Use Of Oxytocin Research Articles

May the indication for a previous cesarean section affect the outcome at trial of labor in women with induction of labor? Aretrospective cohort study.

Cesarean sections are increasing worldwide and are associated with altered risks of complications for both mother and child. Vaginal birth after cesarean section is associated with lower maternal and neonatal morbidity than in repeat cesarean section. Only a few studies have considered the indication for the previous cesarean section to be of importance for the outcome of subsequent labor. The aim of this study was to evaluate whether the indication for a previous cesarean section affects the outcomes at a subsequent delivery in women with induction of labor. This retrospective cohort study of the four largest delivery units in Stockholm during 2012-2015 included 1150 women with one previous cesarean section with induction of labor. women with induced labor and a previous cesarean section, singleton pregnancy, cephalic presentation, gestational age of ≥34 weeks. The women were grouped by indication for the previous cesarean section. mode of delivery (vaginal birth after previous cesarean section or repeat cesarean section). induction to delivery time, postpartum hemorrhage, uterine rupture. Neonatal outcomes: birth weight, Apgar score <7, arterial umbilical cord blood gas pH <7.0. Our study found that the indication of labor dystocia at the previous cesarean section, increased the risk of repeat cesarean section (aOR 5.35; 95% CI: 1.64-17.50) in women with induction of labor. Other risk factors for repeat cesarean section were birth weight >4000 g, maternal BMI ≥30 or if vaginal prostaglandin was used as the method for induction of labor. A previous vaginal delivery and use of oxytocin increased the chance of a vaginal delivery in this group of women. Our study showed that the indication for the previous cesarean section affects the outcome in the subsequent delivery in women with induction of labor. If the indication for the previous cesarean section was labor dystocia, the risk of repeat cesarean section was increased.

A History of Cesarean Birth as a Risk Factor for Postpartum Hemorrhage Even After Successful Planned Vaginal Birth.

It is unclear if a history of cesarean birth (CB) is a risk factor for postpartum hemorrhage (PPH) even after a successful planned vaginal birth. A historical retrospective cohort study from all deliveries (42,456) between 2004 and 2019. Inclusion criteria were as follows: (i) women with only one previous CB; (ii) liveborn cephalic singleton pregnancy and term spontaneous labor; (iii) successful planned vaginal birth; (iv) no operative vaginal delivery; and (v) no history of PPH. Women who experienced intrapartum uterine rupture leading to CB were excluded. Those who experienced uterine rupture diagnosed after vaginal birth were not excluded. The labor after cesarean (LAC) group (109 women with previous CB and current vaginal birth) were compared with 2 control groups to consider the parity: control group 1 (1633 nulliparous women) and control group 2 (4197 parous women). The main outcome was the rate of PPH (> 500 mL). Multivariate analysis was performed to investigate whether previous CB was an independent risk factor for PPH. Bivariate analysis and causal framework was used to determine the relation between variables of clinical interest. The PPH rates in the LAC group, control group 1, and control group 2 were 12.8%, 5.3%, and 6.4%, respectively. Irrespective of the group control (1 or 2), a history of CB was associated with an increased risk of PPH: adjusted odds ratio (aOR) 2.38 [95% confidence interval (CI) 1.28-4.44] (adjusted with maternal age, overweight, hyperthermia, and use of oxytocin) and aOR 2.16 [95% CI 1.20-3.87] (adjusted with maternal age and overweight) for Groups 1 (parous) and 2 (nulliparous), respectively. A history of cesarean birthcould be a risk factor for PPH even after successful planned vaginal delivery.

Oxytocin in old age psychiatry: A systematic review of the safety of using intranasal oxytocin in older adults.

To examine the literature for evidence of adverse events associated with the use of intranasal oxytocin in older adults (60+). A systematic review was undertaken according to PRISMA guidelines. Peer-reviewed literature was searched for studies involving intranasal oxytocin use in older populations. The Joanna Briggs Institute's (JBI) critical appraisal tool was used to assess the quality of included studies. The search identified nine randomized controlled trials (RCTs) that investigated the effects of intranasal oxytocin on a total sample size of 331 older participants. Adverse effects associated with oxytocin administration were predominantly mild and varied inconsistently between studies. Compared to placebo intranasal oxytocin was not significantly associated with severe adverse outcomes in doses ranging from 24 to 72 IU after single dose and or repeated doses in the short-term. In a population of older adults, intranasal oxytocin is devoid of serious adverse events. Although this review offers valuable insights, it may not fully reflect the potential adverse events associated with the long-term administration of intranasal oxytocin such as would be expected in its clinical application if approved for the treatment of dementia.

Severe hyponatremia in obstetrics: Presentations and outcome. Retrospective cohort over 10 years.

