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Journal of Healthcare Engineering 2022Hypertensive disorders of pregnancy (HDP) can cause serious prenatal and postnatal complications and is a threat to maternal and fetal health. To offer guidance for... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Hypertensive disorders of pregnancy (HDP) can cause serious prenatal and postnatal complications and is a threat to maternal and fetal health. To offer guidance for clinical decisions, we systematically reviewed the effects of misoprostol on induction of labour in HDP patients.
METHODS
PubMed, Web of Science, Embase, CNKI, and Wanfang databases were searched for relevant literature from 2010 to 2020. Subsequently, a meta-analysis was performed to compare the effective rate of induction of labour and reducing postpartum hemorrhage (PPH) between the intervention group ( = 544, misoprostol) and the control group ( = 543, oxytocin).
RESULTS
A total of 10 studies with 1087 patients were included. The 10 studies compared the effective rate of induction of labour between the two groups and confirmed that the effective rate in the intervention group was significantly higher than that in the control group (OR = 4.37; 95% CI: 2.73, 7.00). Seven studies compared PPH between the groups and showed that it was significantly reduced in the intervention group compared to the control group (SMD = -1.32; 95% CI: -2.05, -0.59; < 0.0001).
CONCLUSION
Misoprostol has a high effective rate of induction of labour in HDP patients and is an effective uterotonic agent in reducing PPH. This meta-analysis provides clinicians with meaningful information to help them make evidence-based decisions.
Topics: Female; Humans; Hypertension, Pregnancy-Induced; Labor, Induced; Misoprostol; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy
PubMed: 35432818
DOI: 10.1155/2022/8448690 -
Ethiopian Journal of Health Sciences May 2017Solanum nigrum is a widely used plant in oriental medicine where it is considered to be antioxidant, anti- inflammatory and diuretic. This study aimed to evaluate the...
BACKGROUND
Solanum nigrum is a widely used plant in oriental medicine where it is considered to be antioxidant, anti- inflammatory and diuretic. This study aimed to evaluate the effect of Solanum Nigrum on uterine contractions.
METHOD
Female Wistar Wister albino rats were used for the study. They were housed in a single large cage in an atmospheric controlled environment. Twenty-four hours before every experiment, 0.2 mg/kg of diethylstilbesterol constituted in 1:1 ethanol/water solution, was administered intraperitoneally as a pre-treatment to the rats to induce oestrus. It was done for two weeks during the study period. The phytochemical analysis was carried out to test for the phytochemical constituent of the plant.
RESULT
The result showed that the extract inhibited the release of intracellular calcium ion. The effect of acetylcholine was significantly inhibited by the extract that is at 200mg/ml (p>0.05) and 300 mg/ml (p<0.01). The highest mean inhibitory effect of the extract observed on acetylcholine induced contractions was 90.54 ± 1.15. The oxytocin induced contraction was significantly inhibited by the extract at 200 mg/ml (p<0.05) and at 300 mg/ml (p<0.001) doses respectively. The highest mean inhibitory effect of the extract observed on Oxytocin induced contractions was 41.10±1.02 and was significantly stronger compared with acetylcholine induced contractions.
CONCLUSION
The aqueous extract of Solanum nigrun inhibited the activity of oxytocin on the uterus, and it may possess relaxant activity.
Topics: Acetylcholine; Animals; Calcium; Diethylstilbestrol; Estrogens, Non-Steroidal; Estrus; Female; Oxytocics; Oxytocin; Phytochemicals; Plant Extracts; Rats, Wistar; Solanum; Uterine Contraction; Uterus
PubMed: 29217922
DOI: 10.4314/ejhs.v27i3.5 -
Acta Obstetricia Et Gynecologica... Jul 2021There is limited evidence on the safety and outcome of induction of breech labor. In this study, we aimed to compare the outcomes of spontaneous and induced breech...
INTRODUCTION
There is limited evidence on the safety and outcome of induction of breech labor. In this study, we aimed to compare the outcomes of spontaneous and induced breech deliveries and to describe variations in induction rates.
MATERIAL AND METHODS
This was a retrospective cohort study comprising 1054 singleton live fetuses in breech presentation at Trondheim University Hospital from 2012 to 2019. The main outcome was intrapartum cesarean section, and secondary outcomes were postpartum hemorrhage, anal sphincter ruptures, Apgar scores, pH in the umbilical artery, and metabolic acidosis. All data were obtained from the hospital birth journal.
