Oxytocin For Induction Of Labor Research Articles

Oral misoprostol may be an alternative to IV oxytocin for induction of labour

Oral misoprostol may be an alternative to IV oxytocin for induction of labour

Is vaginal birth after cesarean delivery a safe option in India?

Vaginal birth after cesarean delivery (VBAC) has been promoted as a method to reduce overall cesarean delivery rates. The benefits of successful VBAC in North American centers reportedly outweigh risks in most women with a prior low transverse cesarean delivery. Many women come to our center specifically to attempt VBAC since we offer this option for delivery following one lower segment cesarean section. Emergency cesarean delivery is possible within 15 min of decision making. We monitor all women attempting VBAC with continuous electronic monitoring and if required use oxytocin for labor induction and augmentation. We do not routinely explore the uterus after delivery. During the study period prostaglandin E2 gel (0.5 mg) was used for cervical ripening when required. (excerpt)

Current practice in oxytocin dilution and fluid administration for induction of labor.

To determine the types of intravenous fluids used to dilute oxytocin for labor induction in a national sample of obstetric units, as well as the extent to which these fluids reflect current published guidelines. A descriptive design. Questionnaires were mailed to nurse managers at 700 obstetric units chosen via systematic random sampling from eligible hospitals listed in The AHA Guide (1998). Two hundred fifty-six usable questionnaires were included in data analysis. The Labor Induction Protocol Survey, consisting of eight questions relating to number of births per year, percentage of women whose labor is induced or augmented, methods used for induction of labor, intravenous fluids used to dilute oxytocin for induction of labor, the level of perinatal care of the unit, and the protocols units used to guide their practice in the use of oxytocin, was developed for this study. Approximately 98% of the responding sites follow the current recommendations for oxytocin dilution and mainline fluid delivery. However, 5 or 2% of the sites reported the use of 5% dextrose in water for both oxytocin dilution and the mainline intravenous solution. Although only 5 (2%) of the responding facilities indicated the use of 5% dextrose in water for both oxytocin dilution and the mainline intravenous solution, this may be clinically significant because of the serious nature of hyponatremia and the ease of its prevention. Nurses should be aware of the extent to which protocols for the infusion of oxytocin vary, despite what is documented as best practice and the potential consequences for their patients of implementing those protocols. Nurses who advocate for and participate in writing protocols that reflect the best-recommended practice for their patients will assist in ensuring that what is documented as best practice is actually implemented.

Laminaria, induced fetal demise and misoprostol in late abortion

Objectives: To analyze and determine the safety and effectiveness of induced fetal demise as an adjunctive method in outpatient abortion for patients with advanced pregnancies and to evaluate the independent effect of intrauterine misoprostol administered after amniotomy in late abortion. Methods: During a 9-year period, 1677 abortions were performed for patients whose pregnancies ranged from 18 through 34 menstrual weeks in an outpatient facility. Of these, 832 were performed by one physician. Techniques for performing all the abortions included induction of fetal demise by intrauterine fetal injection of digoxin and/or hyperosmolar urea, serial multiple laminaria treatment of the cervix, amniotomy, oxytocin induction of labor, and assisted delivery or surgical evacuation of the fetus and placenta. In the last 411 of the 832 patients whose abortions were performed by one physician, misoprostol was placed in the lower uterine segment following amniotomy in order to enhance labor induction, cervical ripening, and fetal expulsion. Results: Of the entire group of 1677 cases, the median gestational age was 22 menstrual weeks. The median procedure time for all cases was 10 min. Measured median blood loss was 125 ml. Blood loss and procedure time increased with length of gestation, but these were not affected by misoprostol. There were three major complications (0.2%) in the overall series. Among patients seen by one physician ( N=832), amniotomy-to-procedure time was shorter by 26 min for patients receiving misoprostol, and there was 27% more variability in amniotomy-to-procedure time among patients not receiving misoprostol. Complication rates for patients receiving misoprostol were the same as for those not receiving misoprostol. There were no major complications in the 832 patients seen by one physician, no uterine rupture or perforations, and no cervical lacerations. Conclusions: Outpatient abortion may be performed safely from 18 through 34 menstrual weeks using combined surgical and medical procedures. Use of intrauterine post-amniotomy misoprostol was associated with reduced amniotomy-to-procedure time and reduced variability in the amniotomy-to-procedure time.

Amniotomy plus intravenous oxytocin for induction of labour.

