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- Bullarbo, Maria, 1958, et al.
(författare)
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Nitroglycerin for management of retained placenta: a multicenter study.
- 2012
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Ingår i: Obstetrics and gynecology international. - : Hindawi Limited. - 1687-9597 .- 1687-9589. ; 2012
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Tidskriftsartikel (refereegranskat)abstract
- The primary aim was to determine if sequential administration of oxytocin and nitroglycerin is effective for management of retained placenta when performed by obstetricians with no experience of the method. Secondary aims were to examine possible adverse effects of nitroglycerin. One hundred and five women with retained placenta were randomly selected to receive either 1mg nitroglycerin or placebo tablets sublingually if intravenous oxytocin had failed to expel the placenta. At two of the hospitals some of the midwives were familiar with the use of nitroglycerin. The other midwives and all the participating obstetricians had no clinical experience of the method. In the treatment group, detachment of placenta following nitroglycerin occurred in 37.3% of the women compared to 20.4% in the placebo group (P = 0.056). In the two hospitals with some experience of the method, placenta was removed in 9 of 19 (47.4%) women in the nitroglycerin group compared to 3 of 17 (15.0%) women in the placebo group. No adverse effects of clinical importance were registered. Although the difference between the two groups did not reach statistical significance, the higher success rate in the two hospitals with some experience could indicate that clinical experience is of importance in order to achieve placental detachment.
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- Selin, Lotta, et al.
(författare)
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High-dose versus low-dose of oxytocin for labour augmentation : a randomised controlled trial
- 2019
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Ingår i: Women and Birth. - : ELSEVIER. - 1871-5192 .- 1878-1799. ; 32:4, s. 356-363
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Tidskriftsartikel (refereegranskat)abstract
- Problem: Delayed labour progress is common in nulliparous women, often leading to caesarean section despite augmentation of labour with synthetic oxytocin.Background: High-or low-dose oxytocin can be used for augmentation of delayed labour, but evidence for promoting high-dose is weak.Aim: To ascertain the effect on caesarean section rate of high-dose versus low-dose oxytocin for augmentation of delayed labour in nulliparous women.Methods: Multicentre parallel double-blind randomised controlled trial (ClinicalTrials.gov: NCT01587625) in six labour wards in Sweden. Healthy nulliparous women at term with singleton cephalic fetal presentation, spontaneous labour onset, confirmed delay in labour and ruptured membranes (n = 1351) were randomised to labour augmentation with either high-dose (6.6 mU/minute) or low-dose (3.3 mU/minute) oxytocin infusion.Findings: 1295 women were included in intention-to-treat analysis (high-dose n = 647; low-dose n = 648). Caesarean section rates did not differ between groups (12.4% and 12.3%, 95% Confidence Interval -3.7 to 3.8). Women with high-dose oxytocin had: shorter labours (-23.4 min); more uterine tachysystole (43.2% versus 33.5%); similar rates of instrumental vaginal births, with more due to fetal distress (43.8% versus 22.7%) and fewer due to failure to progress (39.6% versus 58.8%). There were no differences in neonatal outcomes.Discussion: Our study could not confirm results of two systematic reviews indicating, with weak evidence, that use of high-dose oxytocin was associated with lower frequency of caesarean section.Conclusion: We found no advantages for routine use of high-dose oxytocin in the management of delay in labour. Low-dose oxytocin regimen is recommended to avoid unnecessary events of tachysystole and fetal distress.
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| 5. |
- Selin, Lotta, et al.
(författare)
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High dose versus low dose oxytocin for augmentation of delayed labour, a randomized controlled trial
- 2014
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Ingår i: Optimizing childbirth across Europe - an intedisciplinary maternity care conference. 9-10 April 2014, Brussels. Part of COST Action IS0907: Childbirth Cultures, Concerns & Consequences: Creating a dynamic EU framework for Optimal maternity care..