RESULTS
Induction of labor was performed in 127/606 (21.0%) women with planned vaginal birth. The frequency of intrapartum cesarean section was 48.0% for induced labor vs 45.7% for spontaneous labor (P = .64). We found no differences in the frequency of postpartum hemorrhage or anal sphincter ruptures between induced and spontaneous births. The median pH in the umbilical artery was significantly lower in neonates with induced labor compared with neonates with spontaneous labor (7.22 vs 7.25; P = .02). The frequency of pH <7.05 was 7.0% for induced labor vs 2.9% (P = .05) for spontaneous labor, but the frequency of pH <7.0 was not significantly different: 2.6% vs 0.8% (P = .14), respectively. Three neonates with planned vaginal birth had metabolic acidosis: two with spontaneous labors and one with induced labor. Three fetuses with planned vaginal birth died during labor: two with spontaneous onset of labor and one with induced labor. All three were extremely preterm: two were delivered in week 23 and one in week 25. We did not observe any significant trend in induction rates in either parous or nulliparous women.
CONCLUSIONS
The induction rates were stable during the study period. We did not observe any significant difference in intrapartum cesarean section rates, in the frequency of pH <7.0 in the umbilical artery, or in the frequency of metabolic acidosis when comparing induced and spontaneous breech deliveries.
Topics: Adult; Breech Presentation; Cesarean Section; Delivery, Obstetric; Female; Humans; Infant, Newborn; Labor, Induced; Oxytocics; Oxytocin; Pregnancy; Retrospective Studies; Time Factors
PubMed: 33423281
DOI: 10.1111/aogs.14083 -
Pregnancy Hypertension Mar 2022Eclampsia is a pregnancy complicationcharacterized bygeneralized tonic-clonicconvulsions.Not all seizures in pregnancy are eclamptic, and othercauses include epilepsy,...
BACKGROUND
Eclampsia is a pregnancy complicationcharacterized bygeneralized tonic-clonicconvulsions.Not all seizures in pregnancy are eclamptic, and othercauses include epilepsy, infection,stroke,tumor, and ruptured aneurysm.
CASE
A 19-year-old G1P0 presentedinlabor at term. She had a generalized tonic-clonicseizure one hour aftervaginaldelivery for which she received methergine for uterine atony. Seizure activity resolved with lorazepam and magnesium sulfate for presumed eclampsia.Brain imaging revealedvasoconstriction of theleftposterior cerebral artery and blood in the subarachnoid space,andshewas diagnosed with eclampsia with reversible cerebral vasoconstrictive syndrome (RCVS).
CONCLUSION
RCVS isapregnancy-related cause of seizure that should remain on the differential for any patient presenting with a seizure in the peripartum period, especially with use of vasoconstrictive agents. Management is controversial but involves calcium channel blockers and magnesium sulfate, as well as avoidance of vasoconstrictive agents.
Topics: Eclampsia; Female; Humans; Methylergonovine; Oxytocics; Posterior Leukoencephalopathy Syndrome; Postpartum Hemorrhage; Pregnancy; Seizures; Young Adult
PubMed: 35063759
DOI: 10.1016/j.preghy.2022.01.002 -
Global Health, Science and Practice Aug 2014Although maternal mortality has declined substantially in recent years, efforts to address postpartum hemorrhage (PPH) and preeclampsia/eclampsia (PE/E) must be...
INTRODUCTION
Although maternal mortality has declined substantially in recent years, efforts to address postpartum hemorrhage (PPH) and preeclampsia/eclampsia (PE/E) must be systematically scaled up in order for further reduction to take place. In 2012, a key informant survey was conducted to identify both national and global gaps in PPH and PE/E program priorities and to highlight focus areas for future national and global programming.
METHODS
Between January and March 2012, national program teams in 37 countries completed a 44-item survey, consisting mostly of dichotomous yes/no responses and addressing 6 core programmatic areas: policy, training, medication distribution and logistics, national reporting of key indicators, programming, and challenges to and opportunities for scale up. An in-country focal person led the process to gather the necessary information from key local stakeholders. Some countries also provided national essential medicines lists and service delivery guidelines for comparison and further analysis.
RESULTS
Most surveyed countries have many elements in place to address PPH and PE/E, but notable gaps remain in both policy and practice. Oxytocin and magnesium sulfate were reported to be regularly available in facilities in 89% and 76% of countries, respectively. Only 27% of countries, however, noted regular availability of misoprostol in health facilities. Midwife scope of practice regarding PPH and PE/E is inconsistent with global norms in a number of countries: 22% of countries do not allow midwives to administer magnesium sulfate and 30% do not allow them to perform manual removal of the placenta.
CONCLUSIONS
Most countries surveyed have many of the essential policies and program elements to prevent/manage PPH and PE/E, but absence of commodities (especially misoprostol), limitations in scope of practice for midwives, and gaps in inclusion of maternal health indicators in the national data systems have impeded efforts to scale up programs nationally.
