternity units, largely due to regional differences. Targeted actions by the regional perinatal care networks may reduce the national episiotomy rate and standardize practices.
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Affiliation(s)
- Julie Cormier
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and StatisticsUniversité de Paris, INSERM, INRAParisFrance
- Port‐Royal Maternity, AP‐HPHôpital Cochin, FHU PREMAParisFrance
| | - Jade Merrer
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and StatisticsUniversité de Paris, INSERM, INRAParisFrance
- Clinical Epidemiology Unit, Robert Debré HospitalAssistance Publique‐Hôpitaux de ParisParisFrance
| | - Béatrice Blondel
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and StatisticsUniversité de Paris, INSERM, INRAParisFrance
| | - Camille Le Ray
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and StatisticsUniversité de Paris, INSERM, INRAParisFrance
- Port‐Royal Maternity, AP‐HPHôpital Cochin, FHU PREMAParisFrance
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Abou-Dakn M, Schäfers R, Peterwerth N, Asmushen K, Bässler-Weber S, Boes U, Bosch A, Ehm D, Fischer T, Greening M, Hartmann K, Heller G, Kapp C, von Kaisenberg C, Kayer B, Kranke P, Lawrenz B, Louwen F, Loytved C, Lütje W, Mattern E, Nielsen R, Reister F, Schlösser R, Schwarz C, Stephan V, Kalberer BS, Valet A, Wenk M, Kehl S. Vaginal Birth at Term - Part 1. Guideline of the DGGG, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/083, December 2020). Geburtshilfe Frauenheilkd 2022; 82:1143-1193. [PMID: 36339636 PMCID: PMC9633231 DOI: 10.1055/a-1904-6546] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 07/16/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose This guideline aims to summarize the current state of knowledge about vaginal birth at term. The guideline focuses on definitions of the physiological stages of labor as well as differentiating between various pathological developments and conditions. It also assesses the need for intervention and the options to avoid interventions. This first part presents recommendations and statements about patient information and counselling, general patient care, monitoring of patients, pain management and quality control measures for vaginal birth. Methods The German recommendations largely reproduce the recommendations of the National Institute for Health and Care Excellence (NICE) CG 190 guideline "Intrapartum care for healthy women and babies". Other international guidelines were also consulted in specific cases when compiling this guideline. In addition, a systematic search and analysis of the literature was carried out using PICO questions, if this was considered necessary, and other systematic reviews and individual studies were taken into account. For easier comprehension, the assessment tools of the Scottish Intercollegiate Guidelines Network (SIGN) were used to evaluate the quality of the additionally consulted studies. Otherwise, the GRADE system was used for the NICE guideline and the evidence reports of the IQWiG were used to evaluate the quality of the evidence. Recommendations Recommendations and statements were formulated based on identified evidence and/or a structured consensus.
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Affiliation(s)
- Michael Abou-Dakn
- Klinik für Gynäkologie und Geburtshilfe, St. Joseph Krankenhaus, Berlin-Tempelhof, Berlin, Germany,Correspondence Prof. Dr. med. Michael Abou-Dakn Klinik für Gynäkologie und GeburtshilfeSt. Joseph Krankenhaus
Berlin-TempelhofWüsthoffstraße 1512101
BerlinGermany
| | - Rainhild Schäfers
- Hochschule für Gesundheit Department für Angewandte Gesundheitswissenschaften Bochum, Bochum, Germany,Prof. Dr. Rainhild Schäfers Hochschule für GesundheitDepartment für Angewandte
GesundheitswissenschaftenGesundheitscampus 6 – 844801
BochumGermany
| | - Nina Peterwerth
- Hochschule für Gesundheit Department für Angewandte Gesundheitswissenschaften Bochum, Bochum, Germany
| | - Kirsten Asmushen
- Gesellschaft für Qualität in der außerklinischen Geburtshilfe e. V., Storkow, Germany
| | | | | | - Andrea Bosch
- Duale Hochschule Baden-Württemberg Angewandte Hebammenwissenschaft, Stuttgart, Germany
| | - David Ehm
- Frauenarztpraxis Bern, Bern, Switzerland
| | - Thorsten Fischer
- Dept. of Gynecology and Obstetrics Paracelcus Medical University, Salzburg, Austria
| | - Monika Greening
- Hochschule für Wirtschaft und Gesellschaft, Hebammenwissenschaften – Ludwigshafen, Ludwigshafen, Germany
| | | | - Günther Heller
- Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, Berlin, Germany
| | - Claudia Kapp
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Constantin von Kaisenberg
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Medizinische Hochschule Hannover, Hannover, Germany
| | - Beate Kayer
- Fachhochschule Burgenland, Studiengang Hebammen, Pinkafeld, Austria
| | - Peter Kranke
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Germany
| | | | - Frank Louwen
- Frauenklinik, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Christine Loytved
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Wolf Lütje
- Institut für Hebammen, Departement Gesundheit, Zürcher Hochschule für Angewandte Wissenschaften ZHAW, Winterthur, Switzerland
| | - Elke Mattern
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Renate Nielsen
- Ev. Amalie Sieveking Krankenhaus – Immanuel Albertinen Diakonie Hamburg, Hamburg, Germany
| | - Frank Reister
- Frauenklinik, Universitätsklinikum Ulm, Ulm, Germany
| | - Rolf Schlösser
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Christiane Schwarz
- Institut für Gesundheitswissenschaften FB Hebammenwissenschaft, Lübeck, Germany
| | - Volker Stephan
- Deutsche Gesellschaft für Kinder- und Jugendmedizin e. V., Köln, Germany
| | | | - Axel Valet
- Frauenklinik Dill Kliniken GmbH, Herborn, Germany
| | - Manuel Wenk
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie Kaiserwerther Diakonie, Düsseldorf, Germany
| | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
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Oxytocin Administration in Low-Risk Women, a Retrospective Analysis of Birth and Neonatal Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084375. [PMID: 33924137 PMCID: PMC8074312 DOI: 10.3390/ijerph18084375] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 12/24/2022]
Abstract
Background: In recent years, higher than the recommended rate of oxytocin use has been observed among low-risk women. This study examines the relationship between oxytocin administration and birth outcomes in women and neonates. Methods: A retrospective analysis of birth and neonatal outcomes for women who received oxytocin versus those who did not. The sample included 322 women with a low-risk pregnancy. Results: Oxytocin administration was associated with cesarean section (aOR 4.81, 95% CI: 1.80–12.81), instrumental birth (aOR 3.34, 95% CI: 1.45–7.67), episiotomy (aOR 3.79, 95% CI: 2.20–6.52) and length of the second stage (aOR 00:18, 95% CI: 00:04–00:31). In neonatal outcomes, oxytocin in labor was associated with umbilical artery pH ≤ 7.20 (OR 3.29, 95% CI: 1.33–8.14). Admission to neonatal intensive care unit (OR 0.56, 95% CI: 0.22–1.42), neonatal resuscitation (OR 1.04, 95% CI: 0.22–1.42), and Apgar score <7 (OR 0.48, 95% CI: 0.17–1.33) were not associated with oxytocin administration during labor. Conclusions: Oxytocin administration during labor for low-risk women may lead to worse birth outcomes with an increased risk of instrumental birth and cesarean, episiotomy and the use of epidural analgesia for pain relief. Neonatal results may be also worse with an increased proportion of neonates displaying an umbilical arterial pH ≤ 7.20.
