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)

Professor Brosens and colleagues (April 27, p.808) questions the safety of prostaglandins (PGs) for the induction of labor when pregnancy is complicated by hypertensive states, especially preeclampsia. Objections are based on the possibility that the uteroplacental bloodflow, which may already be compromised in these situations, could be further reduced by vasoconstrictive effects of the PGs on uterine, placental, and umbilical vessels. We have been using PGs extensively in this department and for the past year have been carrying out a double-blind trial of PGE2 and oxytocin by intravenous infusion after amniotomy for induction of labor in primigravidae. In 23 of the patients included thus far, labor was induced between 36 and 38 weeks because of moderate or severe preeclampsia. Of these, 12 have received oxytocin and 11 PGE2. In all cases, elective epidural analgesia has been employed and continuous fetal heartrate and intrauterine pressure recordings performed throughout. 1 patient in the group required an emergency cesarean section because of fetal distress; 2 others (1 from each group) were delivered by cesarean section because of failure to progress in labor. The remainder delivered vaginally with no evidence of increased incidence of fetal distress in the PG group. No perinatal deaths occurred. In an additional 18 primigravidae labor was induced at 36-38 weeks because of hypertensive complications of pregnancy by local PGE2 administration as previously described. These patients were assessed as clinically unfavorable for induction. 2 patients developed fetal distress and required cesarean sections; the others delivered vaginally. Experience with PGF2alpha is much less extensive but there is no reason to believe that this compound would behave differently, except with regard to maternal side effects. Thus it seems beneficial to use PGs for inducing labor in pregnancies complicated by hypertension and preeclampsia; no evidence of the suggested theoretical hazards has been seen. The suggested dangers may be questioned on 2 bases. It seems premature, based on existing knowledge, to infer that spiral arteries in hypertensive pregnancies are adversely affected by vasoconstrictor substances. Also, it is probable that high concentrations of PGs occur naturally in reproductive tissues and a rapid increase of PG in amniotic fluid occurs in spontaneous labors as well as those induced with oxytocin or PGs. Due caution must be exercised in using PGs where placental function may be impaired. The results-to-date which have been obtained with careful monitoring of the fetal heartrate and intrauterine pressure, show no evidence of adverse effects on the fetus as a result of PG use in preeclampsia and suggest they represent a valuable therapeutic agent in the management of this condition.
 ...
PMID:Letter: Prostaglandins and pre-eclampsia. 413 36

Water diuresis was induced in six patients in mid-pregnancy. Three were then given oxytocin and the remainder prostaglandin F(2)alpha (PGF(2)alpha), both drugs being infused intravenously in doses used to induce labour at term. Pronounced antidiuresis occurred with oxytocin, whereas PGF(2)alpha showed no such effect. The probable absence of any risk of water intoxication when using PGF(2)alpha in inducing labour may be of particular value when maternal pre-eclampsia or renal disease is present.
 ...
PMID:Absence of antidiuresis during administration of prostaglandin F2 alpha. 544 May 98

A non-aggressive approach to the management of post-date pregnancies was tested in a clinical trial involving 156 patients who had reached 294 days of amenorrhea and had a pelvic score of 4 or less. Dates had been established with certainty in each case. In half of the patients (the study group) no time limit was imposed on the pregnancy, but the women were checked at frequent intervals for any increase in pelvic score and for changes in any of the following: fetal movement count recorded daily by the mother, an oxytocin challenge test, and amnioscopy. The pregnancy ended either through spontaneous contractions or through surgical induction carried out because of a change in any one of the parameters or an increase above 4 in the pelvic score. In the 78 control patients labor was induced surgically on day 294, even if the pelvic score was low. In the study group, labor started spontaneously in 52 patients; labor was induced in 17 women after they showed an elevated pelvic score, in 7 because of a pathologic parameter and in one because a mild pre-eclampsia developed. There were 7 cesarean sections in the study group compared with 16 in the control group (P less than 0.05). The average duration of labor was 6.7 h in the study group, compared with 9.4 h in the control (P less than 0.01). There was no significant difference between the two groups with regard to meconium staining during labor, pathologic fetal heart rate, or the 5 min Apgar score. In the study group there was one neonatal death as a result of severe congenital heart disease, and in the control group one infant died due to asphyxia. It is concluded that conservative management of prolonged pregnancies, with close supervision, gives better results than routine induction of labor at 42 wk. The importance of the pelvic score as an indication for induction is stressed. A protocol has been developed which can be used in cases of uncertain dates as well.
 ...
PMID:Non-aggressive management of post-date pregnancies. 634 41

A case of pre-eclampsia is described where suspicion of placental insufficiency arose due to low estriol levels and a positive oxytocin challenge test (OCT). The cause, however, of these findings was later proven to be strictly fetal. It is concluded that low estriol levels and a positive OCT may be caused by a decreased placental capacity but specific tests of placental function, as for instance estimations of HPL in plasma and/or a DHAS-test, should be used to verify or rule out a suspicion of placental insufficiency.
 ...
PMID:Incorrect diagnosis of placental insufficiency in a patient with pre-eclampsia. 644 32

