Solveig Nordén-Lindeberg

ST depression at caesarean section and the relation to oxytocin dose. A randomised controlled trial

Objective  To investigate whether there is a difference in occurrence of electrocardiogram changes suggestive of myocardial ischaemia between two different doses of oxytocin.

Acidemia at birth, related to obstetric characteristics and to oxytocin use, during the last two hours of labor

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.

Perinatal mortality and route of delivery in term breech presentations

Objective To compare intrapartum related infant mortality in term (> 34 weeks) breech presentations in relation to vaginal delivery or delivery by caesarean section.

Metabolic acidosis at birth and suboptimal care – illustration of the gap between knowledge and clinical practice

Objective  To evaluate the occurrence and nature of suboptimal intrapartum care in cases with metabolic acidosis in the newborn, and to estimate the degree to which this may be prevented.

Decreased maternal lipolysis in intrauterine growth restriction in the third trimester

Objective  Intrauterine growth restriction (IUGR) is a common complication of pregnancy. There are many possible aetiologic factors of maternal, placental and/or fetal origin. Often there is no known explanation. The aim of this study was to investigate whether a reduction in maternal energy substrate production could be one of the factors involved in IUGR.

Suboptimal care and metabolic acidemia is associated with neonatal encephalopathy but not with neonatal seizures alone: a population‐based clinical audit

To determine the incidence of moderate to severe neonatal encephalopathy (NE) and neonatal seizures without encephalopathy, and the association with metabolic acidemia. Secondly, to investigate the occurrence of suboptimal intrapartum care and its impact on neonatal outcome.

ST Depression in Preeclampsia Women Receiving Oxytocin during Cesarean Section: A Randomized Controlled Trial

Background: Electrocardiogram changes suggestive of myocardial ischemia, ST depressions, have been reported to be associated with oxytocin administration in healthy women undergoing cesarean section in regional anesthesia. We investigated whether there was a difference in the occurrence of ST depressions on electrocardiograms in preeclamptic women randomized to five or ten units of oxytocin during cesarean section with regional anesthesia. Methods: Double-blind randomized controlled trial. Twenty-five women with preeclampsia delivered by cesarean section under spinal anesthesia were allocated to 5 or 10 units of oxytocin, given as an intravenous bolus. A Holter monitor was used to record electrocardiograms. Non-invasive blood pressure and heart rate were monitored. The main outcome measure was depression of the ST segment on electrocardiogram related to oxytocin bolus; the secondary outcomes were changes in mean arterial pressure and heart rate related to oxytocin bolus. Results: ST depressions associated with oxytocin administration occurred in two women (8%), one in each group. The decrease in mean arterial pressure from baseline to 2 minutes after the oxytocin bolus differed within groups, with 12 mmHg in the five unit group and 16 mmHg in the ten unit group (p<0.01). The increases in mean heart rate from baseline to 2 minutes after the oxytocin bolus did not differ. Conclusion: ST depressions on electrocardiograms were uncommon in patients with preeclampsia undergoing cesarean section in regional anesthesia, although the hemodynamic changes associated with an oxytocin bolus were substantial.