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Girault A, Blondel B, Goffinet F, Le Ray C. Frequency and determinants of misuse of augmentation of labor in France: A population-based study. PLoS One 2021; 16:e0246729. [PMID: 33561131 PMCID: PMC7872232 DOI: 10.1371/journal.pone.0246729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 01/25/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction While use of augmentation of labor (AL) is appropriate for labor dystocia, it is frequently used inadequately and unnecessarily. The objective was to assess at a national level, the frequency and determinants of misuse of augmentation of labor (AL). Material and methods Women of the French perinatal survey of 2016 with a singleton cephalic fetus, delivering at term after a spontaneous labor were included. “Misuse of AL” was defined by artificial rupture of the membranes (ROM) and/or oxytocin within one hour of admission and/or duration between ROM and oxytocin of less than one hour. Women, labor and maternity unit’s characteristics were compared between the “misuse of AL” and “no misuse of AL” groups by bivariate analysis. To identify the determinants of misuse of AL, a multivariable multilevel logistic regression was performed taking into account the data’s hierarchical structure (first level: women, second level: maternity units). Results Among the 7196 women included, 1524 (21.2%) had a misuse of AL. The determinants of misuse of AL were middle school educational level (reference high school), aOR = 1.21; 95%CI[1.01–1.45], gestational age at delivery ≥41weeks (reference 39–40 weeks), aOR = 1.19; 95%CI[1.00–1.42], cervical dilation ≥6cm at admission (reference <3cm), aOR = 1.39; 95%CI[1.10–1.76], epidural analgesia aOR = 1.63; 95%CI[1.35–1.96], delivery in a private hospital (reference public teaching hospital), aOR = 2.25; 95%CI[1.57–3.23]; and maternity units with <1000 deliveries/year and 1000–1999 deliveries/year (reference ≥3000 deliveries/year), respectively aOR = 1.52; 95%CI[1.11–2.08] and aOR = 1.42; 95%CI[1.05–1.92]. Less than 3% of the variance was explained by women characteristics, and 24.17% by the maternity units’ characteristics. Conclusions In France, one spontaneous laboring woman among five is subject to misuse of AL. The misuse is mostly explained by maternity unit’s characteristics. The determinants identified in this study can be used to implement targeted actions in small and private maternity units.
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Affiliation(s)
- Aude Girault
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, Paris, France
- Maternité Port Royal, AP-HP, Hôpital Cochin, FHU PREMA, Paris, France
- * E-mail:
| | - Béatrice Blondel
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, Paris, France
| | - François Goffinet
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, Paris, France
- Maternité Port Royal, AP-HP, Hôpital Cochin, FHU PREMA, Paris, France
| | - Camille Le Ray
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, Paris, France
- Maternité Port Royal, AP-HP, Hôpital Cochin, FHU PREMA, Paris, France
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Delorme P, Kayem G, Legardeur H, Roux-Dessarps LA, Girard G, Meunier G, Keita H, Mandelbrot L. Carbetocin versus Oxytocin for the Prevention of Postpartum Hemorrhage in Cesarean Deliveries: A Retrospective Study of Two Consecutive Periods. AJP Rep 2020; 10:e241-e246. [PMID: 33133760 PMCID: PMC7591351 DOI: 10.1055/s-0040-1715163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/09/2020] [Indexed: 12/05/2022] Open
Abstract
Objective The aim of the study is to investigate whether carbetocin prevents postpartum hemorrhage (PPH) more effectively than oxytocin Methods This historical retrospective single-center cohort study compares women who underwent cesarean deliveries during two periods. During period A, oxytocin was used as a 10-unit bolus immediately after delivery, with 20 units thereafter infused for 24 hours. During period B, carbetocin in a single 100-µg injection replaced this protocol. The main outcome was PPH, defined as a decline in hemoglobin of more than 2 g/dL after the cesarean. The analysis was performed on the overall population and then stratified by the timing of the cesareans (before or during labor). A logistic regression analysis was performed. Results This study included 1,796 women, 52% of whom had a cesarean before labor; 15% had a PPH. The crude PPH rate was lower in period B than in period A (13 vs. 17%, respectively, odds ratio 0.75, 95% confidence interval [CI]: 0.58-0.98). The difference was no longer significant in the multivariate analysis (adjusted odds ratio: 0.81, 95% CI 0.61-1.06). Results were similar when stratified by the timing of the cesareans (before or during labor). Conclusion Carbetocin is not superior to oxytocin in preventing PPH. However, it does provide the advantage of requiring a single injection.
