Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UNIPROT:P01178 (oxytocin)
 15,767 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The purpose of this prospective investigation was to evaluate a protocol for management of term patients with premature rupture of membranes (PROM) and a cervix unfavorable for induction of labor (Bishop score 4 or less). Patients initially were observed for 24 to 36 hours for the spontaneous onset of labor. If spontaneous contractions did not commence, labor was induced with oxytocin. Patients subsequently were divided into three groups: 44 who had spontaneous labor, 29 who had spontaneous labor but required oxytocin augmentation, and 39 women who had oxytocin induction. Patients who entered labor spontaneously had a significantly shorter mean latent period between rupture of membranes and onset of labor (16.0 versus 26.8 and 40.7 hours), shorter mean duration of labor (7.6 versus 12.1 and 13.1 hours), and shorter mean duration of rupture of membranes (23.6 versus 39.0 and 53.8 hours). These women also had a significant decrease in the frequency of chorioamnionitis (7 versus 14 and 33%), and their infants had fewer evaluations for sepsis (25.0 versus 34.5 and 53.8%). We conclude that term patients with PROM and an unfavorable cervix who require oxytocin augmentation or induction of labor are at increased risk for intrapartum and neonatal infection compared with those who progress through labor spontaneously.
 ...
PMID:Management of term patients with premature rupture of membranes and an unfavorable cervix. 155 Jun 36

The impact of chorioamnionitis on the course of labor is controversial. Some clinicians believe the infection has stimulatory effects, whereas others suspect inhibitory influences. Two hundred sixty-six pregnancies with chorioamnionitis requiring labor stimulation with oxytocin were matched to uninfected women for maternal age, race, parity, gestational age, oxytocin dosage regimen, indication for labor stimulation, type of labor stimulation, cervical dilatation at initiation of oxytocin, and time for rupture of membranes to initiation of labor stimulation. Chorioamnionitis diagnosed before oxytocin infusion was associated with shorter oxytocin initiation-to-delivery intervals (4.3 versus 5.6 hours; P = .04) and had no significant impact on the cesarean rate compared with matched controls. In contrast, pregnancies complicated by chorioamnionitis detected late in labor were associated with markedly longer oxytocin initiation-to-delivery intervals (12.6 versus 7.9 hours; P less than .0001) and a fourfold increase in cesarean for dystocia compared with matched controls (40 versus 10%; P less than .0001). Thus, the impact of chorioamnionitis on the course of labor can be divided into two clinical presentations. That diagnosed before labor stimulation does not increase the use of cesarean, whereas that diagnosed after oxytocin stimulation may be a sign of abnormal labor, as it was associated with a marked increase in abdominal delivery for dystocia.
 ...
PMID:Chorioamnionitis: a harbinger of dystocia. 157 12

Although prelabor rupture of membranes at term is common, in most cases, the spontaneous onset of labor relieves the obstetrician of the need for making management decisions. The standard practice in the United States has been to induce labor with intravenous oxytocin in that minority of patients who fail to labor spontaneously. Controlled trials suggest that this practice is associated with higher rates of both chorioamnionitis and the need for cesarean delivery than is expectancy. Expectancy, however, has not been demonstrated to be safer for the perinate.
 ...
PMID:Management of premature rupture of membranes at term. 163 Jul 43

The customary use of Hemabate sterile solution for postpartum hemorrhage was studied at 12 cooperating obstetrics units for a 12-month period. Outcomes of interest were the characteristics of patients chosen by the attending physicians to receive the drug, conditions of drug use, and patient status after drug use. Cessation of bleeding was considered a successful outcome and in 208 of 237 cases (87.8%) the hemorrhage was controlled directly after the administration of Hemabate sterile solution. An additional 17 successful outcomes were achieved with further administration of oxytocics for an overall success rate of 94.9%. Twelve cases of postpartum hemorrhage were considered pharmacologic treatment failures, requiring surgical intervention. Among the patients in whom pharmacologic treatment failed were factors that may have played a significant role in the cause of the hemorrhage including peripheral coagulopathy, retained products of conception, lacerations, chorioamnionitis, oxytocin-induced or augmented labor, increased fetal weight, magnesium-treated preeclampsia, and cesarean delivery. However, no combination of factors could be consistently associated with pharmacologic treatment failure.
 ...
PMID:Controlling refractory atonic postpartum hemorrhage with Hemabate sterile solution. 240 76

