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Umbilical vein oxytocin in the management of retained placenta: an alternative to manual removal of placenta?

Lim PS, Singh S, Lee A, Muhammad Yassin MA

Arch Gynecol Obstet, 2011 Nov;284(5):1073-9.
PMID: 21136267 DOI: 10.1007/s00404-010-1785-6

Retained placenta is potentially life threatening due to possible complications associated with manual removal. Our aim was to determine whether umbilical vein injection of oxytocin in saline reduces the need for manual removal of placenta.

Matched MeSH terms: Oxytocin/therapeutic use*
Two different regimens of outpatient Foley catheter induction of labor in nulliparas: A randomized trial

Hong J, Raghavan S, Siti Nordiana A, Saaid R, Vallikkannu N, Tan PC

Int J Gynaecol Obstet, 2024 Apr;165(1):265-274.
PMID: 37846154 DOI: 10.1002/ijgo.15199

OBJECTIVES: To evaluate expectant compared to immediate return to hospital upon outpatient Foley catheter expulsion predicated on maternal satisfaction and amniotomy-titrated oxytocin infusion to delivery interval.
METHODS: This randomized trial was conducted in a tertiary university hospital in Malaysia from September 2020 to February 2022. A total of 330 nulliparous women at term with unripe cervices (Bishop score ≤5), singleton viable fetus in cephalic presentation, reassuring preinduction fetal heart rate tracing and intact membranes who underwent planned outpatient Foley catheter induction of labor (IOL) were included. Women were randomized to expectant or immediate return to hospital if the Foley was spontaneously expelled at home before their scheduled hospital admission the following day. Primary outcomes were amniotomy-titrated oxytocin infusion to delivery interval and maternal satisfaction on the induction process (assessed by 0-10 visual numerical rating scale [VNRS]).
RESULTS: Amniotomy-titrated oxytocin infusion to delivery interval was 8.7 ± 4.1 versus 8.9 ± 3.9 h, P = 0.605 (mean difference - 0.228 95% CI: -1.1 to +0.6 h) and maternal satisfaction VNRS score was median (interquartile range) 8 (7-9) versus 8 (7-9), P = 0.782. Early return to hospital rates were 37/165 (22.4%) versus 72/165 (43.6%), RR 0.51 (95% CI: 0.37-0.72), P ≤ 0.001, Cesarean delivery rates were 80/165 (48.5%) versus 80/165 (48.5%), RR 1.00 (95% CI: 0.80-1.25), P = 1.00 and duration of hospital stay was 54.4 ± 22.9 versus 56.7 ± 22.8 h, P = 0.364 for the expectant versus immediate return groups respectively.
CONCLUSION: In outpatient Foley catheter IOL, expectant compared to immediate return to hospital following Foley dislodgement results in similarly high maternal satisfaction. The amniotomy-titrated oxytocin to delivery duration is non-inferior with expectant management.

Matched MeSH terms: Oxytocics*; Oxytocin*
Fulltext The Effect Of 5 Units Oxytocin Preparation In The Augmentation Of Labour – Is It Cost Effective?

Roszaman Ramli, Ghazali Ismail

International Medical Journal Malaysia, 2006;5(1):1-8.
MyJurnal

Objectives: To evaluate the cost-effectiveness of the new oxytocin regimes in the augmentation of labour and the effect on the maternal and fetal outcome. Design: Randomized controlled trial. Setting: Labour ward of Hospital Tengku Ampuan Afzan, Kuantan. Participants: 230 pregnant women in labour at term with obstetric indications for labour augmentation. Methods: The women were randomly assigned to receive new oxytocin regime of 5 units in 500 cc of D/Saline at titration of 5 dpm with increments of 5 dpm to a maximum of 60 dpm. Or, old oxytocin regime of 1/2/4 units with titration of 20/40/60 dpm for primips and half the dosage for multips.
Main outcome measures: Cost analysis, duration of labour, duration of augmentation, complication of labour, post partum hemorrhage (PPH), mode of delivery and perinatal outcome.
Results: There was no significant difference in the mean duration of labour (6.8 h vs 6.7 h ; p = 0.45) and mean augmentation time (3.86 h vs 4.0 h; p = 0.9) between the regimes studied There seemed to be higher incidence of caesarean section in the old oxytocin group (6.5% vs 24.7%; p = 0.001). There was no significant influence on the neonatal morbidity and mortality (p = 0.07). A moderate reduction of annual cost for augmentation of labour was noted (RM 962.34).
Conclusion: The results showed that the new oxytocin regime was more cost-effective without apparent increased in the maternal and fetal mortality and morbidity.