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Affiliation(s)
- Pierre Delorme
- Department of Obstetrics and Gynecology, Trousseau Hospital, FHU Prema, Paris, France
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
- Paris Sorbonne University, Paris, France
| | - Gilles Kayem
- Department of Obstetrics and Gynecology, Trousseau Hospital, FHU Prema, Paris, France
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
- Paris Sorbonne University, Paris, France
- Department of Obstetrics and Gynecology, Louis Mourier Hospital, FHU Prema, Paris, France
| | - Hélène Legardeur
- Department of Obstetrics and Gynecology, Louis Mourier Hospital, FHU Prema, Paris, France
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland
| | - Louise Anne Roux-Dessarps
- Department of Obstetrics and Gynecology, Louis Mourier Hospital, FHU Prema, Paris, France
- Department of Obstetrics and Gynecology, Centre Hospitalier Simone-Veil, Eaubonne, France
| | - Guillaume Girard
- Department of Obstetrics and Gynecology, Trousseau Hospital, FHU Prema, Paris, France
- Department of Obstetrics and Gynecology, Louis Mourier Hospital, FHU Prema, Paris, France
| | - Geraldine Meunier
- Department of Obstetrics and Gynecology, Louis Mourier Hospital, FHU Prema, Paris, France
| | - Hawa Keita
- Department of Obstetric Anesthesia-Intensive Care, Louis Mourier Hospital, Paris, France
- Department of Pediatric and Obstetric Anesthesia-Intensive Care, Necker Enfants Malades Hospital, APHP, Paris, France
- Paris University, Paris, France
| | - Laurent Mandelbrot
- Department of Obstetrics and Gynecology, Louis Mourier Hospital, FHU Prema, Paris, France
- Paris University, Paris, France
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Association of Oxytocin Use and Artificial Rupture of Membranes With Cesarean Delivery in France. Obstet Gynecol 2020; 135:436-443. [DOI: 10.1097/aog.0000000000003618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Firmin M, Carles G, Mence B, Madhusudan N, Faurous E, Jolivet A. Postpartum hemorrhage: incidence, risk factors, and causes in Western French Guiana. J Gynecol Obstet Hum Reprod 2018; 48:55-60. [PMID: 30476677 DOI: 10.1016/j.jogoh.2018.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/20/2018] [Accepted: 11/22/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Postpartum hemorrhage remains the leading cause of maternal death in France. Parturients in western French Guiana have specific sociodemographic features and a high rate of pathological pregnancies. The objective of this study was to determine the incidence of immediate postpartum hemorrhage (IPPH) in western French Guiana, and to describe the etiologies and risk factors. METHODS A case control study with incident cases was conducted in the Maternity Department of the Western French Guiana Hospital over a period of one year. The cases included women giving birth to a child of 22 weeks' GA and/or a child weighing 500 g, and who presented with IPPH. Two control subjects were included per case (after pairing for mode of delivery). The data were collected by questionnaire and from medical records. Multivariate analyses by logistic regression were conducted. RESULTS 154 cases and 308 controls were included. The incidence rate of IPPH was 6.7%. The primary etiologies were: atony, placenta retention, and cervico-vaginal lesions. The factors associated with IPPH were: past history of IPPH (ORadj = 3.36 [1.65-6.87]), pre-eclampsia (ORadj = 2.56 [1.07-6.14]), labor induction by oxytocin (ORadj = 2.03 [1.03-3.99]), the absence of managed placental delivery (ORadj = 2.46 [1.24-4.91]), a gap of more than 30 min between birth and placental delivery (ORadj = 10.92 [2.17-54.99]), and macrosomia (ORadj = 6.38 [1.97-20.67]). CONCLUSION The incidence rate of IPPH is similar to that found in metropolitan France and in the literature. The risk factors identified here will enable the development of appropriate preventive protocols.
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Affiliation(s)
- Mathilde Firmin
- Department of Gynecology and Obstetrics, Centre Hospitalier de l'Ouest Guyanais, Saint-Laurent du Maroni, French Guiana.
| | - Gabriel Carles
- Department of Gynecology and Obstetrics, Centre Hospitalier de l'Ouest Guyanais, Saint-Laurent du Maroni, French Guiana
| | - Bénédicte Mence
- Department of Gynecology and Obstetrics, Centre Hospitalier de l'Ouest Guyanais, Saint-Laurent du Maroni, French Guiana
| | - Nikila Madhusudan
- Department of Gynecology and Obstetrics, Centre Hospitalier de l'Ouest Guyanais, Saint-Laurent du Maroni, French Guiana
| | - Emilie Faurous
- Department of Gynecology and Obstetrics, Centre Hospitalier de l'Ouest Guyanais, Saint-Laurent du Maroni, French Guiana
| | - Anne Jolivet
- Department of Public Health, Centre Hospitalier de l'Ouest Guyanais, Saint-Laurent du Maroni, French Guiana; INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et Santé Publique, Department of Social Epidemiology, Paris, France
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Isidore J, Rousseau A. Administration of oxytocin during spontaneous labour: A national vignette-based study among midwives. Midwifery 2018; 62:214-219. [PMID: 29715598 DOI: 10.1016/j.midw.2018.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/20/2018] [Accepted: 04/15/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE (1) to assess variations in oxytocin use by midwives during spontaneous labour (indication, dose, moment), and (2) to identify factors potentially associated with oxytocin administration. DESIGN descriptive cross-sectional study using a case-vignette and questionnaire among French midwives from November 2015 to May 2016. METHODS Midwives were asked to complete an online survey including a case-vignette with hourly partograms of a slowly progressing labour, and a short self-administered questionnaire. Two choices were proposed with each hourly partogram: administration of oxytocin or expectant management. Midwives who selected oxytocin were then asked about the dose, dose-increment and dose-increase delay. The questionnaire asked the midwives about work experience, day or night work, and organisational factors. FINDINGS The study included 204 midwives. At some point during the case-vignette, 159 (77.9%) midwives responded that they would use oxytocin. Answers demonstrated variations in oxytocin administration for initial doses, dose-increments and dose-increase delays. Specifically, a substantial majority of respondents chose high doses of oxytocin (64.1% at doses exceeding 2 mIU/min) and short dose-increase delays (62.9% under 30 min). Excessive administration of oxytocin by midwives was significantly associated with the number of births per year in their maternity unit, midwives' workload (p < 0.001), overload of delivery rooms (p < 0.001) and lack of protocol (22% versus 55.6%, p < 0.001). Midwives considered that their use of oxytocin was related mainly to an overburdened department (48.5%). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE We observed overuse of oxytocin, influenced by organisational factors. Every maternity unit should implement a protocol and/or checklist for oxytocin administration to reduce variation in practice and improve safety of care by using evidence-based clinical indications, initial doses, dose-increments and dose-increase delays. Modifying the organisation of care appears necessary to reduce hospital patient volume or increase staffing to ensure that the number of midwives on duty matches the activity in the delivery room without causing excess work or stress to midwives.
