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

The pressure exerted on the fetal head during the second stage of labor was continuously measured in 42 spontaneous deliveries with a new instrument. The pressure values were correlated to various obstetric variables. Typically, the head pressure remained elevated beyond the end of the uterine contraction in primiparae, whereas it decreased simultaneously with the amniotic pressure in multiparae. On the average, the head pressure was higher in primiparae indicating, together with the longer lasting bearing down period, a higher resistance of the birth canal. Deliveries with pudendal block or peridural analgesia showed no differences, but these two groups differed in other factors which might have influenced the results. Infusion of oxytocin during the course of labor was associated with higher head pressure values that could not be deduced from the hormone administration per se, but from a higher resistance of the birth canal. Maternal age did not influence the head pressure. Within physiological limits, the head pressure was independent from the size of the child and the maternal pelvis.
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PMID:[Stress on the head of the fetus in spontaneous labor in relation to perinatal factors]. 832 70

In Scotland, gynecologists used 200 mg mifepristone followed 36 hours later by 1 mg gemeprost pessary every 6 hours for the first 24 hours and, if termination did not occur, every 3 hours for the next 12 hours, to induce second trimester abortion (12-21 weeks gestation) in 100 women 13-42 years old, attending the Simpson Maternity Pavilion of the Edinburgh Royal Infirmary. Most women only required 2 pessaries (range, 1-9). 47 only needed 1 pessary. 96 and 99 women experienced an abortion within 24 hours and 48 hours, respectively. The median interval between gemeprost administration and abortion was 7.5 hours (range, 2.9-52.3 hours). Just 1 woman experienced the abortion after 48 hours, and she required intravenous infusion of oxytocin. The interval for primigravidas was significantly longer than for multigravidas (8.2 hours vs. 6.6 hours; p .01). 31 women vomited after insertion of the gemeprost pessary. 5 experienced diarrhea after gemeprost administration. 84 required intramuscular diamorphine for analgesia. Evacuation of the uterus was required in 33 women after they expelled the fetus. 24 of these women retained the placenta. None of the 100 women required a blood transfusion. These results compared favorably with those of a similar study using 600 mg mifepristone in combination with 1 mg gemeprost every 3 hours. In other words, clinical efficacy was not lost with a reduction in the dose of both mifepristone and gemeprost. These results demonstrated that 200 mg mifepristone followed by 1 mg gemeprost pessary is a cost-effective, simple, and noninvasive method to induce a second trimester abortion on an outpatient basis.
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PMID:Induction of second trimester abortion with mifepristone and gemeprost. 839 16

To assess the safety and effect of epidural analgesia on the course of labour and delivery in Pakistani women, a retrospective case control study was conducted from November, 1986 to November, 1991 (5 years) at the Aga Khan University Medical Centre, Karachi. All patients (n = 64) who received epidural analgesia for labour (cases) were compared with randomly selected patients (n = 18) who did not receive epidural analgesia during labour (controls). The cases and controls were matched for age, height, body mass index, parity, use of oxytocin, presentation and weight of the foetus. There was no significant difference (P > 0.05) between the two groups in duration of labour, caesarean section rate and foetal apgar scores at 1 and 5 minutes after birth. The incidence of malposition of foetal vertex at delivery and that of instrumental (forceps) deliveries was significantly higher (P < 0.05 and < 0.01 respectively) in the epidural group as compared to controls. The incidence of complications was low and the acceptance and tolerance of epidural analgesia was good in our patients.
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PMID:The safety of epidural analgesia in labour and its effect on delivery--a case control study in Pakistani women. 841 13

The concentrations of plasma oxytocin and prostaglandin F2 alpha metabolite (PGFM) were measured in 10 parturients with and 10 without lumbar epidural analgesia. A blood sample was taken immediately before analgesia and another 60 min later. The control patients were matched for the stage of cervical dilatation at the time of the first blood sample; the second was drawn 60 min later. Plasma PGFM decreased significantly after lumbar epidural anesthesia and increased in controls resulting in a highly significant difference between the groups (P < 0.005). Plasma oxytocin concentrations levels also changed in opposite directions in the two groups but the difference did not reach statistical significance (P < 0.1). Uterine activity increased in the controls and decreased in the analgesia group resulting in a significant difference between the groups (P < 0.05). All subjects delivered vaginally. The total duration of labor was longer in the analgesia group (7.8 +/- 1.0 h vs. 4.7 +/- 0.6 h; P < 0.05) as was the duration after analgesia (5.1 +/- 0.9 h vs. 2.5 +/- 0.8 h; P < 0.05), whereas the duration of the second stage was not significantly different. We conclude that lumbar epidural anesthesia results in suppression of PGF2 alpha release which may be the cause of the diminished uterine activity and the prolonged duration of the first stage of labor.
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PMID:Effects of lumbar epidural analgesia on prostaglandin F2 alpha release and oxytocin secretion during labor. 848 13