Matched MeSH terms: Oxytocin
Strain differences in intermale aggression and possible factors regulating increased aggression in Japanese quail

Maekawa F, Nagino K, Yang J, Htike NTT, Tsukahara S, Ubuka T, et al.

Gen Comp Endocrinol, 2018 01 15;256:63-70.
PMID: 28765073 DOI: 10.1016/j.ygcen.2017.07.025

The National Institute for Environmental Studies (NIES) of Japan established a strain of Japanese quail (Coturnix japonica) known as NIES-L by rotation breeding in a closed colony for over 35years; accordingly, the strain has highly inbred-like characteristics. Another strain called NIES-Brn has been maintained by randomized breeding in a closed colony to produce outbred-like characteristics. The current study aimed to characterize intermale aggressive behaviors in both strains and to identify possible factors regulating higher aggression in the hypothalamus, such as sex hormone and neuropeptide expression. Both strains displayed a common set of intermale aggressive behaviors that included pecking, grabbing, mounting, and cloacal contact behavior, although NIES-Brn quail showed significantly more grabbing, mounting, and cloacal contact behavior than did NIES-L quail. We examined sex hormone levels in the blood and diencephalon in both strains. Testosterone concentrations were significantly higher in the blood and diencephalon of NIES-Brn quail compared to NIES-L quail. We next examined gene expression in the hypothalamus of both strains using an Agilent gene expression microarray and real-time RT-PCR and found that gene expression of mesotocin (an oxytocin homologue) was significantly higher in the hypothalamus of NIES-Brn quail compared to NIES-L quail. Immunohistochemistry of the hypothalamus revealed that numbers of large cells (cell area>500μm2) expressing mesotocin were significantly higher in the NIES-Brn strain compared to the NIES-L strain. Taken together, our findings suggest that higher testosterone and mesotocin levels in the hypothalamus may be responsible for higher aggression in the NIES-Brn quail strain.

Matched MeSH terms: Oxytocin/analogs & derivatives; Oxytocin/genetics; Oxytocin/metabolism
Fulltext Pneumonia and concurrent eggs retention in a river terrapin (Batagur baska)

Inirah, C.I., Donny, Y., Azlan, C.A., Teoh, H.X., Jesse, F.F.A.

Jurnal Veterinar Malaysia, 2017;29(1):13-17.
MyJurnal

A case report of pneumonia and egg retention in a river terrapin was presented in this paper. A 20 year-old river terrapin (Batagur baska) was presented with complaint of coughing with blood discharge, wheezing breathing and inappetance. Plain radiograph showed both right and left lung lobes were consolidated due to pneumonia 90% and 70%, respectively. Tentative diagnosis of pneumonia due to opportunistic bacterial infection of Chromobacterium sp. and Plesiomonas shigelloides was made in this case based on bacterial isolation and response to antibiotic and antiinflammatory drugs. Enrofloxacin and flunixin meglumine were administered from Day-1 to -5. Enrofloxacin was then changed to gentamicin since it showed resistance in those bacteria. No clinical changes were observed. Gentamicin was given at rate 2.5 mg/kg once a week intramuscularly and prednisolone 2 mg/kg once on Day-6 given intramuscularly, showed a response on Day-10 of hospitalisation with the evidence of reduction in lung consolidation by almost 90% clear of lung lobes from pneumonia. Sixteen thin-shelled eggs were also observed in the coelomic cavity on radiographic images. Active laying season, prolonged laying period and the history of laying only two eggs a week before presenting to hospital gives a highly suggestive diagnosis of egg retention syndrome. To encourage laying, the terrapin was given a daily parenteral calcium supplement, oxytocin 5 IU/kg intramuscularly (Day-10 hospitalisation) and was released for sunbath and to sand twice daily. The eggs were completely laid on Day-11 and the overall terrapin condition was greatly improved 2 weeks post-hospitalisation.

