-
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 -
Anaesthesia Aug 2022Carbetocin or oxytocin are given routinely as first-line uterotonic drugs following delivery of the neonate during caesarean delivery to prevent postpartum haemorrhage....
Carbetocin or oxytocin are given routinely as first-line uterotonic drugs following delivery of the neonate during caesarean delivery to prevent postpartum haemorrhage. Low doses may be as effective as high doses with a potential reduction in adverse effects. In this double-blind, randomised, controlled, non-inferiority trial, we assigned low-risk patients undergoing elective caesarean delivery under spinal anaesthesia to one of four groups: carbetocin 20 μg; carbetocin 100 μg; oxytocin 0.5 IU bolus + infusion; and oxytocin 5 IU bolus + infusion. The study drug was given intravenously after delivery of the neonate. Uterine tone was assessed by the obstetrician 2, 5 and 10 minutes after study drug administration according to an 11-point verbal numerical rating scale (0 = atonic, 10 = excellent tone). The primary outcome measure was uterine tone 2 min after study drug administration. The pre-specified non-inferiority margin was 1.2 points on the 11-point scale. Secondary outcomes included uterine tone after 5 and 10 minutes, use of additional uterotonics, blood loss and adverse effects. Data were available for 277 patients. Carbetocin 20 μg resulting in uterine tone of (median (IQR [range])) 8 (7-8 [1-10]) was non-inferior to carbetocin 100 μg with tone 8 (7-9 [3-10]), median (95%CI) difference 0 (-0.44-0.44). Similarly, oxytocin 0.5 IU with tone 7 (6-8 [3-10]) was non-inferior to oxytocin 5 IU with tone 8 (6-8 [2-10]), median (95%CI) difference 1 (0.11-1.89). Carbetocin 20 μg was also non-inferior to oxytocin 5 IU, and oxytocin 0.5 IU was non-inferior to carbetocin 100 μg. Uterine tone after 5 and 10 minutes, use of additional uterotonics, blood loss and adverse effects were similar in all groups.
Topics: Cesarean Section; Double-Blind Method; Female; Humans; Infant, Newborn; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy
PubMed: 35343585
DOI: 10.1111/anae.15714 -
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 -
American Family Physician May 2023
Topics: Pregnancy; Female; Humans; Postpartum Hemorrhage; Oxytocin; Oxytocics
PubMed: 37192081
DOI: No ID Found -
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 Mar 2020Labor augmentation is a commonly used strategy in obstetrics to make labor more efficient or to increase the chance of achieving a vaginal delivery. Intravenous infusion... (Review)
Review
Labor augmentation is a commonly used strategy in obstetrics to make labor more efficient or to increase the chance of achieving a vaginal delivery. Intravenous infusion of synthetic oxytocin and early amniotomy are the most widely used methods, but there is considerable variation in how they are used in clinical practice. There remain significant differences in the timing, dosing, and administration of synthetic oxytocin across institutions. The use and timing of amniotomy is similarly controversial. Much of the clinical variation in augmentation practices stem from the significant heterogeneity that exists in the literature, as well as the lack of an optimal strategy that has been subjected to the scientific scrutiny needed to prove its superiority in both efficacy and safety. Further research is needed to allow for better standardized care of women presenting in spontaneous labor.
Topics: Amniotomy; Evidence-Based Medicine; Female; History, 20th Century; History, 21st Century; Humans; Labor, Induced; Oxytocics; Oxytocin; Pregnancy; Time Factors
PubMed: 31839438
DOI: 10.1016/j.semperi.2019.151219 -
Best Practice & Research. Clinical... Aug 2020This chapter aims to provide an evidence-based approach to cervical-ripening methods and induction of labor in high-, middle-, and low-income countries. We will review... (Review)
Review
This chapter aims to provide an evidence-based approach to cervical-ripening methods and induction of labor in high-, middle-, and low-income countries. We will review the epidemiology of induction and will also review pharmacological and mechanical methods of cervical-ripening as well as oxytocin for induction. Lastly, we will review current guidelines of when to determine an induction to be failed.
Topics: Cervical Ripening; Dinoprostone; Female; Humans; Labor, Induced; Oxytocics; Oxytocin; Pregnancy
PubMed: 32527660
DOI: 10.1016/j.bpobgyn.2020.04.004 -
International Journal of Molecular... Feb 2021Recently, oxytocin (OXT) has been investigated for its potential therapeutic role in addiction. OXT has been found to diminish various drug-seeking and drug-induced... (Review)
Review
Recently, oxytocin (OXT) has been investigated for its potential therapeutic role in addiction. OXT has been found to diminish various drug-seeking and drug-induced behaviors. Although its behavioral effects are well-established, there is not much consensus on how this neuropeptide exerts its effects. Previous research has given thought to how dopamine (DA) may be involved in oxytocinergic mechanisms, but there has not been as strong of a focus on the role that glutamate (Glu) has. The glutamatergic system is critical for the processing of rewards and the disruption of glutamatergic projections produces the behaviors seen in drug addicts. We introduce the idea that OXT has direct effects on Glu transmission within the reward processing pathway. Thus, OXT may reduce addictive behaviors by restoring abnormal drug-induced changes in the glutamatergic system and in its interactions with other neurotransmitters. This review offers insight into the mechanisms through which a potentially viable therapeutic target, OXT, could be used to reduce addiction-related behaviors.
Topics: Animals; Behavior, Addictive; Drug-Seeking Behavior; Glutamic Acid; Humans; Oxytocics; Oxytocin; Substance-Related Disorders
PubMed: 33673694
DOI: 10.3390/ijms22052405