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

Although only about 8 per cent of pregnancies end prematurely, as much as 75 per cent of perinatal deaths are due to prematurity. Since it is difficult to identify the predisposing factors in individual cases and to prevent the premature onset of labor, it is necessary to try to arrest such labor when it occurs. A theoretical scheme for the mechanism of labor in the human subject is presented. This permits the identification of four possible points of attack: (1) replacement of progesterone to reduce the myometrial sensitivity to oxytocin, (2) administration of beta-mimetic agents to relax the uterus and make it unresponsive to stimuli, (3) administration of ethanol to block oxytocin secretion, and (4) administration of anti-inflammatory drugs to inhibit prostaglandin synthesis. Results obtained with ritodrine, a beta-mimetic agent, and with ethanol are presented as illustration. Ritodrine gave somewhat better results than ethanol, possibly because the treatment was continued after discharge of the patients.
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PMID:Prevention of prematurity. 1 89

Procedures and indications for nonstress fetal monitoring, oxytocin challenge tests, 24-hour measurement of urine estriols, ultrasound, and amniocentesis, five of the most widely used diagnostic tools for monitoring the fetus at risk, are reviewed. While none of these tests is completely accurate by itself, selective use of these tests improves the ability to diagnose placental insufficiency and to predict the ability of the fetus to survive outside the uterus. Complications may threaten the life of the fetus, but delivery can be timed to minimize the complications associated with prematurity. Overall, skilled medical management of underlying problems remains most important, while tests of placental insufficiency add valuable, but supplementary guidelines for overall management of the high-risk patient.
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PMID:High-risk pregnancy screening techniques: a nursing overview. 25 50

To ensure an optimum result in pregnancy it is essential that the physician be alert in the antenatal period to recognize those women and their babies who are at risk during labour. Premature labour, with its attendant risk of respiratory distress syndrome in the newborn, continues to be an important factor in perinatal morbidity and mortality. Early recognition of predisposing factors and the judicious use of myometrial inhibiting agents have helped to reduce the incidence of fetal prematurity in these cases. A long interval between rupture of the membranes and delivery continues to be a danger to both mother and fetus. Delivery is recommended when gestation is beyond 36 weeks or when there are signs of incipient infection, and once labour has begun antibiotics should be used prophylactically. Failure of labour to progress should be recognized and managed aggressively in its early stages. Amniotomy and oxytocin infusion have reduced considerably the incidence of prolonged labour and its risks to both mother and fetus. The role of intrapartum monitoring of the fetal heart rate, measurement of the pH in the fetus's scalp blood and assessment of amniotic fluid is discussed, as is the monitoring of maternal well-being.
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PMID:Labour: when to worry. 63 Apr 88

A prospective study of 454 newborn babies with pathological hyperbilirubinemia revealed that in about one-third of cases (34.6%), no cause could be identified despite detailed investigations. Nearly three-fifth of infants (62.5%) had hyperbilirubinemia due to hemolytic causes. On the basis of four variables, i.e., peak serum bilirubin level, age of attaining the peak level, age of starting phototherapy and total duration of phototherapy, the cases of hyperbilirubinemia can be categorized into three groups: (a) Group I (mild) included non-hemolytic hyperbilirubinemia, i.e., idiopathic, bacterial infections, intrauterine infections and others, (b) Group II (moderate) comprised of hemolytic as well as non-hemolytic hyperbilirubinemia due to prematurity, administration of oxytocin, bruising/cephalhematoma, and (c) Group III (severe) comprised of hyperbilirubinemia due to hemolysis as a result of blood group incompatibility between the mother and the neonate and G-6-PD deficiency. Sixty six babies required exchange blood transfusion (EBT) and a total of 100 EBTs were performed. Most of the babies (80.3%) requiring exchange blood transfusion belonged to Group III. The most common cause of hemolytic hyperbilirubinemia needing exchange blood transfusion was Rh isoimmunization followed by G-6-PD deficiency and ABO isoimmunization. There was no death attributable to the procedure of exchange blood transfusion.
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PMID:Spectrum of neonatal hyperbilirubinemia: an analysis of 454 cases. 161 73

The effect of severity of hypertension on fetal heart rate tracing changes and neonatal outcomes was evaluated on all patients with hypertension seen in 1980 and 1981 (666 cases, 10% of the pregnant population) in the Chicago-Lying In Hospital. The patients were grouped according to severity of hypertension, and the fetal heart rate monitoring, drugs administered, mode of delivery, and neonatal outcome were analyzed. Half of the patients (326) had mild hypertension and 13% (87) had severe hypertension; the remainder (253) had moderate hypertension. There were 49% primiparous and 51% multiparous women. The diagnosis of preeclampsia was made in 76% of cases, and chronic hypertension in 19%. Only 12% of the total were premature by dates, but 47% of this group were among the severe group. Oxytocin was given to 50%, whereas delivery was spontaneous in 56% of cases, and by cesarean section in 22%. This was higher among the severe hypertension group (37%), and the prematurity rate was 47%. Nonstress testing was done in one third of cases and only nonreactivity was associated with neonatal death. Neonatal depression (Apgar score less than 6 at 5 minutes) was significantly associated with intrapartum fixed baseline and late decelerations; these were the best predictors of fetal outcome. The administration of magnesium sulfate, hydralazine, meperidine, or morphine did not predictably affect the fetal heart rate pattern. The perinatal mortality was 21% in the mild group and 36% and 138%, respectively, among moderate and severe cases of hypertension. Close antepartum and intrapartum surveillance, including proper fetal monitoring, should help to reduce risks for mother and fetus through timely intervention.
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PMID:Effects of hypertension on pregnancy monitoring and results. 222 Sep 23