Matched MeSH terms: Oxytocin
Onset of labour

Chong HL, Ong HC, Ang LT

Med J Malaysia, 1974 Sep;29(1):44-53.
PMID: 4282630
Matched MeSH terms: Oxytocin/physiology
Fulltext Is there a place for intra-umbilical oxytocin for the management of retained placenta?

Sivalingam N, Surinder S

Med J Malaysia, 2001 Dec;56(4):451-9.
PMID: 12014765

Intra-umbilical injection of oxytocin has been used to hasten placental separation in retained placenta. A randomised controlled trial was done on 35 consequent women who fulfilled the criteria for retained placenta at the Department of Obstetrics & Gynaecology Ipoh Hospital. Nineteen patients who were recruited into the study group received intraumbilical injection of 301U oxytocin in 27mls saline. Another 16 patients who were in the control group received 30mls of 0.9% sodium chloride (placebo). The primary outcome measured was the need for manual removal of placenta (MRP). Nine out of the 19 patients in the oxytocin group required MRP while 10/16 in the control group required MRP. There was a 24% reduction (95% C.I. 0.41 to 1.39) in the need for MRP in the study group compared to the saline group. our results indicate that intra-umbilical vein injection of oxytocin is not clinically useful for the removal of a retained placenta.

Matched MeSH terms: Oxytocin/administration & dosage*; Oxytocin/therapeutic use*
Fulltext Interpersonal touch: the lost art of mankind - a review

Choy, H.H., Khalib, A.L.

Malaysian Journal of Public Health Medicine, 2013;13(1):48-58.
MyJurnal

Surprisingly little was known about the importance of touch in life which was placed at a lower emphasis than the rest-namely visual, auditory, olfactory sense and etc. This writing aimed to decipher the significances of interpersonal touch, its culture, practices, barriers and challenges, which were then conveyed to the public as a form of health promotion. Methodology includes narrative review where the suitable literatures used were searched using ScienceDirect database under the keywords of “Interpersonal Touch”, “Oxytocin” and “Touch”. In this review, we have highlighted some of the most critical points which should have been promoted to the public. For example, touch satisfies individual psychosomatic and psychosocial needs. It forms a non-verbal communication culture which interacts about emotions, trust, compliance and more. Furthermore, it has been linked to the secretion of multifunctional bioactive chemical-oxytocin which was well-known in its therapeutic advantages for a wide range of commonest chronic diseases and social ills. Although some dysfunctional consequences may be resulted, incorporating genuine interpersonal touch into today’s efforts is undeniably viewed as a good option in solving many social problems.

Matched MeSH terms: Oxytocin
Interaction between oxytocin and 'sidaverin' on the gravid and non-gravid rat uterus

Lutterodt GD

Pharmacol Res, 1995 Jul-Aug;32(1-2):89-94.
PMID: 8668653 DOI: 10.1016/S1043-6618(95)80014-X

Sidaverin, a crystalline compound extracted from a polar fraction of Sida veronicaefolia (Lam), elicited oxytocin-like contractions in the non-gravid rat isolated uterus preparation with a concentration-response relationship. Equipotent concentrations of oxytocin and sidaverin, using matched responses, were approximately 0.16 U and 0.4 micrograms ml-1, respectively. Sidaverin-induced contractile response was atropine reversible. The concentration-response curves for sidaverin and oxytocin were parallel, and both responses were inhibited by the specific oxytocin antagonist, Atosiban, indicating possible involvement of oxytocin receptors in the action of sidaverin. There were potentiation of action of one drug to that of the other, irrespective of the order of administration and even after washing off the first before introducing the second drug. In the gravid uterus, sidaverin produced contractions in preparations from day 1 to day 6 or 7, caused relaxation in days 7-11, and elicited contractions in day 11 through term, the sensitivity of the preparations increasing exponentially toward term with strong sustained contractions. With the exception of days 7-11, when sidaverin antagonized oxytocin action, it potentiated action of oxytocin on the gravid uterus.