Hyponatremia in labor and the postpartum period is generally underreported. In this study we aimed to identify attributable causes of severe hyponatremia in an obstetric population and define maternal outcomes. This was a retrospective cohort study, in a single center over a period of 10 years. The study setting was an NHS maternity trust serving a multi-ethnic population in southwest London. The hospital cared for 53 649 pregnant women in the study period. All patients with severe hyponatremia in labor and immediate postpartum period from January 2011 until December 2020 were identified from the laboratory database. Individual case notes were analyzed for fluid use, use and duration of oxytocin, medical conditions, and delivery details. Severe peripartum hyponatremia was identified in 77 patients. A total of 28% of those analyzed required ITU admission for electrolyte correction, of whom 6% presented with severe neurologic symptoms, making symptoms a poor marker of severity (P = 0.051). The main association was to oxytocin and intravenous fluid infusions (80% and 86%, respectively), only one-third of patients had pre-eclampsia. Other associated medical conditions did not appear to have a significant influence on disease course nor prognosis (P = 0.359). Hyponatremia during labor can have detrimental effect on maternal outcomes. Lower threshold for testing and diligent maintenance of fluid balance charts during labor can help with primary prevention.

Magnitude and Determinants of Postpartum Hemorrhage in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Background: Maternal mortality remains a major challenge in sub-Saharan Africa (SSA), accounting for 70% of world's maternal deaths. Hemorrhage is the leading direct cause of maternal mortality worldwide, with postpartum hemorrhage (PPH) responsible for more than two-thirds of hemorrhage-related deaths. This systematic review and meta-analysis integrated data from studies conducted in SSA to provide an accurate estimation of the prevalence of PPH and to identify regional risk variables. Methods: We conducted a search across multiple databases for peer-reviewed articles published between 2013 and 2023. This study included quantitative research employing cross-sectional, case-control, or cohort designs, regardless of sample size, and published in English. This review excluded literature reviews, meta-syntheses, qualitative studies, editorials, systematic reviews, and meta-analyses. We used MetaXL to estimate the pooled magnitude of PPH in SSA, and employed the Q test, I2 statistic, and funnel plots to assess statistical heterogeneity. Furthermore, we used MetaXL to perform subgroup and sensitivity analyses. Finally, we used IBM SPSS Statistics for Windows (Version 29.0.2.0 Armonk, NY, USA), to estimate the pooled effect size of the factors associated with PPH. Results: 26 methodologically rigorous articles were included in this review and meta-analysis. The pooled magnitude of PPH in SSA was 8.6%. The studies exhibited significant heterogeneity. Individual factors associated with PPH include the woman's age (crude odds ratio [OR] = 4.37, 95% confidence interval [95% CI] = 3.03–6.29), place of residence (OR = 2.06, 95% CI = 1.51–2.82), and parity (OR = 3.13, 95% CI = 1.38–7.11). Antenatal factors include antenatal care (ANC) attendance (OR = 3.43, 95% CI = 1.12–10.05), antepartum hemorrhage (APH) (OR = 6.83, 95% CI = 3.64–12.80), and twin pregnancy (OR = 8.25, 95% CI = 3.80–17.92). Intrapartum factors include induction of labor (OR = 4.39, 95% CI = 2.01–9.61), and mode of delivery (OR = 2.61, 95% CI = 1.80–3.78). Postpartum factors include previous history of PPH (OR = 10.86, 95% CI = 3.71–31.84), and oxytocin use after delivery (OR = 0.17, 95% CI = 0.09–0.32). Conclusions: The pooled magnitude of PPH in SSA in this study was considerably higher than that in other regions. Therefore, there is a need to strengthen strategies aimed at improving ANC attendance in SSA to ultimately reduce PPH. Additionally, close monitoring of women with risk factors for PPH and the careful use of oxytocin for labor induction are strategies that can also be used to reduce PPH in SSA.

The Impact of Labor Oxytocin Use on Newborn Liver Enzymes.

Oxytocin is commonly used during labor and delivery for induction of labor and prevention of postpartum hemorrhage. While previous studies have explored the effects of labor oxytocin use on maternal and neonatal outcomes, there is a paucity of research on its impact on newborn liver enzyme function. This study aimed to assess the effects of labor oxytocin use on liver enzyme function in newborns. A case-control study was conducted. The case group consisted of 70 newborns whose mothers received oxytocin during labor, while the control group consisted of 70 newborns whose mothers did not receive oxytocin. Complete blood count (CBC), lactate dehydrogenase (LDH), creatine phosphokinase (CPK), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total and indirect bilirubin levels were measured in all newborns on the second day of life. The levels of AST and total and indirect bilirubin were found to be higher in the case group than in the control group (51 vs. 42, 7.8 vs. 4.6, and 7.4 vs. 4, respectively; p < 0.005). The levels of CPK and LDH were also higher in the case group (p < 0.005). However, the difference in ALT levels was not significant between the study groups. The observed increase in liver enzymes in this study can indicate the effect of maternal oxytocin on the newborn's liver function. While the changes in liver enzyme levels due to oxytocin use were not found to be high enough to cause liver damage, the increase in CPK and LDH levels could potentially elevate bilirubin levels due to hemolysis. Further research is needed to confirm these findings and explore the underlying mechanisms.