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Affiliation(s)
- Johanne Isidore
- Department of Midwifery, Versailles-St Quentin en Yvelines University, UFR des Sciences de la Santé Simone Veil, 2 avenue de la source de la Bièvre, 78180 Montigny le Bretonneux, France.
| | - Anne Rousseau
- Department of Midwifery, Versailles-St Quentin en Yvelines University, UFR des Sciences de la Santé Simone Veil, 2 avenue de la source de la Bièvre, 78180 Montigny le Bretonneux, France; Research Unit EA 7285, Versailles-St Quentin University, UFR des Sciences de la Santé Simone Veil, 2 avenue de la source de la Bièvre, 78180 Montigny le Bretonneux, France .
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Bischoff K, Nothacker M, Lehane C, Lang B, Meerpohl J, Schmucker C. Lack of controlled studies investigating the risk of postpartum haemorrhage in cesarean delivery after prior use of oxytocin: a scoping review. BMC Pregnancy Childbirth 2017; 17:399. [PMID: 29187156 PMCID: PMC5708177 DOI: 10.1186/s12884-017-1584-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/20/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Postpartum haemorrhage (PPH) is a major cause of maternal mortality and morbidity worldwide. Experimental and clinical studies indicate that prolonged oxytocin exposure in the first or second stage of labour may be associated with impaired uterine contractility and an increased risk of atonic PPH. Therefore, particularly labouring women requiring cesarean delivery constitute a subset of patients that may exhibit an unpredictable response to oxytocin. We mapped the evidence for comparative studies investigating the hypothesis whether the risk for PPH is increased in women requiring cesarean section after induction or augmentation of labour. METHODS We performed a systematic literature search for clinical trials in Medline, Embase, Web of Science, and the Cochrane Library (May 2016). Additionally we searched for ongoing or unpublished trials in clinicaltrials.gov and the WHO registry platform. We identified a total of 36 controlled trials investigating the exogenous use of oxytocin in cesarean section. Data were extracted for study key characteristics and the current literature literature was described narratively. RESULTS Our evidence map shows that the majority of studies investigating the outcome PPH focused on prophylactic oxytocin use compared to other uterotonic agents in the third stage of labour. Only 2 dose-response studies investigated the required oxytocin dose to prevent uterine atony after cesarean delivery for labour arrest. These studies support the hypotheses that labouring women exposed to exogenous oxytocin require a higher oxytocin dose after delivery than non-labouring women to prevent uterine atony after cesarean section. However, the study findings are flawed by limitations of the study design as well as the outcome selection. No clinical trial was identified that directly compared exogenous oxytocin versus no oxytocin application before intrapartum cesarean delivery. CONCLUSION Despite some evidence from dose-response studies that the use of oxytocin may increase the risk for PPH in intrapartum cesarean delivery, current research has not investigated the prepartal application of oxytocin in well controlled clinical trials. It was striking that most studies on exogenous oxytocin are focused on PPH prophylaxis in the third stage of labour without differing between the indications of cesarean section and hence the prepartal oxytocin status.
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Affiliation(s)
- Karin Bischoff
- Cochrane Germany, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Monika Nothacker
- AWMF-Institute for Medical Knowledge Management (IMWi), Karl-von-Frisch-Street 1, 35043 Marburg, Germany
| | - Cornelius Lehane
- Department of Anesthesiology and Critical Care, University Heart Center Freiburg-Bad Krozingen, Medical Center - University of Freiburg, Freiburg, Germany
| | - Britta Lang
- Cochrane Germany, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Joerg Meerpohl
- Cochrane Germany, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christine Schmucker
- Cochrane Germany, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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11
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Huet J, Beucher G, Geoffroy L, Morello R, Benoist G, Dreyfus M. Intervention of the obstetrician during childbirth in a supposedly low-risk population and influence of parity. J Gynecol Obstet Hum Reprod 2017. [PMID: 28643664 DOI: 10.1016/j.jogoh.2017.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Compare obstetrician intervention and calling rates during labour and delivery between low-risk and high-risk women and study the influence of parity on these rates. MATERIAL AND METHODS Descriptive retrospective study conducted on 227 patients in a university maternity unit (level 3 university hospital maternity unit) between 1st and 30th January 2014. The low- and high-risk populations were characterised according to the French National Authority for Health (HAS) and NICE guidelines. The obstetrician intervention criteria were: Caesarean section, instrumental vaginal delivery, artificial delivery/uterus examination and postpartum haemorrhage. The obstetrical team also had to call the obstetrician in case of foetal heart rate abnormalities, scalp blood pH measurement, third and/or fourth degree perineal tears, labour dystocia, or any other severe event occurring during labour or delivery. RESULTS In univariate analysis, the obstetrician intervention rates were respectively 44.5% and 34.4% in the high- and low-risk groups (P=0.13). The obstetrician calling rates were similar between the two groups. Using logistic regression model including parity, the obstetrician intervention rate became significantly higher in the "high-risk" group (OR 2.044, 95% CI 1.129-3.703, P=0.018). In the low-risk population, the intervention rate was significantly increased for nulliparous women compared with multiparas (47.5% versus 9.7%, P<0.001, OR=8.2, CI 95% 2.2 to 46.9). CONCLUSION One third of the women defined as low-risk patients appear to need an obstetrician intervention during labour and delivery, with a major influence of parity.