Matched MeSH terms: Oxytocin/antagonists & inhibitors; Oxytocin/pharmacology*
Inhibition of rat testicular microsomal steroidogenesis by oxytocin and metyrapone

Kwan TK, Gower DB

Biochem. Int., 1988 Apr;16(4):629-37.
PMID: 3390195

Capillary gas chromatographic 'steroid profiling' has been utilised to separate and quantify the metabolites (derivatized as methyloximes and/or trimethylsilyl ethers) formed from pregnenolone after incubation with rat testicular microsomes. A wide range of steroid metabolites was found, indicating that both the 5-ene and 4-ene pathways of testosterone biosynthesis were operating, as well as 16 alpha-hydroxylation, 20 beta-reduction and the formation of several C19 steroids (the 16-androstenes). At the concentration used, Metyrapone markedly inhibited 16 alpha- and 17-hydroxylation and side-chain cleavage of 17-hydroxylated C21 steroids. 16-Androstene production was also markedly inhibited and the formation of other metabolites was affected to lesser extents. Oxytocin abolished the formation of all C21 and C19 metabolites of pregnenolone.

Matched MeSH terms: Oxytocin/pharmacology*
Fulltext Increased exposure to sodium during pregnancy and lactation changes basal and induced behavioral and neuroendocrine responses in adult male offspring

Silva MS, Lúcio-Oliveira F, Mecawi AS, Almeida LF, Ruginsk SG, Greenwood MP, et al.

Physiol Rep, 2017 Mar;5(6).
PMID: 28336818 DOI: 10.14814/phy2.13210

Excessive sodium (Na+) intake in modern society has been associated with several chronic disorders such as hypertension. Several studies suggest that early life events can program physiological systems and lead to functional changes in adulthood. Therefore, we investigated behavioral and neuroendocrine responses under basal conditions and after 48 h of water deprivation in adult (60-day-old Wistar rats) male, Wistar rats originating from dams were offered only water or 0.15 mol/L NaCl during pregnancy and lactation. Early life salt exposure induced kidney damage, as shown by a higher number of ED-1 positive cells (macrophages/monocytes), increased daily urinary volume and Na+ excretion, blunted basal water intake and plasma oxytocin levels, and increased plasma corticosterone secretion. When challenged with water deprivation, animals exposed to 0.15 mol/L NaCl during early life showed impaired water intake, reduced salt preference ratio, and vasopressin (AVP) secretion. In summary, our data demonstrate that the perinatal exposure to excessive Na+ intake can induce kidney injury in adult offspring and significantly affect the key mechanisms regulating water balance, fluid intake, and AVP release in response to water deprivation. Collectively, these novel results highlight the impact of perinatal programming on the homeostatic mechanisms regulating fluid and electrolyte balance during exposure to an environmental stress (i.e. dehydration) in later life.

Matched MeSH terms: Oxytocin/blood*
Fulltext In vitro differentiation between oxytocin- and vasopressin-secreting magnocellular neurons requires more than one experimental criterion

da Silva MP, Merino RM, Mecawi AS, Moraes DJ, Varanda WA

Mol Cell Endocrinol, 2015 Jan 15;400:102-11.
PMID: 25451978 DOI: 10.1016/j.mce.2014.11.004

