Acciones óseas de las hormonas de la neurohipófisis / Bone actions of neuro hypophyseal hormones

La oxitocina (OXT) como la arginina-vasopresina (AVP) son dos hormonas primitivas secretadas por la hipófisis posterior. Sus receptores están mucho más ampliamente distribuidos en el organismo de lo que se pensaba originalmente, incluido el hueso. En los estudios preclínicos, la OXT ha mostrado ser anabólica para el hueso, promoviendo la osteogénesis sobre la adipogénesis y favoreciendo la actividad osteoblástica sobre la osteoclástica. Tanto los osteoblastos como los osteoclastos tienen receptores para la OXT, y los efectos de los estrógenos sobre la masa ósea en ratones está mediada por lo menos en parte por la OXT. El mecanismo preciso por el cual la activación de los receptores de oxitocina (OXTR) se traduce en un incremento de la formación ósea permanece poco claro. La AVP también podría afectar el esqueleto en forma directa. Dos de los receptores de la AVP, V1a y V2 están expresados en osteoblastos y osteoclastos. La inyección de AVP en ratones de tipo salvaje aumenta la formación osteoclastos que producen resorción y reduce los osteoblastos formadores de hueso. En forma opuesta, la exposición de precursores osteoblásticos a antagonistas de los receptores V1a o V2, incrementan la osteoblastogénesis, como también lo hace la deleción genética del receptor V1a. (AU)

Both oxytocin (OXT) and argininevasopressin (AVP) are primitive hormones secreted by the posterior pituitary gland. OXT receptors are much more widely distributed in the body than originally thought, including in bone. In preclinical studies, OXT has been shown to be anabolic for bone, promoting osteogenesis over adipogenesis and favoring osteoblastic over osteoclastic activity. Both osteoblasts and osteoclasts have receptors for OXT, and the effects of estrogen on bone mass in mice is mediated at least in part by OXT. The precise mechanism by which the activation of oxytocin receptors (OXTRs) results in an increase in bone formation remains unclear. AVP could also have direct actions on the skeleton. The two AVP receptors, V1a and V2, are expressed in osteoblasts and osteoclasts. Injection of AVP in wild-type mice increases the formation of osteoclasts increasing bone resorption, and reduces bone-forming osteoblasts. On the contrary, the exposure of osteoblastic precursors to V1a and V2 antagonists increase osteoblastogenesis, the same as the genetic deletion of the V1a receptor. (AU)

Exposición a oxitocina sintética intraparto y riesgo de depresión post parto / Intrapartum synthetic oxytocin exposure and risk of postpartum depression

RESUMEN Una complicación frecuente del postparto es la depresión, con una prevalencia del 10 al 20% a nivel mundial. La oxitocina ha sido reconocida como un potente neuromodulador presente en la respuesta materna y la vinculación con su recién nacido. El uso de oxitocina sintética intraparto es una práctica frecuente. Objetivo: Relacionar la exposición a oxitocina sintética intraparto con el riesgo de depresión postparto en mujeres atendidas en un hospital público del sur de Chile, durante los años 2014-2015. Material y método: Estudio cuantitativo de cohorte, analítico, prospectivo. Muestreo no probabilístico, consecutivo a 58 mujeres desde el último trimestre de la gestación hasta las doce semanas postparto, midiendo el riesgo de depresión mediante la escala de Edimburgo. Se relacionaron variables bio-psicosociales y perinatales, con un nivel de significación <0,05. Aprobado por comité de ética. Resultados: La edad promedio fue 26,07 años, la mayoría había cursado enseñanza media, desempeñándose en quehaceres domésticos, con atención sanitaria gratuita y poseían una percepción de buen apoyo social. En los aspectos perinatales el 63,7 % se expusieron a oxitocina sintética. El riesgo de depresión se observó en un 12,07%. Las dosis y tiempo de exposición, al igual que el tipo de parto no resultaron estadísticamente significativos para el riesgo de depresión. Factores protectores y de riesgo psicosociales como perinatales, tampoco demostraron diferencias. Conclusiones: En este grupo, no se encontró asociación estadística entre la exposición a oxitocina intraparto con la sintomatología de depresión en el periodo de posparto, medida a través de la escala de Edimburgo.