Labor records and internal fetal monitor tracings of 65 patients with uncomplicated term pregnancies who entered labor spontaneously and then developed chorioamnionitis were reviewed. Eighty-eight percent of patients were nulliparous. Seventy-five percent had abnormal labor, characterized by decreased uterine contractility, and 34% required cesarean delivery because of failure to progress in labor. The most common fetal heart rate abnormalities were diminished or absent variability (77%) and tachycardia (67%); 15% of the tracings had a sinusoidal pattern. Despite the high prevalence of abnormal fetal heart rate tracings, only one infant had a 5-minute Apgar score less than 7. It is concluded that chorioamnionitis has an inhibitory effect on labor. Compared to uninfected women, certain infected patients appear to require higher doses of oxytocin and greater uterine activity to effect a given change in cervical dilation.
 ...
PMID:The course of labor in term patients with chorioamnionitis. 662 8

A disciplined approach to labor management has resulted in a low cesarean rate (9%) in our population. We wondered if this management scheme was applicable and safe applied to women with previous cesareans. Women with a previous cesarean delivering in a 5-year period were included. Labor management included encouragement of trial of labor, labor stimulation with oxytocin when indicated, epidural analgesia only after entering the active phase, and continuous monitoring. Demographic, labor and delivery, and neonatal data were electronically stored and analysis performed using SPSS release 4.1 for VAX/VMS. Statistical analysis was performed using chi-square and Fisher's exact test where appropriate. Multiple logistic regression was performed to control for potentially confounding variables. A previous cesarean had been performed in 713 (11%) gravidas who met the inclusion criteria. Vaginal delivery was attempted in 588 (82%) and 517 (88%) achieved vaginal birth. Older women (14 versus 1 versus 8%, p = 0.04), of higher parity (63 versus 35 versus 17%, p = 0.0001), requiring preterm delivery (14 versus 8 versus 4%) were more likely to have an elective repeat cesarean than a successful or failed trial of labor. Pregnancies requiring oxytocin (90 versus 53%, p = 0.02), receiving epidural analgesia (62 versus 49%, p = 0.05), developing chorioamnionitis (20 versus 4%, p < 0.0001) were more likely to fail a trial of labor. Four uterine ruptures occurred and only one patient was receiving oxytocin. There were no differences in umbilical artery blood acidemia among elective repeat cesarean sections and successful or failed trial of labor.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Trial of labor: a disciplined approach to labor management resulting in a high rate of vaginal delivery. 761 91

Premature rupture of the membranes (PROM) occurs in 5-10% of pregnancies. Approximately 60% of cases are in term patients. Infection of the lower genital tract and/or amniotic cavity is one of the most important etiologies of PROM. The diagnosis is usually established by direct observation of pooling of amniotic fluid in the vaginal vault. In problematic cases, the nitrazine and fern tests can be used to confirm the diagnosis. Term patients with PROM and favorable cervices should undergo induction of labor with oxytocin. Patients with unfavorable cervices probably are best managed by induction of labor with prostaglandin compounds, although, in highly selected cases, expectant management may be considered. During induction of labor, long latent phases should be anticipated, and vaginal examinations should be minimized. Patients should receive prophylactic antibiotics, if indicated, for prevention of group B streptococcal infection and should be observed carefully for early signs of chorioamnionitis.
 ...
PMID:Premature rupture of the membranes in term patients. 891 94

197 of the 214 women who presented to a Los Angeles, California (US), hospital in 1995-97 with spontaneous rupture of the membranes beyond 36 weeks' gestation (mean, 38 weeks) volunteered for a comparative study of the effectiveness of vaginally administered misoprostol and oxytocin infusion. Induction was started a minimum of 6 hours after the spontaneous rupture of membranes. In 98 women, 25 mcg of misoprostol (Cytotec) was placed in the posterior vaginal fornix and, if uterine contraction frequency was deemed inadequate, the dose was repeated once in the next 6 hours (average, 1.3 dose). In the remaining 99 women, oxytocin was administered by infusion pump according to standard protocol, for a maximum dose of 22 mU/minute. 75 (75.8%) of misoprostol-treated women and 73 (74.5%) of oxytocin-treated subjects were delivered vaginally within 24 hours of induction initiation. The mean time from start of induction to vaginal delivery was 811.5 +or- 511.4 minutes in the misoprostol group and 747.0 +or- 448.0 minutes in oxytocin-treated subjects. 85 (85.9%) misoprostol-treated women and 82 (83.7%) oxytocin-treated subjects delivered vaginally. There were no significant differences between treatment groups in terms of tachysystole or hypertonus incidence or in the frequency of abnormal fetal heart rate tracings. Chorioamnionitis was diagnosed in 28 (28.6%) misoprostol-treated and 26 (26.3%) oxytocin-treated subjects. Neonatal outcomes were similar in both groups. Although misoprostol administration did not reduce the cesarean section delivery rate, its efficacy and safety were similar to oxytocin's, indicating this is a suitable regimen in women with premature rupture of membranes beyond 36 weeks' gestation.
 ...
PMID:Induction of labor with misoprostol for premature rupture of membranes beyond thirty-six weeks' gestation. 991 15