The phenotypic differentiation between oxytocin (OT)- and vasopressin (VP)-secreting magnocellular neurosecretory cells (MNCs) from the supraoptic nucleus is relevant to understanding how several physiological and pharmacological challenges affect their electrical activity. Although the firing patterns of OT and VP neurons, both in vivo and in vitro, may appear different from each other, much is assumed about their characteristics. These assumptions make it practically impossible to obtain a confident phenotypic differentiation based exclusively on the firing patterns. The presence of a sustained outward rectifying potassium current (SOR) and/or an inward rectifying hyperpolarization-activated current (IR), which are presumably present in OT neurons and absent in VP neurons, has been used to distinguish between the two types of MNCs in the past. In this study, we aimed to analyze the accuracy of the phenotypic discrimination of MNCs based on the presence of rectifying currents using comparisons with the molecular phenotype of the cells, as determined by single-cell RT-qPCR and immunohistochemistry. Our results demonstrated that the phenotypes classified according to the electrophysiological protocol in brain slices do not match their molecular counterparts because vasopressinergic and intermediate neurons also exhibit both outward and inward rectifying currents. In addition, we also show that MNCs can change the relative proportion of each cell phenotype when the system is challenged by chronic hypertonicity (70% water restriction for 7 days). We conclude that for in vitro preparations, the combination of mRNA detection and immunohistochemistry seems to be preferable when trying to characterize a single MNC phenotype.

Matched MeSH terms: Oxytocin/genetics; Oxytocin/secretion*
Immediate compared with delayed oxytocin after amniotomy labor induction in parous women: a randomized controlled trial

Tan PC, Soe MZ, Sulaiman S, Omar SZ

Obstet Gynecol, 2013 Feb;121(2 Pt 1):253-259.
PMID: 23344273 DOI: 10.1097/AOG.0b013e31827e7fd9

OBJECTIVE: To compare immediate with delayed (4 hours) oxytocin infusion after amniotomy on vaginal delivery within 12 hours and patient satisfaction with the birth process.
METHODS: Parous women with favorable cervixes after amniotomy for labor induction were randomized to immediate titrated oxytocin or placebo intravenous infusion in a double-blind noninferiority trial. After 4 hours, study infusions were stopped, the women were assessed, and open-label oxytocin was started if required. Maternal satisfaction with the birth process was assessed with a 10-point visual numerical rating scale (lower score, greater satisfaction).
RESULTS: Vaginal delivery rates at 12 hours were 91 of 96 (94.8%) compared with 91 of 94 (96.8%) (relative risk 0.98, 95% confidence interval [CI] 0.92-1.04, P=.72), and maternal satisfaction on a visual numerical rating scale (median [interquartile range]) was 3 [3-4] compared with 3 [3-5], P=.36 for immediate compared with delayed arm, respectively). Cesarean delivery, maternal fever, postpartum hemorrhage, uterine hyperactivity, and adverse neonatal outcome rates were similar between arms. The immediate oxytocin arm had a shorter amniotomy-to-delivery interval of 5.3±3.1 compared with 6.9±2.9 hours (Poxytocin infusion was avoided by 35.6%.
CONCLUSIONS: Immediate or delayed oxytocin infusions are reasonable options after amniotomy for labor induction in parous women with favorable cervixes. The choice should take into account local resources and the woman's wish.
CLINICAL TRIAL REGISTRATION: ISRCTN Register, http://isrctn.org, ISRCTN51476259.
LEVEL OF EVIDENCE: I.

Matched MeSH terms: Oxytocin/administration & dosage*
Extra-amniotic prostaglandin E2 and intravenous oxytocin in termination of mid-trimester pregnancy and the management of missed abortion and hydatiform mole

Arshat H

Med J Malaysia, 1977 Mar;31(3):220-5.
PMID: 904515
Matched MeSH terms: Oxytocin/administration & dosage*
Ergometrine stability in postpartum haemorrhage kits: Does temperature and light matter?

Donnan F, Senarathna SMDKG, Ware B, Rawlins MDM, Dontham C, Chuang VTG, et al.