ABSTRACT Depression is a frequently-seen postpartum complication, with 10-20% prevalence worldwide. Oxytocin has been recognized as a powerful neuromodulator and is present in the mothers' response and bonding with their newborn. Use of intrapartum synthetic oxytocin is a common practice. Objective. To study potential connections between administration of intrapartum synthetic oxytocin and risk of postpartum depression in women from a public hospital in southern Chile, from 2014 to 2015. Material and method. Analytical, prospective cohort study with a consecutive sampling of 58 women, since their third trimester of pregnancy to twelve weeks after birth, using the Edinburgh Postnatal Depression Scale (EPDS). Biopsychosocial and perinatal variables were analyzed (significance level < 0.05). This study was approved by the hospital ethics committee. Results. Average age was 26.07 years. Most of them had attended high school and were homemakers, had free health care and reported a good social support network. 63.7% received synthetic oxytocin. Risk of postpartum depression was 12.07%. Protective factors, and psychosocial and perinatal risk factors, as well as dosage and exposure time, were not statistically significant. Conclusion. According to EPDS, this group showed no statistical relationship between administration of intrapartum oxytocin and postpartum depression symptoms.

Episiotomy and its relationship to various clinical variables that influence its performance / Episiotomia e sua relação com diferentes variáveis cínicas que influenciam sua realização / La episiotomía y su relación con distintas variables clínicas que influyen en su realización

Objective: to understand the episiotomy rate and its relationship with various clinical variables. Method: a descriptive, cross-sectional, analytic study of 12,093 births in a tertiary hospital. Variables: Parity, gestational age, start of labor, use of epidural analgesia, oxytocin usage, position during fetal explusion, weight of neonate, and completion of birth. The analysis was performed with SPSS 19.0. Results: the global percentage of episiotomies was 50%. The clinical variables that presented a significant association were primiparity (RR=2.98), gestational age >41 weeks (RR=1.2), augmented or induced labor (RR=1.33), epidural analgesia use (RR=1,95), oxytocin use (RR=1.58), lithotomy position during fetal expulsion (RR=6.4), and instrumentation (RR=1.84). Furthermore, maternal age ≥35 years (RR=0.85) and neonatal weight <2500 g (RR=0.8) were associated with a lower incidence of episiotomy. Conclusions: episiotomy is dependent on obstetric interventions performed during labor. If we wish to reduce the episiotomy rate, it will be necessary to bear in mind these risk factors when establishing policies for reducing this procedure.

Objetivo: conhecer a taxa de episiotomia e sua relação com diferentes variáveis clínica. Método: e Estudo descritivo, transversal e analítico de 12.093 partos em um hospital terciário. Variáveis: paridade, idade gestacional, início do parto, uso de analgesia epidural, uso de oxitocina, posição durante expulsão do feto, peso do neonato e finalização do parto. A análise foi feita com o SPSS 19.0. Resultados: a porcentagem global de episiotomias foi de 50%. As variáveis clínicas que apresentaram uma associação significativa foram: primiparidade (RR=2,98), idade gestacional > 41 semanas (RR=1,2), início do parto estimulado ou induzido (RR=1,33), uso de analgesia epidural (RR=1,95), uso de ocitocina (RR=1,58), posição de litotomia durante a expulsão fetal (RR=6,4) e instrumentação (RR=1,84). Por outro lado, idade materna ≥ 35 anos (RR=0.85) e peso do neonato < 2500 g (RR=0,8) estão associados a uma menor incidência de episiotomia. Conclusões: a episiotomia depende de intervenções obstétricas feitas durante o parto. Se desejarmos reduzir a taxa de episiotomia, será necessário manter em mente esses fatores de risco para estabelecer políticas para reduzir esse procedimento.

