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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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Rosli AA, Nawi AM, Atan IK, Kalok AM, Ahmad S, Ismail NAM, Mahdy ZA, Rahman RA. Cervical dilatation at diagnosis of active phase of labour determines the mode of delivery and peripartum outcomes: a retrospective study in a single tertiary centre in Malaysia. BMC Pregnancy Childbirth 2023; 23:221. [PMID: 37005571 PMCID: PMC10067294 DOI: 10.1186/s12884-023-05523-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/15/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND There is an increasing trend of Caesarean section rate in Malaysia. Limited evidence demonstrated the benefits of changing the demarcation of the active phase of labour. METHODS This was a retrospective study of 3980 singletons, term pregnancy, spontaneous labouring women between 2015 and 2019 comparing outcomes between those with cervical dilation of 4 versus 6 cm at diagnosis of the active phase of labour. RESULTS A total of 3403 (85.5%) women had cervical dilatation of 4 cm, and 577 (14.5%) at 6 cm upon diagnosis of the active phase of labour. Women in 4 cm group were significantly heavier at delivery (p = 0.015) but significantly more multiparous women were in 6 cm group (p < 0.001). There were significantly fewer women in the 6 cm group who needed oxytocin infusion (p < 0.001) and epidural analgesia (p < 0.001) with significantly lower caesarean section rate (p < 0.001) done for fetal distress and poor progress (p < 0.001 both). The mean duration from diagnosis of the active phase of labour until delivery was significantly shorter in the 6 cm group (p < 0.001) with lighter mean birth weight (p = 0.019) and fewer neonates with arterial cord pH < 7.20 (p = 0.047) requiring neonatal intensive care unit admissions (p = 0.01). Multiparity (AOR = 0.488, p < 0.001), oxytocin augmentation (AOR = 0.487, p < 0.001) and active phase of labour diagnosed at 6 cm (AOR = 0.337, p < 0.001) reduced the risk of caesarean delivery. Caesarean delivery increased the risk of neonatal intensive care admission by 27% (AOR = 1.73, p < 0.001). CONCLUSIONS Active phase of labour at 6 cm cervical dilatation is associated with reduced primary caesarean delivery rate, labour intervention, shorter labour duration and fewer neonatal complications.
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Affiliation(s)
- Anizah Aishah Rosli
- Department of Obstetrics & Gynaecology, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Malaysia
- Department of Obstetrics & Gynaecology, Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, 56000, Malaysia
| | - Azmawati Mohd Nawi
- Department of Statistics, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Malaysia
| | - Ixora Kamisan Atan
- Department of Obstetrics & Gynaecology, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Malaysia
- Department of Obstetrics & Gynaecology, Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, 56000, Malaysia
| | - Aida Mohd Kalok
- Department of Obstetrics & Gynaecology, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Malaysia
- Department of Obstetrics & Gynaecology, Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, 56000, Malaysia
| | - Shuhaila Ahmad
- Department of Obstetrics & Gynaecology, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Malaysia.
- Department of Obstetrics & Gynaecology, Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, 56000, Malaysia.
| | - Nor Azlin Mohamed Ismail
- Department of Obstetrics & Gynaecology, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Malaysia
- Department of Obstetrics & Gynaecology, Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, 56000, Malaysia
| | - Zaleha Abdullah Mahdy
- Department of Obstetrics & Gynaecology, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Malaysia
- Department of Obstetrics & Gynaecology, Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, 56000, Malaysia
| | - Rahana Abd Rahman
- Department of Obstetrics & Gynaecology, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Malaysia
- Department of Obstetrics & Gynaecology, Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, 56000, Malaysia
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Oxytocin receptor DNA methylation is associated with exogenous oxytocin needs during parturition and postpartum hemorrhage. COMMUNICATIONS MEDICINE 2023; 3:11. [PMID: 36707542 PMCID: PMC9882749 DOI: 10.1038/s43856-023-00244-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 01/12/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The oxytocin receptor gene (OXTR) is regulated, in part, by DNA methylation. This mechanism has implications for uterine contractility during labor and for prevention or treatment of postpartum hemorrhage, an important contributor to global maternal morbidity and mortality. METHODS We measured and compared the level of OXTR DNA methylation between matched blood and uterine myometrium to evaluate blood as an indicator of uterine methylation status using targeted pyrosequencing and sites from the Illumina EPIC Array. Next, we tested for OXTR DNA methylation differences in blood between individuals who experienced a postpartum hemorrhage arising from uterine atony and matched controls following vaginal birth. Bivariate statistical tests, generalized linear modeling and Poisson regression were used in the analyses. RESULTS Here we show a significant positive correlation between blood and uterine DNA methylation levels at several OXTR loci. Females with higher OXTR DNA methylation in blood had required significantly more exogenous oxytocin during parturition. With higher DNA methylation, those who had oxytocin administered during labor had significantly greater relative risk for postpartum hemorrhage (IRR 2.95, 95% CI 1.53-5.71). CONCLUSIONS We provide evidence that epigenetic variability in OXTR is associated with the amount of oxytocin administered during parturition and moderates subsequent postpartum hemorrhage. Methylation can be measured using a peripheral tissue, suggesting potential use in identifying individuals susceptible to postpartum hemorrhage. Future studies are needed to quantify myometrial gene expression in connection with OXTR methylation.
