Oxytocin Group Research Articles

Dinoprostone pessary for labor induction in Chinese patients with premature rupture of membranes at term: A retrospective cohort.

Whether the use of dinoprostone pessary increased the vaginal delivery rate of labor induction in Chinese nulliparous women with term premature rupture of membranes (PROM) and unfavorable cervices? PROM women at term with singleton pregnancies and Bishop scores ≤4 who needed labor induction were enrolled in this retrospective study. They received either the dinoprostone pessary followed by oxytocin infusion if necessary (n= 102, PGE2 group) or oxytocin infusion alone (n= 103, oxytocin group). Compared with oxytocin infusion alone, vaginal delivery within 12 h and total vaginal delivery were higher in the PGE2 group (28.4% vs 7.8%, p= 0.0001; 79.4% vs 62.1%, p= 0.009, respectively). There were no statistical differences between the two groups in terms of maternal and neonatal outcomes, such as postpartum hemorrhage, endometritis, third- and fourth-degree vaginal lacerations and neonatal weight, 1- and 5-min Apgar score ≤7, neonatal jaundice, and neonatal unit admission (p> 0.05). However, there was a higher rate of uterine hyperstimulation in the PGE2 group (20.6% vs 3.9%, p< 0.0001). The effective rate of cervical ripening increased in the PGE2 group at 8 and 12 h of labor induction (p< 0.001). Despite higher rates of uterine hyperstimulation, the use of dinoprostone was associated with higher rates of vaginal deliveries in Chinese nulliparous women with term PROM and Bishop scores ≤4, compared with use of oxytocin only.

THE EFFECTIVENESS OF MISOPROSTOL COMPARES TO OXYTOCIN IN MANAGEMENT OF RETAINED PLACENTA: AN EVIDENCE-BASED CASE REPORT

ABSTRACT&#x0D; Introduction: Retained placenta is one of major cause for postpartum haemorrhage. Various medication and routes of administration have been reported to increase spontaneous placenta delivery and prevent manual removal of placenta. Purpose of the study to compare the outcome between misoprostol and oxytocin in management of retained placenta.&#x0D; &#x0D; Method: literature searching was done in 4 databases (Pubmed, EbscoHost, Cochrane and Scopus) with specific keywords, continued with article selection and critical appraisal. &#x0D; &#x0D; Result: 5 randomized controlled trial articles were found match to eligibility criteria. 3 of 5 studies found that spontaneous placental delivery occurred more in misoprostol group than oxytocin group. Based on 2 studies, the NNT value of misoprostol are 3 compare to oxytocin group. 2 other studies found that no significant differences of spontaneous delivery of placenta in misoprostol and oxytocin group. 2 studies found that misoprostol had shorter time for spontaneous placenta delivery. However, 2 other studies also found that misoprostol had longer time for spontaneous delivery. 1 study also found that Misoprostol group have less blood loss than oxytocin group.&#x0D; &#x0D; Conclusion: administration of misoprostol has better outcome in induce spontaneous placenta delivery, time needed for delivery and less blood loss volume compared to oxytocin.&#x0D; &#x0D; Keywords: misoprostol; oxytocin; prolonged third stage labour; retained placenta&#x0D;

Intra-umbilical Oxytocin versus Methyl Ergometrine in the Third Stage of Labor: A Comparative Study from an Egyptian Tertiary Care Hospital

AbstractRecently, the active management of the third stage of labor hasbecome a routine practice. In this study we compared two different ecobolics which were oxytocin and methyl ergometrinethrough intra-umbilical route. The method: the trial divided theincluded pregnant full term (>37 weeks) women in two groupsrandomly; one for 0.2 mg methyl ergometrine and the second 10units oxytocin. The outcomes were on the short term; estimatedblood loss (EBL), the need to add another ecobolic, vomiting,blood pressure changes and the duration of the third stage, andthe long-term outcomes were hemoglobin levels and the needfor surgical or medical uterine evacuation. The results: the meanblood loss was 155± 50.45ml and 167± 45.76 in the methyl ergometrine and the oxytocin groups respectively. Three cases inthe oxytocin group (3%) required additional methyl ergometrinewhile in the ergometrine group only one case was given an additional oxytocin (1%). No vomiting was reported in both groupsand there were trivial changes in blood pressure. In the oxytocin group, the third stage duration was average 3.03± 1.02 minin comparison to 2.98± 1.54min in the ergometrine group. Neither did those cases who were injected methyl ergometrine havesignificant changes in the hemoglobin levels nor did they needuterine evacuation. However, only one case in the oxytocin siderequired blood transfusion due to uterine atony. Conclusion: intra-umbilical methyl ergometrine should be considered as an effective safe ecobolic in the third stage of labor.