Induction of labour is a common obstetric intervention. Amniotomy alone for induction of labour is reviewed separately and oxytocin alone for induction of labour is being prepared for inclusion in The Cochrane Library. This review will address the use of the combination of these two methods for induction of labour in the third trimester. This is one of a series of reviews of methods of cervical ripening and labour induction using standardised methodology. To determine, from the best available evidence, the efficacy and safety of amniotomy and intravenous oxytocin for third trimester induction of labour. The Cochrane Pregnancy and Childbirth Group Trials Register, the Cochrane Controlled Trials Register and reference lists of articles were searched. Date of last search: May 2001. The criteria for inclusion included the following: (1) clinical trials comparing amniotomy plus intravenous oxytocin used for third trimester cervical ripening or labour induction with placebo/no treatment or other methods listed above it on a predefined list of labour induction methods; (2) random allocation to the treatment or control group; (3) adequate allocation concealment; (4) violations of allocated management not sufficient to materially affect conclusions; (5) clinically meaningful outcome measures reported; (6) data available for analysis according to the random allocation; (7) missing data insufficient to materially affect the conclusions. Trial quality assessment and data extraction were done by both reviewers. A strategy was developed to deal with the large volume and complexity of trial data relating to labour induction. This involved a two-stage method of data extraction. The initial data extraction was done centrally, and incorporated into a series of primary reviews arranged by methods of induction of labour, following a standardised methodology. The data is to be extracted from the primary reviews into a series of secondary reviews, arranged by category of woman. Seventeen trials involving 2566 women were included. Amniotomy and intravenous oxytocin were found to result in fewer women being undelivered vaginally at 24 hours than amniotomy alone (relative risk (RR) 0.03, 95% confidence intervals (CI) 0.001-0.49). This finding was based on the results of a single study of 100 women. As regards secondary results amniotomy and intravenous oxytocin resulted in significantly fewer instrumental vaginal deliveries than placebo (RR 0.18, CI 0.05-0.58). Amniotomy and intravenous oxytocin resulted in more postpartum haemorrhage than vaginal prostaglandins (RR 5.5, CI 1.26-24.07). Significantly more women were also dissatisfied with amniotomy and intravenous oxytocin when compared with vaginal prostaglandins, RR 53, CI 3.32-846.51. Data on the effectiveness and safety of amniotomy and intravenous oxytocin are lacking. No recommendations for clinical practice can be made on the basis of this review. Amniotomy and intravenous oxytocin is a combination of two methods of induction of labour and both methods are utilised in clinical practice. If their use is to be continued it is important to compare the effectiveness and safety of these methods, and to define under which clinical circumstances one may be preferable to another.

Oxytocin for Labor Induction

Induction of labor has increased from 9% to 18% of all U.S. deliveries in recent years. Several useful oxytocin induction protocols are available, both from the ACOG Practice Bulletin #10 and institutional sources. Higher-dose protocols tend to result in fewer cesarean deliveries for dystocia but more "fetal distress." There is no consensus as to which protocol is best, and the clinician is advised to understand the trade-offs involved and how those trade-offs could relate to the clinician's local situation. Given the availability now of prostaglandin agents for induction with an unfavorable cervix, the advantage of less hyperstimulation in low-dose oxytocin protocols may become increasingly important. The most important risks include hyperstimulation (frequent but usually brief and well-tolerated), failed induction (occasional and important), and uterine rupture in some studies (rare but dangerous). Pain was not a sensitive indicator of uterine rupture in a large 1989 study. Fetal heart rate changes were much more likely to herald uterine rupture in that study. Oxytocin's greatest weakness is that some patients will not respond well to it, especially with marked cervical unfavorability. However, given an individual patient whose uterus will respond adequately to this drug, oxytocin has the advantage of short half-life and the option for prompt cessation if desired. Intrauterine pressure catheters with oxytocin usage are usually well-worth their minor risks. Current ACOG literature lists induction of labor in the setting of one or more previous low-transverse cesarean deliveries as necessitating "special attention" and "close patient monitoring." The well-informed clinician will be familiar with the issues involved.