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Affiliation(s)
- J Huet
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, 14033 Caen, France; Université de Caen, 14000 Normandie, France.
| | - G Beucher
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, 14033 Caen, France
| | - L Geoffroy
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, 14033 Caen, France
| | - R Morello
- Unité de biostatistique et recherche clinique, CHU de Caen, 14033 Caen, France
| | - G Benoist
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, 14033 Caen, France; Université de Caen, 14000 Normandie, France
| | - M Dreyfus
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, 14033 Caen, France; Université de Caen, 14000 Normandie, France
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Dupont C, Carayol M, Le Ray C, Deneux-Tharaux C, Riethmuller D. Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Guidelines short text. J Gynecol Obstet Hum Reprod 2017; 46:539-543. [DOI: 10.1016/j.jogoh.2017.04.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Coulm B, Tessier V. Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 4: Oxytocin efficiency according to implementation in insufficient spontaneous labor. J Gynecol Obstet Hum Reprod 2017; 46:499-507. [PMID: 28526519 DOI: 10.1016/j.jogoh.2017.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- B Coulm
- Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité (CRESS), University Hospital Department "Risks in Pregnancy", université Paris Descartes, 53, avenue de l'Observatoire, 75014 Paris, France.
| | - V Tessier
- University Hospital Department "Risks in Pregnancy", AP-HP, HUPC-AP-HP, 53, avenue de l'Observatoire, 75014 Paris, France.
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Fischer C. Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 7: Epidural analgesia and use of oxytocin during spontaneous labor. J Gynecol Obstet Hum Reprod 2017; 46:531-538. [PMID: 28476692 DOI: 10.1016/j.jogoh.2017.04.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- C Fischer
- Service anesthésie réanimation chirurgicale, hôpital Cochin Port Royal, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
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15
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Dupont C, Carayol M, Le Ray C, Deneux-Tharaux C, Riethmuller D. Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Introduction and methodology. J Gynecol Obstet Hum Reprod 2017; 46:465-467. [PMID: 28473288 DOI: 10.1016/j.jogoh.2017.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- C Dupont
- AURORE perinatal network, 69004 Lyon, France; Pôle IMER, Lyon university hospital, 69003 Lyon, France; EA 7425, Health Services and Performance Research (HESPER), University Lyon, Claude-Bernard Lyon 1 University, 69008 Lyon, France.
| | - M Carayol
- Mother and child protection services, Paris Direction of Family and Early Childhood, Paris City Hall, 75196 Paris, France
| | - C Le Ray
- Port-Royal Maternity Unit, Cochin Hospital, AP-HP, DHU Risks in Pregnancy, Paris Descartes University, 75014 Paris, France; Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in pregnancy, Paris Descartes University, 75014 Paris, France
| | - C Deneux-Tharaux
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in pregnancy, Paris Descartes University, 75014 Paris, France
| | - D Riethmuller
- Besançon University Hospital, 3, boulevard Fleming, 25000 Besançon, France
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Gaucher L, Le Ray C. Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 2: Indications of oxytocin according the first and second stages of spontaneous labor. J Gynecol Obstet Hum Reprod 2017; 46:479-487. [PMID: 28473289 DOI: 10.1016/j.jogoh.2017.04.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- L Gaucher
- Hôpital Femme-Mère-Enfant, Lyon University Hospital (HCL), 69500 Bron, France; HESPER EA 7425, Lyon University, University Claude-Bernard Lyon 1, 69008 Lyon, France; Centre of Medical Information and Research Evaluation (IMER), Lyon University Hospital (HCL), 69003 Lyon, France.
| | - C Le Ray
- Port Royal Maternity, Hôpitaux Universitaires Paris Centre, AP-HP, Paris Descartes University, 75014 Paris, France; Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), center for epidemiology and statistics Sorbonne Paris Cité, 75014 Paris, France; DHU risks in pregnancy, 75014 Paris, France
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Kayem G, Deneux-Tharaux C. [Increased risk of maternal death by postpartum hemorrhage in France: Are French practices involved?]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2017; 45:259-261. [PMID: 28479074 DOI: 10.1016/j.gofs.2017.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Indexed: 06/07/2023]
Affiliation(s)
- G Kayem
- Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale périnatale et pédiatrique (EPOPé), centre de recherche en épidémiologie et statistiques Sorbonne Paris Cité, DHU risques et grossesse, Paris-Descartes université, 53, avenue de l'Observatoire, 75014 Paris, France; Service de gynécologie obstétrique, hôpital Trousseau, université Pierre-et-Marie-Curie, AP-HP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France.
| | - C Deneux-Tharaux
- Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale périnatale et pédiatrique (EPOPé), centre de recherche en épidémiologie et statistiques Sorbonne Paris Cité, DHU risques et grossesse, Paris-Descartes université, Paris, France
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18
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Rousseau A, Burguet A. Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 5: Maternal risk and adverse effects of using oxytocin augmentation during spontaneous labor. J Gynecol Obstet Hum Reprod 2017; 46:509-521. [PMID: 28473291 DOI: 10.1016/j.jogoh.2017.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- A Rousseau
- Département de Maïeutique, UFR des Sciences de la Santé Simone-Veil, Université Versailles-Saint-Quentin, 78180 Montigny-le-Bretonneux, France; EA 7285 RISCQ, UFR des Sciences de la Santé Simone-Veil, Université Versailles-Saint-Quentin, 78180 Montigny-le-Bretonneux, France.
| | - A Burguet
- Pédiatrie 2, CHU de Dijon, 21030 Dijon cedex, France; Réseau Périnatal Franche-Comté, CHU de Besançon, 25030 Besançon cedex, France
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Invasive therapies for primary post-partum haemorrhage as missed opportunities for medical prevention. Curr Opin Obstet Gynecol 2017; 29:66-70. [PMID: 28253206 DOI: 10.1097/gco.0000000000000349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Examine the available results from population-based studies to test the hypothesis that differences between countries in medical practices for the management of labour, delivery and early bleeding may lead to a differential risk of post-partum haemorrhage (PPH)-related maternal morbidity and in the need for PPH-related invasive therapies. RECENT FINDINGS International comparison of ratios of maternal mortality due to PPH shows significant differences between developed countries. Direct international comparisons of PPH rates to investigate these differences are difficult because PPH definition is not homogeneous. One widely used proxy for severe PPH is the use of secondary invasive procedures for PPH treatment. Comparative analysis of results from population-based studies shows wide variations in the rates of invasive therapies for PPH across countries and suggests that high rates of such therapies may be explained partly by variations in practices for the management of first and third stages of labour and in the noninvasive steps of PPH treatment. SUMMARY Invasive therapies for PPH may be considered markers of missed opportunities for primary or secondary prevention of PPH. Management of first and third stages of labour as well as the early steps of PPH treatment are important keys to prevent severe maternal complications of PPH and the need for invasive therapies.