English

BACKGROUND The ability to induce and augment labour has been of keen interest to many societies from the time immemorial till date. For majority of the women, the process of labour starts spontaneously at or near term and would result in vaginal “delivery.”1 Augmentation refers to the stimulation of spontaneous contractions that are considered inadequate because of failed cervical dilatation and foetal descent5. The purpose should be to relieve the parturient from the prolonged painful and exhausting delivery process into a short time frame. We wanted to compare the efficacy of titrated oral misoprostol solution with that of IV oxytocin infusion for augmentation of labour and determine the indications for failure of the augmentation process. METHODS The present study is a randomized control trial. 200 patients requiring labour augmentation were divided randomly into two groups by the method of colour code cards that were picked by the patients themselves from November 2011 to October 2013. Titrated oral misoprostol (TOM) solution 20 ml (1 μg / ml, 20 μg total) given for one group every hourly until the contractions were adequate. If adequate contractions were not achieved even after 4 doses, then, the dose was increased to 40 μg till adequate contractions were achieved. Another group received Oxytocin IV infusion with the maximum dosing rate of 20 mill units / min. RESULTS 200 women were enrolled in the study, of whom 100 were given titrated oral misoprostol solution, and 100 were given intravenous oxytocin for labour augmentation. The main outcome of augmentation to delivery interval time was 4 hours in TOM and 4.2 hours in oxytocin group. 88 % and 85 % achieved vaginal delivery within 12 hours in TOM and IV oxytocin group respectively. 8 % and 4 % in the TOM and IV oxytocin group underwent lower segment caesarean section (LSCS) in view of failure to progress, whereas 2 % and 8 % in TOM and oxytocin group had LSCS in view of foetal distress. APGAR score was normal in both the groups. CONCLUSIONS Titrated oral misoprostol solution is as efficacious as IV Oxytocin infusion for labour augmentation. It is safe, inexpensive and easy to use. Augmentation-to-delivery interval is very much reduced with the use of titrated oral misoprostol solution and the incidence of Caesarean section is comparable to that of IV oxytocin group. KEY WORDS Tom, Oxytocin, Augmentation, Labour

Oxytocin increases pregnancy rates after fixed time artificial insemination in Kazak ewes.

It is probable that reduced pregnancy rates in ewes after fixed time artificial insemination (FTAI) is attributable, in part, to the reduced number of normal spermatozoa that colonize the oviduct. Administration of oxytocin stimulates both cervical dilation and uterine/oviductal contractility. The hypothesis that oxytocin can enhance sperm transport into the uteri and the oviducts, and thereby increase pregnancy rates, was tested in the present study. Oestrus was synchronized in 199 multiparous Kazak ewes using intravaginal flurogestone-impregnated sponge. The sponge was left in the vagina for 12days followed with an injection of 330IU of eCG at sponge removal. Each ewe was intracervically inseminated twice at 50hr and 62hr after the removal of sponges using an insemination catheter containing 0.25ml of diluted semen. Semen was collected from seven Texel rams and all the ejaculates were pooled and diluted in ultra-high temperature-treated commercial skimmed milk without (Control group, 0.05ml of saline per mL milk, n=144) or with oxytocin supplement (Oxytocin group, 0.5U of oxytocin per ml milk, n=55). Pregnancy status was determined by transabdominal ultrasound examination 45days after insemination. Lambing performance was recorded at delivery. Significant differences were observed between the Oxytocin group and the Control group in terms of the pregnancy rate and the fecundity rate (85.5% and 92.7% versus 68.8% and 72.9%, respectively). In conclusion, low dose oxytocin supplementation of semen extender significantly increased pregnancy and fecundity rates in oestrus-synchronized Kazak ewes after FTAI.

Effect of oxytocin nasal spray on auditory automatic discrimination measured by mismatch negativity.

