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Induction Of Labor
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
When administering oxytocin, the target is to stimulate uterine activity that is enough to effect cervical change as well as fetal descent without compromising the fetus. Minimal criteria for effective uterine activity are three contractions per 10 minutes averaging greater than 25 mmHg above baseline, with five contractions in 10 minutes. The Montevideo unit was created in 1957 to describe the summation of the amplitudes of all contractions in a 10-minute window. Uterine tachysystole is defined as more than five contractions in 10 minutes. During induction with oxytocin, 91% of patients delivered vaginally achieved 200 Montevideo units without neonatal morbidity in one retrospective study [131]. Contraction pressures of ≥200 Montevideo units should be targeted in induction or augmentation of laboring patients to achieve adequate labor [131, 132]. Induced labor should be managed, in general, as spontaneous labor (see Chaps. 8 and 9). If active phase is not achieved within 24 hours, this is not a reason per se for CD. A failed induction should not be diagnosed until after 18–24 hours of oxytocin after membrane rupture in the active phase (usually 6 cm in a nulliparous patient), assuming reassuring fetal heart pattern [11, 133].
Abnormal Uterine Contractions
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
Uterine tachysystole: The uterine contraction of more than 5 in 10 minutes is called tachysystole. It may or may not be accompanied by abnormalities of the fetal heart. Any contraction lasting more than 60 seconds is referred to as hypercontraction. Any excess uterine contractility accompanied by fetal heart rate abnormality was earlier referred to as hyperstimulation. Excessive use of oxytocics and not maintaining adequate gap between the cervical ripening agents such as prostaglandin E2 and the inducing agents such as oxytocin or prostaglandin E1 can cause tachysystole. Sometimes chorioamnionitis can also cause tachysystole.
Non-Reassuring Fetal Status
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Tiran Dias, Amarnath Bhide, Austin Ugwumadu
Intrapartum uterine contractions reduce uteroplacental perfusion. In a healthy, well-grown, term fetus, no significant hypoxia or damage results from these contractions. However, in the growth restricted fetus or the appropriately grown fetus exposed to uterine tachysystole, there is a risk of fetal hypoxaemia and hypoxia, which, in turn, activates the peripheral chemoreflex. The aim of the chemoreflex activation is to centralise the circulation and prioritise the blood and oxygen supply to central organs such as the heart, brain, and the adrenals, at the expense of the non-essential organs such as the skin, skeletal muscles, gastrointestinal organs, and the kidneys. If this adaptation is sustained for too long and/or fails, the fetus is at increased risk of central hypotension, hypoperfusion of essential organs, and reperfusion injuries.
Titrated oral misoprostol versus static regimen of oral misoprostol for induction of labour: a systematic review and meta-analysis
Published in Journal of Obstetrics and Gynaecology, 2022
Saeed Baradwan, Majed Saeed Alshahrani, Khalid Khadawardi, Ehab Badghish, Waleed H. Alkhamis, Doaa Fathy Mohamed, Shaimaa Hanafy Moustafa Kamal, Hala Waheed Abdel Halim, Eman A. Alkholy, Mariam Salah Mohamed, Asmaa Abdelaal Mohamed, Shaimaa Ali Barakat, Hagar Abdelgawad Magdy, Eman Ibrahim Abd Elrehim, Ahmed Mohamed Abdelhakim, Bassem Ragab, Saged Mohamed Metyli Elmazzaly, Mostafa Ellaban, Ahmed M. Abbas, Ghada Ibrahim Soror
The differences in the abnormalities of uterine contractility may be due to differences in the individual response to misoprostol and different regimens of misoprostol administrated. The response to misoprostol mainly depends on its absorption, peak levels, and various uterine actions in different population groups (Antil and Gupta 2016). Uterine tachysystole can cause poor uteroplacental perfusion leading to foetal oxygenation decline and adverse neonatal outcomes. The increase in small doses of misoprostol with continuous modification in line with the response may be responsible for the decline in the incidence of uterine hyperactivity (Cheng et al. 2008).
The efficacy and safety of second dinoprostone pessary or balloon catheter after unsuccessful primary ripening with dinoprostone pessary
Published in Journal of Obstetrics and Gynaecology, 2022
Dongli Sun, Qiaoai Wu, Xinfan Wang, Fengmei Wang
Neonatal and maternal outcomes are presented in Table 3. In total, 22 participants experienced uterine tachysystole in the dinoprostone group, involving 14 cases in the primary IOL and 8 cases in the second IOL with dinoprostone pessary. However, there were no significant differences between the two groups with respect to neonatal outcomes, including birth weight, Apgar Score <7 at 1 and 5 min after birth, foetal distress rate and NICU admission rate. Similarly, there were no significant differences between the two groups with respect to maternal infection and postpartum haemorrhage rates (p = .1726 and p = .0783, respectively).
Induction of labour in term premature rupture of membranes; oxytocin versus sublingual misoprostol; a randomised clinical trial
Published in Journal of Obstetrics and Gynaecology, 2018
Leila Pourali, Nafiseh Saghafi, Saeed Eslami Hasan Abadi, Fatemeh Tara, Atieh Mohamadzadeh Vatanchi, Elham Motamedi
The frequency of uterine tachysystole and FHR abnormalities were significantly higher in the misoprostol group, as similar to some studies (Zeteroglu et al. 2006). These findings are in contrast to other study (Mozurkewich et al. 2003), who used oral misoprostol 100 μg every 6 hours up to maximum of two doses versus intravenous oxytocin infusion. Again, the oral route of administration and the lesser number of doses for misoprostol in the latter study could account for these different findings.