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PubMed1999

Treatment of severe postpartum hemorrhage by rectally administered gemeprost pessaries.

OBJECTIVE: To assess the efficacy of rectally administered gemeprost pessaries in the treatment of severe postpartum hemorrhage. DESIGN: Retrospective analysis of a twelve month period in which all patients having postpartum hemorrhage treated with rectal gemeprost were analyzed. SETTING: Royal Darwin Hospital, Northern Territory, Australia. POPULATION: Fourteen women with established postpartum hemorrhage not responding to oxytocine and ergometrine regimens, or not responsive to oxytocine and having contraindications to ergometrine. MAIN OUTCOME MEASURES: Per vaginum bleeding with continued postpartum hemorrhage; adverse patient reactions to gemeprost; need for operative intervention. RESULTS: All patients who were treated with rectally administered gemeprost pessaries had cessation of bleeding per vaginum. There were no adverse side effects noted from the medication and no patient required surgical treatment. CONCLUSIONS: Rectally administered gemeprost administered pessaries appear to be safe and effective method of treating severe postpartum hemorrhage in those patients in whom the standard oxytocic regimens fail. This form of treatment may avoid the need for parenteral prostaglandins or surgical intervention.

Administration, Rectal↗
PubMed2006

Infants' blood volume in a controlled trial of placental transfusion at preterm delivery.

OBJECTIVE: To investigate whether it was possible to promote placental blood transfer to infants at preterm delivery by (1) delaying cord clamping, (2) holding the infant below the placenta, and (3) administering an oxytocic agent to the mother, we measured the infants' blood volumes. DESIGN: Randomized study. METHODS: Forty-six preterm infants (gestational age: 24[0/7] to 32[6/7] weeks) were assigned randomly to either placental blood transfer promotion (delayed cord clamping [DCC] group, ie, > or =30 seconds from moment of delivery) or early cord clamping (ECC) with conventional management (ECC group). Eleven of 23 and 9 of 23 infants assigned randomly to DCC and ECC, respectively, were delivered through the vaginal route. The study was conducted at a tertiary perinatal center, the Queen Mother's Hospital (Glasgow, United Kingdom). RESULTS: The infants' mean blood volume in the DCC group (74.4 mL/kg) was significantly greater than that in the ECC group (62.7 mL/kg; 95% confidence interval for advantage: 5.8-17.5). The blood volume was significantly increased by DCC for infants delivered vaginally. The infants in the DCC group delivered through cesarean section had greater blood volumes (mean: 70.4 mL/kg; range: 45-83 mL/kg), compared with the ECC group (mean: 64.0 mL/kg; range: 48-77 mL/kg), but this was not significant. Additional analyses confirmed the effect of DCC (at least 30 seconds) to increase average blood volumes across the full range of gestational ages studied. CONCLUSIONS: The blood volume was, on average, increased in the DCC group after at least a 30-second delay for both vaginal and cesarean deliveries. However, on average, euvolemia was not attained with the third stage management methods outlined above.

Blood Transfusion↗
PubMed1975

A comparison of the characteristics of parturition induced by prostaglandin F2alpha, infused intra-aortically, with those following ovariectomy in the rat.

Prostaglandin F2alpha (PGF2alpha) was infused intra-aortically at different rates into rats for 11-5 h from day 18 of gestation. At doses in excess of 5 mug/h premature delivery invariably occ'rred 40-41 h later. At lower doses an all-or-none effect was observed, some animals delivering prematurely and others continuing to term. Parturition could not be induced earlier than 40 h after the start of the treatment even by a continuous infusion of PGF2alpha, suggesting that the luteolytic role of PGF2alpha is more important than its oxytocic action in this case. The rate of fall in plasma progesterone was greater in the rats delivering prematurely than those delivering at term, although the final concentrations of between 15 and 30 ng/ml at delivery were the same. Labour appeared more normal in the animals receiving PGF2alpha than in those which had been bilaterally ovariectomized. The possible significance of this in relation to an effect of PGF2alpha on oestrogen secretion is discussed.

