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ABSTRACT: To determine the effects of adding an oxytocin infusion to bolus oxytocin on blood loss at elective caesarean section.
Double blind, placebo controlled, randomised trial, conducted from February 2008 to June 2010.
Five maternity hospitals in the Republic of Ireland.
2069 women booked for elective caesarean section at term with a singleton pregnancy. We excluded women with placenta praevia, thrombocytopenia, coagulopathies, previous major obstetric haemorrhage (>1000 mL), or known fibroids; women receiving anticoagulant treatment; those who did not understand English; and those who were younger than 18 years.
Intervention group: intravenous slow 5 IU oxytocin bolus over 1 minute and additional 40 IU oxytocin infusion in 500 mL of 0.9% saline solution over 4 hours (bolus and infusion). Placebo group: 5 IU oxytocin bolus over 1 minute and 500 mL of 0.9% saline solution over 4 hours (placebo infusion) (bolus only). Main outcomes Major obstetric haemorrhage (blood loss >1000 mL) and need for an additional uterotonic agent.
We found no difference in the occurrence of major obstetric haemorrhage between the groups (bolus and infusion 15.7% (158/1007) v bolus only 16.0% (159/994), adjusted odds ratio 0.98, 95% confidence intervals 0.77 to 1.25, P=0.86). The need for an additional uterotonic agent in the bolus and infusion group was lower than that in the bolus only group (12.2% (126/1033) v 18.4% (189/1025), 0.61, 0.48 to 0.78, P<0.001). Women were less likely to have a major obstetric haemorrhage in the bolus and infusion group than in the bolus only group if the obstetrician was junior rather than senior (0.57, 0.35 to 0.92, P=0.02).
The addition of an oxytocin infusion after caesarean delivery reduces the need for additional uterotonic agents but does not affect the overall occurrence of major obstetric haemorrhage. Trial Registration Current Controlled Trials ISRCTN17813715.
BMJ (Clinical research ed.). 01/2011; 343:d4661.
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ABSTRACT: To assess whether women who underwent forceps delivery were more likely than those who delivered either normally (spontaneous vaginal delivery [SVD]) or by cesarean to experience deterioration in fecal continence as they aged.
The study investigated fecal continence assessment among women who gave birth to their first child 10, 20, or 30 years previously. Women who had undergone forceps delivery in the selected years were matched with women who had SVD in the same year. Two additional cohorts (1 premenopausal, 1 postmenopausal), who had only ever delivered by pre-labor cesarean, were identified for comparison.
Of the 85 women who participated, 36 had undergone forceps delivery, 35 SVD, and 14 cesarean delivery only. The mode of vaginal delivery had no significant effect on continence scores or manometry pressures. Premenopausal women who had undergone cesarean delivery had significantly higher manometry pressures than those who delivered vaginally, but this protective effect was lost after the menopause. Multivariate analysis of pudendal nerve conduction found that the adverse effect of duration since delivery was greater than the adverse effect of forceps compared with vaginal delivery.
Mode of delivery and aging affect pelvic floor function. Women who deliver via cesarean are not immune to age-related deterioration of anal sphincter function.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 11/2010; 112(2):93-7. · 1.41 Impact Factor
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ABSTRACT: Cycle-dependent fluctuations in natural killer (NK) cell populations in endometrium and circulation may differ, contributing to unexplained infertility.
NK cell phenotypes were determined by flow cytometry in endometrial biopsies and matched blood samples.
While circulating and endometrial T cell populations remained constant throughout the menstrual cycle in fertile and infertile women, circulating NK cells in infertile women increased during the secretory phase. However, increased expression of CD94, CD158b (secretory phase), and CD158a (proliferative phase) by endometrial NK cells from infertile women was observed. These changes were not reflected in the circulation.