Aust N Z J Obstet Gynaecol, 2020 06;60(3):344-349.
PMID: 31512230 DOI: 10.1111/ajo.13046

BACKGROUND: Postpartum haemorrhage (PPH) kits containing uterotonics are used on obstetric units for the timely management of PPH. Visible discolouration of ergometrine and ergometrine-oxytocin injections was observed in PPH kits stored in medical refrigerators on the obstetric unit at our hospital.
AIM: To investigate the stability of ergometrine and ergometrine-oxytocin injections in PPH kits under simulated clinical storage conditions and to determine the potency of ampoules quarantined from PPH kits on our obstetric unit.
MATERIAL AND METHODS: Ergometrine and ergometrine-oxytocin injection ampoules were stored exposed to and protected from light at 4°C and room temperature (25°C) for up to three months, and assayed by high-performance liquid chromatography. Stability was based on the time for the ergometrine or oxytocin concentration to fall to 90% of the original concentration (t90 ). The potency of quarantined discoloured ampoules also was determined.
RESULTS: Ergometrine was stable at both temperatures for >6 months, when stored protected from light in simulated clinical conditions. When exposed to light, ergometrine was stable for approximately 4 days at 25°C and 10 days at 4°C. Discoloured ergometrine and ergometrine-oxytocin injection ampoules were found to be <90% of the nominal concentration.
CONCLUSION: Stability of ergometrine in PPH kits is largely unaffected by temperature fluctuations (at 4°C and 25°C) over 6 months when protected from light. Ergometrine and ergometrine-oxytocin ampoules should be inspected prior to use and any discoloured ampoules discarded.

Matched MeSH terms: Oxytocin
Fulltext Effectiveness of breathing exercises, foot reflexology and back massage (BRM) on labour pain, anxiety, duration, satisfaction, stress hormones and newborn outcomes among primigravidae during the first stage of labour in Saudi Arabia: a study protocol for a randomised controlled trial

Baljon KJ, Romli MH, Ismail AH, Khuan L, Chew BH

BMJ Open, 2020 06 15;10(6):e033844.
PMID: 32540887 DOI: 10.1136/bmjopen-2019-033844

INTRODUCTION: Labour pain is among the severest pains primigravidae may experience during pregnancy. Failure to address labour pain and anxiety may lead to abnormal labour. Despite the many complementary non-pharmacological approaches to coping with labour pain, the quality of evidence is low and best approaches are not established. This study protocol describes a proposed investigation of the effects of a combination of breathing exercises, foot reflexology and back massage (BRM) on the labour experiences of primigravidae.
METHODS AND ANALYSIS: This randomised controlled trial will involve an intervention group receiving BRM and standard labour care, and a control group receiving only standard labour care. Primigravidae of 26-34 weeks of gestation without chronic diseases or pregnancy-related complications will be recruited from antenatal clinics. Eligible and consenting patients will be randomly allocated to the intervention or the control group stratified by intramuscular pethidine use. The BRM intervention will be delivered by a trained massage therapist. The primary outcomes of labour pain and anxiety will be measured during and after uterine contractions at baseline (cervical dilatation 6 cm) and post BRM hourly for 2 hours. The secondary outcomes include maternal stress hormone (adrenocorticotropic hormone, cortisol and oxytocin) levels, maternal vital signs (V/S), fetal heart rate, labour duration, Apgar scores and maternal satisfaction. The sample size is estimated based on the between-group difference of 0.6 in anxiety scores, 95% power and 5% α error, which yields a required sample size of 154 (77 in each group) accounting for a 20% attrition rate. The between-group and within-group outcome measures will be examined with mixed-effect regression models, time series analyses and paired t-test or equivalent non-parametric tests, respectively.
ETHICS AND DISSEMINATION: Ethical approval was obtained from the Ethical Committee for Research Involving Human Subjects of the Ministry of Health in the Saudi Arabia (H-02-K-076-0319-109) on 14 April 2019, and from the Ethics Committee for Research Involving Human Subjects (JKEUPM) Universiti Putra Malaysia on 23 October 2019, reference number: JKEUPM-2019-169. Written informed consent will be obtained from all participants. Results from this trial will be presented at regional, national and international conferences and published in indexed journals.
TRIAL REGISTRATION NUMBER: ISRCTN87414969, registered 3 May 2019.

