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Best Practice & Research. Clinical... Aug 2020Augmentation of labour aims at improving the efficiency of uterine contractions in order to reduce maternal and foetal adverse outcomes associated with prolonged labour.... (Review)
Review
Augmentation of labour aims at improving the efficiency of uterine contractions in order to reduce maternal and foetal adverse outcomes associated with prolonged labour. This review covers the current best practice for different methods of augmentation of labour, namely, artificial rupture of membranes and oxytocin infusion as a prevention of, or therapy for, prolonged labour. The review highlights essential practice points and identifies knowledge gaps for future research in this important area of clinical obstetric practice.
Topics: Female; Humans; Labor, Induced; Oxytocics; Oxytocin; Pregnancy; Prenatal Care; Time Factors; Uterine Contraction
PubMed: 32360367
DOI: 10.1016/j.bpobgyn.2020.03.011 -
Best Practice & Research. Clinical... Nov 2021Oral and vaginal misoprostol are effective induction methods, but there is a delicate balance between a quicker labour and avoiding side effects. In randomised... (Review)
Review
Oral and vaginal misoprostol are effective induction methods, but there is a delicate balance between a quicker labour and avoiding side effects. In randomised comparisons with balloon catheters, oral misoprostol resulted in more vaginal births in the first 24 h as well as fewer caesarean sections without an increase in hyperstimulation events. Vaginal misoprostol was most effective when used concurrently with a balloon catheter. In comparison with dinoprostone, oral misoprostol had lower rates of caesarean section and uterine hyperstimulation with foetal heart rate changes, but fewer babies were born vaginally within 24 h. In contrast, vaginal misoprostol resulted in more vaginal births within 24 h, with no significant differences in caesarean section rates. There were no differences in perinatal adverse events with either route. When oral and vaginal misoprostol were compared, vaginal misoprostol resulted in more vaginal births in the first 24 h, but with more maternal and neonatal complications.
Topics: Cesarean Section; Dinoprostone; Female; Humans; Infant, Newborn; Labor, Induced; Misoprostol; Oxytocics; Pregnancy
PubMed: 34607746
DOI: 10.1016/j.bpobgyn.2021.09.003 -
Obstetrical & Gynecological Survey Jan 2024Induction of labor (IOL) is a common obstetric intervention. Augmentation of labor and active management of the second stage is frequently required in obstetric...
IMPORTANCE
Induction of labor (IOL) is a common obstetric intervention. Augmentation of labor and active management of the second stage is frequently required in obstetric practice. However, techniques around labor and induction management vary widely. Evidence-based practice regarding induction and labor management can reduce birth complications such as infection and hemorrhage and decrease rates of cesarean delivery.
OBJECTIVE
To review existing evidence on IOL and labor management strategies with respect to preparing for induction, cervical ripening, induction and augmentation, and second stage of labor techniques.
EVIDENCE ACQUISITION
Review of recent original research, review articles, and guidelines on IOL using PubMed (2000-2022).
RESULTS
Preinduction, pelvic floor training and perineal massage reduce postpartum urinary incontinence and perineal trauma, respectively. Timely membrane sweeping (38 weeks) can promote spontaneous labor and prevent postterm inductions. Outpatient Foley bulb placement in low-risk nulliparous patients with planned IOL reduces time to delivery. Inpatient Foley bulb use beyond 6 to 12 hours shows no benefit. When synthetic prostaglandins are indicated, vaginal misoprostol should be preferred. For nulliparous patients and those with obesity, oxytocin should be titrated using a high-dose protocol. Once cervical dilation is complete, pushing should begin immediately. Warm compresses and perineal massage decrease risk of perineal trauma.
CONCLUSION AND RELEVANCE
Several strategies exist to assist in successful IOL and promote vaginal delivery. Evidence-based strategies should be used to improve outcomes and decrease risk of complications and cesarean delivery. Recommendations should be shared across interdisciplinary team members, creating a model that promotes safe patient care.
Topics: Pregnancy; Female; Humans; Misoprostol; Delivery, Obstetric; Labor, Induced; Cesarean Section; Cervical Ripening; Oxytocics
PubMed: 38306291
DOI: 10.1097/OGX.0000000000001225 -
European Journal of Obstetrics,... Feb 2022
Topics: Female; Humans; Labor, Induced; Labor, Obstetric; Oxytocics; Pregnancy
PubMed: 34740471
DOI: 10.1016/j.ejogrb.2021.10.023 -
Anesthesia and Analgesia Nov 2015
Topics: Female; Hospitalization; Humans; Oxytocics; Parturition; Practice Patterns, Physicians'; Pregnancy; Uterine Inertia
PubMed: 26484466
DOI: 10.1213/ANE.0000000000000847 -
Taiwanese Journal of Obstetrics &... Aug 2018
Topics: Female; Humans; Oxytocics; Oxytocin; Postpartum Hemorrhage
PubMed: 30122562
DOI: 10.1016/j.tjog.2018.06.001 -
Best Practice & Research. Clinical... Nov 2019Every six minutes, a mother dies from post-partum haemorrhage (PPH) in low- and middle-income countries, often in the prime of her life and often leaving behind a young... (Review)
Review
Every six minutes, a mother dies from post-partum haemorrhage (PPH) in low- and middle-income countries, often in the prime of her life and often leaving behind a young family. To prevent PPH, the routine administration of a uterus-contracting ('uterotonic') agent is a standard practice across the world. Oxytocin is the standard uterotonic agent recommended for this purpose, and is recommended for all women giving birth. Oxytocin is problematic as it requires cold storage and transport, and in low-resource settings, the cold chain is not commonly available. Hence, using heat-stable carbetocin in these settings can be advantageous. Heat-stable carbetocin is a promising alternative to oxytocin. Because of its heat stability, it can overcome the persistent problems with oxytocin quality as it does not require cold chain for storage and transport. Considering the totality of the evidence, it appears to have some additional desirable effects compared with oxytocin and a very favourable side effect profile similar to oxytocin. However, because carbetocin costs 20 times more than oxytocin and is not widely available yet, oxytocin remains the mainstay for prevention of PPH. However, this may change as WHO has signed a memorandum of understanding with the manufacturer to provide carbetocin for the public sector of LMIC at a similar price level to that of oxytocin. Currently, carbetocin is being registered in 90 low- and middle-income countries to be made available and improve access to this life-saving uterotonic agent.