A randomized trial of misoprostol versus extra-amniotic sodium chloride infusion with oxytocin for induction of labor

Objective: Our purpose was to compare the efficacy and safety of misoprostol and extra-amniotic sodium chloride infusion with oxytocin for induction of labor. Study Design: This randomized trial compared two methods of labor induction in women requiring cervical ripening. One hundred twenty-three women undergoing labor induction with a Bishop score ≤5 were randomly selected to receive either misoprostol, 50 μg intravaginally every 4 hours, or extra-amniotic sodium chloride infusion. The primary outcome variable was the time interval from induction to vaginal delivery. Results: Sixty-one women received extra-amniotic sodium chloride infusion and 62 women received misoprostol. The mean time interval from the start of induction to vaginal delivery was 15.0 ± 5.0 hours and 16.5 ± 7.2 hours for the extra-amniotic infusion and misoprostol groups, respectively ( P , not significant). The cesarean delivery rate was not significantly different between the 2 groups (32.8% for the extra-amniotic infusion group; 19.4% for the misoprostol group). Maternal and neonatal outcomes were similar between the 2 groups. Conclusions: Both methods of induction are equally efficacious and result in similar maternal and neonatal outcomes. (Am J Obstet Gynecol 2000;182:1039-44.)

A blinded randomized controlled trial of misoprostol, dinoprostone, and oxytocin for labor induction

Objectives: Our objectives were to compare misoprostol via oral and vaginal routes in a randomized, controlled, blinded fashion; to compare misoprostol with a standard regimen of dinoprostone and oxytocin; to include a broad range of gestational ages; and to include patients with rupture of membranes prior to labor onset.Methods: 156 consecutive patients were enrolled. They were randomly assigned to one of three groups. Group A received oral misoprostol, 50 μg, and an inert vaginal placebo every 4 hours for 24 hours, with an optional additional dose of 50 μg after the second dose. Group B received misoprostol, 25 μg, intravaginally and an inert oral placebo every 4 hours for 24 hours, with an optional oral placebo after the second dose. Group C received dinoprostone intravaginally for 12 hours followed by oxytocin, or only oxytocin based on admitting bishop’s score.Results: Induction in groups A and B resulted in 86% and 87% vaginal delivery rate, compared with 79% for Group C. Of those delivered vaginally, groups B and C resulted in 20.0 and 20.3 hours to delivery versus 25.9 hours in group A. These differences reached statistical significance. Rates of tachysystole for groups A and B were 16% and 20%, whereas group C was 2%. Hyperstimulation rates were not statistically different (4%, 7%, and 2%, respectively).Conclusions: Misoprostol is superior to dinoprostone/oxytocin in producing vaginal deliveries. Vaginal misoprostol resulted in similar times to delivery as dinoprostone/oxytocin, whereas oral misoprostol required longer induction times. While misoprostol created more tachysystole than dinoprostone/oxytocin, rates of hyperstimulation were similar.

Labour characteristics and uterine activity: misoprostol compared with oxytocin in women at term with prelabour rupture of the membranes

To compare the labour pattern and uterine activity of oral misoprostol with oxytocin for labour induction in women presenting with prelabour rupture of membranes at term. Prospective randomised study. Department of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong. Eighty women presenting with prelabour rupture of membranes at term. The women were randomised to receive either 100 microg misoprostol orally every 4 hours to a maximum of three doses, or intravenous oxytocin infusion according to the hospital protocol. Intrauterine pressure transducers were inserted one hour before induction of labour in both groups of women. We compared the pattern of uterine activity, the induction-to-delivery interval, duration of labour, mode of delivery and neonatal outcome between the two groups. Both oxytocin and oral misoprostol caused an increase in uterine activity within one hour of labour induction. Peak uterine activity was reached 6-8 h after oral misoprostol, with persistent effects, and 8-10 h after oxytocin, requiring continuous titration of medication. The duration of labour was significantly reduced in nulliparous women, but not in those who were multiparous in the misoprostol group. The induction-to-delivery interval, the mode of delivery and the perinatal outcome were similar for the two groups. Oral misoprostol caused earlier peak uterine activity, compared with oxytocin (6-8 h vs 8-10 h). Oral misoprostol was not only as effective as oxytocin in inducing labour in women at term with prelabour rupture of the membranes, but it reduced significantly the duration of labour in nulliparous women.