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Selmani C, Chabane D, Bouguedoura N. ETHNOBOTANICAL SURVEY OF PHOENIX DACTYLIFERA L. POLLEN USED FOR THE TREATMENT OF INFERTILITY PROBLEMS IN ALGERIAN OASES. AFRICAN JOURNAL OF TRADITIONAL, COMPLEMENTARY, AND ALTERNATIVE MEDICINES 2017; 14:175-186. [PMID: 28480429 PMCID: PMC5412223 DOI: 10.21010/ajtcam.v14i3.19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: The Phoenix dactylifera L. (date palm) is known for its traditional medicinal properties across the history of native population in Algerian Sahara. There is a large trend of consumption of date palm pollen preparations in many human infertility cases in our country. However, the validity has not been scientifically tested. There has been no direct scientific research on this application. This study was undertaken to identify cultivars with greater potential in the traditional medicine uses. To evaluate the effects of date palm pollen on some sexual behavioural parameters of male adult rats, we tested the role of pollen powder from Deglet Nour cultivar on some male reproductive parameters. Materials and Methods: An Ethnobotanical survey was conducted in 17 oases in southern Algeria to identify all cultivars with medicinal interest. Local people were interviewed with open questions. A questionnaire and personal interviews for data collection were designed to record important cultivars, parts used and preparations. To determine the active constituents of date palm pollen used in traditional medicine, a phytochemical screening was performed. The effects of oral administration of date palm pollen suspension on male adult rats were investigated on body and testicle weights, serum testosterone level. Results: 131 prominent cultivars were found within 12 cultivars containing various parts with medicinal effects. Some primary and secondary metabolites were detected by phytochemical screening. The pollen increased the weight of the body, testicles and enhanced the serum testosterone level of male rats treated. Conclusion: The present survey has provided the identification and recognition of date palm cultivars used in traditional Saharan medicine. Date palm pollen could improve sexual activities in male infertility cases and may be attempted to derive drugs.
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Affiliation(s)
- Cherifa Selmani
- Research Laboratory of Arid Areas (LRZA). Faculty of Biological Sciences. University of Sciences and Technology Houari Boumediene (USTHB). PO Box, 32 El Alia Bab-Ezzouar, 16111, Algiers, Algeria
| | - Djamila Chabane
- Research Laboratory of Arid Areas (LRZA). Faculty of Biological Sciences. University of Sciences and Technology Houari Boumediene (USTHB). PO Box, 32 El Alia Bab-Ezzouar, 16111, Algiers, Algeria
| | - Nadia Bouguedoura
- Research Laboratory of Arid Areas (LRZA). Faculty of Biological Sciences. University of Sciences and Technology Houari Boumediene (USTHB). PO Box, 32 El Alia Bab-Ezzouar, 16111, Algiers, Algeria
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Dupont C, Carayol M, Le Ray C, Barasinski C, Beranger R, Burguet A, Chantry A, Chiesa C, Coulm B, Evrard A, Fischer C, Gaucher L, Guillou C, Leroy F, Phan E, Rousseau A, Tessier V, Vendittelli F, Deneux-Tharaux C, Riethmuller D. Recommandations pour l’administration d’oxytocine au cours du travail spontané. Texte court des recommandations. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.sagf.2016.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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Coulm B, Tessier V. Recommandations pour l’administration d’oxytocine au cours du travail spontané. Chapitre 4 : efficacité de l’oxytocine au cours du travail spontané selon les modalités d’administration. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.sagf.2016.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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23
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Dupont C, Carayol M, Le Ray C, Barasinski C, Beranger R, Burguet A, Chantry A, Chiesa C, Coulm B, Evrard A, Fischer C, Gaucher L, Guillou C, Leroy F, Phan E, Rousseau A, Tessier V, Vendittelli F, Deneux-Tharaux C, Riethmuller D. [Oxytocin administration during spontaneous labour: Guidelines for clinical practice. Guidelines short text]. ACTA ACUST UNITED AC 2017; 45:56-61. [PMID: 28238320 DOI: 10.1016/j.gofs.2016.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/21/2016] [Accepted: 12/21/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To define the different stages of spontaneous labour. To determine the indications, modalities of use and the effects of administering synthetic oxytocin. And to describe undesirable maternal and perinatal outcomes associated with the use of synthetic oxytocin. METHOD A systematic review was carried out by searching Medline database and websites of obstetrics learned societies until March 2016. RESULTS The 1st stage of labor is divided in a latence phase and an active phase, which switch at 5cm of cervical dilatation. Rate of cervical dilatation is considered as abnormal below 1cm per 4hour during the first part of the active phase, and below 1cm per 2hours above 7cm of dilatation. During the latent phase of the first stage of labor, i.e. before 5cm of cervical dilatation, it is recommended that an amniotomy not be performed routinely and not to use oxytocin systematically. It is not recommended to expect the active phase of labor to start the epidural analgesia if patient requires it. If early epidural analgesia was performed, the administration of oxytocin must not be systematic. If dystocia during the active phase, an amniotomy is recommended in first-line treatment. In the absence of an improvement within an hour, oxytocin should be administrated. However, in the case of an extension of the second stage beyond 2hours, it is recommended to administer oxytocin to correct a lack of progress of the presentation. If dynamic dystocia, it is recommended to start initial doses of oxytocin at 2mUI/min, to respect at least 30min intervals between increases in oxytocin doses delivered, and to increase oxytocin doses by 2mUI/min intervals without surpassing a maximum IV flow rate of 20mUI/min. The reported maternal adverse effects concern uterine hyperstimulation, uterine rupture and post-partum haemorrhage, and those of neonatal adverse effects concern foetal heart rate anomalies associated with uterine hyperstimulation, neonatal morbidity and mortality, neonatal jaundice, weak suck/poor breastfeeding latch and autism. CONCLUSION The widespread use of oxytocin during spontaneous labour must not be considered as simply another inoffensive prescription without any possible deleterious consequences for mother or foetus. Conditions for administering the oxytocin must therefore respect medical protocols. Indications and patient consent have to be report in the medical file.