As a treatment for cognitive dysfunction in schizophrenia, oxytocin nasal sprays potentially improve social cognition, facial expression recognition, and sense of smell. Mismatch negativity (MMN) is an event-related potential (ERP) reflecting auditory discrimination while MMN deficits reflect cognitive function decline in schizophrenia. To determine whether oxytocin nasal spray affects auditory MMN METHODS: We measured ERPs in healthy subjects during an auditory oddball task, both before and after oxytocin nasal spray administration. Forty healthy subjects were randomly assigned to either the oxytocin or placebo group. ERPs were recorded during the oddball task for all subjects before and after a 24 international unit (IU) intranasal administration, and MMN was compared between the two groups. Participants who received oxytocin had significantly shorter MMN latencies than those who received a placebo. Oxytocin had no significant effect on the Change in MMN amplitude. The shortened MMN latencies that were observed after oxytocin nasal spray administration suggest that oxytocin may promote the comparison-decision stage.

Oxytocin and Misoprostol With Diclofenac in the Preparation for Magnetic Resonance–Guided High-Intensity Ultrasound Treatment of Symptomatic Uterine Fibroids: A Prospective Cohort Study

Uterine fibroids (UFs) are very common benign tumors of the female reproductive tract. According to recent reports, magnetic resonance–guided high-intensity ultrasound (MR-HIFU) appears to be a well-tolerated and efficient treatment option for UFs. However, MR-HIFU still presents several limitations. The treatment is rarely associated with achieving complete non-perfused volume (NPV). Not all patients are qualified for a final procedure, and selected women obtain very good results in such treatment. The primary objective of this experimental study was to assess the effect of transvaginal misoprostol and intravenous oxytocin preparation on UF volume change, sonication time and NPV after MR-HIFU procedure in women of reproductive age with symptomatic UFs. Secondary outcomes included the effect on the peri-procedural effectiveness of misoprostol and oxytocin. This study enrolled 247 women with symptomatic UFs; based on gynecologic examinations and magnetic resonance imaging (MRI) scans, 128 women qualified for MR-HIFU without pharmacologic treatment, 57 women qualified for the misoprostol/diclofenac group and 62 women qualified for the oxytocin group. Pharmacologic pre-treatment improved NPV compared with non-pharmacologic treatment (average NPV: controls 61.9% ± 25.8%; oxytocin 76.8% ± 20.7%; misoprostol/diclofenac 85.2% ± 15.1%; average sonication time: controls 120 min ± 56.4%; oxytocin 111 min ± 45.4%; misoprostol/diclofenac 80 min ± 47.7%). Statistical analysis did not reveal significant intergroup differences in UF volume changes after 6 mo (controls: n = 40, 37.4% ± 27.5%; oxytocin n = 25, 45.8% ± 31%; misoprostol/diclofenac n = 19, 33.4% ± 23.2%). The misoprostol/diclofenac group, which achieved the highest NPV immediately after the MR-HIFU procedure, was characterized by the lowest UF volume change percentages 6 mo later. The administration of vasoconstrictor drugs (oxytocin and misoprostol/diclofenac) to support MR-HIFU in UF treatment is a new issue that may improve the total effectiveness of this method. Randomized controlled trials are necessary to estimate the real effect of vasoconstrictors on MR-HIFU.

A COMPARISON OF THE EFFECTIVENESS OF SUBLINGUAL MISOPROSTOL VERSUS INTRAVENOUS OXYTOCIN INFUSION IN REDUCING BLOOD LOSS IN FIRST TWO HOURS AT CAESAREAN SECTION

OBJECTIVE&#x0D; The objective of the study was to compare the effectiveness of sublingual misoprostol in reducing intraoperative and postoperative blood loss with that of intravenous (IV) oxytocin infusion in the first two hours at cesarean delivery.&#x0D; STUDY DESIGN&#x0D; Randomized controlled trial&#x0D; PLACE AND DURATION OF STUDY&#x0D; The study was conducted in Lady Aitchison Hospital, Lahore unit IV-King Edward Medical University, and the duration of the study was one year.&#x0D; MATERIALS and METHODS&#x0D; Eighty-two women with term singleton pregnancy undergone elective cesarean section under spinal anesthesia were randomly allocated to receive either misoprostol 400 µg sublingually or IV infusion of 20 units oxytocin in 1000ml of normal saline soon after delivery of the baby. Estimated blood loss at the surgery and within the first 2 h post-operation were measured in both groups. Side effects in both groups were also recorded.&#x0D; RESULTS&#x0D; Mean blood loss with misoprostol was significantly less as compared to that of oxytocin. Post-operative hemoglobin was decreased by -4.95% in sublingual misoprostol and in the oxytocin group it was decreased by -9.33%. Blood transfusion and additional uterotonic therapy were significantly higher in the oxytocin group as compared to that of misoprostol. Nausea, vomiting, and hypotension was significantly higher in oxytocin group as compared to that of the misoprostol group. On the other hand, pyrexia and shivering were significantly higher in the misoprostol group.&#x0D; CONCLUSION&#x0D; The results of this trial showed that sublingual misoprostol is more effective as compared to intravenous oxytocin infusion in terms of reduction of blood loss in the first two hours at the cesarean section. It offers several advantages over oxytocin including long shelf life, stability at room temperature, and oral administration which makes it a suitable uterotonic agent in low-resource areas.