Objetivo: conocer la tasa de episiotomía y su relación con distintas variables clínicas. Método: estudio descriptivo, transversal y analítico, de 12.093 partos en un hospital de tercer nivel. Las variables fueron: paridad, edad gestacional, inicio del parto, uso de analgesia epidural, uso de oxitocina, posición durante la expulsión fetal, peso del recién nacido y finalización del parto. El análisis se realizó con el programa estadístico SPSS 19.0. Resultados: el porcentaje global de episiotomías fue de 50%. Las variables clínicas que presentaron una asociación significativa fueron: primiparidad (RR=2,98), edad gestacional > 41 semanas (RR=1,2), inicio del parto estimulado o inducido (RR= 1,33), uso de analgesia epidural (RR=1,95), uso de oxitocina (RR=1,58), posición de litotomía durante la expulsión fetal (RR=6,4) e instrumentación (RR=1,84). Por otra parte, la edad materna fue ≥35 años (RR=0,85) y el peso del recién nacido < 2500g. (RR=0,8), se asociaron con una menor incidencia de episiotomía. Conclusiones: la episiotomía estuvo condicionada por las intervenciones obstétricas que se realizaron durante el desarrollo del parto. Si deseamos reducir la tasa de episiotomía será necesario tener en cuenta los factores de riesgo para establecer políticas de reducción de este procedimiento.

Efficacy of rectal misoprostol for prevention of postpartum hemorrhage

Postpartum hemorrhage is an important cause of maternal morbidity and mortality after delivery. Active management of postpartum hemorrhage by an uterotonic drug decreases the rate of postpartum hemorrhage. The aim of this study is to evaluate the efficacy of rectal misoprostol for prevention of postpartum hemorrhage. This double blind randomized clinical trial was performed on full term pregnant women candidate for vaginal delivery, referred to Zahedan Imam Ali Hospital during 2008-2009. They were randomly divided into two groups of rectal misoprostol and oxytocin. The women in misoprostol group received 400 micro g rectal misoprostol after delivery and the women in oxytocin group received 3 IU oxytocin in 1 L ringer serum, intravenously. Rate of bleeding, need to any surgery interventions, rate of transfusion and changes in hemoglobin and hematocrite were compared between two groups. A total of 400 patients [200 cases in misoprostol group and 200 in oxytocin group] entered to the study. Rate of bleeding > 500 cc was significantly higher in oxytocin group than misoprostol group [33% vs. 19%] [p = 0.005]. Also, need to excessive oxytocin for management of postpartum hemorrhage was significantly lower in misoprostol group than oxytocin group [18% vs. 30%] [p = 0.003]. Decrease in hematocrite was significantly more observed in oxytocin group than misoprostol group [mean decrease of hematocrite was 1.3 +/- 1.6 in misoprostol group and 1.6 +/- 2.2 in oxytocin group]. Two groups were similar in terms of side-effects. Rectal misoprostol as an uterotonic drug can decrease postpartum hemorrhage and also can prevent from decrease of hemoglobin as compared to oxytocin

Comparación del efecto del misoprostol sublingual y la oxitocina endovenosa en la pérdida sanguínea durante la cesárea / Comparison of the effect of sublingual misoprostol and intravenous oxytocin on blood loss at caesarean section

Se realizó un estudio prospectivo, descriptivo, al azar, doble ciego para comparar la efectividad de la oxitocina endovenosa y el misoprostol sublingual en la reducción de la pérdida sanguínea durante la realización de cesárea electiva. Se estudió una muestra de 58 pacientes con embarazo simple a término e indicación de cesárea electiva ajo anestesia regional, atendidas en el servicio de Obstetricia del Hospital Universitario de Caracas entre agosto de 2007 y febrero de 2009. Se distribuyeron en 2 grupos de 29 pacientes cada uno. El grupo A recibió 400 µg de misoprostol sublingual y 100 mL de solución fisiológica en infusión endovenosa. El grupo B recibió una cantidad equivalente de placebo sublingual y 20 UI de oxitocina diluídas en 1200 mL de solución fisiológica en infusión endovenosa. La variación de la hemoglobina y el hematocrito fue de 1,5 ± 0,9 g/dL y 4,2 ± 2,6 % en el grupo A y de 1,2 ± 0,7 g/dL y 3,7 ± 3,2 % en el grupo B. Estas diferencias no fueron estadísticamente significativas. El misoprostol sublingual y la oxitocina endovenosa son igualmente efectivas en la reducción de la pérdida sanguínea durante la cesárea electiva

