| 1. |
- Marchi, J., et al.
(författare)
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Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews
- 2015
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Ingår i: Obesity Reviews. - : Wiley. - 1467-7881. ; 16:8, s. 621-638
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Forskningsöversikt (refereegranskat)abstract
- Maternal obesity is linked with adverse outcomes for mothers and babies. To get an overview of risks related to obesity in pregnant women, a systematic review of reviews was conducted. For inclusion, reviews had to compare pregnant women of healthy weight with women with obesity, and measure a health outcome for mother and/or baby. Authors conducted full-text screening, quality assurance using the AMSTAR tool and data extraction steps in pairs. Narrative analysis of the 22 reviews included show gestational diabetes, pre-eclampsia, gestational hypertension, depression, instrumental and caesarean birth, and surgical site infection to be more likely to occur in pregnant women with obesity compared with women with a healthy weight. Maternal obesity is also linked to greater risk of preterm birth, large-for-gestational-age babies, foetal defects, congenital anomalies and perinatal death. Furthermore, breastfeeding initiation rates are lower and there is greater risk of early breastfeeding cessation in women with obesity compared with healthy weight women. These adverse outcomes may result in longer duration of hospital stay, with concomitant resource implications. It is crucial to reduce the burden of adverse maternal and foetal/child outcomes caused by maternal obesity. Women with obesity need support to lose weight before they conceive, and to minimize their weight gain in pregnancy.
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| 2. |
- Bergqvist, Liselotte, et al.
(författare)
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Labor augmentation by means of oxytocin – women's experiences
- 2007
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Ingår i: American Journal of Obstetrics and Gynecology. ; 195:6
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objective To study labor experiences in women exposed to oxytocin treatment vs no or delayed treatment of spontaneous, but prolonged labor in nulliparos women. Study design A randomised controlled study. If labor was prolonged during the active phase with no further opening of the cervix for two hours, the subject were randomly allocated to either labor augmentation by means of oxytocin (SG) or expectancy (EG). 461 women filled out a questionnaire including the following items: level of sense of security, pain, sense of control, experience of their own role in labor, and satisfaction with healthcare. Results The oxytocin-treated women's labor experiences did not differ in secondary inertia as compared with the women who chose to delay oxytocin treatment for three hours. The number of women who experienced a labor that met with their expectations was significantly higher in the oxytocin group than in the delay group. Both groups had a high level of lasting memories from their labor experience that resulted in a state of depression or low-spiritedness one month postpartum, SG (41%) and EG (35%), with no significant difference between the two groups. Conclusion Although the labor experiences of both groups were equivalent, the women of the oxytocin group felt that their labor process had proceeded as expected to a higher degree than the women who postponed oxytocin treatment for three hours. Hence, this study does not support the assertion that there would be a difference in labor experience if oxytocin stimulation is postponed. Many patients with inertia have lasting memories from the labor process which result in a state of depression or low-spiritedness one month postpartum, SG (41%) and EG (35%). Questionnaires filled out from women without inertia showed that the group giving spontaneous birth withouth any intravenous drip the proportion for depression was 12%.
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| 3. |
- Buckley, Sarah, et al.
(författare)
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Maternal and newborn plasma oxytocin levels in response to maternal synthetic oxytocin administration during labour, birth and postpartum : a systematic review with implications for the function of the oxytocinergic system
- 2023
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The reproductive hormone oxytocin facilitates labour, birth and postpartum adaptations for women and newborns. Synthetic oxytocin is commonly given to induce or augment labour and to decrease postpartum bleeding.AIM: To systematically review studies measuring plasma oxytocin levels in women and newborns following maternal administration of synthetic oxytocin during labour, birth and/or postpartum and to consider possible impacts on endogenous oxytocin and related systems.METHODS: Systematic searches of PubMed, CINAHL, PsycInfo and Scopus databases followed PRISMA guidelines, including all peer-reviewed studies in languages understood by the authors. Thirty-five publications met inclusion criteria, including 1373 women and 148 newborns. Studies varied substantially in design and methodology, so classical meta-analysis was not possible. Therefore, results were categorized, analysed and summarised in text and tables.RESULTS: Infusions of synthetic oxytocin increased maternal plasma oxytocin levels dose-dependently; doubling the infusion rate approximately doubled oxytocin levels. Infusions below 10 milliunits per minute (mU/min) did not raise maternal oxytocin above the range observed in physiological labour. At high intrapartum infusion rates (up to 32 mU/min) maternal plasma oxytocin reached 2-3 times physiological levels. Postpartum synthetic oxytocin regimens used comparatively higher doses with shorter duration compared to labour, giving greater but transient maternal oxytocin elevations. Total postpartum dose was comparable to total intrapartum dose following vaginal birth, but post-caesarean dosages were higher. Newborn oxytocin levels were higher in the umbilical artery vs. umbilical vein, and both were higher than maternal plasma levels, implying substantial fetal oxytocin production in labour. Newborn oxytocin levels were not further elevated following maternal intrapartum synthetic oxytocin, suggesting that synthetic oxytocin at clinical doses does not cross from mother to fetus.CONCLUSIONS: Synthetic oxytocin infusion during labour increased maternal plasma oxytocin levels 2-3-fold at the highest doses and was not associated with neonatal plasma oxytocin elevations. Therefore, direct effects from synthetic oxytocin transfer to maternal brain or fetus are unlikely. However, infusions of synthetic oxytocin in labour change uterine contraction patterns. This may influence uterine blood flow and maternal autonomic nervous system activity, potentially harming the fetus and increasing maternal pain and stress.