A comparative study on rectal misoprostol versus intramuscular oxytocin to prevent postpartum haemorrhage

Objective: 1. To compare the efficacy of 800 mcg of rectal misoprostol with 10U I.M Oxytocin in prevention of postpartum haemorrhage 2. To assess the safety of both the drugs.Methodology: A prospective, double-blind study carried out for a period of 1 year. 240 cases had been taken for the study, which were divided randomly into two groups containing 120 cases each i.e. Group A were given 10 IU oxytocin intramuscularly immediately after delivery. Group B were given 800 mcg rectal misoprostol immediately after delivery. The personal information and medical data of the selected cases were collected in structured proforma. Statistical analysis was done using Epidemiological Information Package (EPI2002).Results: Mean Blood loss for Group A – 224.4 ml and mean Blood Loss for Group B – 240.4 ml and with insignificant difference (p 0.132). The mean blood loss in the injection Oxytocin group was lower than mean blood loss in the tablet Misoprostol group but the difference was not statistically significant. The incidence of PPH was 5.82% in Group A and 6.6% in Group B. The difference was not statistically significant.Shivering, pyrexia was found more in misoprostol group than oxytocin with the incidence being 12.5% versus 7% (shivering) and 8.3% versus 2.5% (pyrexia) respectively. Conclusion: It is observed that the misoprostol 800µg rectally is as effective as intramuscular oxytocin 10 IU when used during the active management of third stage of labour for prevention of postpartum haemorrhage.

Prophylactic Administration of Uterotonics to Prevent Postpartum Hemorrhage in Women Undergoing Cesarean Delivery for Arrest of Labor: A Randomized Controlled Trial.

To evaluate whether prophylactic administration of oxytocin plus ergonovine or oxytocin plus carboprost is more effective than oxytocin alone in reducing the need for additional uterotonics among women undergoing cesarean delivery for labor arrest. In this double-blind, three-arm randomized controlled trial, participants were assigned to receive either oxytocin 5 units intravenous alone, or with ergonovine 0.25 mg intravenous or carboprost 0.25 mg intramuscular immediately after delivery, followed with maintenance infusion of oxytocin 40 milliunits/minute in all groups. Uterine tone was assessed at 3, 5, and 10 minutes after delivery, and additional uterotonics were administered if deemed necessary. The primary outcome was intraoperative need for additional uterotonics. Secondary outcomes included uterine tone, calculated blood loss, and side effects. A sample size of 34 per group (n=102), based on the null hypothesis that there is no association between treatment assignment and the need for additional uterotonics, permitted independent post hoc pairwise comparisons between oxytocin plus ergonovine, oxytocin plus carboprost, and oxytocin alone using an adjusted P-value of .025. The association between the need for additional uterotonics and treatment group was assessed using the χ2 test. From June 2013 through July 2019, 105 participants were randomized (35 per group) and data from 100 participants were analyzed: oxytocin (n=35), oxytocin plus ergonovine (n=33), and oxytocin plus carboprost (n=32). There was no difference in the requirement of additional intraoperative uterotonics across groups (oxytocin [37%] vs oxytocin plus ergonovine [33%] vs oxytocin plus carboprost [34%], P=.932). Uterine tone and calculated blood loss were similar across groups. Incidence of nausea or vomiting was higher in oxytocin plus ergonovine (85%; odds ratio [OR] 5.3, 95% CI 1.7-16.9, P=.003) and oxytocin plus carboprost (72%; OR 2.4, 95% CI 0.9-6.7, P=.086) compared with the oxytocin (51%) group. Compared with oxytocin alone, prophylactic use of a combination of uterotonic drugs did not reduce the need for additional uterotonics at cesarean delivery for labor arrest. ClinicalTrials.gov, NCT01869556.