Animals↗
PubMed1981

Inhibitory effect of O-alkylated analogues of oxytocin and vasopressin on human and rat myometrial activity.

Analogues of oxytocin and vasopressin modified through O-alkylation (methyl, ethyl and butyl) at position 2 of the peptide chain were synthesized and tested for effects on the rat uterus in vivo and on isolated rat and human myometrial preparations. None of the analogues showed any appreciable oxytocic activity. When tested together with oxytocin or vasopressin the analogues inhibited the uterine response to the hormones in a dose-dependent and reversible way. Ethyl-analogues were more powerful antagonists than methyl-analogues but further prolongation of the alkyl-chain (butyl) diminished the antagonistic properties of the compounds. The effect of antagonistic potency of deamination at position 1 of the analogues varied among the analogues and depended on the test system used. The possible clinical value of the antagonists is discussed.

Animals↗
PubMed1978

Haemodynamic effects of oxytocin (syntocinon) and methyl ergometrine (methergin) on the systemic and pulmonary circulations of pregnant anaesthetized women.

The haemodynamic effects of oxytocin (Syntocinon) and methyl ergometrin (Methergin) were studied in 9 healthy females in the first trimester of pregnancy. The patients were anaesthetized with sodium thiomebumal, pethidine and pancuronium bromide and ventilated on a Manley respirator. 10 i.u. oxytocin given as an i.v. bolus brought about a fall in femoral arterial pressure of 40%, systemic resistance 59% and pulmonary resistance 44% 30 sec after injection. However, the heart rate increased 31% and stroke volume 17%, so that the cardiac output increased by 54%. The pulmonary arterial pressure and wedge pressure were increased by 33% and 35%, respectively 150 sec after injection. No changes were seen in the haemodynamic parameters during infusion of 80 mU oxytocin for 10 min. 0.2 mg Methergin brought about an increase in the femoral arterial pressure of 11%, pulmonary arterial pressure 27% and wedge pressure 31%, with no changes in the other measured parameters. The use of oxytocic drugs in patients with compromised circulation is discussed.

Adult↗
PubMed1989

Effect of beta-receptor blockers on uterine contractility in a puerperal model.

beta-receptor blockers are increasingly used in the treatment of pregnancy-induced hypertension. Hitherto an oxytocic effect on the myometrium could not be excluded. We investigated the effect of 0.8 resp 1.6 mg pindolol on uterine activity in a double blind study in comparison with a placebo group, using a puerperal model. A "paradoxical" decline in uterine activity could be demonstrated, speaking in favor of a further propagation of beta-blockers in obstetric practice.

Adrenergic beta-Antagonists↗
PubMed1992

Improving placental blood flow in pre-eclampsia with prostaglandin A1.

Prostaglandin A1 is a potent hypotensive, peripheral vasodilator, a weak oxytocic, antiplatelet aggregator. It improves the renal hemodynamics. Its effect on placental circulation was evaluated (expressed as systolic/diastolic ratio and umbilical artery resistance index) in 20 women with severe pre-eclampsia and 10 normotensive pregnant women, by using the Doppler technique. Moreover, another 10 women with severe pre-eclampsia received dextrose 5% as a placebo for comparative purposes. Significant improvements in both parameters studied were observed in the women with severe pre-eclampsia. The beneficial changes differed significantly from the recorded values when using dextrose in pre-eclampsia or prostaglandin A1 in normotensive subjects. Such promising data add another important perspective to prostaglandin A1 in severe pre-eclampsia and may open up new avenues for its use in other situations with compromised placental flow.

Adult↗
PubMed1997

Maternal mortality in different Pakistani sites: ratios, clinical causes and determinants.