In infertile women, changes in circulating NK cell percentages are found exclusively during the secretory phase and not in endometrium; cycle-related changes in NK receptor expression are observed only in infertile endometrium. While having exciting implications for understanding NK cell function in fertility, our data emphasize the difficulty in attaching diagnostic or prognostic significance to NK cell analyses in individual patients.
American Journal Of Reproductive Immunology 05/2009; 61(4):265-76. · 2.17 Impact Factor
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ABSTRACT: Problem Cycle-dependent fluctuations in natural killer (NK) cell populations in endometrium and circulation may differ, contributing to unexplained infertility.Method of study NK cell phenotypes were determined by flow cytometry in endometrial biopsies and matched blood samples.Results While circulating and endometrial T cell populations remained constant throughout the menstrual cycle in fertile and infertile women, circulating NK cells in infertile women increased during the secretory phase. However, increased expression of CD94, CD158b (secretory phase), and CD158a (proliferative phase) by endometrial NK cells from infertile women was observed. These changes were not reflected in the circulation.Conclusion In infertile women, changes in circulating NK cell percentages are found exclusively during the secretory phase and not in endometrium; cycle-related changes in NK receptor expression are observed only in infertile endometrium. While having exciting implications for understanding NK cell function in fertility, our data emphasize the difficulty in attaching diagnostic or prognostic significance to NK cell analyses in individual patients.
American Journal Of Reproductive Immunology 03/2009; 61(4):265 - 276. · 2.17 Impact Factor
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ABSTRACT: Antenatal perineal massage has been shown to reduce the incidence of perineal tears in primiparous women. The aim of this study was to determine whether perineal massage impacts on primary prevention of symptomatic disruption of the fecal continence mechanism.
An observational study recruited two cohorts of women. The first, massage group (MG) chose to perform daily perineal massage from 34 weeks gestation, and the second, control group (CG) was asked to avoid massage. Perineal injury and postnatal pain were documented and all women were invited to attend at three months postpartum for continence assessment, anal manometry, and endoanal ultrasound.
Of 179 women recruited, 100 were in the MG while 79 women were controls. Mode of delivery was not influenced by perineal massage. Although the impact did not reach statistical significance, women aged over 30 years in the MG were more likely to be delivered with an intact perineum than controls. Postnatal perineal pain was much reduced in the MG compared with the CG (p = 0.029). Of the women recruited, 136 (75.9%) returned for a postnatal continence assessment. Manometry pressures, continence scores, and endoanal ultrasound findings were similar in both groups.
Antenatal perineal massage was found to significantly affect postnatal perineal pain scores although it did not impact on the incidence of intact perineum at delivery, postnatal continence scores, anal manometry pressures, or endoanal ultrasound findings.
Journal of Maternal-Fetal and Neonatal Medicine 05/2006; 19(4):225-9. · 1.50 Impact Factor
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ABSTRACT: The purpose of this review is to outline optimum practice in diagnosis and management of obstetric anal sphincter injury. The review focuses briefly on prevention of the problem before outlining diagnosis of sphincter injury as well as immediate and long-term management of patients who have sustained such injuries.
Increasing vigilance is vital in order that sphincter injury is not overlooked; immediate radiological assessment may play a role in diagnosis. Optimum anal sphincter repair should be followed by oral laxative administration to maintain sphincter integrity. Biofeedback physiotherapy and sacral nerve stimulation show great promise in treatment of persistent symptoms. Optimum mode of delivery in future pregnancies is not clearly defined, and decisions should be individualized.
Because obstetric injury to the anal sphincter mechanism cannot always be prevented, efforts must focus on limiting its occurrence, documenting its severity and providing optimum therapy to women who have sustained it. Management includes routine postnatal review of at-risk women and antenatal assessment in future pregnancies to limit deterioration in continence after future deliveries.
Current opinion in obstetrics & gynecology 05/2006; 18(2):141-6. · 2.49 Impact Factor
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Journal of Obstetrics and Gynaecology 07/2004; 24(4):459-60. · 0.54 Impact Factor