Postpartum Hemorrhage in Humanitarian Settings: Implementation Insights from Using Heat-Stable Carbetocin and Tranexamic Acid

Background and Objective Maternal mortality, largely due to postpartum hemorrhage (PPH), remains high in resource-limited and crisis-affected settings, where heat-stable carbetocin (HSC) and tranexamic acid (TXA) offer promise for PPH prevention and treatment but lack evidence. This study, implemented in basic maternity facilities within humanitarian settings, explores healthcare providers’ perspectives on an HSC and TXA-inclusive PPH intervention package and related operational challenges and facilitators. Methods Based on semi-structured interview guides and using thematic analysis, this qualitative research, through 13 focus group discussions and individual interviews, investigated the perspectives of 64 healthcare staff (mostly midwives) from eight basic emergency obstetric care facilities in South Sudanese and Ugandan settings hosting large numbers of forcibly displaced populations. The PPH intervention package comprised refresher training, an online provider community, PPH readiness kits, alarm bells, and displayed algorithms. Results Findings from both countries converged, highlighting providers’ positive views on HSC and TXA. HSC effectiveness in preventing bleeding was acknowledged, bolstering staff’s confidence in its use. TXA was perceived as effective although providers reported having less experience with it due to the limited number of PPH cases. Enabling factors included the ease of administration, practical training, endorsement by national and local authorities, and the absence of a cold chain requirement. Appreciation was given to the WhatsApp community of practice as it facilitated knowledge exchange, quality improvement projects that enhanced PPH diagnosis, and innovative tools like wall clocks to record the timing of clinical actions and bells to call for assistance. Challenges included confusion between new and existing medications and record systems that inadequately capture HSC, TXA, and other PPH indicators. Conclusion and Global Health Implications HSC and TXA integrated into a PPH intervention package were overall positively valued by providers in humanitarian settings. Continued education and support are crucial. Addressing challenges like medication confusion underscores the need for ongoing education and clear guidelines for the use of HSC, TXA, oxytocin, and other drugs for PPH prevention and treatment. Our findings stress the importance of a comprehensive strategy to overcome health system barriers in PPH management, potentially improving maternal health outcomes in resource-limited and fragile contexts, with broader global implications.

Multidisciplinary team training in postpartum hemorrhage: impact on the use of blood products.

Compare the number of puerperal women submitted to blood transfusion before and after the implementation of a care protocol for postpartum hemorrhage (PPH) with multidisciplinary team training. Cross-sectional study in a university hospital, analyzing births from 2015 to 2019, compared the use of blood products before and after the adoption of a PPH protocol with multidisciplinary training. Between 2015 and 2019, there were 17,731 births, with 299 (1.7%) postpartum women receiving blood products and 278 postpartum women were considered for this analysis, 128 (0.7%) at Time 1 and 150 (0.8%) at Time 2. After the multiprofessional team training (T2), there was a difference in the complete use of the PPH protocol (use of oxytocin, misoprostol and tranexamic acid) (T1 = 5.1% x T2 = 49.5%, p≤0.0001). An individual categorized analysis revealed that, in the T2 period, there was lower use of blood component units per patient compared to T1 (Mann-Whitney, p=0.006). It should be noted that at T1 and T2, 54% and 24% respectively received two units of blood products. It is important to highlight that after the multidisciplinary team training for the PPH protocol, the goal of zero maternal death due to hemorrhage was reached. The adoption of a specific protocol for PPH, combined with the training of a multidisciplinary team, had an impact on the ability to identify women at high risk of hemorrhage, resulting in a decrease in the use of blood components.

Severe adverse maternal and neonatal outcomes according to the planned birth setting being midwife-led birth centers or obstetric-led units.