BACKGROUND: Population-based estimates of maternal mortality from Pakistan are inadequate to define the magnitude of the problem or provide information on clinical causes and determinants. METHODS: Surveys were conducted in selected clusters in Karachi, Balochistan and North West Frontier Province from 1989-1992. Pre-coded questionnaires were administered to 38,563 households to ascertain household characteristics, complete pregnancy histories and deaths of household members in the five years preceding the survey. Verbal autopsy questionnaires were then conducted to establish cause of death to women in the reproductive age group. Descriptive, bivariate and multivariable analyses were carried out to determine the association between the background variables, biological and women's status indicators and maternal mortality using a nested case-control design. RESULTS: Overall, the estimated maternal mortality ratio combining the data from the different sites was 433 per 100,000 livebirths. The estimated maternal mortality ratios per 100,000 livebirths ranged from a low of 281 in Karachi to a high of 673 in Khuzdar [Balochistan]. Hemorrhage (52.9%), puerperal sepsis (16.3%) and eclampsia (14.4%) were the leading causes for direct maternal deaths. Logistic regression identified the important risk factors as poor housing construction material (OR = 2.1; 95% CI = 1.3,3.2), distance of 40 or more miles from nearest hospital (OR = 1.3; 95% CI = 0.9,1.8), grandmultigravidity (OR = 1.6; 95% CI = 1.1,2.4) and prior fetal losses (OR = 5.3; 95% CI = 3.8,7.4). CONCLUSION: Focusing on special groups of pregnant women with targeted programs such as training, monitoring and supervision of birth attendants for the provision of oxytocics, will go a long way in decreasing the proportion of maternal deaths attributed to direct, avoidable causes.

Adult↗
PubMed1986

The genetic polymorphism of sparteine metabolism.

The formation of the two major metabolites of the antiarrhythmic and oxytocic drug sparteine (2- and 5-dehydrosparteine) exhibits a genetic polymorphism. Two phenotypes, extensive (EM) and poor metabolizers (PM) are observed in the population. The frequency of the PM phenotype in various populations (Caucasian and Japanese) ranges from 2.3 to 9%. The metabolism of sparteine is determined by two allelic genes at a single gene locus. PM subjects are homozygous for an autosomal recessive gene. The metabolism of sparteine is predominantly under genetic control as treatment with drugs such as antipyrine and rifampicin known to induce oxidative drug metabolism elicited only marginal changes in sparteine metabolism. The formation of 2-dehydrosparteine in human liver microsomes from EM and PM subjects showed a more than 40-fold difference in Km between EM and PM subjects. However, Vmax-values were almost identical in both groups. These data indicate that the basis of the differences in oxidative capacity between EM and PM subjects is more likely to be due to a variant isozyme with defective catalytic properties than to a decreased amount of the isozyme.

Animals↗
PubMed1976

Partial purification of the ovarian oviposition-inducing factor and estimation of its chemical nature.

The ovarian ruptured follicles larger than 0.2 g. of wet weight were collected from laying hens and an ovarian oviposition-inducing factor (OOIF) was extracted from the follicles. The extract was chromatographed on a column of Sephadex G-75. Material from the active region for inducing premature oviposition was subjected to thioglycollate or trypsin treatment. It was found that oxytocic activity of this material was completely destroyed by thioglycollate buy not by trypsin, when tested on the contractility of the isolated hen's uterus. The OOIF was found to be diffusible through a cellophane bag. It is suggested that the OOIF may be a relatively small molecule have a disulfied bridge and it seems to be a hormone or hormone-like substance resembling the posterior pituitary hormones in the chemical nature.

Animals↗
PubMed2005

Factors influencing post abortion outcomes among high-risk patients in Zimbabwe.

Post abortion complications remain one of the major causes of mortality among women of child bearing age in Zimbabwe. Based on this problem, factors associated with mortalities due to abortion were investigated with the aim of improving post abortion outcomes for Zimbabwe's women, and possibly also for women of other African countries. Cases and controls were selected from 4895 post abortion records to conduct a retrospective case-control study. Significant risk factors identified for reducing mortalities due to post abortion complications included the administration of oxytocic drugs and evacuation of the uterus whilst anaemia and sepsis apparently reduced these women's chances of survival. Women who died (cases) from post abortion complications apparently received better reported quantitative care than controls. Recommendations based on this research report include improved education of health care workers and enhanced in-service training, regular audits of patients' records and changed policies for managing these conditions more effectively in Zimbabwe.