Previous studies have failed to demonstrate a block of the endocrine response to upper abdominal surgery by thoracic epidural analgesia. To clarify the bases for this failure, we compared the effects of epidural analgesia of different dermatome levels up to C8-T2 or C3-4. The patients who received general anesthesia alone showed significant increases of adrenocorticotropic hormone (ACTH) and arginine vasopressin (AVP) immediately after skin incision. The patients with C8-T2 blocked developed significant increases in these hormones, not after the skin incision, but after the intraabdominal procedure. Of the eight patients with C3-4 block, six developed no such responses throughout the study period. The responses of oxytocin (OXT) and prolactin (PRL) were more susceptible to epidural analgesia and were blocked at the C8-T2 level. Growth hormone (GH) showed no correlation with surgical procedures and epidural block. These findings indicate that the nociceptive neural information during upper abdominal surgery is conveyed by the sensory fibers included in both the thoracic and lumbar spinal nerves that innervate the abdominal wall and the intraabdominal viscera, and by the phrenic nerves that innervate the diaphragm. The rationale for postulating the involvement of the phrenic nerves can be referred to the embryonal descent of the diaphragm from the C3-5 myotomes that serves as the upper wall of the abdominal cavity.
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PMID:The role of the phrenic nerves in stress response in upper abdominal surgery. 863 94

The pain associated with labour can be severe. The ideal labour analgesic does not exist and systemic opioids provide little relief. Nausea, vomiting and sedation are common adverse effects of systemic opioids. Paracervical block can relieve only the pain of the first stage of labour. The duration of analgesia obtained using paracervical block is limited and repeat blocks increase the risk of direct fetal injection. Epidural analgesia effectively relieves labour pain. The insertion of an epidural catheter can provide continuous analgesia throughout labour. In addition, the catheter can be used to provide surgical anaesthesia, should operative delivery be required. Epidural local anaesthetics commonly produce maternal hypotension and motor blockade. However, opioids potentiate the effect of epidural local anaesthetics. Thus, concomitant epidural opioid injection allows the use of lower concentrations of local anaesthetics, decreasing the frequency and severity of hypotension and motor blockade. Epidural analgesia has other, potentially catastrophic, adverse effects but, with safe clinical practice, these problems are extremely rare. Intrathecal injection of opioids or local anaesthetics also effective labour analgesia. However, no single intrathecal drug or drug combination reliably provides analgesia for the duration of labour. Many clinicians use both intrathecal and epidural analgesia as a combined spinal-epidural technique. This approach provides the rapid onset of intrathecal drugs and the flexibility of continuous epidural block. Fetal heart rate decelerations occasionally follow the use of any of the above labour analgesic techniques. Most studies of the aetiology of fetal heart rate decelerations have focused on factors unique to each analgesic technique. However, the similar timing and appearance of fetal bradycardia suggests a common cause. Induction of maternal analgesia may transiently alter the balance between factors encouraging and inhibiting uterine contraction. A temporary increase in the uterotonic effects of endogenous or exogenous oxytocin may then produce a tetanic uterine contraction with subsequent decrease fetal oxygen delivery and resultant fetal bradycardia. Regardless of aetiology, these bradycardias are transient and should not produce maternal or fetal morbidity. Much controversy surrounds the effects of analgesia, especially epidural block, on the course and outcome of labour. Various studies have reported that epidural analgesia slows labour, increases the incidence of malposition of the fetal head, increases the need for forceps delivery and increases the risk of caesarean delivery. Most of the studies reporting these effects are retrospective and nonrandomised. More careful studies suggest that specific anaesthetic techniques (i.e. local anaesthetic-opioid mixtures) or obstetrical management can limit or eliminate these 'risks' of epidural labour analgesia.
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PMID:Labour analgesia. A risk-benefit analysis. 871 92

