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Query: UNIPROT:P01178 (oxytocin)
 15,767 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Twelve patients with either severe preeclampsia (9) or eclampsia (3) were treated with intravenous diazoxide, 300-mg bolus, for the reduction of diastolic blood pressure (less than or equal 110 torr) after the usual and customary measures had been initiated to include parenteral MgSO4 and diazepam. Diazoxide precipitously decreased both systolic and diastolic blood pressure proportionately (35-50%); the nadir was invariably reached in 5-15 minutes. Diastolic pressure never fell below 50 torr, and mean arterial pressure always exceeded 70 torr. Oliguria was not apparent. The vasodepressor response was fairly persistent for 4 hours in all but 3 patients; 2 of these received a second 300-mg dose. Significant changes in fetal heart activity (bradycardia, dysrhythmia) were observed in only 1 patient. Labor was immediately ablated in all patients, but could be restimulated with oxytocin. All pregnancies were terminated within 7 hours (mean, 3.7 hours), seven of them by cesarean section. Eleven newborns did well. We conclude that the immediate reduction in maternal arterial blood pressure is without apparent hazard to the mother as well as the fetus.
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PMID:The management of severe preeclampsia and eclampsia with intravenous diazoxide. 86 30

Since 1955, a standardized treatment regimen has been used to manage 245 cases of eclampsia at Parkland Memorial Hospital. Magnesium sulfate alone effectively controlled controlled convulsions in the great majority of cases. The only maternal death among the 245 cases reemphasizes the risk of respiratory arrest that is inherent in the administration of magnesium sulfate when given in large doses intravenously. Hydralazine to lower the diastolic blood pressure somewhat, when it was 110 mm Hg or higher, prevented intracranial hemorrhage. Avoidance of diuretics and hyperosmotic agents and limitation of fluid intake were not associated with severe renal failure. Pulmonary edema was rare. Vaginal delivery was achieved in the majority of cases. Oxytocin often proved effective for initiating and maintaining labor even remote from term. The results obtained with this regimen justify its continued clinical application.
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PMID:The Parkland Memorial Hospital protocol for treatment of eclampsia: evaluation of 245 cases. 671 34

In the Department of Obstetrics and Gynecology, Yekatit 12 Hospital, Addis Ababa, Ethiopia, during August 1990-October 1992, pregnant women at 20-28 weeks of gestation who presented with intra-uterine fetal death (IUFD) were enrolled in a comparative study after giving verbal consent. Patients were randomly assigned to two groups. In the first group, abortion was induced in the conventional method by oxytocin infusion alone. In the second group, in addition to oxytocin infusion, the condom-Foley catheter method (CFCM) was employed. All 25 patients with the CFCM aborted within 24 hours, yielding an induction abortion time interval (IATI) of 14.60 +or- 5.27 hours. In contrast, induction failed twice among the 20 patients getting oxytocin infusion alone, and 5 patients were submitted to combined medical and surgical induction (CMSI) (IATI of 59.4 +or- 8.7 hours), as they had an appropriate cervix, and they expelled the fetus within 48 hours. Among the remaining 15 patients induction failure occurred for the third time, and 8 of them had developed an appropriate cervix (Bishop scone = 4-6), but the other 7 patients did not show any cervical change. Those with the appropriate cervix were submitted to CMSI, and those whose cervical state was unchanged were transferred to the CFCM. Both groups aborted within 72 hours; the respective IATIs were 93.5 +or- 12.0 hours and 86.7 +or- 4.8 hours. In 48.9% of the patients, the cause of the IUFD was preeclampsia/eclampsia (2 patients had eclampsia). One patient was positive for syphilis and another was diabetic, both received treatment before admission. There was no abnormal bleeding or any signs of infection. Blunt curettage was performed in 37.8% of patients between 20 and 26 weeks of gestation after the expulsion of the fetus in the oxytocin group. 53.3% of the patients in the CFCM group also received this treatment.
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PMID:Induction of abortion by condom-Foley catheter method in pregnant women with intra-uterine foetal death. 803 76

Induction of labour with local application of PgE2 in breech presentation is still a much discussed problem. We aimed at studying the effect of local application of PgE2 (Prostin E2--3 mg) vaginal tablets for induction of labour in breech presentation. 15 pregnancies were studied and induced--8 for postdate, 6 for prae-eclampsia and 1 for fetal demise. Sonographic biometry and cardiotocographic examinations were conducted as well as a precise bishop score. Labour began within the interval of 3-13 hours after the application on the first tablet. The length of delivery was 4-24 hours. Effective labour was instituted in 93.33% on the parturiens, while in 1 (6.67%) there was a need for augmentation with oxytocin. There were no cases of hyperstimulation. Vaginal delivery was accomplished in 100% of the patients among which the breech was delivered with the classical manoeuvre in 10 cases and by the Bracht manoeuvre in 5 cases. Our results show, despite is small case number, that with favourable pelvic scores and absence of cephalopelvic disproportion and fetal distress PgE2 induction can be done locally even for breech presentation.
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PMID:[A breech delivery and induction with prostaglandin E2]. 985 22