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Affiliation(s)
- C Dupont
- Pôle IMER, Réseau périnatal Aurore, hospices civils de Lyon, 69003 Lyon, France; HESPER EA 7425, université Lyon, université Claude-Bernard-Lyon 1, 69008 Lyon, France.
| | - M Carayol
- Service de PMI, direction des familles et de la petite enfance, mairie de Paris, 75196 Paris, France
| | - C Le Ray
- Maternité Port Royal, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 75014 Paris, France; Inserm U1153, épidémiologie obstétricale, périnatale et pédiatrique (équipe EPOPé), centre de recherche en épidémiologie et statistiques Sorbonne Paris Cité (CRESS), DHU risques et grossesse, université Paris Descartes, 75014 Paris, France
| | - C Barasinski
- EA 4681 PEPRADE, université d'Auvergne, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - R Beranger
- Inserm U1085, IRSET, équipe 9 « recherches épidémiologiques sur l'environnement, la reproduction et le développement », 35000 Rennes, France
| | | | - A Chantry
- Inserm U1153, épidémiologie obstétricale, périnatale et pédiatrique (équipe EPOPé), centre de recherche en épidémiologie et statistiques Sorbonne Paris Cité (CRESS), DHU risques et grossesse, université Paris Descartes, 75014 Paris, France; École de sages-femmes Baudelocque, université Paris Descartes, DHU risques et grossesse, Assistance publique-Hôpitaux de Paris, 75014 Paris, France
| | - C Chiesa
- Inserm U1153, épidémiologie obstétricale, périnatale et pédiatrique (équipe EPOPé), centre de recherche en épidémiologie et statistiques Sorbonne Paris Cité (CRESS), DHU risques et grossesse, université Paris Descartes, 75014 Paris, France
| | - B Coulm
- Inserm U1153, épidémiologie obstétricale, périnatale et pédiatrique (équipe EPOPé), centre de recherche en épidémiologie et statistiques Sorbonne Paris Cité (CRESS), DHU risques et grossesse, université Paris Descartes, 75014 Paris, France
| | - A Evrard
- Association bien naître, 69003 Lyon, France
| | - C Fischer
- Maternité Port Royal, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 75014 Paris, France
| | - L Gaucher
- HESPER EA 7425, université Lyon, université Claude-Bernard-Lyon 1, 69008 Lyon, France; Hôpital Femme-Mère-Enfant, hospices civils de Lyon, 69500 Bron, France; Pôle information médicale évaluation recherche, 69003 Lyon, France
| | - C Guillou
- Clinique Natecia, 69008 Lyon, France
| | - F Leroy
- Hôpital Montélimar, 26200 Montélimar, France
| | - E Phan
- Association d'usagers, collectif inter-associatif autour de la naissance (CIANE), 75014 Paris, France
| | - A Rousseau
- Département de Maïeutique, UFR des sciences de la santé Simone-Veil, université Versailles-Saint-Quentin, 78000 Versailles, France
| | - V Tessier
- Département hospitalo-universitaire « risques et grossesse », groupe hospitalier Cochin, AP-HP, 53, avenue de l'Observatoire, 75014 Paris, France
| | - F Vendittelli
- EA 4681 PEPRADE, université d'Auvergne, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - C Deneux-Tharaux
- Inserm U1153, épidémiologie obstétricale, périnatale et pédiatrique (équipe EPOPé), centre de recherche en épidémiologie et statistiques Sorbonne Paris Cité (CRESS), DHU risques et grossesse, université Paris Descartes, 75014 Paris, France
| | - D Riethmuller
- Pôle Mère-Femme, CHRU de Besançon, 3, boulevard Fleming, 25000 Besançon, France
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Anesthetic and Obstetrical Factors Associated With the Effectiveness of Epidural Analgesia for Labor Pain Relief. Reg Anesth Pain Med 2017; 42:109-116. [DOI: 10.1097/aap.0000000000000517] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cardaillac C, Rua C, Simon E, El-Hage W. L’ocytocine et la dépression du post-partum. ACTA ACUST UNITED AC 2016; 45:786-795. [DOI: 10.1016/j.jgyn.2016.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/30/2016] [Accepted: 05/06/2016] [Indexed: 01/19/2023]
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Chuilon AL, Le Ray C, Prunet C, Blondel B. L’épisiotomie en France en 2010 : variations des pratiques selon le contexte obstétrical et le lieu d’accouchement. ACTA ACUST UNITED AC 2016; 45:691-700. [DOI: 10.1016/j.jgyn.2015.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 10/13/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
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Loscul C, Chantry AA, Caubit L, Deneux-Tharaux C, Goffinet F, Le Ray C. [Association between oxytocin augmentation intervals and the risk of postpartum haemorrhage]. ACTA ACUST UNITED AC 2016; 45:708-15. [PMID: 26874663 DOI: 10.1016/j.jgyn.2015.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 11/22/2015] [Accepted: 12/16/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To study the association between the duration of oxytocin augmentation intervals and the risk of postpartum haemorrhage (PPH) among primiparous women in spontaneous labour. MATERIALS AND METHODS Retrospective cohort including primiparous women in spontaneous labour who received oxytocin during labour (n=454). Oxytocin augmentation intervals were dichotomized in intervals<20minutes and≥20minutes. Obstetrical and neonatal issues were analyzed according to the duration oxytocin augmentation intervals. The association between oxytocin augmentation intervals and PPH was analyzed using univariate and multivariate analysis. RESULTS Oxytocin augmentation intervals were shorter than 20minutes for 43.8% of the study population. The rate of PPH was higher (9.1% vs 3.5%; P=0.014), and the use of sulprostone was more frequent (6.5% vs 3.5%; P=0.013) if oxytocin augmentation intervals were shorter than 20minutes in comparison with intervals≥20minutes. The association between oxytocin augmentation intervals and PPH remains significant after adjustment on other PPH risk factors (adjusted OR=3.48, 95% CI [1.45-8.34]). The rate of adverse neonatal issue, defined by arterial pH at birth≤7.10 and/or 5minutes score d'Apgar≤7, was higher if oxytocin augmentation intervals were<20minutes (12.1% vs 4.3%; P=0.002). CONCLUSION Our study demonstrated an increased risk of PPH for primiparous women in spontaneous labour who received oxytocin with augmentation intervals shorter than 20minutes.
