The Effect of the Implementation of Institutional Checklist on Expert Opinion of Oxytocin Use in Labor

Oxytocin is a commonly used drug in the labor and delivery unit. There are wide variations in oxytocin use between countries and medical centers, which may reflect the lack of structured guidelines. The aim of our study was to evaluate the need of oxytocin checklist in labor and delivery unit, while assessing the management of oxytocin with and without such a checklist. This study was conducted in a single, university-affiliated medical center in two phases: before and after the implementation of an oxytocin checklist in the labor and delivery unit (2016-2017). Six experts reviewed cardiotocographs of deliveries performed in an urgent Cesarean delivery due to non-reassuring fetal heart rate, after completing at least 4h of oxytocin infusion for induction or augmentation of labor. The experts included three obstetricians, a midwife, and two obstetrical expert nurses, who were tasked to conclude whether oxytocin was managed properly or not. Each case was reviewed by two reviewers separately. A total of 100 cases were reviewed; 50 before the oxytocin checklist implementation, and 50 after that implementation. We did not find a difference in the reviewers' assessment of oxytocin management before and after the institutional implementation of the checklist. Additionally, there were significant inconsistencies and inter-observer variations in their assessment before and after the checklist implementation. The implementation of an institutional oxytocin checklist did not affect expert assessment of the use of oxytocin in labor.

A protocol for use of oxytocin

Amniotomy and the use of oxytocin in labor in nulliparous women : Seitchik J; Holden AEC; Castillo M Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, TX 78284, USA

Objetivos: medir a prevalência da utilização de ocitocina no trabalho de parto e parto em maternidades públicas e identificar os fatores associados. Método: estudo transversal, realizado em duas maternidades públicas no município de Londrina, entre janeiro e junho de 2017, com 344 puérperas. Os dados foram coletados por meio da análise dos prontuários. Para análise dos fatores associados, utilizada uma regressão multivariada de Poisson, considerada p <5%. Os dados foram analisados no Statistical Package for the Social Sciences 22.0. Resultados: a prevalência de uso de ocitocina foi de 50,0%. Uma variável aborto anterior (RP = 0,64; p = 0,001)apresenta como fator de risco para uso ocitocina, enquanto presença de dilatação maior ou igual a 5 cm de internação (RP = 1,36, p = 0,004) e rotura espontânea de membranas (RP = 2,33, p = 0,003) proteção para uso da ocitocina. Conclusões: os resultados demonstraram uma prevalência elevada de uso de ocitocina e a diferença estatisticamente significativa na presença de aborto anterior. Por outro lado, a presença de amniotomia espontânea e a internação de mulheres na fase ativa do trabalho de parto são fatores de proteção para uso ocitocina, evidência de comprometimento do processo fisiológico da participação.

Impact of labor and delivery unit policy modifications on maternal and neonatal outcomes during the coronavirus disease 2019 pandemic

Labor induction with vaginal misoprostol and extra-amniotic prostaglandin F 2α gel

This article provides a comprehensive review of current evidence on the challenges and controversies in obstetrics, with a focus on shoulder dystocia, fetal monitoring, and the use of oxytocin in labor and delivery. A systematic search was conducted in three databases (Scielo, Google Scholar, and LILACS), resulting in the selection of 10 relevant studies for an integrative review. The studies encompassed various research methodologies, including systematic reviews, cohort studies, clinical trials, qualitative studies, and narrative reviews. The findings provided important insights into the investigated topics, including risk factors associated with shoulder dystocia, effectiveness of fetal monitoring, comparison of oxytocin use protocols, women’s experiences with shoulder dystocia, obstetric complications, controversies surrounding oxytocin use, incidence of shoulder dystocia, and utilization of fetal monitoring. These findings contribute to a better understanding of these topics and may guide clinical practice towards safer and more effective obstetric care. However, further research is needed to fill existing knowledge gaps and inform evidence-based decision-making in obstetrics.