Age and intranasal oxytocin effects on trust-related decisions after breach of trust: Behavioral and brain evidence.

Age-related differences in cognition and socioemotional functions, and in associated brain regions, may reduce sensitivity to cues of untrustworthiness, with effects on trust-related decision making and trusting behavior. This study examined age-group differences in brain activity and behavior during a trust game. In this game, participants received "breach-of-trust" feedback after half of the trials. The feedback indicated that only 50% of the monetary investment into their fellow players had resulted in returns. The study also explored the effects of intranasal oxytocin on trust-related decisions in aging, based on suggestions of a modulatory role of oxytocin in response to negative social stimuli and perceptions of trust. Forty-seven younger and 46 older participants self-administered intranasal oxytocin or placebo, in a randomized, double-blind, between-subjects procedure, before they engaged in the trust game while undergoing functional magnetic resonance imaging (fMRI). Younger participants invested less into their game partners after breach-of-trust feedback, while older participants showed no significant difference in their investment after breach-of-trust feedback. Oxytocin did not modulate the behavioral effects. However, after breach-of-trust feedback, older participants in the oxytocin group showed less activity in the left superior temporal gyrus. In contrast, older participants in the placebo group showed more activity in left superior temporal gyrus after breach of trust. The findings may reflect reduced responsiveness to cues of untrustworthiness in older adults. Furthermore, the modulatory effect of oxytocin on left superior temporal gyrus activity among older adults supports the neuropeptide's age-differential role in neural processes in aging, including in the context of trust-related decision making. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Dosage of oxytocin for augmentation of labor and women's childbirth experiences: A randomized controlled trial.

IntroductionThe aim of this study was to compare childbirth experiences and experience of labor pain in primiparous women who had received high‐ vs low‐dose oxytocin for augmentation of delayed labor.Material and methodsA multicenter, parallel, double‐blind randomized controlled trial took place in six Swedish labor wards. Inclusion criteria were healthy primiparous women at term with uncomplicated singleton pregnancies, cephalic fetal presentation, spontaneous onset of labor, confirmed delayed labor progress and ruptured membranes. The randomized controlled trial compared high‐ vs low‐dose oxytocin used for augmentation of a delayed labor progress. The Childbirth Experience Questionnaire version 2 (CEQ2) was sent to the women 1 month after birth. The CEQ2 consists of 22 items in four domains: Own capacity, Perceived safety, Professional support and Participation. In addition, labor pain was reported with a visual analog scale (VAS) 2 hours postpartum and 1 month after birth. The main outcome was the childbirth experience measured with the four domains of the CEQ2. The clinical trial number is NCT01587625.ResultsThe CEQ2 was sent to 1203 women, and a total of 1008 women (83.8%) answered the questionnaire. The four domains of childbirth experience were scored similarly in the high‐ and low‐dose oxytocin groups of women: Own capacity (P = .36), Perceived safety (P = .44), Professional support (P = .84), Participation (P = .49). VAS scores of labor pain were reported as similar in both oxytocin dosage groups. Labor pain was scored higher 1 month after birth compared with 2 hours postpartum. There was an association between childbirth experiences and mode of birth in both the high‐ and low‐dose oxytocin groups.ConclusionsDifferent dosage of oxytocin for augmentation of delayed labor did not affect women’s childbirth experiences assessed through CEQ2 1 month after birth, or pain assessment 2 hours or 1 month after birth.

Graph Theoretic Analysis Reveals Intranasal Oxytocin Induced Network Changes Over Frontal Regions

In this study, we aim to elucidate how intranasal oxytocin modulates brain network characteristics, especially over the frontal network. As an essential brain hub of social cognition and emotion regulation, we also explore the association between graphic properties of the frontal network and individual personality traits under oxytocin (OT) administration. Fifty-nine male participants administered intranasal OT or placebo were followed by resting-state fMRI scanning. The correlation-based network model was applied to study OT modulation effects. We performed community detection algorithms and conducted further network analyses, including clustering coefficient, average shortest path and eigenvector centrality. In addition, we conducted a correlation analysis between clustering coefficients and the self-assessed psychological scales. Modular organizations in the OT group reveal integrations of the frontoparietal network (FPN) and the default mode network (DMN) over frontal regions. Results show that frontal nodes within the FPN are characterized by lower clustering coefficients and higher average shortest path values compared to the placebo group. Notably, these modulation effects on frontal network property are associated with Interpersonal Reactivity Index (IRI) fantasy value. Our results suggest that OT elevates integrations between FPN, DMN and limbic system as well as reduces small-worldness within the FPN. Our results support graph theoretic analysis as a potential tool to assess OT induced effects on the information integration in the frontal network.