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Gülümser C, Yassa M. Clinical management of uterine contraction abnormalities; an evidence-based intrapartum care algorithm. BJOG 2022. [PMID: 35415963 DOI: 10.1111/1471-0528.16727] [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] [Accepted: 01/29/2021] [Indexed: 11/29/2022]
Abstract
AIM To develop algorithms as decision support tools for identifying, managing and monitoring abnormal uterine activity during labour. POPULATION Women with singleton, term (37-42 weeks) pregnancies in active labour at admission. SETTING Institutional birth settings in low- and middle-income countries (the algorithm may be applicable to any health facility). SEARCH STRATEGY PubMed was searched up to January 2020 using keywords. We also searched The Cochrane Library, and international guidelines from World Health Organization (WHO), National Institute for Health and Care Excellence (NICE), American College of Obstetricians and Gynecologists (ACOG) and French College of Gynaecologists and Obstetricians (CNGOF). CASE SCENARIOS Algorithms were developed for two case scenarios: uterine hypoactivity and excessive uterine contractions. Key themes in the algorithm are: diagnosis, identification of probable causes, assessment of maternal and fetal condition and labour progress, monitoring and management. CONCLUSION The algorithms for uterine hypoactivity and excessive uterine contractions have been developed to facilitate safe and effective management of abnormal uterine activity during labour. Research is needed to assess the views of healthcare professionals and women accessing healthcare to explore the feasibility of implementing these algorithms, and impact on labour outcomes. TWEETABLE ABSTRACT An evidence-based algorithm to support clinical management of abnormal uterine activity during labour.
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Affiliation(s)
- C Gülümser
- Department of Obstetrics and Gynaecology, Yuksek Ihtisas University School of Medicine, Ankara, Turkey
| | - M Yassa
- Department of Obstetrics and Gynaecology, Bahcesehir University Medical Park Maltepe Hospital, İstanbul, Turkey
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Nunes I, Dupont C, Timonen S, Ayres de Campos D, Cole V, Schwarz C, Kwee A, Yli B, Vayssiere C, Roth GE, Gliozheni E, Savochkina Y, Ivanisevic M, Janku P, Timonen S, Daskalakis G, Beke A, Santo S, Druškovič M, Duvekot JJ, Farr A, Dreyfus M. European Guidelines on Perinatal Care - Oxytocin for induction and augmentation of labor[Formula: see text]. J Matern Fetal Neonatal Med 2021; 35:7166-7172. [PMID: 34470113 DOI: 10.1080/14767058.2021.1945577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OF RECOMMENDATIONS1. Oxytocin for induction or augmentation of labor should not be started when there is a previous scar on the body of the uterus (such as previous classical cesarean section, uterine perforation or myomectomy when uterine cavity is reached) or in any other condition where labor or vaginal delivery are contraindicated. (Moderate quality evidence +++-; Strong recommendation).2. Oxytocin should not be started before at least 1 h has elapsed since amniotomy, 6 h since the use of dinoprostone (30 min if vaginal insert) and 4 h since the use of misoprostol (Low quality evidence ++- -; Moderate recommendation).3. Cardiotocography (CTG) should be performed and a normal pattern without tachysystole should be documented for at least 30 min before oxytocin is used. Continuous CTG, with adequate monitoring of both fetal heart rate and uterine contractions, should be maintained for as long as oxytocin is used, and thereafter until delivery (Low ++- - to moderate +++- quality evidence; Strong recommendation).4. For