Abortion, Induced↗
PubMedDate not supplied

Vaginal birth following two cesarean deliveries--are the risks exaggerated?

BACKGROUND: Prior to 1996, most women who had undergone two previous cesarean deliveries were offered only cesarean delivery at Al-Hasa Health Centre. A policy of trial of labor was instituted in 1996. We compared the outcome of trial of labor versus cesarean delivery in women with a history of two previous cesarean deliveries who delivered between 1997 and 2002. PATIENTS AND METHODS: All patients with a history of two previous lower segment cesarean deliveries were included in the study. Those considered suitable were permitted a trial of labor that was neither induced nor augmented at any stage. RESULTS: Of the 205 patients in the study, 66 delivered vaginally (32.2%), 68 had an emergency cesarean delivery (33.2%), and 71 an elective cesarean delivery (34.6%). No scar dehiscence was observed, nor was hysterectomy performed in either group. The rate of complications was lower in the vaginal delivery group (4.5%) than in the cesarean delivery group (19.4%). CONCLUSION: Trial of labor in women with a history of two cesarean deliveries is a reasonable consideration, and when carried out without the use of oxytocics or prostaglandins, is associated with reduced maternal morbidity with no difference in perinatal morbidity.

Female↗
PubMed1978

Third stage management: how important is it?

The normal physiology of the third stage of labour and the effect of oxytocics at the end of the second stage have been discussed. An assessment of the results of different policies of third stage management has been made, including a comparison of the advantages and disadvantages of the traditional method versus the use of controlled cord traction. It is recommended that ergometrine (0.25 mg) be administered intravenously after delivery of the baby, and the exclusion of a second twin. Once the uterus has contracted the placenta should then be delivered by the technique of controlled cord traction.

Delivery, Obstetric↗
PubMedDate not supplied

Planned homebirths in South Australia 1976-1987.

Homebirths booked with a group of general practitioners and midwives in South Australia in 1976-1987 are described using data obtained from midwives' and hospital records. The births represented 84.7% of all births occurring at home in South Australia in 1984-1987, as assessed by official birth registrations. Of the 799 women intending to deliver at home, 136 (17.0%) required transfer to hospital before or during labour. A further 38 mothers or babies (4.8%) required transfer after delivery. The women tended to be of a relatively high socioeconomic status and older age distribution when compared with women who had hospital births as identified from the State perinatal data collection. Some had recognised pregnancy risk factors. They had lower frequencies of ultrasound examination, induced labour, epidural analgesia, episiotomy, forceps delivery and caesarean section, and a low frequency of use of oxytocics for the third stage. Their rates of postpartum haemorrhage and, in particular, perinatal mortality were higher. Potential sources of risk and difficulty in homebirth care and evaluation of this care are identified and an approach to providing an effective homebirth service is proposed.

Adolescent↗
PubMed2001

A five year review of scar dehiscence in the Rotunda Hospital, Dublin.

The aims of this study were to identify risk factors for scar dehiscence in labour, to illustrate the clinical presentations of patients with scar dehiscence and to quantify the risk posed by the use of oxytocin in labour. This was a case controlled, 5 year retrospective study. Patients with scar dehiscence were identified from labour ward records with matched controls and chart review of case and control patients were performed. Our results showed that the vaginal delivery rate for trial of scar was 76.9%. The incidence of scar dehiscence was 0.043%. Oxytocic labour augmentation was a risk factor (OR 4.5, 95% CI 0.9313-42.8, p=0.065) but induction of labour using oxytocin was not (p=0.222). The commonest symptom of scar dehiscence was fetal distress (OR 12.3, 95% CI 1.9-81). There was no maternal or fetal mortality. We concluded that trial of labour after one caesarean section is acceptable practice with a good success rate and a low incidence of serious morbidity. The use of oxytocin to augment labour is associated with scar dehiscence.

