Prospective randomized study of oxytocin discontinuation after the active stage of labor is established

AIM: To investigate the effects of discontinuing oxytocin infusion on labor outcomes once the active stage of labor is established. METHODS: This is a prospective study involving 342 pregnant women who underwent labor induction at our institution. Patients were randomly divided into two groups. In the first group oxytocin was discontinued at the beginning of the active phase of labor, and in the other group, oxytocin was administered until delivery. RESULTS: Duration of the active phase and the second stage of labor were longer in the oxytocin-discontinued group; however, this was not statistically significant. The rate of uterine hyperstimulation was significantly higher in oxytocin-continued group (P < 0.05). The total cesarean delivery rate for the oxytocin-continued group was 6.9%, compared with 4.8% in the oxytocin-discontinued group (P > 0.05). CONCLUSION: Discontinuing oxytocin infusion once the active stage of labor is established may be an alternative protocol in developing countries where the conditions for fetal monitoring and emergency cesarean section are less available.     

Effect of oxytocin discontinuation during the active phase of labor

Objective: To observe the progression of labor when oxytocin use is limited to the onset of the active stage of labor.

Methods: A randomized, prospective controlled study was performed to address the issue of oxytocin infusion after the onset of active labor in 140 patients. In the study group, infusion of oxytocin was discontinued at the onset of the active phase of labor, which was accepted as a cervical dilatation of 5?cm. In the control group, incremental oxytocin infusion was administered until 5?cm cervical dilatation, and then was maintained at the same level until delivery.

Results: The primary outcome variable was duration from the beginning of the active phase to delivery. In the study group, the duration of the active phase of labor was about 30?min longer than in the control group and this difference was significant. The secondary outcomes of the study were maternal–fetal complications of oxytocin and in both groups there were no significant differences.

Conclusion: It is not reasonable to discontinue oxytocin infusion at the beginning of active labor. Nevertheless, for an accurate conclusion expanded investigations are needed.     

Maternal and fetal oxytocin levels at parturition in a paraplegic woman

Maternal and fetal oxytocin levels were measured by radioimmunoassay in a paraplegic woman with a spinal cord lesion at $\text{T-4}\text{T-5}$ who went into spontaneous labor at 39 wk of pregnancy and delivered vaginally a male infant weighing 3220 g. She showed signs of autonomic hyperreflexia during labor. Maternal plasma oxytocin was 3–12 pg/ml in 3 blood samples and undetectable in another 4 taken during the first stage, with a surge of 38 pg/ml at delivery of the fetus. Oxytocin levels were 73 pg/ml in umbilical venous plasma, and 14 pg/ml in amniotic fluid. The findings indicate that the fetus was an important source of oxytocin to the maternal uterus.     

Reducing postpartum hemorrhage in Vietnam: assessing the effectiveness of active management of third-stage labor

AIM: The study was undertaken to meet the need of the Ministry of Health to have local evidence on the effectiveness of active management of third-stage labor (AMTSL) in reducing the incidence of postpartum hemorrhage (PPH) > or = 500 mL and the need for PPH treatment. METHODS: Using a quasi-experimental design, AMTSL was introduced for all births attended by government midwives (at home, community, and district levels) in one district while standard practice without AMTSL was continued in three neighboring districts (with a 1:2 ratio of participants). Oxytocin (10 IU) was administered either by standard disposable syringe and needle or by a prefilled, single-use injection device. Postpartum blood loss was estimated using standard containers; other outcome measures included the duration of third stage, the need for additional treatments, and final maternal condition. A total of 3607 women participated (1236 in the intervention district and 2371 in the comparison districts). Multivariate logistic regression was used to control for age, parity, place of delivery, and first-stage oxytocin augmentation. RESULTS: AMTSL was associated with reduced risks for prolonged third stage beyond 30 min (odds ratio [OR] = 0.20, 95%; confidence interval [CI]: 0.11, 0.35), supplemental oxytocin (OR = 0.68, 95% CI: 0.49, 0.94), and bimanual compression (OR = 0.63, 95%; CI: 0.41, 0.98). When cases with first-stage oxytocin augmentation were excluded, AMTSL was associated with a 34% reduction in PPH incidence (OR = 0.66, 95%; CI: 0.45, 0.98). CONCLUSION: This study supports the value of AMTSL in reducing the incidence of PPH, shortening the third stage of labor, and reducing the need for additional treatments.     