Topics: Disease Management; Female; Global Health; Health Policy; Health Services Accessibility; Humans; Midwifery; National Health Programs; Oxytocics; Postpartum Hemorrhage; Pre-Eclampsia; Pregnancy
PubMed: 25276587
DOI: 10.9745/GHSP-D-14-00034 -
Proceedings of the National Academy of... Aug 2017Never before have individuals had to adapt to social environments defined by such magnitudes of ethnic diversity and cultural differentiation. However, neurobiological... (Randomized Controlled Trial)
Randomized Controlled Trial
Never before have individuals had to adapt to social environments defined by such magnitudes of ethnic diversity and cultural differentiation. However, neurobiological evidence informing about strategies to reduce xenophobic sentiment and foster altruistic cooperation with outsiders is scarce. In a series of experiments settled in the context of the current refugee crisis, we tested the propensity of 183 Caucasian participants to make donations to people in need, half of whom were refugees (outgroup) and half of whom were natives (ingroup). Participants scoring low on xenophobic attitudes exhibited an altruistic preference for the outgroup, which further increased after nasal delivery of the neuropeptide oxytocin. In contrast, participants with higher levels of xenophobia generally failed to exhibit enhanced altruism toward the outgroup. This tendency was only countered by pairing oxytocin with peer-derived altruistic norms, resulting in a 74% increase in refugee-directed donations. Collectively, these findings reveal the underlying sociobiological conditions associated with outgroup-directed altruism by showing that charitable social cues co-occurring with enhanced activity of the oxytocin system reduce the effects of xenophobia by facilitating prosocial behavior toward refugees.
Topics: Administration, Intranasal; Adolescent; Adult; Altruism; Female; Humans; Male; Oxytocics; Oxytocin; Prejudice; White People; Xenophobia; Young Adult
PubMed: 28808030
DOI: 10.1073/pnas.1705853114 -
The Journal of Maternal-fetal &... Dec 2024This study aims to compare the safety and efficacy of misoprostol administered orally and vaginally in obese pregnant women at term with either gestational hypertension...
OBJECTIVE
This study aims to compare the safety and efficacy of misoprostol administered orally and vaginally in obese pregnant women at term with either gestational hypertension or diabetes.
METHODS
A total of 264 pregnant women were enrolled and categorized into two groups based on their primary condition: hypertension (134 cases) or diabetes mellitus (130 cases) and were further divided into subgroups for misoprostol administration: orally (Oral group) or vaginally (Vaginal group). The primary outcomes measured were changes in the Bishop score following treatment, induction of labor (IOL) success rates, requirement for oxytocin augmentation, duration of labor, mode of delivery, and cesarean section rates.
RESULTS
Significant enhancements in Bishop scores, decreased cesarean section rates and increased success rates of IOL were noted in both administration groups. The incidence of vaginal delivery within 24 h was significantly higher in the Vaginal group compared to the Oral group. Adverse effects, including nausea, uterine overcontraction, hyperfrequency of uterine contraction and uterine hyperstimulation without fetal heart rate deceleration, were significantly more prevalent in the Vaginal group than in the Oral group.
CONCLUSION
Misoprostol administration, both orally and vaginally, proves effective for labor induction in obese pregnant women with hypertension or diabetes. However, the oral route presents a lower risk of adverse maternal and neonatal outcomes, suggesting its preference for safer labor induction in this demographic.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Misoprostol; Oxytocics; Pregnant Women; Administration, Intravaginal; Cesarean Section; Labor, Induced; Administration, Oral; Hypertension, Pregnancy-Induced; Diabetes Mellitus
PubMed: 38485520
DOI: 10.1080/14767058.2024.2327573 -
Sheng Li Xue Bao : [Acta Physiologica... Dec 2019One of the core symptoms in anxiety disorders is dysregulated fear response. It is crucial for psychologists and neuroscientists to understand how fear responses are... (Review)
Review
One of the core symptoms in anxiety disorders is dysregulated fear response. It is crucial for psychologists and neuroscientists to understand how fear responses are enhanced and inhibited. Although oxytocin (OXT) was initially conceived as a prosocial molecule and mammalian neuropeptide that enhances cooperation and trust, later studies showed that it produces modulatory influence on fear responses. Therefore, OXT is now regarded as a promising pharmacological agent to boost treatment response in anxiety disorders. However, the effect of OXT on fear responses have been somewhat complex, and there are some contradictions among animal experiments and human studies. In this article, we summarize recent studies that employed animal models, brain region-specific manipulations and preclinical studies to explore the role of OXT in the acquisition and processing of fear response. We also discuss the methodological differences among these studies and review the potential factors that may contribute to the complicated effect of OXT on fear response. This review will help to promote the potential clinical application of OXT.