In Finland a nationwide free prenatal care system was mandated by law in 1944. At present, 99.9% of Finland's pregnant women use it. The primary aim is to provide advice and care to all women in local centers and to identify pregnant women exhibiting risk factors and refer them to specialized prenatal units located in 21 central hospital districts. This screening has succeeded well since the late 1970s, as judged by the low frequency of stillborn and low birthweight children born outside central hospitals. The rate of preterm birth has decreased by 1% during the latter half of the 1970s and is now 5.8%. This decrease occurred concomitantly with an overall decrease of 55% in the use of betamimetic drugs, which suggests that the use of betamimetic agents has had minor or no significant impact on the reduction of the incidence of prematurity. In order to improve the identification of mothers at high risk for preterm delivery, a mathematical model was constructed that included 13 risk factors. This model successfully identified a class made up of 22% of all women in whom 65% of preterm deliveries occurred, but 35% of mothers delivering prematurely still remained unidentified. Efficient screening of genital tract infections, relieving mothers of heavy work, and developing new oxytocin analogues may further reduce prematurity in the future.
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PMID:Effective prenatal care decreases the incidence of low birthweight. 271 20

The authors use an intravenous dose of 0.5 g glucose/kg. body weight as a fetal stimulation test in one hundred pregnant patients after the 34th week. Glucose produced a remarkable increase of fetal heart rate variability, as well as an increase in the number of fetal movements and accelerations. Those fetuses lacking reactivity before and after the glucose test presented, in 55.5% of the cases, neonatal depression. This suggests that glucose perinatal surveillance is of utmost importance in these cases. The glucose overload test presents a clear advantage with respect to the oxytocin test, which is the total absence of labor stimulation and this may not be desirable in cases of prematurity or previous uterine scars.
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PMID:[The glucose perfusion test: value in detecting fetal distress]. 277 83

The diagnosis, aetiology, management and outcome of face presentation were analyzed in 51 cases. Primigravidas accounted for 17.6%, multiparas for 54.9% and grand multiparas (5 deliveries or more) for 27.5%. Prematurity did not appear to be an important aetiologic factor. The position was mentum anterior in 26 patients (51%), all but one of whom were delivered vaginally. Of 12 fetuses in the mentum transverse position, 11 were delivered vaginally after spontaneous rotation to mentum anterior. Ten patients presented with mentum posterior; only 2 were delivered vaginally after spontaneous rotation. Three fetuses were diagnosed as face presentation during Caesarean section. The mean birth-weight of the infants who rotated from mentum posterior to mentum anterior was 3,425 +/- 35g, while that of those with persistent mentum posterior was 3,792 +/- 347 (p less than 0.01). Records of monitored fetal heart rate were available in 21 cases. Late decelerations and variable decelerations were recorded in 6 (28.5%). The incidence of Caesarean section was 25.5% compared to an overall incidence of 4.4% during the period of the study. Oxytocin was administered to 10 patients, and 7 of them were delivered vaginally. Early diagnosis of presentation and position, with close fetal surveillance may improve fetal outcome. In case of mento-posterior position, primary Caesarean section at term should be considered.
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PMID:Face presentation. 346 36

Oxytocin is a potent uterine stimulant that is used for the induction and augmentation of labor, antenatal fetal assessment, and control of postpartum hemorrhage. If used improperly, oxytocin can lead to such complications as uterine hypercontractility with fetal distress, uterine rupture, maternal hypotension, water intoxication, and iatrogenic prematurity. These complications can almost always be avoided if oxytocin is given in proper dosages and with careful fetal and maternal monitoring. Recent interest in active management of labor policies has resulted in a reexamination of the use of oxytocin in the augmentation of the labors of nulliparous women.
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PMID:Oxytocin: pharmacology and clinical application. 353 34

An analysis of 25 perinatal malpractice cases filed in Wisconsin between 1978 and 1984 clearly revealed that the unfavorable outcomes were preventable and caused by professional negligence. Each case was settled or adjudicated in favor of the plaintiff, and the awards totaled $25.1 million. Although cases with a total recovery of over $1 million are relatively infrequent, they are not so rare as to be considered extra-ordinary occurrences. Fifty-six percent of physicians involved failed to recognize a high-risk pregnancy or fetal distress, while 44% failed to render proper care. The most common errors involved inadequate fetal monitoring, the injudicious use of oxytocin and the failure to recognize a high-risk pregnancy, such as prematurity or postterm or multiple gestation. The purpose of this study was to examine the medicolegal issues operating in such cases in order to develop guidelines for reducing professional negligence, thereby preventing injury to women and their newborns.
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PMID:Perinatal malpractice. Risks and prevention. 356 83


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