Misoprostol versus oxytocin for labor induction: Randomized controlled trial

Misoprostol versus oxytocin for labor induction: Randomized controlled trial

Randomized Comparison of Oral Misoprostol and Oxytocin for Labor Induction in Term Prelabor Membrane Rupture

Randomized Comparison of Oral Misoprostol and Oxytocin for Labor Induction in Term Prelabor Membrane Rupture

Randomized comparison of oral misoprostol and oxytocin for labor induction in term prelabor membrane rupture

Objectives: To compare labor induction intervals between oral misoprostol and intravenous oxytocin in women who present at term with premature rupture of membranes. Methods: One hundred eight women were randomly assigned to misoprostol 50 μg orally every 4 hours as needed or intravenous oxytocin. The primary outcome measure was time from induction to vaginal delivery. Sample size was calculated using a two-tailed α of 0.05 and power of 80%. Results: Baseline demographic data, including maternal age, gestation, parity, Bishop score, birth weight, and group B streptococcal status, were similar. The mean time ± standard deviation to vaginal birth with oral misoprostol was 720 ± 382 minutes compared with 501 ± 389 minutes with oxytocin ( P = .007). The durations of the first, second, and third stages of labor were similar. There were no differences in maternal secondary outcomes, including cesarean birth (eight and seven, respectively), infection, maternal satisfaction with labor, epidural use, perineal trauma, manual placental removal, or gastrointestinal side effects. Neonatal outcomes including cord pH, Apgar scores, infection, and admission to neonatal intensive care unit were not different. Conclusion: Although labor induction with oral misoprostol was effective, oxytocin resulted in a shorter induction-to-delivery interval. Active labor intervals and other maternal and neonatal outcomes were similar.

A randomized comparison of oral misoprostol versus Foley catheter and oxytocin for induction of labor at term

Objective: We sought to compare the efficacy and safety of oral misoprostol administered to patients with the efficacy and safety in a control group treated with a Foley catheter and oxytocin for induction of labor. Study Design: Two hundred patients requiring induction of labor at term with a Bishop score of ≤5 were randomized to receive oral misoprostol or a cervical Foley catheter plus oxytocin. Patients in the misoprostol group received 50 μg at 4-hour intervals for a maximum of 6 doses or until an adequate contraction pattern developed. Those in the control group had a Foley catheter inserted in the cervix, whereas oxytocin was administered intravenously by a standard incremental infusion protocol to a maximum dose of 36 mU/min. Results: In multiparous patients the percentage delivered of their neonates within 24 hours and the median induction-to-delivery times were similar in the 2 groups. In nulliparous patients, however, delivery within 24 hours was significantly less likely in the misoprostol group (53.4% vs 82.5%; P < .001), and the median induction-to-delivery time was longer (23.3 hours vs 17.2 hours; P < .01). There were no differences in the incidence of meconium, chorioamnionitis, low Apgar scores, or cesarean delivery. The incidence of hyperstimulation was higher in the oxytocin-Foley group (4.1% vs 13.1%; P = .02). Conclusion: Oral misoprostol is as effective as oxytocin-Foley catheter for inducing labor in multiparous women. Misoprostol appears less efficacious in nulliparous patients. (Am J Obstet Gynecol 1999;181:1108-12.)

Uterine rupture during induction of labor at term with intravaginal misoprostol

Misoprostol (prostaglandin E1) compares favorably with dinoprostone (prostaglandin E2) and oxytocin for labor induction at term. Excessive uterine activity has been reported using high-dose regimens, but no negative effect on outcomes has been observed. Labor was induced in a 34-year-old multipara at 39 weeks' gestation using intravaginal misoprostol tablets. Five hours after administration of the second 25-microgram dose, fetal bradycardia prompted emergency cesarean delivery. Hysterectomy and left salpingo-oophorectomy were necessary to control bleeding from a 15-cm posterior uterine wall rupture. Misoprostol can cause excessive uterine activity and uterine rupture.