labor induction, at least 1-h should be allowed after amniotomy before oxytocin infusion is started, to evaluate whether adequate uterine contractility has meanwhile ensued. For augmentation of labor, if the membranes are intact and there are conditions for a safe amniotomy, the latter should be considered before oxytocin is started (Very low quality evidence +- --; Weak recommendation).5. Oxytocin should be administered intravenously using the following regimen: 5 IU oxytocin diluted in 500 mL of 0.9% normal saline (NaCl) (each mL contains 10 mIU of oxytocin), in an infusion pump at increasing rates, as shown in Table 1, until a frequency of 3-4 contractions per 10 min is reached, a non-reassuring CTG pattern ensues, or maximum rates are reached (Low quality evidence ++ - -; Strong recommendation). If the frequency of contractions exceeds 5 in 10 min, the infusion rate should be reduced, even if a normal CTG pattern is present. With a non-reassuring CTG pattern, urgent clinical assessment by an obstetrician is indicated, and strong consideration should be given to reducing or stopping the oxytocin infusion. The minimal effective dose of oxytocin should always be used. (Low ++- - to Moderate +++- - quality evidence; Strong recommendation).[Table: see text]6. Use of oxytocin for induction and augmentation of labor should be regularly audited (Low quality evidence ++--; Strong recommendation).
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Affiliation(s)
| | - Inês Nunes
- School of Medicine and Biomedical Sciences (ICBAS), University Hospital Center of Porto, CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Corinne Dupont
- University Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE) INSERM U1290; AURORE Perinatal Network, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France
| | - Susanna Timonen
- Finnish Society of Perinatology, Turku University Hospital, Turku University, Turku, Finland
| | | | | | | | - Christiane Schwarz
- Dept. Midwifery Science, University Lubeck, Institute for Health Sciences, Lubeck, Germany
| | - Anneke Kwee
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Branka Yli
- Delivery Deparment, Oslo University Hospital, Oslo, Norway
| | - Christophe Vayssiere
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse; UMR1295 CERPOP (Centre for Epidemiology and Population Health Research), Team SPHERE (Study of Perinatal, Paedriatric and Adolescent Health: Epidemiological Research and Evaluation) Toulouse III University, Toulouse, France
| | | | - Elko Gliozheni
- Albanian Association of Perinatology, Department of Obstetrics and Gynecology, University Hospital of Obstetrics and Gynaecology 'Koco Gliozheni', Tirana, Albania
| | - Yuliya Savochkina
- Bielorussian Society of Human Reproduction, 5th Minsk City Hospital and Belarus Medical Academy of Postgraduate Education, Minsk, Belarus
| | - Marina Ivanisevic
- Croatian Association of Perinatal Medicine, University Clinic for Obstetrics and Gynecology, School of Medicine, Zagreb, Croatia
| | - Petr Janku
- Czech Society of Perinatology and Feto-Maternal Medicine, Department of Obstetrics and Gynecology, University Hospital Brno, Masaryk University Brno, Brno, Czech Republic; Department of Nursing and Midwifery, Masaryk University Brno, Czech Republic
| | - Susanna Timonen
- Finnish Society of Perinatology, Turku University Hospital, Turku University, Turku, Finland
| | - George Daskalakis
- Hellenic Society of Perinatal Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Artur Beke
- Hungarian Society of Perinatology and Obstetric Anesthesiology, Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Susana Santo
- Portuguese Society of Obstetrics and Maternal-Fetal Medicine, Santa Maria Hospital, University of Lisbon Medical School, Lisbon, Portugal