Matched MeSH terms: Oxytocin/blood
Effect of oxytocin on plasma testosterone levels in the male macaques (Macaca fascicularis)

Tan GJ, Kwan TK

Contraception, 1987 Sep;36(3):359-67.
PMID: 3677679

The effect of oxytocin on testicular function was examined in the adult male long-tailed macaques (Macaca fascicularis). The monkeys were either infused with increasing concentrations of synthetic oxytocin (16-128 m.i.u./min for 3 h) or injected daily for a week with the same hormone (20 i.u., i.v.) and the plasma testosterone levels measured. The results of the present study show that acute infusion or chronic injection of oxytocin does not significantly affect the plasma testosterone levels, suggesting that systemic control of testicular endocrine function by oxytocin may be unimportant.

Matched MeSH terms: Oxytocin/pharmacology*
Fulltext Effect of epidural analgesia on labour: a retrospective comparison study

Norziah Aman, Fatimah Sham, Rashidah Bahari, Aminuddin Ahmad, Normala Salim

Malaysian Journal of Medicine and Health Sciences, 2020;16(105):73-0.
MyJurnal

Introduction: Epidural analgesia is the most effective method for intra-partum pain relief and most widely applied during childbirth. Various adverse effects of epidural analgesia have been described such as lower rate of sponta- neous vaginal delivery, a higher rate of instrumental vaginal delivery and prolongation of labour, however it remains controversial. The aim of this study to determine the effect of epidural on maternal outcome. The objective of this study was to assess the effect of epidural analgesia on the mothers with epidural and non epidural parturient at Hospital Putrajaya. Methods: Retrospective cohort study was used to collect data through Total Hospital Informa- tion System (THIS) on all delivery cases in Hospital Putrajaya from 1st January to 31st December 2016. A total of 906 mothers was retrospectively investigated in a cohort of 8000 delivery; and was divided into two groups of 453 mothers with epidural analgesia and non-epidural analgesia. Data were analysed using inferential statistics. Results: The mean age in this study was 30.1±4.1 years old with body mass index (BMI) was 28.5±4.5. Univariate analysis demonstrated that epidural group have lower rate of instrumental delivery (34.4%) and caesarean section (30.5%). However, they required more oxytocin used for augmentation (66.4%). The mean duration of first stage of labour was prolong in epidural group (6.0±2.5 hours) compared with non-epidural group (4.3±1.7 hours) while the duration of second stage of labour was also prolong in epidural group (15±19 min) as compared with non-epidural (7±11 min). Conclusion: Epidural analgesia had better maternal outcomes in term of mode of delivery but had adverse effects on duration of labour and oxytocin used.

Matched MeSH terms: Oxytocin
Early versus delayed amniotomy with immediate oxytocin after Foley catheter cervical ripening in nulliparous labor induction: A randomized trial

Hasan NA, Hong JGS, Teo IH, Zaidi SN, Hamdan M, Tan PC

Int J Gynaecol Obstet, 2022 Dec;159(3):951-960.
PMID: 35726368 DOI: 10.1002/ijgo.14313