Topics: Animals; Brain; Fear; Humans; Oxytocics; Oxytocin
PubMed: 31879746
DOI: No ID Found -
PloS One 2022Postpartum hemorrhage (PPH) is a major cause of maternal morbidity, and oxytocin is the first-line uterotonic agent for PPH prevention. Clinical findings have reported...
BACKGROUND
Postpartum hemorrhage (PPH) is a major cause of maternal morbidity, and oxytocin is the first-line uterotonic agent for PPH prevention. Clinical findings have reported carbetocin to reduce PPH risk without increasing risk of important side effects. Hong Kong is a low PPH burden and high-resource city in China. We aimed to examine the cost-effectiveness of PPH prevention with carbetocin from the perspective of Hong Kong public healthcare provider.
METHODS
A decision-analytic model was developed to simulate clinical and economic outcomes of carbetocin and oxytocin for PPH prevention in a hypothetical cohort of women at the third stage of labor following vaginal birth or Caesarean section (C-section). The model inputs were retrieved from literature and public data. Base-case analysis and sensitivity analysis were performed. The model time horizon was the postpartum hospitalization period. Primary model outcomes included PPH-related direct medical cost, PPH, hysterectomy, maternal death, and quality-adjusted life-year (QALY) loss.
RESULTS
In base-case analysis, carbetocin (versus oxytocin) reduced PPH-related cost (by USD29 per birth), PPH ≥500 mL and ≥1,500 mL (by 13.7 and 1.9 per 1,000 births), hysterectomy (by 0.15 per 1,000 births), maternal death (by 0.02 per 1,000 births), and saved 0.00059 QALY per birth. Relative risk of PPH ≥500 mL with carbetocin versus oxytocin, and proportion of child births by C-section were two influential parameters identified in deterministic sensitivity analysis. In probabilistic sensitivity analysis, carbetocin was accepted as cost-effective in >99.7% of the 10,000 Monte Carlo simulations at a willingness-to-pay threshold of zero USD/QALY.
CONCLUSION
PPH prevention with carbetocin appeared to reduce major unfavorable outcomes, and save cost and QALYs.
Topics: Child; Female; Humans; Pregnancy; Cesarean Section; Cost-Effectiveness Analysis; Maternal Death; Oxytocics; Oxytocin; Postpartum Hemorrhage
PubMed: 36520799
DOI: 10.1371/journal.pone.0279130 -
BMC Pregnancy and Childbirth Oct 2021Oxytocin is widely used for induction and augmentation of labour, particularly in low- and middle-income countries (LMICs). In this systematic review and meta-analysis,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Oxytocin is widely used for induction and augmentation of labour, particularly in low- and middle-income countries (LMICs). In this systematic review and meta-analysis, we examined the effect of intra-partum Oxytocin use on neonatal encephalopathy.
METHODS
The protocol for this study was registered with PROSPERO (ID: CRD42020165049). We searched Medline, Embase and Web of Science Core Collection databases for papers published between January 1970 and May 2021. We considered all studies involving term and near-term (≥36 weeks' gestation) primigravidae and multiparous women. We included all randomised, quasi-randomised clinical trials, retrospective studies and non-randomised prospective studies reporting intra-partum Oxytocin administration for induction and/or augmentation of labour. Our primary outcome was neonatal encephalopathy. Risk of bias was assessed in non-randomised studies using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. The RoB 2.0 tool was used for randomised studies. A Mantel-Haenszel statistical method and random effects analysis model were used for meta-analysis. Odds ratios were used to determine effect measure and reported with 95% confidence intervals.
RESULTS
We included data from seven studies (6 Case-control studies, 1 cluster-randomised trial) of which 3 took place in high-income countries (HICs) and 4 in LMICs. The pooled data included a total of 24,208 women giving birth at or after 36 weeks; 7642 had intra-partum Oxytocin for induction and/or augmentation of labour, and 16,566 did not receive intra-partum Oxytocin. Oxytocin use was associated with an increased prevalence of neonatal encephalopathy (Odds Ratio 2.19, 95% CI 1.58 to 3.04; p < 0.00001).
CONCLUSIONS
Intra-partum Oxytocin may increase the risk of neonatal encephalopathy. Future clinical trials of uterotonics should include neonatal encephalopathy as a key outcome.
Topics: Bias; Brain Diseases; Case-Control Studies; Developed Countries; Developing Countries; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor, Obstetric; Odds Ratio; Oxytocics; Oxytocin; Pregnancy
PubMed: 34717571
DOI: 10.1186/s12884-021-04216-3