| | - Mirjam Druškovič
- Slovenia Medical Association - Society of Perinatal Medicine, Division of Obstetrics and Gynecology, UMC Ljubljana, Ljubljana, Slovenia
| | - J J Duvekot
- Dutch Society of Obstetrics and Gynecology, Department of Obstetrics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Alex Farr
- Austrian Society for Pre- and Perinatal Medicine, Department of Obstetrics and Gynecology, Division of Obstetrics and feto-maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Michel Dreyfus
- Societé Française de Medicine Perinatale, Service d'Obstétrique, Gynécologie et Médecine de la Reproduction, Centre Hospitalier Universitaire de Caen, Caen, France
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Baena-García L, Marín-Jiménez N, Romero-Gallardo L, Borges-Cosic M, Ocón-Hernández O, Flor-Alemany M, Aparicio VA. Association of Self-Reported Physical Fitness during Late Pregnancy with Birth Outcomes and Oxytocin Administration during Labour-The GESTAFIT Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158201. [PMID: 34360494 PMCID: PMC8346096 DOI: 10.3390/ijerph18158201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/26/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022]
Abstract
We explored (a) the associations between self-reported maternal physical fitness and birth outcomes; (b) whether self-reported maternal physical fitness (PF) is related to the administration of oxytocin to induce or stimulate labour. Pregnant women from the GESTAFIT project randomized controlled trial (n = 117) participated in this prospective longitudinal study. Maternal physical fitness was assessed through the International Fitness Scale at the 34th gestational week. Maternal and neonatal birth outcomes and oxytocin administration were collected from the obstetric medical records. Umbilical arterial and venous cord blood gas were analysed immediately after birth. Self-reported overall fitness, cardiorespiratory fitness, muscular strength and flexibility were not related to any maternal and neonatal birth outcomes (all p > 0.05). Greater speed-agility was associated with a more alkaline arterial (p = 0.04) and venous (p = 0.02) pH in the umbilical cord blood. Women who were administered oxytocin to induce or stimulate labour reported lower cardiorespiratory fitness (p = 0.013, Cohen's d = 0.55; 95% confidence interval (CI): 0.14, 0.93) and flexibility (p = 0.040, Cohen´s d = 0.51; 95% CI: 0.09, 0.89) compared to women who were not administered oxytocin. Greater maternal physical fitness during pregnancy could be associated with better neonatal birth outcomes and lower risk of needing oxytocin administration.
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Affiliation(s)
- Laura Baena-García
- Department of Nursing, Faculty of Health Sciences, University of Granada, 51001 Ceuta, Spain;
| | - Nuria Marín-Jiménez
- Sport and Health University Research Institute (iMUDS), 18007 Granada, Spain; (L.R.-G.); (M.B.-C.); (M.F.-A.)
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain
- Correspondence:
| | - Lidia Romero-Gallardo
- Sport and Health University Research Institute (iMUDS), 18007 Granada, Spain; (L.R.-G.); (M.B.-C.); (M.F.-A.)
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain
| | - Milkana Borges-Cosic
- Sport and Health University Research Institute (iMUDS), 18007 Granada, Spain; (L.R.-G.); (M.B.-C.); (M.F.-A.)
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain
| | - Olga Ocón-Hernández
- Gynaecology and Obstetrics Unit, ‘San Cecilio’ University Hospital, 18016 Granada, Spain;
| | - Marta Flor-Alemany
- Sport and Health University Research Institute (iMUDS), 18007 Granada, Spain; (L.R.-G.); (M.B.-C.); (M.F.-A.)