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Delay in labour due to ineffective uterine contractions is a major problem in obstetric care and a main reason for the increased rate of caesarean deliveries, particularly among nulliparous women. Infusion with synthetic oxytocin is a commonly used treatment of hypotonic uterine contractions however there is a gap of knowledge concerning which dosage of oxytocin should be used, both starting dose and increment dose of oxytocin. Aim of the study: The aim is to compare starting dose and increment of amount of oxytocin for augmentation of delayed labour to determine whether augmentation by high dose of oxytocin improves labour outcomes compared with a low dose of oxytocin, without affecting neonatal or maternal outcomes including birth experiences negatively. Research methodology: In a randomized double-blind controlled trial conducted in three labour wards in Sweden, consenting nulliparous women in active labour and with a defined delayed progress are randomized to receive a regimen of either high dose or low dose of oxytocin (33.2 respectively 16,6 microgram oxytocin in 1000 ml isotone saline solution). randomization will be computer-generated, with allocation concealment by a coding system. Primary outcome is caesarean delivery rate. Based on a sample size calculation (α=0.05, β=0.80), a minimum of 688 women will be included in each group in order to reduce caesarean section rate from 17.5 % to 12 %. Ethical approval: The study is approved by the regional Ethics Board in Gothenburg (dnr: 090-12), and by the medical Products Agency –Sweden (Eudra-CTnr:2012-000356-33). Study finding: This poster will describe the study protocol and the first period of data collection. Results will concern: 1) maternal and fetal outcomes in randomized groups, and 2) maternal overall childbirth experience including labour pain. Conclusion: The study will contribute to establishment of evidencebased routines regarding oxytocin treatment of delayed labour progress.
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| 6. |
- Selin, Lotta, et al.
(författare)
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High Dose versus Low Dose Oxytocin for Augmentation of Delayed Labour: a randomized controlled trial
- 2016
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Ingår i: NJF (Nordiskt Jordemoderförbund) Congress. Programme and abstracts. Gothenburg, May 12-14, 2016. - 9789163742699
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background Delay in labour due to ineffective uterine contractions is a major problem in obstetric care and a main reason for the increased rate of caesarean deliveries, particularly among nulliparous women. Infusion with synthetic oxytocin is a commonly used treatment of hypotonic uterine contractions however there is a gap of knowledge concerning which dosage of oxytocin should be used, both starting dose and increment dose of oxytocin. Aim To compare dosage of oxytocin treatment in nulliparous women with delayed labour progress in active phase of labour. The hypothesis is that augmentation by high dose of oxytocin improves labour outcomes compared with a low dose of oxytocin, without affecting neonatal or maternal outcomes including birth experiences negatively. Methods In a randomized double-blind controlled trial conducted in six labour wards in Sweden, consenting nulliparous women in active labour and with a defined delayed progress are randomized to receive a regimen of either high dose or low dose of oxytocin (33.2 respectively 16,6 microgram oxytocin in 1000 ml isotone saline solution). Randomization is computergenerated, with allocation concealment by a coding system. Primary outcome is caesarean delivery rate. Based on a sample size calculation (α=0.05, β=0.80), a minimum of 1 045 women will be included in each group in order to reduce caesarean section rate from 17.5 % to 13 %. The study is approved by the regional Ethics Board in Gothenburg (dnr: 090-12), by the Medical Products Agency –Sweden (Eudra-CTnr:2012-00035633) and registered at ClinicalTrials.gov. Identifier: NCT01587625. Results Data collection started 15th of August 2013 and data is still under collection. This presentation will describe the study protocol and the first half period of the data collection. Conclusion The study will contribute to establishment of evidence based routines regarding oxytocin treatment of delayed labour progress.
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| 7. |
- Selin, Lotta, et al.
(författare)
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Use and abuse of oxytocin for augmentation of labor.
- 2009
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Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 88:12, s. 1352-7
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the use of oxytocin for augmentation of labor and its relation to labor progress and delivery outcome. DESIGN AND SETTING: A retrospective observational study undertaken in a Swedish hospital during 2000-2001. SAMPLE: Singleton pregnancies at > or = 37 weeks of gestation with cephalic presentation and spontaneous onset of labor. METHODS: Data were collected from 1,263 clinical records. The partogram was used to diagnose labor dystocia (LD). MAIN OUTCOME MEASURES: Prevalence of oxytocin administration, LD and operative delivery. RESULTS: Oxytocin was administered to 55% of the women (75% of primiparas and 38.1% of multiparas); a majority did not meet LD criteria. LD frequency was 19.8% (32.7% in primiparas and 7.4% in multiparas). Oxytocin was started both 'too early' and 'too late' in relation to the diagnosis of LD. Cesarean section (CS) was performed on 17.1% of primiparous and 2.4% of multiparous oxytocin recipients with LD, compared to 2.3 and 1.5%, respectively, of oxytocin recipients without diagnosed LD. CONCLUSIONS: Oxytocin augmentation was undertaken in an unstructured manner; some women were inadequately treated and others were treated unnecessarily. Oxytocin recipients with LD underwent operative delivery to a higher extent than oxytocin recipients without LD, suggesting that the main reason for CS was the underlying problem of LD rather than the oxytocin augmentation itself.
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