The establishment of midwife-led birth centers (MLBCs) is still being debated. The study aimed to compare severe adverse outcomes and mode of birth in low-risk women according to their birth planned in MLBCs or in obstetric-led units (OUs) in France. We used nationwide databases to select low-risk women at the start of care in labor in MLBCs (n = 1294) and in OUs (n = 5985). Using multilevel logistic regression, we compared severe adverse maternal and neonatal morbidity as a composite outcome and as individual outcomes. These include severe postpartum hemorrhage (≥1000 mL of blood loss), obstetrical anal sphincter injury, maternal admission to an intensive care unit, maternal death, a 5-minute Apgar score <7, neonatal resuscitation at birth, neonatal admission to an intensive care unit, and stillbirth or neonatal death. We also studied the mode of birth and the role of prophylactic administration of oxytocin at birth in the association between birth settings and severe postpartum hemorrhage. Severe adverse maternal and neonatal outcome indicated a slightly higher rate in women in MLBCs compared to OUs according to unadjusted analyses (4.6% in MLBCs vs. 3.4% in OUs; cOR 1.36; 95%CI [1.01-1.83]), but the difference was not significant between birth settings after adjustment (aOR 1.37 [0.92-2.05]). Severe neonatal morbidity alone was not different (1.7% vs. 1.6%; aOR 1.17 [0.55-2.47]). However, severe maternal morbidity was significantly higher in MLBCs than in OUs (3.0% vs. 1.9%; aOR 1.61 [1.09-2.39]), mainly explained by higher risks of severe postpartum hemorrhage (2.4 vs. 1.1%; aOR 2.37 [1.29-4.36]), with 2 out of 5 in MLBCs partly explained by the low use of prophylactic oxytocin. Cesarean and operative vaginal births were significantly decreased in women with a birth planned in MLBCs. In France, 3 to 4% of low-risk women experienced a severe adverse maternal or neonatal outcome regardless of the planned birth setting. Results were favorable for MLBCs in terms of mode of birth but not for severe postpartum hemorrhage, which could be partly addressed by revising practices of prophylactic administration of oxytocin.

Temporalities of oxytocin for labour augmentation: a mixed-methods study of time factors shaping labour practices in a busy maternity unit in Tanzania

BackgroundHigh rates of labour augmentation with oxytocin have been found in some low- and lower-middle-income countries, causing potential perinatal harm. It is critical to understand the reasons for this overuse. Aim was to explore factors that shape practices around using oxytocin for labour augmentation in a high-volume labour ward in Dar es Salaam, Tanzania.MethodsMixed-methods data collection was conducted from March 2021 to February 2022, including structured observations of 234 births, 220 h of unstructured labour ward observations and 13 individual in-depth interviews with birth attendants. Thematic network analysis and descriptive statistics were used to analyse data. We used a time-lens to understand practices of oxytocin for labour augmentation in time-pressured labour wards.ResultsBirth attendants constantly had to prioritise certain care practices over others in response to time pressure. This led to overuse of oxytocin for augmentation to ensure faster labour progression and decongestion of the, often overburdened, ward. Simultaneously, birth attendants had little time to monitor foetal and maternal condition. Surprisingly, while oxytocin was used in 146 out of 234 (62.4%) structured labour observations, only 9/234 (4.2%) women had active labour lasting more than 12 h. Correspondingly, 21/48 (43.8%) women who were augmented with oxytocin in the first stage of labour had uncomplicated labour progression at the start of augmentation. While the partograph was often not used for decision-making, timing of starting oxytocin often correlated with natural cycles of ward-rounds and shift-turnovers instead of individual women’s labour progression. This resulted in co-existence of ‘too early’ and ‘too late’ use of oxytocin. Liberal use of oxytocin for labour augmentation was facilitated by an underlying fear of prolonged labour and low alertness of oxytocin-related risks.ConclusionsTime scarcity in the labour ward often made birth attendants deviate from clinical guidelines for labour augmentation with oxytocin. Efforts to navigate time pressure resulted in too many women with uncomplicated labour progression receiving oxytocin with little monitoring of labour. Fear of prolonged labour and low alertness to oxytocin-mediated risks were crucial drivers. These findings call for research into safety and benefits of oxytocin in low-resource settings and interventions to address congestion in labour wards to prevent using oxytocin as a time-management tool.

Dangerous Intersection of Alcoholism and Othello Syndrome: A Comprehensive Review of Delusional Jealousy and Treatment Strategies.

The modern pace of life, increased susceptibility to stressors, and easy access to psychoactive substances have contributed to the increase in the number of people addicted to alcohol. Alcoholism has serious and life-threatening consequences, one of which is brain damage causing morbid jealousy, otherwise known as Othello syndrome. The disease, currently classified as a subtype of delusional disorder, manifests itself in groundless and dangerous judgments about a partner's sexual infidelity. People with Othello syndrome constantly believe in their partner's infidelity despite inadequate evidence of it. Patients become aggressive toward their partners as well as themselves, which is why in a fit of anger they can commit murder or suicide. Othello syndrome can occur as a symptom of an underlying mental illness, but it is most often associated with brain damage caused by chronic alcohol use. Antipsychotic drugs and serotonin reuptake inhibitors are used in pharmacotherapy. Targeted treatment using the neuropeptide oxytocin, which modulates the transmitter systems responsible for disease symptoms, is also being considered. The use of oxytocin seems groundbreaking, but it remains at the research stage. The treatment of addictions and primary diseases, as well as long-term cognitive-analytic psychotherapy, also have a huge impact. Othello syndrome is a life-threatening disease with an insidious course and serious consequences. This article aims to review the manifestations of morbid jealousy, including delusional disorder, and the association with alcoholism.