A Prospective Study of High- Versus Low-Dose Oxytocin for Induction of Labor

A Prospective Study of High- Versus Low-Dose Oxytocin for Induction of Labor

A Randomized Trial of Misoprostol and Oxytocin for Induction of Labor

In Brief Objective To compare the safety and efficacy of misoprostol and oxytocin for induction of labor. Methods One hundred thirty women requiring induction of labor were randomized to receive either intravenous oxytocin or 100 μg misoprostol, administered intravaginally every 4 hours until labor was established. Results Compared with women receiving oxytocin, a greater percentage of women in the misoprostol group had Bishop scores of 3 or less (58 versus 38%, P < .05). Nonetheless, the median induction-to-delivery interval was significantly shorter (585 versus 885 minutes, P < .001) in the misoprostol group. Women in the misoprostol group were more likely to deliver vaginally within 24 hours of the start of induction (77 versus 55%, P < .002). Epidural analgesia was used more frequently in women receiving oxytocin than in those receiving misoprostol (73 versus 50%, P = .025). The total percentage of cesarean deliveries was not significantly different, although the percentage of cesarean deliveries for dystocia was lower in the misoprostol group (8 versus 21%, P = .02). Uterine tachysystole was significantly more common (70 versus 11%, P < .001) and hospital charges significantly less with misoprostol. Conclusion Compared with oxytocin for labor induction, misoprostol results in a shorter induction-to-delivery interval, a reduction in the rate of cesarean delivery for dystocia, and a decreased use of epidural analgesia. Uterine tachysystole is significantly more common with the use of misoprostol. Compared with oxytocin, misoprostol results in a shorter induction-delivery interval, a decreased rate of cesarean for dystocia, and lower hospital charges.

A randomized trial of misoprostol and oxytocin for induction of labor: Safety and efficacy

To compare the safety and efficacy of misoprostol and oxytocin for induction of labor. One hundred thirty women requiring induction of labor were randomized to receive either intravenous oxytocin or 100 micrograms misoprostol, administered intravaginally every 4 hours until labor was established. Compared with women receiving oxytocin, a greater percentage of women in the misoprostol group had Bishop scores of 3 or less (58 versus 38%, P < .05). Nonetheless, the median induction-to-delivery interval was significantly shorter (585 versus 885 minutes, P < .001) in the misoprostol group. Women in the misoprostol group were more likely to deliver vaginally within 24 hours of the start of induction (77 versus 55%, P < .002). Epidural analgesia was used more frequently in women receiving oxytocin than in those receiving misoprostol (73 versus 50%, P = .025). The total percentage of cesarean deliveries was not significantly different, although the percentage of cesarean deliveries for dystocia was lower in the misoprostol group (8 versus 21%, P = .02). Uterine tachysystole was significantly more common (70 versus 11%, P < .001) and hospital charges significantly less with misoprostol. Compared with oxytocin for labor induction, misoprostol results in a shorter induction-to-delivery interval, a reduction in the rate of cesarean delivery for dystocia, and a decreased use of epidural analgesia. Uterine tachysystole is significantly more common with the use of misoprostol.

A randomized trial of misoprostol and oxytocin for induction of labor: Safety and efficacy

A randomized trial of misoprostol and oxytocin for induction of labor: Safety and efficacy

Clinical amnionitis and endometritis in patients with premature rupture of membranes: Endocervical prostaglandin E 2 gel versus oxytocin for induction of labor

To compare the rates of clinical amnionitis and endometritis in patients with premature rupture of membranes (PROM), using endocervical prostaglandin E2 (PGE2) gel for induction of labor versus immediate oxytocin induction of labor. We randomized 118 patients to receive either endocervical 0.5 mg of PGE2 gel (study group) or immediate oxytocin induction of labor (control group). If labor was not established in the group receiving PGE2 gel in 24 hours, intravenous oxytocin was given in incremental doses. The rates of clinical amnionitis and endometritis in the two groups were analyzed. Also compared were hours of labor, duration of rupture of membranes and number of vaginal examinations. Student t test, chi 2, or Wilcoxon rank-sum test were used for statistical analysis, as appropriate. P < .05 was considered significant. The rates of clinical amnionitis were 5.3% in the PGE2 group and 8% in the control group. Endometritis developed in 1.7% of PGE2 patients and 3.2% of controls. These differences in maternal infection rates were not statistically significant. The two groups were comparable with respect to age, parity, and antepartum group B streptococcal colonization. No significant differences in hours of labor, duration of ruptured membranes, or vaginal examinations were observed. Neonatal outcome data (mean birth weight, Apgar scores at 1 and 5 minutes, Apgar score less than 7 at 5 minutes) were not statistically significant. Endocervical placement of 0.5 mg of PGE2 gel does not increase the incidence of clinical amnionitis and endometritis in patients with PROM at term when compared with immediate induction of labor with oxytocin.

Vaginal Misoprostol as an Alternative to Oxytocin for Induction of Labor in Women With Late Fetal Death

Bugalho, Antonio; Bique, Cassimo; Machungo, Fernanda; Bergstrom, Staffan Author Information