Prophylactic Administration of Per Rectal Misoprostol vs Intramuscular Injection of Oxytocin in Third-stage of Labour for Prevention of Postpartum Haemorrhage: A Randomised Controlled Trial

Introduction: In India, the routine Active Management of Third- Stage of Labour (AMTSL) with conventional intramuscular oxytocin, at the rural, resource-constrained areas, is often compromised due to lack of trained healthcare personnel and proper maintenance of cold chain system, causing maternal mortality and morbidity from Postpartum Haemorrhage (PPH). In these scenarios, tablet misoprostol, can be efficacious and convenient alternative. Aim: To evaluate efficacy and safety of misoprostol administered per rectum with respect to intramuscular oxytocin for effective control of PPH in a Randomised Controlled Trial (RCT). Materials and Methods: In this RCT, conducted in Sambhunath Pandit Hospital, kolkata, West Bengal, India from September 2015 to August 2016, total 80 eligible pregnant mothers in normal labour with prior consent and fulfilled criteria, were allocated to two separated groups (n=40) by computer generated randomisation table. Control group received 10 IU injection oxytocin and case group received 600 μg misoprostol tablet per rectally within one minute of cord clamping and cutting. The primary outcome measures were mean third- stage and mean postpartum blood loss up to eight hours after delivery. Secondary outcome variables were Mean Arterial Pressure (MAP) after eight hours postdelivery, haemoglobin and haematocrit after 24 hours of delivery and reported side effects. Data was entered into a Microsoft excel spreadsheet and statistical analysis was done by Statistical Package for the Social Sciences (SPSS) version 20.0.1 and Graph Pad Prism version 5.0. Results: Total sample size was 80 equally divided into two groups, with a mean age of 23.20±3.1558 years and 23.7750±3.8927 years in case and control group respectively. The mean third-stage blood loss (332.4105±72.6632 mL versus {vs} 329.0088±59.4503 mL, p=0.8193) and mean total blood loss (426.5575±80.0215 mL vs 424.8783±61.5808 mL, p=0.9165) were statistically indifferent between misoprostol and oxytocin groups by two-sample t-tests. The mean for eight hours postpartum MAP (p=0.0894), 24 hours postpartum haemoglobin (p=0.4534) and haematocrit (p=0.1325) were statistically insignificant between the two groups by two- sample t-tests. Incidence of adverse effects like shivering, diarrhoea, compared by Pearson’s Chi-square test, were found to be more but non significant in misoprostol group. Conclusion: This study concludes that per-rectal misoprostol is equally effective as intramuscular oxytocin to control PPH without significant adverse effects.

Microbubble contrast agent SonoVue combined with oxytocin improves the efficiency of high-intensity focused ultrasound ablation for adenomyosis

Background To investigate the combined enhancing effects of microbubble-contrast SonoVue and oxytocin on high-intensity focused ultrasound (HIFU) ablation of adenomyosis. Methods 330 patients with adenomyosis were randomly assigned to SonoVue and oxytocin group (group A, n = 82), oxytocin (group B, n = 85), SonoVue (group C, n = 81), or the control (group D, n = 82) for HIFU ablation. In group A, oxytocin was dripped 0.32 IU/min, and HIFU ablation was started one minute after SonoVue injection. In group B, oxytocin was dripped 0.32 IU/min during ablation. In group C, HIFU ablation was started one minute after SonoVue injection. In group D, neither oxytocin nor SonoVue was applied. The clinical data, treatment results, and complications were analyzed. Results All participants underwent HIFU treatment safely, and the mean energy efficiency factor (EEF) in the four groups was 4.7 ± 0.9J/mm3, 8.5 ± 0.6J/mm3, 8.9 ± 0.7J/mm3, and 12.6 ± 1.8J/mm3, respectively, with the mean ablation time (AT) of 633.7 ± 55.1 s, 874.2 ± 65.6 s, 936.3 ± 85.2 s, and 1103.2 ± 96.2 s, respectively. The non-perfused volume ratios (NPVR) were 90.4 ± 8.8%, 88.7 ± 9.1%, 89.4 ± 7.2%, 80.5 ± 7.9%, respectively. In addition, EEF and AT were the shortest in group A (p < 0.05). NPVR was significantly higher in group A than in the control group D (p < 0.05). The incidence rates of adverse events were not significantly different in the four groups (p > 0.05). Conclusions Compared to the control group, oxytocin combined with SonoVue in HIFU for adenomyosis can significantly decrease the energy and time needed for the ablation and safely enhance the treatment efficiency by improving the cavitation and heating of HIFU ablation and increasing the non-perfused volume ratio.