Variations in the use of oxytocin for augmentation of labour in Sweden: a population-based cohort study

National Swedish data shows substantial variation in the use of oxytocin for augmentation of spontaneous labour between obstetric units. This study aimed to investigate if variations in the use of oxytocin augmentation are associated with maternal and infant characteristics or clinical factors. We used a cohort design including women allocated to Robson group 1 (nulliparous women, gestational week ≥ 37 + 0, with singleton births in cephalic presentation and spontaneous onset of labour) and 3 (parous women, gestational week ≥ 37 + 0, with singleton births in cephalic presentation, spontaneous onset of labour, and no previous caesarean birth). Crude and adjusted logistic regression models with marginal standardisation were used to estimate risk ratios (RR) and risk differences (RD) with 95% confidence intervals (CI) for oxytocin use by obstetric unit. An interaction analysis was performed to investigate the potential modifying effect of epidural. The use of oxytocin varied between 47 and 73% in Robson group 1, and 10% and 33% in Robson group 3. Compared to the remainder of Sweden, the risk of oxytocin augmentation ranged from 13% lower (RD − 13.0, 95% CI − 15.5 to − 10.6) to 14% higher (RD 14.0, 95% CI 12.3–15.8) in Robson group 1, and from 6% lower (RD − 5.6, 95% CI − 6.8 to − 4.5) to 18% higher (RD 17.9, 95% CI 16.5–19.4) in Robson group 3. The most notable differences in risk estimates were observed among women in Robson group 3 with epidural. In conclusion, variations in oxytocin use remained despite adjusting for risk factors. This indicates unjustified differences in use of oxytocin in clinical practice.

Carbetocin versus oxytocin for the prevention of postpartum haemorrhage during caesarean section in patients at high risk of bleeding

ObjectiveTo evaluate the efficacy of carbetocin versus oxytocin in preventing postpartum haemorrhage (PPH) in women with risk factors for PPH who were delived by caesarean section. MethodsThis retrospective, monocentric, before-and-after cohort study assessed patients with haemorrhagic risk factors who underwent caesarean section after 24 weeks of gestation and who had haemorrhagic risk factors between August 2014 to December 2019. ResultsThis study enrolled 518 patients, including 250 in the oxytocin group and 268 in the carbetocin group. The use of carbetocin was independently associated with a PPH decrease compared to oxytocin use (adjusted odds ratio [OR]: 0.52; 95 % confidence interval [CI]: 0.35–0.79; p = 0.002). Carbetocin use was associated with a reduction in the need for therapy escalation (6 % vs 10.8 %; p = 0.046). ConclusionCarbetocin was more effective than oxytocin in preventing PPH after caesarean section in high-risk patients.

The influence of epidural analgesic techniques on obstetrical outcomes

PurposeThe aim of this study is to compare and evaluate the obstetrical differences between three techniques, including the programmed intermittent epidural bolus (PIEB), the patient-controlled epidural analgesia (PCEA), and the continuous epidural analgesia (CEA).MethodsThis is a retrospective cohort study that investigates the obstetrical outcomes of 2240 patients who received EA during labor in a tertiary maternal unit over the course of 9 years (2011–2018). The only inclusion criterion was the use of epidural analgesia during childbirth and the only exclusion criteria were multiplets’ gestation. Multivariate logistic regression, Kruskal–Wallis test, and the log-rank test were utilized to compare the differences between the three EA techniques in terms of cesarean section rate, the incidence of perineal tears, the use of Oxytocin, the duration of labor, and the incidence of paresthesia.ResultsOut of the 2240 included deliveries; 1084 utilized PIEB, 1086 PCEA, and 70 CEA techniques. The incidence of Cesarean section was the highest in the CEA group (45.7%) compared to PIEB (24.8%) and PCEA (24.4%) P < 0.001. A significantly shorter duration of labor (vaginal delivery) was observed in the PCEA group (n: 821, 336.7 min) compared to the PIEB group (n: 814, 368.8 min) P < 0.001. There were no statistically significant differences in the incidence of perineal tears, the need of uterotonics, and the incidence of paresthesia.ConclusionThe results of this study indicate that the PIEB and PCEA techniques are superior to the CEA technique when it comes to analgesia during childbirth. In this study, the PCEA technique seems to be the best-suited technique for childbirth, since it had a significantly shorter duration of labor than the PIEB technique.