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| 4. |
- Daly, D., et al.
(författare)
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How much synthetic oxytocin is infused during labour? A review and analysis of regimens used in 12 countries
- 2020
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 15:7
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Tidskriftsartikel (refereegranskat)abstract
- Objective To compare synthetic oxytocin infusion regimens used during labour, calculate the International Units (IU) escalation rate and total amount of IU infused over eight hours. Design Observational study Setting Twelve countries, eleven European and South Africa. Sample National, regional or institutional-level regimens on oxytocin for induction and augmentation labour Methods Data on oxytocin IU dose, infusion fluid amount, start dose, escalation rate and maximum dose were collected. Values for each regimen were converted to IU in 1000ml diluent. One IU corresponded to 1.67 mu g for doses provided in grams/micrograms. IU hourly dose increase rates were based on escalation frequency. Cumulative doses and total IU amount infused were calculated by adding the dose administered for each previous hour. Main Outcome Measures Oxytocin IU dose infused Results Data were obtained on 21 regimens used in 12 countries. Details on the start dose, escalation interval, escalation rate and maximum dose infused were available from 16 regimens. Starting rates varied from 0.06 IU/hour to 0.90 IU/hour, and the maximum dose rate varied from 0.90 IU/hour to 3.60 IU/hour. The total amount of IU oxytocin infused, estimated over eight hours, ranged from 2.38 IU to 27.00 IU, a variation of 24.62 IU and an 11-fold difference. Conclusion Current variations in oxytocin regimens for induction and augmentation of labour are inexplicable. It is crucial that the appropriate minimum infusion regimen is administered because synthetic oxytocin is a potentially harmful medication with serious consequences for women and babies when inappropriately used. Estimating the total amount of oxytocin IU received by labouring women, alongside the institution's mode of birth and neonatal outcomes, may deepen our understanding and be the way forward to identifying the optimal infusion regimen.
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| 5. |
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| 6. |
- Dencker, Anna, 1956, et al.
(författare)
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A randomized trial of labor augmentation by oxytocin vs delayed oxytocin treatment or no oxytocin in nulliparous women with spontaneous contractions
- 2005
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Ingår i: American Journal of Obstetrics and Gynecology. ; 193:6
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objective To study the effects of oxytocin treatment vs. no or delayed oxytocin treatment on the obstetrical and neonatal outcome of spontaneous but prolonged labor in nulliparous women. Study design A randomized controlled study of healthy nulliparous women at term with normal pregnancies and spontaneous labor. If labor was prolonged during the active phase with no further opening of the cervix or descent of the head for two hours the women were randomly allocated to either labor augmentation by oxytocin infusion (standard care group= SG) or to expectancy (Expectant care group=EG) and observed for another 3 hours. If the women in the EG after the 3 hours still do not progress in their labor, a reassessment regarding the need for labor augmentation was done. Results Totally 516 women participated in the study, 276 in the SG and 241 in the EG. All 241 women in the SG received oxytocin vs 211 (87.6%) in the EG (p<0,001). There were no differences in gestational age between the groups. Mean gestational age was 40 weeks in both groups. There were no difference in cervical dilatation at randomization, cx dilatation in centimeters was 5,7 (SD1,5) in the SG vs 5,5 (SD 1,3), p= 0.17 in the EG. The time from randomization to delivery differed, 332 (SD=211) minutes in the SG vs 457 (SD=238) minutes in the EG (p <.0001). There was no differences in mode of delivery, Caesarean sectio 23 (8,3%) in the SG vs 21 (8,7%) in the EG, (p=0.9), operative vaginal delivery 44 (15,9%) SG vs 25 (10,4%) EG p=0.07, Spontaneous vaginal delivery 209 (75,7%) SG vs 195 (80,9%) EG p=0.2,. Usage of epidural anesthesia was 29 (10,5%) SG vs 39 (16,2%) EG p=0.07. Apgar score below 7 after 5 minutes was found in 5 (1.8%) in SG vs 9 (3.7%) in EG. Conclusion In nulliparous women at term with spontaneous contractions a policy of delaying the initiation of oxytocininfusion in prolonged active phase for 180 minutes resulted in no difference in mode of delivery, usage of epidural anesthesia or neonates with apgar score below 7 at 5 minutes. The time from randomization to delivery differed by 125 minutes.