Oxytocin administered during labor and breast-feeding: a retrospective cohort study

Abstract

Objective: The relationship between labor physiology and the onset of lactation leads to assess the potential correlation between oxytocin administration during labor and duration of breast-feeding.

Methods: This study was designed as a retrospective cohort study where patients given synthetic oxytocin during labor induction were considered as the exposed cohort, and patients not given oxytocin formed the non-exposed cohort. Four hundred of the 7465 children born at our maternity during 2006 were randomly selected. Information about breast-feeding was available for 316 of these children. Eventual confounding or adjustment factors were analyzed using stratified and multivariate analysis.

Results: Oxytocin was used for delivery of 189 (59.8%) newborns, multiplying the risk of bottle-feeding by 1.451 (95% CI 1.28–1.63). The best-fit regression model of oxytocin use effect on bottle-feeding included sex and gestational age of the newborn. The use of oxytocin also multiplies the risk of breast-feeding withdrawal at 3 months by 2.29 (95% CI 1.41–3.74). This effect is confounded by maternal age, being higher for mothers under 27 years.

Conclusion: Oxytocin administration during labor had some impact on both onset and duration of breast-feeding, particularly in mothers under 27 years of age and newborns delivered at term. Clinical Study registered at U.S. NIH, ID: NCT01951040.     

Effect of birth ball usage on pain in the active phase of labor: a randomized controlled trial

Introduction: Anxiety can be a contributor to labor pain, which is known to be multifactorial. Because there is little information available on the efficacy of birth ball use for labor pain management, this study aimed to evaluate the effectiveness of use of a birth ball on labor pain, contractions, and duration of the active phase of labor. Methods: In this randomized controlled trial, 60 primiparous women aged 18 to 35 years were divided into birth ball and control groups. Pain scores were measured by a visual analogue scale. Results: Mean pain scores in the birth ball group were significantly lower than the mean pain scores in the control group (P < .05). There were no significant differences between duration of the active phase of labor or the interval between uterine contractions in the 2 groups (P > .05). Discussion: Although the use of a birth ball had no effect on the duration of the active phase of labor, the duration of uterine contractions, or the interval between contractions, this complementary treatment could reduce the intensity of pain during the active phase of labor.     

Oxytocin: new perspectives on an old drug

Oxytocin is the drug most commonly associated with preventable adverse perinatal outcomes and was recently added by the Institute for Safe Medication Practices to a small list of medications "bearing a heightened risk of harm," which may "require special safeguards to reduce the risk of error." Current recommendations for the administration of this drug are vague with respect to indications, timing, dosage, and monitoring of maternal and fetal effects. A review of available clinical and pharmacologic data suggests that specific, evidence-based guidelines for the intrapartum administration of oxytocin may be derived from available data. If implemented, such practices may reduce the likelihood of patient harm. These suggested guidelines focus on limited elective administration of oxytocin, consideration of strategies that have been shown to decrease the need for indicated oxytocin use, reliance on low-dose oxytocin regimens, adherence to specific semiquantitative definitions of adequate and inadequate labor, and an acceptance that once adequate uterine activity has been achieved, more time rather than more oxytocin is generally preferable. The use of conservative, specific protocols for monitoring the effects of oxytocin on mother and fetus is likely not only to improve outcomes but also reduce conflict between members of the obstetric team. Implementation of these guidelines would seem appropriate in a culture increasingly focused on patient safety.     

Measurement of the fetal occiput-spine angle during the first stage of labor as predictor of the progress and outcome of labor

Background: Fetal head attitude has a substantial impact on labor progress and outcome. Fetal head deflexion is basically diagnosed by digital vaginal examination during labor.