Patterns of oxytocin use for induction and augmentation of labour among healthcare providers in Nigeria

BackgroundThe practice of intrapartum use of oxytocin for induction and augmentation of labour is increasing worldwide with documented wide variations in clinical use, especially dose administrations. There is also evidence of intrapartum use by unauthorized cadre of staff.AimThis study assessed the patterns – frequency of intrapartum use of oxytocin, the doses and routes of administration for induction and augmentation of labour, and identified the predictors of oxytocin use for induction and augmentation of labour by healthcare providers in Nigeria.MethodsThis was a cross-sectional study conducted among healthcare providers – doctors, nurses/midwives and community health workers (CHWs) in public and private healthcare facilities across the country’s six geopolitical zones. A multistage sampling technique was used to select 6,299 eligible healthcare providers who use oxytocin for pregnant women during labour and delivery. A self-administered questionnaire was used to collect relevant data and analysed using STATA 17 statistical software. Summary and inferential statistics were done and further analyses using multivariable regression models were performed to ascertain independent predictor variables of correct patterns of intrapartum oxytocin usage. The p-value was set at < 0.05.ResultsOf the 6299 respondents who participated in the study, 1179 (18.7%), 3362 (53.4%), and 1758 (27.9%) were doctors, nurses/midwives and CHWs, respectively. Among the respondents, 4200 (66.7%) use oxytocin for augmentation of labour while 3314 (52.6%) use it for induction of labour. Of the 1758 CHWs, 37.8% and 49% use oxytocin for induction and augmentation of labour, respectively. About 10% of the respondents who use oxytocin for the induction or augmentation of labour incorrectly use the intramuscular route of administration and about 8% incorrectly use intravenous push. Being a doctor, and a healthcare provider from government health facilities were independent positive predictors of the administration of correct dose oxytocin for induction and augmentation of labour. The CHWs were most likely to use the wrong route and dose administration of oxytocin for the induction and augmentation of labour.ConclusionOur study unveiled a concerning clinical practice of intrapartum oxytocin use by healthcare providers in Nigeria – prevalence of intrapartum use of oxytocin, inappropriate routes of administration for induction and augmentation of labour, varied and inappropriately high start dose of administration including unauthorized and high intrapartum use of oxytocin among CHWs.

Effect of oxytocin use during colostrum harvest and the association of cow characteristics with colostrum yield and immunoglobulin G concentration in Holstein dairy cows

Our objectives were to determine the effect of oxytocin use during colostrum harvest on colostrum yield and IgG concentration in Holstein dairy cows on a commercial dairy in New York and to describe associations of cow characteristics with these outcomes. Animals were enrolled between July and October 2023 using a randomized block design, with day of enrollment as the unit of randomization. A median (range) of 10 (3-19) cows were enrolled per day. Treatments were (1) 40 IU oxytocin (OXY40), (2) 20 IU oxytocin (OXY20), and (3) an untreated control group (CNTR). Oxytocin was administered i.m. ∼45 s before unit attachment in a rotary parlor. Colostrum weight was measured using the colostrum bucket-embedded scale or a platform scale when the yield was less than the smallest bucket scale. The concentration of IgG ([IgG]) in colostrum was determined using radial immunodiffusion and used to calculate total IgG, and DM (%) was determined by oven drying. Individual cow characteristics such as parity, calf sex, weight, dystocia score, stillbirth, and milk production in wk 4 of lactation; additionally, for multiparous cows, dry period length and previous lactation dry-off linear SCS were collected. Data were analyzed separately for primiparous and multiparous cows using backward stepwise elimination. To produce final mixed effects ANOVA models, primiparous cows (n = 201) were randomized to 35.8% (n = 72) OXY40, 32.8% (n = 66) OXY20, and 31.3% (n = 63) CNTR. Multiparous groups (n = 435) were randomized to 34.7% (n = 151) OXY40, 29.7% (n = 129) OXY20, and 35.6% (n = 155) CNTR. The median (range) colostrum yield was 6.0 (0-20.6) kg and [IgG] was 98.5 (0.1-293.6) g/L in the study population. In primiparous cows, OXY40 had a higher colostrum yield (LSM [95% CI]) of 5.4 (4.9-5.9) kg compared with both OXY20 (4.1 [3.5-4.7] kg) and CNTR (3.8 [3.3-4.3] kg). In multiparous cows, OXY40, OXY20, and CNTR did not differ in colostrum yield (5.9 [5.3-6.5], 5.7 [5.1-6.3], and 5.4 [4.8-6.0] kg, respectively), but colostrum yield was greater in parity 2 compared with all other parities, cows giving birth to male calves, cows with the highest milk production at wk 4 of lactation, and cows with a dry period of >65 d. Oxytocin use did not affect [IgG] in either primiparous or multiparous cows, but [IgG] was highest in cows in parity ≥4 and lowest in cows dry >65 d. In summary, oxytocin use at 40 IU i.m. was associated with a higher colostrum yield in primiparous cows only and no change in [IgG]. Oxytocin use likely addressed disturbed milk ejection and therefore increased colostrum yield in heifers milked for the first time in a rotary parlor. This study confirms cow characteristics associated with colostrum production within a single herd.

Effect of different concentrations of sufentanil combined with ropivacaine on epidural fever during labor: A single-center retrospective study.