The effect of adding a minidose of clonidine to intrathecal sufentanil during the early first stage of a painful labour was evaluated in this preliminary open-label, non-randomised trial. Group 1 received sufentanil 5 micrograms + clonidine 30 micrograms intrathecally (n = 10) and group 2 only intrathecal sufentanil 5 micrograms (n = 11). The two groups were not statistically different regard-ing age, weight, height, primiparity (67 vs 50%), oxytocin use (37 vs 60%), initial cervical dilation (m +/- DS: 2.9 +/- 1.1 vs 2.9 +/- 1 cm) and VAS pain scores (70 +/- 14 vs 68 +/- 19 mm). In group 1, analgesia was markedly prolonged with a reduced variability in duration: 146 +/- 27 min vs 95 +/- 44 min, (P = 0.006). VAS pain scores were: 14 +/- 20 vs 19 +/- 13, 1 +/- 3 vs 9 +/- 12, 0 vs 5 +/- 7, 48 +/- 12 vs 65 +/- 15, five and fifteen minutes after intrathecal injection, during maximum efficacy, and at the time additional analgesia was required, in group 1 and group 2, respectively. Analgesia evaluated with the VAS pain scores was better in group 1 compared with group 2 (P = 0.02) and decreased somewhat slower. Side effects, such as hypotension, pruritus and sedation, were not statistically different between groups. Nausea and motor blockade did not occur. In conclusion, the addition of a minidose (30 micrograms) of clonidine to sufentanil 5 micrograms given intrathecally seems to potentiate markedly the analgesia obtained during the early first stage of labour.
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PMID:[Combined spinal and epidural analgesia for labor. Prolongation by addition of a minidose of clonidine to sufentanil. An initial study]. 918 Sep 99

This randomized clinical trial compared oxytocin induction of labor with expectant care for 48 hours after prelabor rupture of the membranes at term. Women at term with prelabor rupture of the membranes for at least 8 hours were assigned at random to induction with oxytocin or to expectant management for 48 hours followed by induction if necessary. Of 168 eligible women, 123 (73%) agreed to participate. More women in the induction group (23%) than in the expectant group (10%) had operative delivery, either cesarean section or instrumental vaginal delivery. In the induction group 41% received analgesia versus 24% in the expectant group (p < 0.005). There was no difference in the rate of maternal and neonatal infection between groups and sepsis was not observed. The active policy of oxytocin induction exposed the mother to a higher risk of operative delivery and a less comfortable labor than the 48 hours expectant care option.
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PMID:Controlled comparison of induction versus expectant care for prelabor rupture of the membranes at term. 882 72

We investigated the maternal characteristics, labour performance and delivery mode of 497 nulliparas entering labour spontaneously at term to identify the obstetric factors which influenced their choice of analgesia; 51.7% of these women used epidural analgesia. They were shorter (163 versus 165 cm, p = 0.002) and the mean gestation was 3 days greater than those not using epidural analgesia (40.2 versus 39.6 weeks, p = 0.0007). Median birth-weight in the epidural group was greater by 155 g (3,450 versus 3,295 gs, p = 0.0001). Analysis of the labour characteristics showed a lesser cervical dilatation on admission, significantly longer latent and active phases of labour and second stage length in the epidural cohort. The need for oxytocin augmentation was significantly greater in the epidural group, both prior to and after insertion. Oxytocin augmentation was strongly associated with an increased risk of operative intervention regardless of analgesia. Selection of intrapartum analgesia is not a random event and epidural analgesia appears to be an indicator of abnormal labour patterns. To further investigate the impact of analgesic methods on nulliparous labour we are currently conducting a prospective randomized controlled trial.
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PMID:Factors influencing the selection of analgesia in spontaneously labouring nulliparous women at term. 932 7

The suggestions offered in this article represent an effort to reduce the incidence of cesarean delivery for dystocia while maintaining a safe course to vaginal birth. Avoiding difficult labor induction in which a compelling indication is lacking, providing prompt and effective oxytocin therapy of arrested first stage labor, and liberalizing the use of oxytocin therapy in selected cases of second-stage arrest are emphasized. With the widening use of conduction analgesia, indicated operative vaginal delivery has an increasingly important role in tempering cesarean birth rates. Operative vaginal delivery can play an effective role only when strict conditions to insure its safety are met.
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PMID:Managing difficult labor: avoiding common pitfalls. 932 32


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