Objectives: To assess the effect of the fetal occiput-spine angle (OSA) measured through transabdominal ultrasound during the first stage of labor on the progress and outcome of labor.

Material and methods: A prospective cohort study conducted on 400 women with term uncomplicated singleton pregnancy with occipitoanterior position during active labor. The angle between two tangential lines to occipital bone and the vertebral body of the first cervical spine was measured during active labor. Follow up till delivery was done. The primary outcome parameter was the labor duration. Secondary outcomes included the mode of delivery, occurrence of maternal and fetal complications.

Results: There was a significant longer duration of both first and second stage of labor among women with OSA <126° when compared to those with OSA ≥126° (6.8?±?2.1 and1.89?±?0.85 versus 4.16?±?1.63 and 0.92?±?0.43, respectively). Women with OSA <126° had higher incidence of CS (46.3 versus 5.7%), perineal tears (10.4 versus 5.1%), vaginal tears (22.4 versus 6.3%), need for oxytocin augmentation (47.8 versus 21.3%) when compared to those with OSA ≥126. OSA at cutoff value of 126° had a sensitivity, specificity, and accuracy of 8264.6 and 78.4% and 93.79 and 92% in prediction of mode of delivery and overall complications, respectively.

Conclusions: There was a significantly longer duration of both first and second stages of labor with higher rates of CS and maternal and fetal complications in women with OSA <126.     

Effects of combined spinal–epidural analgesia on first stage of labor: a cohort study

Background: Neuraxial anesthesia is considered as the gold standard in the control labor of pain. Its variants are epidural analgesia and combined spinal–epidural analgesia. Few studies, as yet, have investigated the duration of labor as a primary outcome. Some authors have suggested that combined spinal–epidural analgesia may reduce labor duration but at the moment the benefit of shortening labor is uncertain. The main aim of this study was to compare combined spinal–epidural with epidural analgesia in terms of their effect on duration of stage I labor, maternal, and neonatal outcomes.

Methods: A prospective cohort study was conducted. Parturients who requested analgesia at cervical dilatation <6?cm were included. Analgesia was either epidural with low concentration levobupivacaine or combined spinal epidural with subarachnoid sufentanil. The primary outcome was the length of stage I labor. Onset and quality of analgesia, mode of delivery, effects on uterine activity and use of oxytocin, fetal heart rate abnormalities and uterine hyperkinesia, maternal, and neonatal complications were also considered.

Results: We enrolled 400 patients: 176 in the combined spinal–epidural group and 224 in the epidural group. Patients in the two treatment groups were similar with regard to demographic characteristics, parity, and incidence of obstetric comorbidities, labor induction, oxytocin infusion, Bishop score, and Visual Analogue Score (VAS) at analgesia request. Duration of stage I labor did not differ, at 195 (120–300) minutes for both the groups (p?=?.7). Combined spinal–epidural was associated with less reduction in uterine contractility after initial administration: 15.34 versus 39.73%, (p?p?=?.002). Onset of analgesia was quicker for combined spinal–epidural analgesia: 31 versus 20%, with VAS <4 after 5?minutes, (p?Conclusions: Combined spinal–epidural with subarachnoid sufentanil may not reduce the duration of stage I labor, but in our study it appeared to affect uterine contractility less. It also had a more rapid onset and was more effective, without any concomitant increase in maternal or neonatal complications.     

Natural eating behavior in latent labor and its effect on outcomes in active labor

This study examined the effect of eating during the latent phase of labor on the hospital-estimated labor duration and birth outcomes for the mother and baby. A prospective, comparative trial with concurrent controls compared labor duration and outcomes of 176 low-risk, nulliparous women who birthed at four hospitals in Sydney, Australia. Food was voluntarily consumed by 82 women, whereas 94 consumed clear fluids only. Food intake during the latent phase of the first stage of labor was associated with a longer duration of labor (mean difference = 2.35 hours). No difference was found between eating and noneating groups for the rate of medical interventions, adverse birth outcomes, or vomiting. Results suggest that eating during the latent phase of labor may increase labor duration.     