Labor epidural analgesia (LEA) is associated with increased maternal body temperature; however, the responsible mechanism is unknown. Recent studies suggest that changes in EA affect the incidence of fever and that epidural sufentanil supplementation enhances analgesia and reduces the amount of local anesthetic. The aim of this study was to evaluate the effect of different concentrations of sufentanil combined with ropivacaine on intrapartum fever during delivery. We performed a retrospective study comparing maternal fever rates in patients receiving labor analgesia between December 2018 and January 2019. Each patient receiving different concentrations of sufentanil in their EA received either proposal H (0.08% ropivacaine + 0.4 µg/mL sufentanil) or proposal L (0.08% ropivacaine + 0.2 µg/mL sufentanil), with the same nulliparous status. The primary outcome of this study was the incidence of intrapartum maternal fever, which was defined as any temperature ≥ 38°C during labor using Fisher exact test. Secondary outcome measures included visual analog scale (VAS) pain scores, birth events, and neonatal outcomes. We observed a perinatal fever incidence rate of 11.7% in the group receiving proposal L, while the incidence rate was 19.8% in the group receiving proposal H (P = .001). Five hours after administration, the average body temperature of the puerpera decreased significantly in the proposal L group compared with proposal H group. In addition, treatment with 0.2 µg/mL sufentanil provided satisfactory pain relief during labor, shortened the first stage of labor and total labor time, reduced oxytocin use, and had no significant adverse effects on neonatal outcomes. EA may increase the risk of intrapartum epidural-associated fever. Compared with the 0.4 µg/mL sufentanil group, the 0.2 µg/mL sufentanil group can provide better analgesia and improve maternal fever. These retrospective results highlighted the importance of prospective and mechanistic studies of maternal fever associated with intraspinal analgesia.

Early pharmacological interventions for prevention of post-traumatic stress disorder (PTSD) in individuals experiencing acute traumatic stress symptoms.

Acute traumatic stress symptoms may develop in people who have been exposed to a traumatic event. Although they are usually self-limiting in time, some people develop post-traumatic stress disorder (PTSD), a severe and debilitating condition. Pharmacological interventions have been proposed for acute symptoms to act as an indicated prevention measure for PTSD development. As many individuals will spontaneously remit, these interventions should balance efficacy and tolerability. To assess the efficacy and acceptability of early pharmacological interventions for prevention of PTSD in adults experiencing acute traumatic stress symptoms. We searched the Cochrane Common Mental Disorders Controlled Trial Register (CCMDCTR), CENTRAL, MEDLINE, Embase and two other databases. We checked the reference lists of all included studies and relevant systematic reviews. The search was last updated on 23 January 2023. We included randomised controlled trials on adults exposed to any kind of traumatic event and presenting acute traumatic stress symptoms, without restriction on their severity. We considered comparisons of any medication with placebo, or with another medication. We excluded trials that investigated medications as an augmentation to psychotherapy. We used standard Cochrane methodological procedures. Using a random-effects model, we analysed dichotomous data as risk ratios (RR) and calculated the number needed to treat for an additional beneficial/harmful outcome (NNTB/NNTH). We analysed continuous data as mean differences (MD) or standardised mean differences (SMD). Our primary outcomes were PTSD severity and dropouts due to adverse events. Secondary outcomes included PTSD rate, functional disability and quality of life. We included eight studies that considered four interventions (escitalopram, hydrocortisone, intranasal oxytocin, temazepam) and involved a total of 779 participants. The largest trial contributed 353 participants and the next largest, 120 and 118 participants respectively. The trials enrolled participants admitted to trauma centres or emergency departments. The risk of bias in the included studies was generally low except for attrition rate, which we rated as high-risk. We could meta-analyse data for two comparisons: escitalopram versus placebo (but limited to secondary outcomes) and hydrocortisone versus placebo. One study compared escitalopram to placebo at our primary time point of three months after the traumatic event. There was inconclusive evidence of any difference in terms of PTSD severity (mean difference (MD) on the Clinician-Administered PTSD Scale (CAPS, score range 0 to 136) -11.35, 95% confidence interval (CI) -24.56 to 1.86; 1 study, 23 participants; very low-certainty evidence), dropouts due to adverse events (no participant left the study early due to adverse events; 1 study, 31 participants; very low-certainty evidence) and PTSD rates (RR 0.59, 95% CI 0.03 to 13.08; NNTB 37, 95% CI NNTB 15 to NNTH 1; 1 study, 23 participants; very low-certainty evidence). The study did not assess functional disability or quality of life. Three studies compared hydrocortisone to placebo at our primary time point of three months after the traumatic event. We found inconclusive evidence on whether hydrocortisone was more effective in reducing the severity of PTSD symptoms compared to placebo (MD on CAPS -7.53, 95% CI -25.20 to 10.13; I2 = 85%; 3 studies, 136 participants; very low-certainty evidence) and whether it reduced the risk of developing PTSD (RR 0.47, 95% CI 0.09 to 2.38; NNTB 14, 95% CI NNTB 8 to NNTH 5; I2 = 36%; 3 studies, 136 participants; very low-certainty evidence). Evidence on the risk of dropping out due to adverse events is inconclusive (RR 3.19, 95% CI 0.13 to 75.43; 2 studies, 182 participants; low-certainty evidence) and it is unclear whether hydrocortisone might improve quality of life (MD on the SF-36 (score range 0 to 136, higher is better) 19.70, 95% CI -1.10 to 40.50; 1 study, 43 participants; very low-certainty evidence). No study assessed functional disability. This review provides uncertain evidence regarding the use of escitalopram, hydrocortisone, intranasal oxytocin and temazepam for people with acute stress symptoms. It is therefore unclear whether these pharmacological interventions exert a positive or negative effect in this population. It is important to note that acute traumatic stress symptoms are often limited in time, and that the lack of data prevents the careful assessment of expected benefits against side effects that is therefore required. To yield stronger conclusions regarding both positive and negative outcomes, larger sample sizes are required. A common operational framework of criteria for inclusion and baseline assessment might help in better understanding who, if anyone, benefits from an intervention. As symptom severity alone does not provide the full picture of the impact of exposure to trauma, assessment of quality of life and functional impairment would provide a more comprehensive picture of the effects of the interventions. The assessment and reporting of side effects may facilitate a more comprehensive understanding of tolerability.