We performed a prospective randomized study to compare maternal and fetal outcomes in pregnancies with prelabour rupture of the membranes (PROM) at term with early induction of labour or expectant management, 126 women with singleton pregnancy, cephalic presentation and gestational duration > or = 37 weeks, were randomized either to immediate induction of labour with oxytocin (Group 1) (n=52), or conservative management (Group 2) (n=74). Women who constituted Group 2 were divided into 2 groups. The first group (Group 2A) (n=25) included women in whom spontaneous labour did not begin after a waiting period of 24 hours, in which case labour was induced with oxytocin i.e. expectant management. The second group consisted of women (Group 2B) (n=49) in whom labour began spontaneously within 24 hours. The base Caesarean section rate was significantly higher in Group 2 (28.4%) (p<0.05). The rates of Caesarean section in the Groups 1-2A-2B were 19.2%, 60%, and 12.2%, respectively for nulliparous and parous women together. The rate of fetal distress was significantly higher in Group 2 (p<0.05). For determining maternal outcomes, the other parameters such as clinical chorioamnionitis, fever before or during labour, receiving antibiotics before or during labour, postpartum fever, analgesia, anaesthesia did not differ in Groups 1 and 2. Women in Group 1 went into active labour sooner, had fewer digital vaginal examinations, had a shorter interval between membrane rupture and delivery, and spent less time in the hospital before delivery than those in Group 2 (p<0.05). Babies in Group 2 were more likely to receive antibiotics, and more likely to stay in an intensive care nursery for more than 24 hours, and more likely to receive ventilation after initial resuscitation than those babies in Group 1. For developing apnoea and hypotonia, there was no significant difference between Groups 1 and 2. However, for babies in Group 2A there was a significant difference. We conclude that immediate induction of labour with oxytocin does not increase the risk of Caesarean section, compared with a practice of expectant management. Women at term with prelabour rupture of the membranes should therefore be reassured that immediate induction with oxytocin currently appears to be the best policy with respect to maternal and neonatal morbidity.
 ...
PMID:Prelabour rupture of the membranes at term--no advantage of delaying induction for 24 hours. 1055 36

Objective: To clarify the relationships between intrapartum chorioamnionitis and abnormalities of uterine function, including labor abnormalities, cesarean delivery, and hemorrhage during parturition.Methods: We did a retrospective cohort study on 16,226 deliveries between 1986 and 1996 that were identified from the University of California, San Francisco Perinatal Database. Variables included maternal age, parity, birth weight, gestational age, epidural usage, oxytocin usage, cesarean delivery, labor abnormalities, length of labor stages, estimated blood loss, and chorioamnionitis status. Analyses included chi(2), Student t test, and logistic regression.Results: In the chorioamnionitis group, there was a statistically significantly higher proportion of women with labor abnormalities (relative risks [RRs] 2.6-4.1), cesarean delivery (RR 3.3; 95% confidence interval [CI] 3.0, 3.5), hemorrhage after cesarean (RR 1.2; 95% CI 1.1, 1.3), and hemorrhage after vaginal delivery (RR 2.1; 95% CI 1.9, 2.4) compared with the nonchorioamnionitis group. Those findings stayed significant after multivariate analysis for various labor abnormalities (adjusted odds ratios [ORs] ranged 1.3-2.1), cesarean delivery (adjusted OR 1.8; 95% CI 1.5, 2.1), hemorrhage after cesarean (adjusted OR 1.5; 95% CI 1.2, 1.8), and hemorrhage after vaginal delivery (adjusted OR 1.8; 95% CI 1.5, 2.1).Conclusion: Adverse associations between chorioamnionitis and labor abnormalities, cesarean rate, and hemorrhage during parturition appear to be significant, suggesting a deleterious effect of chorioamnionitis on uterine function.
 ...
PMID:Chorioamnionitis and uterine function 1083 90


1 2 3 Next >>