Topics: Female; Humans; Oxytocics; Oxytocin; Parturition; Postpartum Hemorrhage; Pregnancy
PubMed: 31164260
DOI: 10.1016/j.bpobgyn.2019.04.001 -
Seminars in Perinatology Oct 2015Pharmacologic methods for induction of labor have been used for many decades. Pharmacologic agents have an advantage over mechanical methods in that they can be used... (Review)
Review
Pharmacologic methods for induction of labor have been used for many decades. Pharmacologic agents have an advantage over mechanical methods in that they can be used during both the initial cervical ripening stage of induction and throughout the second stage of labor. Pharmacologic induction agents such as prostaglandins and oxytocin are commonly used for labor and delivery floors and are well established for use in cervical ripening. Nitric oxide donors and mifepristone are known agents in medicine but are new and actively studied in the area of cervical ripening. These agents are introduced and analyzed in this review.
Topics: Adult; Cervix Uteri; Drug Delivery Systems; Female; Humans; Labor, Induced; Mifepristone; Nitric Oxide Donors; Oxytocics; Oxytocin; Practice Guidelines as Topic; Pregnancy; Pregnancy Outcome; Prostaglandins
PubMed: 26434613
DOI: 10.1053/j.semperi.2015.07.009 -
Seminars in Perinatology Oct 2015Labor-induction rates have increased considerably in the United States as well as around the world. With up to half of all induced labors requiring cervical ripening,... (Review)
Review
Labor-induction rates have increased considerably in the United States as well as around the world. With up to half of all induced labors requiring cervical ripening, prostaglandins have been utilized to increase induction success and achieve vaginal delivery. Misoprostol, a synthetic prostaglandin E1 analog has the ability to mimic the changes of spontaneous labor and has been used off label for over 30 years as a labor-induction agent. In the following article, cervical ripening and induction of labor with misoprostol will be discussed. The risks and benefits of misoprostol for ripening and induction and routes of administration will be reviewed, as well as future directions and new developments for its use.
Topics: Administration, Intravaginal; Adult; Cesarean Section; Drug Delivery Systems; Female; Fetal Monitoring; Humans; Infant, Newborn; Labor, Induced; Misoprostol; Oxytocics; Practice Guidelines as Topic; Pregnancy; Randomized Controlled Trials as Topic; Risk Assessment
PubMed: 26601733
DOI: 10.1053/j.semperi.2015.07.008 -
Current Opinion in Anaesthesiology Jun 2016Obstetric anesthesiologists are supposed to understand the uterotonics and tocolytics used in the perinatal period to provide a better clinical practice. This review... (Review)
Review
PURPOSE OF REVIEW
Obstetric anesthesiologists are supposed to understand the uterotonics and tocolytics used in the perinatal period to provide a better clinical practice. This review describes current consensus of uterotonics and tocolytics used in the perinatal period that an obstetric anesthesiologist should know.
RECENT FINDINGS
Rational use of uterotonics for cesarean section has been well studied in the past decades. Oxytocin remained as a first line uterotonics for cesarean section. For continuous infusion, it is reported that ED90 is higher for laboring parturients than for nonlaboring parturients (6.2 vs. 44.2 IU/h) implying that protocol for oxytocin infusion should be different between laboring patients with prior exposure to oxytocin and nonlaboring patients. For bolus administration, 'rule of three' has been proposed and its efficacy has been reported. When oxytocin fails to achieve sufficient uterine contraction, second-line agents must be administered, and it has been reported that methylergonovine is a superior second-line uterotonic to carboprost. On the other hand, the role of tocolytic agents in obstetric anesthesia has not been well studied.
SUMMARY
Anesthesiologists involved in obstetric anesthesia should be able to determine the appropriate uterotonic for cesarean section and know the indication of tocolytics in perinatal period.
Topics: Anesthesiologists; Cesarean Section; Clinical Decision-Making; Female; Humans; Labor, Obstetric; Obstetric Labor, Premature; Oxytocics; Perinatal Care; Placenta, Retained; Pregnancy; Tocolytic Agents; Uterine Inversion; Uterus; Version, Fetal
PubMed: 26974052
DOI: 10.1097/ACO.0000000000000332