It was made a prospective, descriptive and randomized, double blind study to compare the effectivity between endovenous oxytocin and sublingual misoprostol in the blood loss reduction during elective cesarean section. It was studied a sample of 58 patients with term simple pregnancy and indication of elective cesarean under regional anesthesia, who were attended in the Obstetrician Service from the Hospital Universitario de Caracas between August, 2007 and February, 2009. They were distributed in two groups of 29 patients each one. Group A received 400 µg of sublingual misoprostol and 100 mL of saline solution in endovenous infusion. Group B received equal dosis of sublingual placebo and 20 UI of endovenous infusion of oxytocin diluted in 100 mL of saline solution. Hemoglobin and hematocrit variation was 1,5 ± 0,9 g/dL and 4,2 ± 2,6 % in group A and 1,2 ± 0,7 g/dL y 3,7 ± 3,2 % in group B. These differences were not statistically significative. Sublingual misoprostol and endovenous oxytocin are equally efective in the reduction of blood loss during elective cesarean

Risk factors in relation with uterine rupture

To determine the risk factors in relation with uterine rupture in patients coming to Abbasi Shaheed Hospital. Case Control Study. The department of Gynecology and obstetric Abbasi Shaheed Hospital Karachi from January 2001 - December 2002. All cases of ruptured uterus who were either admitted with or who developed this complication in the hospital were included in the study. These cases were compared with their control i.e. women who delivered normal at Abbasi Shaheed Hospital in the same period and did not develop rupture uterus; matched by same age parity socioeconomic status and area of residence. The cases were further divided in two groups, those with previously scarred uterus [n=20] and those with unscarred uterus [n=23]. Risk factors associated with uterine rupture included injudicious use of oxytocin by traditional birth attendants [TBAs] or unskilled persons [88%] no antenatal care [79%] or late referral by TBAs or Dais [58%] and obstructed labour [25.5%]. All cases referred by Dais had crossed the partographic alert line. In unscarred group oxytocin used injudiciously in all cases with no antenatal care [ANC] at all and late referral by Dais in 78% cases. Injudicious use of oxytocin and late referral by TBAs [Dais] and lack of Ante Natal Care are the significant risk factors for uterine rupture

Influence of time at which oxytocin is administered during labor on uterine activity and perinatal death in pigs

Oxytocin is extensively used to induce or augment uterine contractions, especially to facilitate the third stage of labor in humans. Administration of oxytocin to parturient sows reduces duration of labor whereas mortality of the offspring may remain unchanged. This study aimed to evaluate whether time of administration of oxytocin during parturition may alter the uterine response and fetal outcomes. Two hundred parturient sows were randomly assigned to intramuscularly receive either saline solution (control group) or oxytocin 0.083 IU/kg immediately after the delivery of the 1st, 4th or 8th piglet (groups O-1, 0-4 and 0-8, respectively). Uterine effects and fetal outcomes were registered in all groups. The duration of labor was 20-40 min shorter (P < 0.0001) and time interval between babies was reduced by 3-5 min (P < 0.0001) in the three groups receiving oxytocin. The duration and intensity of contractions, meconium-stained piglets and intrapartum deaths decreased as time at which oxytocin administered during labor was increased. In group 0-8, we observed approximately 70 percent less meconium-stained piglets and intrapartum deaths than in the control group. In conclusion, oxytocin administered at early phases of parturition to sows may increase duration and intensity of uterine contractions as well as adverse fetal outcomes.

