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Acidemia at birth, related to obstetric characteristics and to oxytocin use, during the last two hours of labor
Örebro University, Department of Clinical Medicine.
Örebro University, School of Health and Medical Sciences.
2008 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 87, no 7, p. 745-750Article in journal (Refereed) Published
Abstract [en]

Objective. Evaluate obstetric characteristics during the last two hours of labor in neonates born with acidemia. Design. Case-control study. Setting. Delivery units at two university hospitals in Sweden. Study population. Out of 28,486 deliveries during 1994-2004, 305 neonates had an umbilical artery pH value <7.05 at birth. Methods. Cases: neonates with an umbilical artery pH < 7.05. Controls were neonates with pH ≥ 7.05 and an Apgar score ≥7 at 5 minutes. Obstetric characteristics, cardiotocographic patterns and oxytocin treatment during the last two hours of labor were recorded. Results. In the univariate analysis, ≥6 contractions/10 minutes (odds ratio (OR) 4.94, 95% confidence interval (CI) 3.25-7.49), oxytocin use (OR 2.20, 95% CI 1.66-2.92), bearing down ≥45 minutes (OR 1.77, 95% CI 1.31-2.38) and occipito-posterior position (OR 2.18, 95% CI 1.19-3.98) were associated with acidemia at birth. In the multivariate analysis, only ≥6 contractions/10 minutes (OR 5.36, 95% CI 3.32-8.65) and oxytocin use (OR 1.89, 95% CI 1.21-2.97) were associated with acidemia at birth. Among cases with ≥6 contractions/10 minutes, 75% had been treated with oxytocin. Pathological cardiotocographic patterns occurred in 68.8% of cases and in 26.1% of controls (p<0.001). Conclusion. A hyperactive uterine contraction pattern and oxytocin use are the most important risk factors for acidemia at birth. The increased uterine activity was related to overstimulation in the majority of cases. The duration of bearing down is less important when uterine contraction frequency has been considered.

Place, publisher, year, edition, pages
Informa Healthcare , 2008. Vol. 87, no 7, p. 745-750
Keywords [en]
Acidosis/*etiology, Adult, Cardiotocography, Case-Control Studies, Female, Humans, Hydrogen-Ion Concentration, Labor Stage; Second, Multivariate Analysis, Oxytocics/administration & dosage/*adverse effects, Oxytocin/administration & dosage/*adverse effects, Pregnancy, Risk Factors, Umbilical Arteries/chemistry, Umbilical Cord, Uterine Contraction
National Category
Medical and Health Sciences Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
URN: urn:nbn:se:oru:diva-3403DOI: 10.1080/00016340802220352PubMedID: 18607817OAI: oai:DiVA.org:oru-3403DiVA, id: diva2:137700
Available from: 2008-12-04 Created: 2008-12-04 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Use and Misuse of Oxytocin During Delivery
Open this publication in new window or tab >>Use and Misuse of Oxytocin During Delivery
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Obstetric malpractice claims, concerning delivery during a period of eight years, were analysed for motives behind disciplinary actions, and for the frequency of inappropriate oxytocin use.Failure to respond to signs of foetal distress, injudicious use of oxytocin and a failure to effect a timely delivery were the recurrent problems that accounted for the majority of disciplinary actions. Inappropriate use of oxytocin was more frequent than reported in earlier studies. (Paper I)

In a case-control study, differences in the obstetric management in neonates born with and without acidaemia (umbilical artery pH < 7.05), was evaluated. Out of 28,486 deliveries during 1994–2004, 305 neonates were born with acidaemia. Uterine hyperactivity and oxytocin use were independently associated to acidaemia at birth. The increased uterine activity was related to oxytocin treatment in 75 % of cases. Pathological cardiotocographic patterns occurred significantly more often in the case group. The results indicate that guidelines on oxytocin use and foetal surveillance are not followed. The duration of bearing down is less important when uterine contraction frequency has been considered. (Paper II)

In a subset of study II, cases with metabolic acidosis (umbilical artery pH < 7.05 and base deficit ≥12 mmol/L) and controls were audited for the occurrence of suboptimal intrapartum care, and the nature of such care. It was found that suboptimal care occurred in half (49%) of the cases, while it was less frequent but not uncommon among controls (13%). Suboptimal care consisted of injudicious use of oxytocin and a failure of appropriate action upon signs of foetal distress. A high rate of NICU admissions and diagnosis of encephalopathy in the case group confirms that metabolic acidosis should be avoided. We estimate that metabolic acidosis could probably have been prevented in 40-50% of the cases.(PaperIII)

Women (n=103) scheduled for elective caesarean section in regional anaesthesia were randomised to 5 or 10 units oxytocin, given as an intravenous bolus (double blinded), and electrocardiograms were analysed for ST depressions as a sign of myocardial ischaemia. ST depressions were associated with oxytocin administration significantly more often in subjects receiving 10 compared with 5 units. A dose of 10 units resulted in a more marked decrease of the mean arterial blood pressure, but no difference in increase of the heartrate. There was no difference in estimated blood loss. (paper IV)

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2009. p. 69
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 443
National Category
Medical and Health Sciences Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-100357 (URN)978-91-554-7481-2 (ISBN)
Public defence
2009-05-15, Rosénsalen, Ingång 95/96 nb, Akademiska Sjukhuset, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2009-04-24 Created: 2009-03-31 Last updated: 2009-04-27Bibliographically approved

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Östlund, IngridHanson, Ulf

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