Foley尿管水囊联合缩宫素用于足月妊娠促宫颈成熟的有效性、安全性和对产程的影响#br#

Objective?To explore the application effectiveness and safety of Foley catheter water bag combined with oxytocin in promoting cervical ripening and its influences on stages of labor in full-term pregnancy. Methods?A total of 102 full-term pregnant women with induced labor indications in Obstetrics Department of our hospital were enrolled between June 2017 and January 2021. According to different treatment methods by their willingness, they were divided into control group (51 cases, oxytocin) and combination group (51 cases, Foley balloon combined with oxytocin). Before induced labor and after intervention, cervical ripening effects in both groups were observed. The effect of cervical ripening before labor induction and after intervention in the two groups was observed, and the labor process and maternal and infant outcomes were compared between the two groups. Results?After intervention, Bishop scores were significantly higher than those before induced labor in both groups, which were significantly higher in combination group than control group (P<0.05). The first stage of labor and total stage of labor in combination group were significantly shorter than those in control group (P<0.05). The successful rate of labor induction and vaginal delivery in the combined group were higher than those in the control group, and the rates of postpartum hemorrhage and soft birth canal tearing were lower than those in the control group (P<0.05). The neonatal Apgar score in combination group was higher than that in control group (P<0.05). Conclusion?Foley catheter water bag combined with oxytocin can effectively and safely promote cervical ripening and shorten stages of labor in full-term pregnant women.     

Effect of intravenous hyoscine-N-butyl bromide on active phase of labor progress: a randomized double blind placebo controlled trial

Introduction: Appropriate cervical dilatation and effacement are essential for the progression of labor. With the active management of labor, number of cesarean deliveries reduces and the duration of labor shortens. Cervical dilatation can be facilitated by mechanical, pharmacological and non-pharmacologic methods. Cervix is richly supplied by autonomic nerves, which may play a role in the dilatation of cervix. Hyoscine-N-butylbromide (HBB) is a muscarinic antagonist and acts as a cervical spasmolytic agent. After intravenous administration it is rapidly distributed into the tissues. We aimed to study the effects and safety of a single dose 20?mg HBB injection during the active phase of labor in both primi- and multigravid women.

Materials and method: A randomized, double-blinded, controlled trial, with healthy primigravid and multigravid women in spontaneous labor at term was considered in this study. Once the active phase of labor was achieved, either a single dose of 20?mg (1?mL) of HBB or placebo (1?mL saline) was given intravenously.

Results: The mean duration of the first stage of labor was 191.1?±?43.06?min in the primigravid patients of the HBB group, while it was 248.2?±?66.1?min in the placebo group, a statistically significant difference of 57?min (p?p?Conclusion: A single dose of 20?mg intravenous HBB is effective and safe in shortening the duration of the first stage of labor without any adverse effects on fetus and mother.     

产程中胎儿安全监测

产程中胎儿监测方法主要有胎心听诊,胎儿电子监护、胎儿血气分析及胎儿脉冲血氧测定等,上述方法的合理应用,能及时判定胎儿有无缺氧,以便适时干预,从而保障胎儿在产程中的安全。     

The evidence for physiologic management of the active phase of the first stage of labor

The active phase of first stage labor is generally defined as the period between 3 cm to 4 cm to complete cervical dilatation, in the presence of regular uterine contractions. Most women will experience this portion of labor within hospital obstetric units, where care commonly features restriction to bed, electronic fetal monitoring, early treatment of "slow" labors, and few pain management options beyond epidurals and narcotics. However, the available evidence on appropriate care for healthy childbearing women favors activity in labor, intermittent auscultation, patience from caregivers, and nonpharmacologic methods of pain relief. This article reviews the evidence for care practices that support physiologic labor. Modifying intrapartum care to reflect current evidence will improve women's health, and will require a multilevel approach and consistent midwifery demonstration of the model.