Our study of 390 patients enrolled in a birthing suite program revealed that antepartum or intrapartum problems allowed only 160 (41%) to actually give birth in the birthing suite. Antepartum complications included premature labor in ten (2.5%), premature ruptured membranes in 31 (8%), postdatism in 50 (13%), preeclampsia in 27 (7%), and diabetes mellitus in five (1.3%). Intrapartum complications included meconium in 62 (16%), arrest of labor in 64 (16%), oxytocin use in 85 (22%), and fetal heart rate decelerations in 28 (7%). Two hundred ninety-seven births (76%) were spontaneous. Forty-two low-forceps deliveries (10%), 12 mid-forceps deliveries (3%), and 39 cesarean sections (10%) were done in the traditional labor and delivery suite. Puerperal complications included one uterine inversion, two cases of placenta accreta, one rectovaginal fistula, and two requirements of blood transfusion. Neonatal morbidity included 22 low Apgar scores (7%), two shoulder dystocia, three cytomegalovirus infestations, and one lethal anomaly. Six infants had meconium aspiration, two with severe hypoxia. Any of these complications would overwhelm the patient in home birth. Intense prenatal screening may decrease some risk factors, but the intrapartum period was found to pose unacceptable risks for home birth in this population.
 ...
PMID:Home birth: negative implications derived from a hospital-based birthing suite. 682 92

Effects of smoking on a fetus include higher perinatal mortality rates, lower birth weight, and impaired mental and physical growth due to carbon monoxide and nicotine. Infants of smoking mothers have greater risk for uteroplacental insufficiency which can be detected by the RAD (fetal activity-acceleration determination). A study of 350 high-risk nonsmoking pregnant women and 128 smoking pregnant women showed that pre-eclampsia was significantly less in smoking women; however, there was a higher incidence of fetal nonactivity (20.8% versus 13.1% for nonsmokers). When nonreactive FAD was evaluated, and OCT (oxytocin challenge test) was performed with more positive OCT's encountered in the nonsmoking group. Cesarean sections were higher (21.9%) in smokers than nonsmokers (17.8%) and cesareans due to fetal distress were also higher in smokers (3.9%). There was a 254.1 gm mean birth weight difference for infants of smoking mothers. Sporatic progression from reactive to nonreactive FAD may be due to: 1) a mother smoking prior to an FAD which could stimulate activity; or 2) exhaustion in the morning after the fetus has been stimulated due to smoking for approximately 16 hours; therefore, depending on when the last cigarette was smoked, fetal reactivity or nonreactivity could result.
 ...
PMID:Diminished fetal reactivity with smoking. 735 4

Based on analyses of the oxytocin challenge test (OCT) in 293 cases, an OCT-reactivity classification is proposed to improve the predictive value of OCT for fetal outcome. All of the 6 perinatal deaths occurred in the 2 groups associated with nonreactive pattern. The positive nonreactive test had 90% accuracy of predicting a sick infant, and the negative reactive test assured good fetal outcome. A nonreactive pattern seems to reflect a compromised fetus, as a high incidence of this pattern was found in patients with pre-eclampsia-hypertension, intrauterine growth retardation (IUGR), low and falling estriol levels, and suspected fetal problems. A positive OCT seems to reflect the limits of fetoplacental reserve under the stressed condition. A high incidence of positive OCT was associated with IUGR, low estriol levels, and a small placenta.
 ...
PMID:An OCT-reactivity classification to predict fetal outcome. 738 82

To investigate the association of serum levels of progesterone (P), estradiol (E2), and estriol (E3) with the initiation of regular contractions, venous blood samples were taken prior to and 3 hours after the successful induction of labor in 83 parturients by means of low amniotomy and intravenous oxytocin infusion. The serum P level and P/E2 ratio decreased and serum E2 level increased after induction in healthy primigravidas and in parturients with an initial P dominance (serum P/E2 ratio more than 5). There was also a decrease in the serum P level and P/E2 ratio in postterm patients and parturients with a ripe cervical state. Cholestasis of pregnancy was associated with a rise in the serum level of E2 and a decrease in the P/E2 ratio. In an unfavorable cervical state there was a rise in the serum E2 level; patients with an initial E2 dominance (serum P/E2 ratio 5 or less) showed a rise in the serum P level and P/E2 ratio. Healthy multigravidas and patients with pre-eclampsia did not show any hormonal changes. The onset of induced labor seems to be associated with a rise in serum E2 concentration and/or with a drop in P concentration. The increase in serum E2 level is thought to be due to the activation of the anterior pituitary--adrenal axis. The lower P level is supposedly a result of diminished uteroplacental circulation.
 ...
PMID:Serum progesterone, estradiol, and estriol before and during induced labor. 738 31

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.
 ...
PMID:Induction of abortion by condom-Foley catheter method in pregnant women with intra-uterine foetal death. 803 76

It was elected to induce labor in Mrs AB after excluding any evidence of severe preeclampsia. Both the fetus and Mrs AB were evaluated. The history, physical examination, and laboratory results were all within normal limits for Mrs AB. Her fetus was appropriately grown for gestational age with an estimated fetal weight of 3,200 g. There was ample but not excessive amniotic fluid noted clinically and by sonography. An amniocentesis to document fetal lung maturation was not done. Two hours after commencing parenteral magnesium sulfate therapy, an oxytocin induction of labor was begun. Fetal well-being was assessed using continuous external electronic monitoring of the fetal heart rate and uterine contractions. Three hours after the induction was started, the cervix was completely effaced and 3 cm dilated. The fetal head was at O station. At this time, the fetal membranes were ruptured and clear amniotic fluid was noted. An internal uterine pressure catheter was inserted, and a fetal scalp electrode applied. The patient received 75 mg of meperidine and 25 mg of promethazine intramuscularly at this time. Five hours after commencing the induction of labor, both mother and fetus were tolerating the labor well. The cervix was 7 cm dilated, and the fetal head was at +2/+5 station. The oxytocin induction was discontinued and another 75 mg dose of meperidine was administered. Blood pressure readings between 150/100 mm Hg and 140/98 mm Hg were recorded throughout labor. Urine output exceeded 150 mL/h. The patient delivered a 3,070-g male infant approximately 9 hours after the start of the induction.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Mild pregnancy-induced hypertension at term. 806 77


<< Previous 1 2 3 4 5 6 Next >>