ORAL MISOPROSTOL VERSUS INTRAMUSCULAR OXYTOCIN IN THE ACTIVE MANAGEMENT OF THE THIRD STAGE OF LABOUR

Background: The third stage of labor is defined as the time between the delivery of the baby and delivery of the placenta. The third stage of labor is potentially the most dangerous part for the mother. The main risk is the occurrence of postpartum hemorrhage. Objective: To compare the efficacy and safety of oral misoprostol with intramuscular oxytocin in the active management of third stage of labor for the prevention of postpartum hemorrhage. Patient and Methods: The study was conducted in the labor ward of Obstetrics and Gynecology Department at Imbaba General Hospital from September 2018 till September 2019. This study included four hundred healthy pregnant women during the course of normal labor. Patients in this study were randomly divided into two equal groups: Group (I) received 600 mcg Misoprostol orally within 1 minute of delivery of the baby and Group (II) received 10 IU oxytocin intramuscularly within 1 minute of delivery of the baby. We compared the two groups using computer programs to evaluate the safety and efficacy of each drug. The primary outcome measure was postpartum fall in haemoglobin after 8 h of delivery. Secondary outcome measure was duration of third stage of labor, need for an additional uterotonic drug, need for blood transfusion and side effects of both the drugs. Results: There was no significant difference between the two groups regarding the duration of the third stage of labor, the change in hemoglobin and hematocrit levels from before labor to 8 hours postpartum, and the occurrence of complications (the need for more utrotonic drugs and the need for blood transfusion). As regard the duration of third stage of labor, there was a slight advantage for the oxytocin group over the misoprostol group, 4% of cases in oxytocin group have side effects, while 13% of cases in misoprostol group have sides effects in the form of nausea, vomiting, fever, shivering. Conclusions: No major difference in oral misoprostol and intramuscular oxytocin in the management of third stage of labor.

ORAL MISOPROSTOL VERSUS INTRAMUSCULAR OXYTOCIN IN THE ACTIVE MANAGEMENT OF THE THIRD STAGE OF LABOUR

Background: The third stage of labor is defined as the time between the delivery of the baby and delivery of the placenta. The third stage of labor is potentially the most dangerous part for the mother. The main risk is the occurrence of postpartum hemorrhage. Objective: To compare the efficacy and safety of oral misoprostol with intramuscular oxytocin in the active management of third stage of labor for the prevention of postpartum hemorrhage. Patient and Methods: The study was conducted in the labor ward of Obstetrics and Gynecology Department at Imbaba General Hospital from September 2018 till September 2019. This study included four hundred healthy pregnant women during the course of normal labor. Patients in this study were randomly divided into two equal groups: Group (I) received 600 mcg Misoprostol orally within 1 minute of delivery of the baby and Group (II) received 10 IU oxytocin intramuscularly within 1 minute of delivery of the baby. We compared the two groups using computer programs to evaluate the safety and efficacy of each drug. The primary outcome measure was postpartum fall in haemoglobin after 8 h of delivery. Secondary outcome measure was duration of third stage of labor, need for an additional uterotonic drug, need for blood transfusion and side effects of both the drugs. Results: There was no significant difference between the two groups regarding the duration of the third stage of labor, the change in hemoglobin and hematocrit levels from before labor to 8 hours postpartum, and the occurrence of complications (the need for more utrotonic drugs and the need for blood transfusion). As regard the duration of third stage of labor, there was a slight advantage for the oxytocin group over the misoprostol group, 4% of cases in oxytocin group have side effects, while 13% of cases in misoprostol group have sides effects in the form of nausea, vomiting, fever, shivering. Conclusions: No major difference in oral misoprostol and intramuscular oxytocin in the management of third stage of labor.