OBJECTIVE: To evaluate immediate oxytocin and early amniotomy compared with delayed amniotomy after Foley catheter cervical ripening in nulliparous women on intervention-to-delivery interval.
METHODS: A randomized trial was conducted from September 2020 to March 2021. A total of 140 term nulliparas (70 early amniotomy, 70 delayed amniotomy) with Foley catheter-ripened cervices (dilatation ≥3 cm achieved), singleton fetus, cephalic presentation with intact membranes, and reassuring fetal heart rate tracing were recruited. Women were randomized to immediate titrated intravenous oxytocin infusion and early amniotomy or delayed amniotomy (after 4 h of oxytocin). The primary outcome was intervention (oxytocin)-to-delivery interval (h).
RESULTS: Intervention-to-delivery intervals (h) were mean ± standard deviation 9.0 ± 3.6 versus 10.6 ± 3.5 h (mean difference of 1.4 h) (P = 0.004) for the early versus delayed amniotomy arms, respectively. Birth rates at 6 h after oxytocin infusion were 19 of 70 (27.1%) versus 8 of 70 (11.4%) (relative risk, 2.38 [95% confidence interval (CI), 1.11-5.06]; number needed to treat: 7 [95% CI, 3.5-34.4]) (P = 0.03), cesarean delivery rates were 29 of 70 (41.4%) versus 33 of 70 (47.1%) (relative risk, 0.88; 95% CI, 0.61-1.28) (P = 0.50), and maternal satisfaction on birth process were a median of 7 (interquartile range, 7-8) versus 7 (interquartile range, 7-8) (P = 0.40) for the early versus delayed amniotomy arms, respectively.
CONCLUSION: In term nulliparas with cervices ripened by Foley catheter, immediate oxytocin and early amniotomy compared with a planned 4-h delay to amniotomy shortened the intervention-to-delivery interval but did not significantly reduce the cesarean delivery rate.

Matched MeSH terms: Oxytocin
Early versus delayed amniotomy with immediate oxytocin after Foley catheter cervical ripening in multiparous women with labor induction: A randomized controlled trial

Jamaluddin A, Azhary JMK, Hong JGS, Hamdan M, Tan PC

Int J Gynaecol Obstet, 2023 Feb;160(2):661-669.
PMID: 35869943 DOI: 10.1002/ijgo.14361

OBJECTIVE: To evaluate immediate oxytocin and early amniotomy compared with delayed amniotomy after Foley catheter cervical ripening in multiparous women on intervention-to-delivery interval.
METHODS: This randomized trial was conducted in Malaysia in 232 term multiparous women with balloon catheter-ripened cervixes (dilatation ≥3 cm), singleton fetus, cephalic presentation with intact membranes, and reassuring fetal heart rate tracing. They were randomized to immediate titrated intravenous oxytocin infusion and early amniotomy (116) or delayed amniotomy after 4 h of oxytocin (116). Primary outcome was intervention (oxytocin initiation)-to-delivery interval.
RESULTS: Oxytocin-to-delivery intervals were a median of 4.99 h (interquartile range [IQR], 3.21-7.82 h) versus 6.23 h (IQR, 4.50-8.45 h) (P oxytocin infusion were 40 of 116 (35%) versus 22 of 116 (19%) (relative risk [RR], 1.82 [95% confidence interval (CI), 1.16-2.86], P = 0.011) and 77 of 116 (66%) versus 54 of 116 (47%) (RR, 1.43 [95% CI, 1.13-1.80], P = 0.003) for the early versus delayed amniotomy arms, respectively. Maternal satisfaction on birth process were 7 (IQR, 6-8) versus 7 (IQR, 7-8) (P = 0.006), uterine hyperstimulation rates were 10 of 116 (9%) versus 14 of 116 (12%) (RR, 0.71 [95% CI, 0.33-1.54]) (P = 0.519), and Cesarean delivery rates were 17 of 116 (15%) versus 19 of 116 (16%) (RR, 0.90 [95% CI, 0.49-1.63], P = 0.856) for the early versus delayed amniotomy arms, respectively.
CONCLUSION: In multiparas at term following cervical ripening by Foley catheter, immediate oxytocin and early amniotomy compared with a scheduled 4-h delay to amniotomy shortens the interval to birth and decreases uterine hyperactivity in labor but lowers maternal satisfaction. The cesarean delivery rate is not significantly reduced.
CLINICAL TRIAL REGISTRATION: This study was registered with the International Standard Randomised Controlled Trial Number (ISRCTN) on September 29, 2020, with trial identification number: ISRCTN87066007 (https://doi.org/10.1186/ISRCTN87066007). The first participant was recruited on September 29, 2020, after ISRCTN registry confirmation was received.

Matched MeSH terms: Oxytocics*; Oxytocin*

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