Oral misoprostol alone, compared with oral misoprostol followed by oxytocin, in women induced for hypertension of pregnancy: A multicentre randomised trial.

To assess whether, in those requiring continuing uterine stimulation after cervical ripening with oral misoprostol and membrane rupture, augmentation with low-dose oral misoprostol is superior to intravenous oxytocin. Open-label, superiority randomised trial. Government hospitals in India. Women who were induced for hypertensive disease in pregnancy and had undergone cervical ripening with oral misoprostol, but required continuing stimulation after artificial membrane rupture. Participants received misoprostol (25 micrograms, orally, 2-hourly) or titrated oxytocin through an infusion pump. All women had one-to-one care; fetal monitoring was conducted using a mixture of intermittent and continuous electronic fetal monitoring. Caesarean birth. A total of 520 women were randomised and the baseline characteristics were comparable between the groups. The caesarean section rate was not reduced with the use of misoprostol (misoprostol, 84/260, 32.3%, vs oxytocin, 71/260, 27.3%; aOR 1.23; 95% CI 0.81-1.85; P = 0.33). The interval from randomisation to birth was somewhat longer with misoprostol (225 min, 207-244 min, vs 194 min, 179-210 min; aOR 1.137; 95% CI 1.023-1.264; P = 0.017). There were no cases of hyperstimulation in either arm. The rates of fetal heart rate abnormalities and maternal side effects were similar. Fewer babies in the misoprostol arm were admitted to the special care unit (10 vs 21 in the oxytocin group; aOR 0.463; 95% CI 0.203-1.058; P = 0.068) and there were no neonatal deaths in the misoprostol group, compared with three neonatal deaths in the oxytocin arm. Women's acceptability ratings were high in both study groups. Following cervical preparation with oral misoprostol and membrane rupture, the use of continuing oral misoprostol for augmentation did not significantly reduce caesarean rates, compared with the use of oxytocin. There were no hyperstimulation or significant adverse events in either arm of the trial.

An Audit of Stroke at Muhammad Medical College.

Objective:1. To determine the number of stroke patients admitted at Muhammad Medical College, Mirpurkhas.2. To see the facilities available for management of stroke and make recommendationsStudy Design: Retrospective review of case notes.Place &amp; Duration of Study: Patients admitted with diagnosis of stroke at Muhammad Medical College,Mirpurkhas with effect from 01-01-2010 to 31-12-2010Methodology: Retrospective audit of file notes of all patients admit in 2010 with stroke. This study was approved by the Hospital Research &amp; Ethics Committee (No. 240811/REC/001)Results: 39 patients (24 males and 15 females) were admitted with diagnosis of stroke during this period. Theaverage age was 57 years (14-90). CT scan showed infarction in 27 (69%) and hemorrhage in 12 (31%). 10 patients (25.6%) died during admission.Conclusions: Rupture of gravid uterus is a life threatening emergency requiring immediate surgical interventionwith more than 95% feotal deaths and Injudicious use of oxytocin by Dais/ TBAS was the most common cause ofruptured uterus.High parity, illiteracy, ignorance coupled with inadequate maternity service, lack of antepartum and intraprtumcare, prior caesarean delivery were identified as risk factors for uterine rupture, its occurrence is usuallyassociated with considerable maternal and fetal mortality and morbidity.Keywords: Stroke, Cerebrovascular accident, infarction, hemorrhage.