A Comparative Study: Is Misoprostol as Effective as Oxytocin in Active Management of Third Stage of Labor?

Background: The third stage of labor is that period from birth of the infant until the delivery of the placenta. Active management of the third stage of labor plays an important role in reducing maternal morbidity and mortality. Oxytocin is an effective drug in preventing postpartum hemorrhage (PPH) however; it requires a controlled environment and intramuscular administration. Misoprostol is an orally active uterotonic agent,stable at room temperature.The purpose of this study was to compare the efficacy of misoprostol with oxytocin in active management of third stage of labor.&#x0D; Materials and Methods: This was a hospital based study carried out in Paropakar Maternity and Women Hospital, Kathmandu, Nepal during six months period from February 2012 to July 2012. One hundred patients fulfilling inclusion criteria were recruited to receive either 10 unit of IM oxytocin or 600 mcg of oral misoprostol for the management of the third stage of labor.&#x0D; Results: The mean blood loss in misoprostol and oxytocin group was 209±76.7ml and 197±68.8 ml respectively with p value-0.41 which was insignificant. Similarly mean hemoglobin change was also not significant. The additional uterotonics needed in misoprostol was higher (9 cases) than that in oxytocin (5 cases) but it was also not significant. Shivering and fever were significantly high among misoprostol group than in oxytocin group.&#x0D; Conclusion: Efficacy of oxytocin and misoprostol is equal in active management of third stage of labor.

Efficacy of Self-Administered Intranasal Oxytocin on Alcohol Use and Craving After Detoxification in Patients With Alcohol Dependence. A Double-Blind Placebo-Controlled Trial.

AimsThe aim of this study was to assess the efficacy of self-administered intranasal oxytocin on alcohol dependence after detoxification.MethodsIn a double-blind, randomized, placebo-controlled trial, 38 patients fulfilling the criteria for ICD-10 diagnosis of alcohol dependence received either 8 IU oxytocin or placebo at their own discretion up to thrice daily for 4 weeks, after completing detoxification. Primary outcome was alcohol intake specified as the amount of alcohol consumed, the number of days to relapse into alcohol use and the proportion of subjects relapsing. Secondary outcomes were self-reported symptoms of craving, sleep and mental distress.ResultsThere were no significant differences between the oxytocin group and the placebo group in daily alcohol intake in total (mean 1.3 ± 2.9 vs. 2.0 ± 5.0 units; P = 0.63) or on drinking days (mean 8.4 ± 2.7 vs. 7.7 ± 6.0 units; P = 0.76), in the number of days until relapse (P = 0.91) or in the proportion of subjects relapsing (37.5 vs. 41.2%; P = 0.84). Neither were there any statistically significant differences in any other outcomes, except a larger decrease in self-reported nervousness in the oxytocin group (P = 0.022).ConclusionThe results were inconclusive as to whether intranasal oxytocin reduced the time to relapse, degree of craving or total amount of alcohol consumed after detoxification. However, the oxytocin group had a larger decrease in self-reported nervousness.

Induction of Labor with Titrated Oral Misoprostol Solution versus Oxytocin in Term Pregnancy

Background: The goal of labor induction is to stimulate uterine contractions before the spontaneous onset of labor, resulting in good pregnancy outcomes. Both uterine contractions and cervical ripening are two important factors in successful induction and vaginal delivery. Objective: The Objective of this study was to evaluate the effectiveness and the safety of orally administered misoprostol solution in comparison to that of intravenously infused of oxytocin for labor induction in term pregnant women. Methods: This randomized clinical study was carried out in the emergency unit of Obstetrics and Gynecology Department of Zagazig University Maternity Hospitals during the period from February 2018 to January 2019, and this study included 110 patients were randomly assigned into two groups misoprostol group or oxytocin group. The misoprostol group received 25 µg every2hours. The oxytocin group received an infusion of 5IU which was gradually increased the maximum time for drug administration was 24 hours. The time from induction to delivery and induction to active Phases were recorded. Results: showed that both values of mean time from induction to active phase and induction to delivery were significantly shorter in misoprostol group than in oxytocin group (10.4 and 13.2 versus 12.9and15.8) hours respectively. Conclusion: Induction time to vaginal delivery was shorter in misoprostol group when compared with oxytocin group. So, titrated oral misoprostol solution can be used as an alternative to intravenous oxytocin infusion for induction of labor.