The purpose of this study was to investigate the delivery outcome in relation to oxytocin use in labor. We studied 106,755 deliveries from 1995 to 2002 in the Perinatal Revision South, a population-based register comprising information from 10 hospitals in southern Sweden. Oxytocin use in labor increased from 27.6% in 1995/96 to 33.2% in 2001/02 (p<0.000006). Oxytocin was administered to 47.7% of the nulliparas and 18.5% of the multiparas. There were large differences between hospitals (range among nulliparas: 32.6-60.4%; among multiparas: 13.9-27.0%). After exclusion of deliveries with induction of labor and deliveries lasting >12 h, there was a significant association between oxytocin use and Apgar score < 7 at 5 min (OR 2.3; 95% CI 1.8-2.9), need for neonatal intensive care (OR 1.6; 95% CI 1.5-1.7), and operative delivery (OR 4.0; 95% CI 3.7-4.2). In deliveries with relatively short duration (< or =12 h), a significant association was seen between oxytocin use and adverse outcome. Even though the results are difficult to interpret, the significant difference between the use of oxytocin in different hospitals, as well as the increase of oxytocin use over time, calls for a randomized controlled study to elucidate the advantages and disadvantages of oxytocin use during labor and delivery.

Stillbirth rate at an emerging tertiary health institution in Enugu, southeast Nigeria

Amniotomy and the use of oxytocin in labor in nulliparous women

Use of Oxytocin in Labor

Interview and record review data from 12,023 singleton deliveries were analyzed to determine the relationships between neonatal hyperbilirubinemia (10 mg/dL or greater) and maternal characteristics. Confounding variables were controlled by multiple logistic regression analysis. There was a statistically significant positive relationship between hyperbilirubinemia and low birth weight, Oriental race, premature rupture of membranes, breast-feeding, neonatal infection, use of the "pill" at time of conception, instrumental delivery, and history of first trimester bleeding. Maternal smoking and black race were negatively related to hyperbilirubinemia and statistically significant. In this study, other previously suspected etiologic factors such as epidural anesthesia, parity, use of oxytocin in labor, and white race were not associated with hyperbilirubinemia.

Neonatal jaundice is a yellowish discoloration of the skin and other tissues of a newborn. Hyperbilirubinemia in the first 24 hrs often results in hemolytic diseases of the newborn erythroblastosis fetalis an abnormal rapid rate of RBC destruction. The causes of neonatal jaundiceare the breakdown of fetal hemoglobin, prematurity, trisomy syndrome, use of oxytocin in labor, presence of bruising cephalo hematoma and a family history of neonatal jaundice. In India neonatal jaundice, contributes 4.55% death in neonatal period.

Check One, Check Two, Check Three. Implementation of a Shoulder Dystocia Checklist in the Labor and Delivery Unit

Although recent evidence suggests the simultaneous approach use of oxytocin for induction of labor in nullipara, there is limited data from low-income settings that support this. This study aimed to determine whether induction of labor with simultaneous use of oxytocin and a Foley balloon catheter decreases the induction of labor to delivery interval in nulliparous women, compared with sequential use of a Foley balloon catheter followed by oxytocin. This was a randomized controlled trial of nulliparous women with singleton pregnancies presenting for induction of labor at >28 weeks of gestation at St. Paul's Hospital Millennium Medical College (Addis Ababa, Ethiopia). The participants were randomly assigned to either the simultaneous group (the use of oxytocin and a Foley balloon catheter for induction of labor) or the sequential group (overnight intracervical Foley balloon catheter placement followed by the use of oxytocin the next morning). The primary outcome was induction of labor to delivery interval. Comparisons between the groups were made using the Student t test or Wilcoxon rank-sum test and chi-square test on Stata (version 15; StataCorp LLC, College Station, TX). This study is registered with the Pan African Clinical Trials Registry (identifier: PACTR201709002509200). From November 2019 to March 2020, a total of 140 women were randomly assigned to the simultaneous group (70 women) or the sequential group (70 women). The median oxytocin initiation to delivery intervals were 6.09 hours (range, 4.03-10.7) in the sequential group and 8.1 hours (range, 4.7-11.6) in the simultaneous group (P=.46). The mean Foley balloon catheter insertion to delivery intervals were 16.09±5.7 hours in the sequential group and 8.06±4.2 hours in the simultaneous group (P<.001). Cesarean delivery rate, composite neonatal outcomes, and chorioamnionitis were not different between the 2 groups. In nulliparous pregnant women, induction of labor using the simultaneous approach did not shorten the oxytocin initiation to delivery interval compared with the sequential approach. Moreover, both approaches showed no difference in the rates of adverse maternal and neonatal outcomes.