This article discusses the role of postpartum care as well as other options for reducing health risks from pregnancy. Process indicators are identified for determining successful interventions. One-fourth of the estimated 585,000 maternal deaths result from hemorrhage; one-sixth result from infection. Other major causes are eclampsia, other hypertensive disorders, and obstructed labor. One study found that pregnancy-related morbidity ranged from 153 women per maternal death in Bangladesh to 908 per maternal death in Indonesia. In developing countries and the US, over 60% of maternal deaths occur in the postpartum period. Nearly 50% occur in the first week, and 80% occur within 2 weeks. A World Health Organization (WHO) panel of experts recommends that mothers have a postpartum check-up 3 days after delivery. Maternal mortality and morbidity decline with fewer pregnancies, increased use of contraceptives, and improved medical care during pregnancy. Health risks are greater for first pregnancies, adolescents, older women, and sometimes low-risk women in their 20s. Obstetric complications are dealt with in developed countries with improved surgical procedures, better aseptic techniques, the drug oxytocin, antibiotics, blood transfusions, and management of eclampsia. Improvements in care are not always expensive. Maternal midwives posted at the village level can improve maternal survival. Surviving complications may depend upon the time it takes to receive care. WHO identifies six process measures for determining successful interventions: availability of emergency obstetric care; geographic distribution of facilities; proportion of births in medical facilities; proportion of women with complications who are treated at medical facilities; percentage of all births by cesarean section; and case fatality rate. These indicators are essential for program management.
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PMID:Better postpartum care saves lives. 1229 83

The purpose of this study was to assess the quality of maternity care in a large, public, Palestinian referral hospital, as a first step in developing interventions to improve safety and quality of maternity care. Provider interviews, observation and interviews with women were used to understand the barriers to improved care and prepare providers to be receptive to change. Some of the inappropriate practices identified were forbidding female labour companions, routine use of oxytocin to accelerate labour, restriction of mobility during labour and frequent vaginal examinations. Magnesium sulfate was not used for pre-eclampsia or eclampsia, and post-partum haemorrhage was a frequent occurrence. Severe understaffing of midwives, insufficient supervision and lack of skills led to inadequate care. Use of evidence-based practices which promote normal labour is critical in settings where resources are scarce and women have large families. The report of this assessment and dissemination meetings with providers, hospital managers, policymakers and donors were a reality check for all involved, and an intervention plan to improve quality of care was approved. In spite of the ongoing climate of crisis and whatever else may be going on, women continue to give birth and to want kindness and good care for themselves and their newborns. This is perhaps where the opportunity for change should begin.
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PMID:Evoking the guardian angel: childbirth care in a Palestinian hospital. 1793 75

We conducted a retrospective study of the management and outcome for eclampsia patients in the intensive care unit (ICU) of National hospital, Abuja between November 2001 and April 2005 (42 months). The patients' case files and ICU records were used to extract the necessary data. During the study period, there were a total of 4857 deliveries, with 5051 total births (including multiple births) and 4854 live births. Forty eclamptics were admitted to the ICU, giving an ICU admission rate of 8.2/1000 live births. The records of two patients were incomplete. The average age of the patients was 28.4 years (range 17-4 years). Six patients (15.8%) were booked and 32 (84.2%) were not. The average duration of stay in ICU was 5 days. Twenty patients (52.6%) had antepartum eclampsia, 12 (31.6%) had postpartum eclampsia and six (15.8%) presented with intrapartum eclampsia. Twenty-nine (76.3%) gave birth via caesarean section and nine (23.7%) delivered per vagina augmented by oxytocin infusion. Seventeen (45%) received mechanical ventilation; 20 (53%) received oxygen via nasal prongs, nasal catheters or variable performance facemask. One patient (2%) did not receive oxygen therapy. All the patients were admitted postpartum. There were 11 maternal deaths, giving a case fatality rate of 29%. There were five (45.4%) deaths due to haemolysis, elevated liver enzymes and low platelet count syndrome and two (18.2%) due to disseminated intravascular coagulation. The remaining deaths were due to cerebrovascular accident (9.1%), lobar pneumonia (9.1%), acute renal failure (9.1%) and multiple organ failure (9.1%). All patients were admitted postpartum. This fatality rate is higher than that detailed in the reports reviewed in this study. Early referral of eclamptics or at risk patients to a tertiary care institution may help reduce morbidity and mortality. In addition, early referral to a facility providing basic essential obstetric care or comprehensive essential obstetric care is also important. Another important factor is the correct diagnosis of pre-eclampsia during antenatal and postpartum care by screening, noting blood pressure levels, performing urinalysis for protein and asking about warning signs such as headache, blurred vision, epigastric pain, etc.
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PMID:Critical care management of eclamptics: challenges in an African setting. 1830 51

PATH, an international nonprofit organization, assessed nearly 40 technologies for their potential to reduce maternal mortality from postpartum hemorrhage and preeclampsia and eclampsia in low-resource settings. The evaluation used a new Excel-based prioritization tool covering 22 criteria developed by PATH, the Maternal and Neonatal Directed Assessment of Technology (MANDATE) model, and consultations with experts. It identified five innovations with especially high potential: technologies to improve use of oxytocin, a uterine balloon tamponade, simplified dosing of magnesium sulfate, an improved proteinuria test, and better blood pressure measurement devices. Investments are needed to realize the potential of these technologies to reduce mortality.
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PMID:Prioritizing investments in innovations to protect women from the leading causes of maternal death. 2440 72