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Affiliation(s)
- C Loscul
- Maternité Port-Royal, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; École de sages-femmes Baudelocque, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 75014 Paris, France.
| | - A-A Chantry
- École de sages-femmes Baudelocque, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 75014 Paris, France; Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, DHU risques et grossesse, université Paris Descartes, 75014 Paris, France
| | - L Caubit
- Maternité Port-Royal, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France
| | - C Deneux-Tharaux
- Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, DHU risques et grossesse, université Paris Descartes, 75014 Paris, France
| | - F Goffinet
- Maternité Port-Royal, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, DHU risques et grossesse, université Paris Descartes, 75014 Paris, France
| | - C Le Ray
- Maternité Port-Royal, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, DHU risques et grossesse, université Paris Descartes, 75014 Paris, France
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Kayem G, Dupont C, Bouvier-Colle MH, Rudigoz RC, Deneux-Tharaux C. Invasive therapies for primary postpartum haemorrhage: a population-based study in France. BJOG 2015; 123:598-605. [DOI: 10.1111/1471-0528.13477] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2015] [Indexed: 11/28/2022]
Affiliation(s)
- G Kayem
- Inserm UMR 1153; Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé); Centre for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in Pregnancy; Paris Descartes University; Paris France
- Department of Obstetrics and Gynaecology; APHP; Trousseau Hospital; Université Pierre et Marie Curie; Paris France
| | - C Dupont
- Aurore Perinatal Network; Hôpital de la Croix Rousse; Hospices Civils de Lyon; Lyon France
| | - MH Bouvier-Colle
- Inserm UMR 1153; Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé); Centre for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in Pregnancy; Paris Descartes University; Paris France
| | - RC Rudigoz
- Aurore Perinatal Network; Hôpital de la Croix Rousse; Hospices Civils de Lyon; Lyon France
| | - C Deneux-Tharaux
- Inserm UMR 1153; Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé); Centre for Epidemiology and Statistics Sorbonne Paris Cité; DHU Risks in Pregnancy; Paris Descartes University; Paris France
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Kenkel WM, Yee JR, Carter CS. Is oxytocin a maternal-foetal signalling molecule at birth? Implications for development. J Neuroendocrinol 2014; 26:739-49. [PMID: 25059673 DOI: 10.1111/jne.12186] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 07/21/2014] [Accepted: 07/22/2014] [Indexed: 01/08/2023]
Abstract
The neuropeptide oxytocin was first noted for its capacity to promote uterine contractions and facilitate delivery in mammals. The study of oxytocin has grown to include awareness that this peptide is a neuromodulator with broad effects throughout the body. Accumulating evidence suggests that oxytocin is a powerful signal to the foetus, helping to prepare the offspring for the extrauterine environment. Concurrently, the use of exogenous oxytocin or other drugs to manipulate labour has become common practice. The use of oxytocin to expedite labour and minimise blood loss improves both infant and maternal survival under some conditions. However, further investigations are needed to assess the developmental consequences of changes in oxytocin, such as those associated with pre-eclampsia or obstetric manipulations associated with birth. This review focuses on the role of endogenous and exogenous oxytocin as a neurochemical signal to the foetal nervous system. We also examine the possible developmental consequences, including those associated with autism spectrum disorder, that arise from exogenous oxytocin supplementation during labour.
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Affiliation(s)
- W M Kenkel
- Department of Psychology, Northeastern University, Boston, MA, USA
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Le Ray C, Théau A, Ménard S, Goffinet F. [What is new about obstetrical interventions during labor and normal delivery?]. ACTA ACUST UNITED AC 2014; 43:413-23. [PMID: 24485806 DOI: 10.1016/j.jgyn.2014.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/20/2013] [Accepted: 01/03/2014] [Indexed: 10/25/2022]
Abstract
This systematic review of the literature reports studies published over the last five years (2008-2013) about interventions during labor and normal delivery. The points made concerning active management of labor, interventions aimed at improving maternal comfort, management of occiput posterior fetal presentations, management of second stage of labor and prevention techniques for perineal lesions. Although obstetrics remains an "art" to which training is mainly based on experience and clinical expertise, this "art" at present cannot live without the evidence-based medicine. Numerous randomized trials published and in process, demonstrate awareness of this reality in our specialty.
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Affiliation(s)
- C Le Ray
- Maternité Port-Royal, université Paris Descartes, groupe hospitalier Cochin Broca Hôtel-Dieu, AP-HP, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, PRES Sorbonne Paris Cité, 53, avenue de l'Observatoire, 75014 Paris, France; Unité Inserm U953, recherche épidémiologique en santé périnatale et santé des femmes et des enfants, université Pierre-et-Marie-Curie, 53, avenue de l'Observatoire, 75014 Paris, France.
| | - A Théau
- Maternité Port-Royal, université Paris Descartes, groupe hospitalier Cochin Broca Hôtel-Dieu, AP-HP, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, PRES Sorbonne Paris Cité, 53, avenue de l'Observatoire, 75014 Paris, France
| | - S Ménard
- Maternité Port-Royal, université Paris Descartes, groupe hospitalier Cochin Broca Hôtel-Dieu, AP-HP, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, PRES Sorbonne Paris Cité, 53, avenue de l'Observatoire, 75014 Paris, France
| | - F Goffinet
- Maternité Port-Royal, université Paris Descartes, groupe hospitalier Cochin Broca Hôtel-Dieu, AP-HP, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, PRES Sorbonne Paris Cité, 53, avenue de l'Observatoire, 75014 Paris, France; Unité Inserm U953, recherche épidémiologique en santé périnatale et santé des femmes et des enfants, université Pierre-et-Marie-Curie, 53, avenue de l'Observatoire, 75014 Paris, France
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Faut-il craindre les fermetures et fusions de maternités en France ? ACTA ACUST UNITED AC 2013; 42:407-9. [DOI: 10.1016/j.jgyn.2013.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 06/25/2013] [Indexed: 11/22/2022]
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