Adult↗
PubMed2002

Policy and management constraints on access to and use of life-saving emergency obstetric care in India.

Maternal mortality is still very high in India and the developing world. India's maternal mortality ratio is about 540 deaths per 100,000 live births. Poverty and lack of resources contribute to this, but the main reasons for such high maternal mortality are policy barriers and management problems that impede access to good-quality emergency obstetric care in rural areas. The government policy does not encourage training general practitioners to provide cesarean sections, even when there are very few specialists available in rural and remote areas. Nurses are also prohibited from providing such basic emergency care procedures as intravenous oxytocics, antibiotics, and anticonvulsants. The doctors, nurses, and other hospital staff in managerial positions are not trained in modern management skills, which contributes to poor-quality services. The situation can be improved by training existing medical staff to provide emergency obstetric services in rural areas and training hospital managers in management skills. International aid organizations and women doctors should lobby for such policy changes, which will help increase access and quality of emergency obstetric care.

Emergency Medical Services↗
PubMed2003

Use of packing in obstetric hemorrhage of uterine origin.

OBJECTIVE: To determine the safety and effectiveness of uterine packing to stop hemorrhage in obstetric patients following delivery and pregnancy termination. STUDY DESIGN: A review of obstetric records at Children's Hospital of Buffalo in a 9-year period was undertaken. Patients with uterine packing were identified. Indications, additional medical and surgical procedures, estimated blood loss, postoperative complications and packing material used were reviewed. RESULTS: A total of 9 patients were identified among 34,071. Five patients had hemorrhage during cesarean section. Two patients had hemorrhage after vaginal delivery; 1 case of which had failure with packing and resulted in postpartum hysterectomy. The remaining 2 patients had hemorrhage after dilation and evacuation. Uterine atony unresponsive to oxytocics was the most common indication for uterine packing (44%). The average hematocrit decrease was 10.4% (average total blood loss, 2,200 mL), and all patients received transfusion except 1. The only immediate postoperative complications occurred in a patient with postpartum hysterectomy after failed packing; she developed a pelvic abscess but did well after drainage. CONCLUSION: Uterine packing may be a reasonable alternative to further surgical intervention in patients with intractable obstetric hemorrhage who wish to preserve fertility.

Adult↗
PubMed1954

Infant survival in prematurity.

Reduction of neonatal mortality and the rate of stillbirth may be expected from improved management of spontaneous labor and delivery.Neither roentgenographic measurement nor the inception of fetal movement or heartbeat nor any other single test is an index of fetal maturity; all must be considered together. Prenatal care, particularly supplemented diet, will help to avoid premature delivery, or at least to prolong pregnancy; since the fetus undergoes accelerated growth during the last weeks of pregnancy, even slight extension of gestation increases the chances for survival. Analgesia in the first stage of premature labor is contraindicated. Only low spinal anesthesia and other types of conduction anesthesia should be employed for later stages. The fetal membranes should be preserved as long as possible, but premature rupture does not call for immediate termination of pregnancy. Deep episiotomy and prophylactic outlet forceps are routinely employed to hasten the second stage of premature delivery and to protect the immature fetus. Breech presentation is managed by unassisted expulsion or by forceps extraction of the head. The umbilical cord is not immediately severed on delivery; administration of oxytocic drugs after the second stage of labor, combined with gentle stripping of the cord, results in rapid transfer of increased amount of placental blood. The airways of the infant should be immediately cleared. Artificial respiration may be necessary and it must be gentle.All premature infants should receive supplementary oxygen to render breathing regular and more efficient. They should be insulated immediately in controlled temperature and humidity, and they should be handled little.

Breech Presentation↗