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| 7. |
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| 8. |
- Dencker, Anna, 1956
(författare)
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Avvaktande eller aktiv handläggning vid långsam förlossningsprogress hos friska förstföderskor - En studie om riskfaktorer, obstetriskt utfall och förlossningsupplevelse
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Slow labour progress is common in nulliparous women and is associated with childbirth complications and negative birth experiences. Oxytocin augmentation is widely used to treat slow labour despite associated risks for the fetus. An ongoing debate concerns whether oxytocin should be administered directly or postponed after arrested labour. The overall aim of this thesis was to study labour progress in healthy nulliparous women and to compare childbirth outcomes and experiences in women randomised to expectant versus early oxytocin augmentation for slow labour progress. Objectives. The four studies comprising this thesis are based on a randomised controlled study where nulliparous women with a normal pregnancy, spontaneous onset of active labor at term, and a cervical dilatation of 4 – 9 centimetres on admission to the delivery ward were included (n=2,072). All women whose labour did not progress after amniotomy (n=630) were randomly allocated either to labour augmentation by oxytocin infusion (Early oxytocin, n=314) or to postponement of oxytocin augmentation for another three hours (Expectant, n=316). Study I examined if mode of delivery differed between treatment groups. Study II was conducted to identify independent predictors of active labour duration. Study III described the development and validation of a questionnaire to assess women’s experiences of childbirth. In Study IV, the questionnaire was used to assess and compare childbirth experiences one month postpartum in early vs expectant treatment. Results. Study I showed that rates of spontaneous vaginal births, instrumental vaginal or caesarean births did not differ between early and expectant oxytocin augmentation. Study II identified independent predictors of extended labor duration (controlling for known predictors): a long latent phase, few hours of rest and sleep without normal food intake during the preceding 24 hours and low levels of labour pain. In Study III, factor analysis of the 22 item postpartum questionnaire yielded four factors; Own capacity, Professional support, Perceived safety, and Participation, accounting for 54% of the variance. The questionnaire showed good reliability and sensitivity. Study IV revealed no significant differences between early vs. expectant treatment in any of the four domains; however, operative births (caesarean and instrumental vaginal births) were associated with significantly worse childbirth experiences. Nearly one-third of the women in both groups had negative and depressing memories from labour. Conclusions. Early oxytocin augmentation for slow labour progress does not appear to be more beneficial than expectant management regarding mode of delivery and women’s perceptions of childbirth one month postpartum. Given the risks for the fetus associated with oxytocin treatment, prudent expectant management seems to be a safe and viable alternative. As negative experiences of first childbirth are known to influence mothers’ decisions about future pregnancies and mode of delivery, it is vital that childbirth experiences be comprehensively assessed. The assessment instrument developed here may be adequate for this purpose. More research is needed to isolate factors contributing to negative childbirth experiences and to improve methods for identifying women with such experiences.
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| 9. |
- Dencker, Anna, 1956, et al.
(författare)
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Childbirth experience questionnaire (CEQ): development and evaluation of a multidimensional instrument.
- 2010
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Ingår i: BMC pregnancy and childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 10:81
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Tidskriftsartikel (refereegranskat)abstract
- Background: Negative experiences of first childbirth increase risks for maternal postpartum depression and may negatively affect mothers' attitudes toward future pregnancies and choice of delivery method. Postpartum questionnaires assessing mothers' childbirth experiences are needed to aid in identifying mothers in need of support and counselling and in isolating areas of labour and birth management and care potentially in need of improvement. The aim of this study was to develop and evaluate a questionnaire for assessing different aspects of first-time mothers' childbirth experiences. Methods: Childbirth domains were derived from literature searches, discussions with experienced midwives and interviews with first-time mothers. A draft version of the Childbirth Experience Questionnaire (CEQ) was pilot tested for face validity among 25 primiparous women. The revised questionnaire was mailed one month postpartum to 1177 primiparous women with a normal pregnancy and spontaneous onset of active labor and 920 returned evaluable questionnaires. Exploratory factor analysis using principal components analysis and promax rotation was performed to identify dimensions of the childbirth experience. Multitrait scaling analysis was performed to test scaling assumptions and reliability of scales. Discriminant validity was assessed by comparing scores from subgroups known to differ in childbirth experiences. Results: Factor analysis of the 22 item questionnaire yielded four factors accounting for 54% of the variance. The dimensions were labelled Own capacity, Professional support, Perceived safety, and Participation. Multitrait scaling analysis confirmed the fit of the four-dimensional model and scaling success was achieved in all four sub-scales. The questionnaire showed good sensitivity with dimensions discriminating well between groups hypothesized to differ in experience of childbirth. Conclusion: The CEQ measures important dimensions of the first childbirth experience and may be used to measure different aspects of maternal satisfaction with labour and birth.
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