- Institute of Nutrition and Food Technology (INYTA), Biomedical Research Centre (CIBM), University of Granada, 18016 Granada, Spain;
- Department of Physiology, Faculty of Pharmacy, University of Granada, 18011 Granada, Spain
| | - Virginia A. Aparicio
- Institute of Nutrition and Food Technology (INYTA), Biomedical Research Centre (CIBM), University of Granada, 18016 Granada, Spain;
- Department of Physiology, Faculty of Pharmacy, University of Granada, 18011 Granada, Spain
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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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Ramö Isgren A, Kjölhede P, Carlhäll S, Blomberg M. Maternal body mass index and oxytocin in augmentation of labour in nulliparous women: a prospective observational study. BMJ Open 2021; 11:e044754. [PMID: 33771828 PMCID: PMC8006853 DOI: 10.1136/bmjopen-2020-044754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate oxytocin use for augmentation of labour in relation to body mass index (BMI) on admission to the labour ward, focusing on cumulative oxytocin dose and maximum rate of oxytocin infusion during the first stage of labour. DESIGN Prospective observational study. SETTING Seven hospitals in Sweden. PARTICIPANTS 1097 nulliparous women with singleton cephalic presentation pregnancy, ≥37 weeks of gestation, spontaneous onset of labour and treatment with oxytocin infusion for labour augmentation. The study population was classified into three BMI subgroups on admission to the labour ward: normal weight (18.5-24.9), overweight (25.0-29.9) and obese (≥30.0). The cumulative oxytocin dose was measured from the start of oxytocin infusion until the neonate was born. PRIMARY OUTCOME Cumulative oxytocin dose. SECONDARY OUTCOME Maximum rate of oxytocin infusion during the active phase of first stage of labour. RESULTS The mean cumulative oxytocin dose increased in the BMI groups (normal weight 2278 mU, overweight 3108 mU and obese 4082 mU (p<0.0001)). However, when adjusted for the confounders (cervical dilatation when oxytocin infusion was started, fetal birth weight, epidural analgesia), the significant difference was no longer seen. The maximum oxytocin infusion rate during the first stage of labour differed significantly in the BMI groups when adjusted for the confounding factors individually but not when adjusted for all three factors simultaneously. In addition, the maximum oxytocin infusion rate was significantly higher in women with emergency caesarean section compared with women with vaginal delivery. CONCLUSIONS Women with increasing BMI with augmentation of labour received a higher cumulative oxytocin dose and had a higher maximum oxytocin infusion rate during first stage of labour, however, when adjusted for relevant confounders, the difference was no longer seen. In the future, the guidelines for augmentation of labour with oxytocin infusion might be reconsidered and include modifications related to BMI.
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Affiliation(s)
- Anna Ramö Isgren
- Department of Obstetrics and Gynaecology, Department of Biomedical and Clinical Sciences, University Hospital, Linköping University, Linköping, Sweden
| | - Preben Kjölhede
- Department of Obstetrics and Gynaecology, Department of Biomedical and Clinical Sciences, University Hospital, Linköping University, Linköping, Sweden
| | - Sara Carlhäll
- Department of Obstetrics and Gynaecology, Department of Biomedical and Clinical Sciences, University Hospital, Linköping University, Linköping, Sweden
| | - Marie Blomberg
- Department of Obstetrics and Gynaecology, Department of Biomedical and Clinical Sciences, University Hospital, Linköping University, Linköping, Sweden
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Lukasse M, Hovda I, Thommessen S, McAuley S, Morrison M. Oxytocin and emergency caesarean section in a mediumsized hospital in Pakistan: A cross-sectional study. Eur J Midwifery 2020; 4:33. [PMID: 33537634 PMCID: PMC7839144 DOI: 10.18332/ejm/124111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/15/2020] [Accepted: 06/17/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION One of the most common complications during labor is prolonged labor (dystocia), which is associated with risks for the mother and fetus. Dystocia is usually treated with oxytocin, which is also used to induce labor. Oxytocin may not have the desired effect of progress and can negatively affect the fetus, thus resulting in an emergency caesarean section (CS). The aim of this study was to describe obstetric practice, use of oxytocin and its association with an emergency CS. METHODS A cross-sectional retrospective register study was conducted that included all women who gave birth during 2014 and 2015 at a hospital in a large city in Pakistan. RESULTS A total of 6652 women gave birth to 6767 newborns, 66.8% were multiparous and 33.2% primiparous women. Of the primiparous women, 78.9% had a spontaneous vaginal birth, 1.2% an elective CS and 14.4% an emergency CS. Of the multiparous women, 81.9% had a spontaneous vaginal birth, 8.0% an elective CS and 6.7% an emergency CS. Operative vaginal birth was 2.1% among primiparous and 0.2% among multiparous women. Oxytocin for induction or augmentation was administered to 60.0% of primiparous and 30.5% of multiparous women. Oxytocin during the first stage of labor was associated with an increased risk for emergency CS for both primiparous and multiparous women. CONCLUSIONS Despite the association between oxytocin and emergency CS, the CS rate was low in this hospital. The majority of the women gave birth vaginally, even with a breech presentation. Few operative vaginal births were performed.
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Affiliation(s)
- Mirjam Lukasse
- Institute of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences,University of South-Eastern Norway, Borre, Norway
| | - Ingrid Hovda
- Institute of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Sara Thommessen
- Institute of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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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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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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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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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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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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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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