Peripartum hysterectomy

To find out the frequency, indication and its associated morbidity in our setup. Prospective cross-sectional observational study for the period one year [from June 2003 - May 2004] carried out in the Department of Obs / Gynae, Lahore General Hospital Lahore. During the study there were 26 cases of peripartum hysterectomy, of which 14 case were of caesarean hysterectomy, while 10 cases were following normal vaginal delivery and 2 cases followed by instrumental delivery. Uterine atony was the most common indication for peripartum hysterectomy in 12 cases [46.15%]. Uterine rupture including instrumental delivery tear was 2nd most frequent cause in 4 +2=6[23.07%] of cases. In 19.2% [5] of cases abnormal placentation was the cause. In 2[7.6%] of cases sepsis was the cause leading to secondary PPH followed by hysterectomy. A subtotal hysterectomy was carried out in 10 [38.46%] and total hysterectomy was performed in 16 [61.53%] cases. there were 4 maternal deaths. Urinary tract injuries occurred in 3[11.53%] cases, fever, chest infection and wound infection were common morbidity. Anemia was found in almost every case. Intra and post operative Blood transfusion s were given in all cases. Reloparotomy was done in one patient for continues vaginal bleeding. Despite its morbidity and mortality emergency Obstetric hysterectomy remains an essential life saving tool. Uterine atony, uterine rupture and abnormal placentation were mast common indications, reflecting under utilization of existing antenatal, family planning services. Injudicious use of oxytocin, lack of transportation facilities, poverty and delayed referral all contribute to morbidity and mortality associated with emergency Obstetric hysterectomy

[Comparison of intramuscular syntometrine and intravenous oxytocin in management of the third stage of labor]

One of the main etiologies of maternal mortality is obstetrical hemorrhage. The first step in decreasing hemorrhage is the use of uterotonic drugs in the third stage of labor. To compare the efficacy and safety of intravenous oxytocin and intramuscular syntometrine in management of the third stage of labor. This randomized double blind clinical trial was carried out at Kosar Hospital, Qazvin [Iran] in 2005. A total of 800 women having a singleton pregnancy and vaginal delivery were randomized to receive either 1 ml of syntometrine intramuscularly, or 10 units of intravenous oxytocine following delivery of the anterior shoulder of fetus. Hemoglobin level pre- and 24 hours post-delivery, duration of third stage, need for re-administration of uterotonic drugs, need for manual removal of placenta, and unpleasant side effects including nausea, vomiting, headache and hypertension were recorded. The data were analyzed using chi-square test. Mean drop percent of hemoglobin level in oxytocin group was 3.7 +/- 2.54% and in syntometrine group 3.6+2.49% with no significant difference, statistically. There was also no statistically significant difference between the need for re-administration of uterotonic drugs, duration of third stage of labor, need for manual removal of placenta and the maternal side effect in two groups. Regarding the efficacy and side effects of intravenous oxytocin and intramuscular syntometrine, no difference was found

Acute pulmonary oedema following oxytocin administration: a life threatening complication.

Water Intoxication is not a common complication of oxytocin infusion. A 26 years primigravida developed acute onset severe pulmonary oedema in postpartum period to whom oxytocin was infused for the induction of labour and to prevent postpartum haemorrhage. The relative role of oxytocin and of electrolyte-free fluids in the pathogenesis of this problem is discussed.

Secondary postpartum haemorrhage due to rupture of uterus

We report a very unusual case of secondary postpartum hemorrhage due to uterine rupture. Our case was a 23 years old lady who presented with heavy bleeding per vagina and gave history of home delivery. Rupture was most probably caused by injudicious use of oxytocic injection by a Traditional Birth Attendant at home. Surprisingly, after recovering completely from primary episode she again had heavy blood loss after 5 days. An emergency hysterectomy of the patient was performed to save the life

Induction of labour single vaginal PGE 2 Vs early amniotomy and I/V oxytocin

To compare two methods of induction of labour. Amniotomy with intravenous oxytocin infusion versus single use of prostaglandin E2 vaginal tablet. Design Perspective randomized clinical trial. The department of Gynae and Obs Nishtar Hospital Multan and Ganga Ram hospital lahore 100 patients were recruited .50 were randomized for amniotomy followed by oxytocin infusion. Second group underwent labour induction with PGE2 which was repeated after 6 hours, if n o change in bishop score is observed. 17 .2 .2004 to 17 .2.2005 In the study the results regarding mean Bishop score change, duration of labour and apgar score at 5 minutes were comparable in both groups. In the group 2 mean induction to delivery time was 9 hours.[6-12 hrs].The mean cervical change score was 8.5 Duration of labour in group 2 was in the mean of 7hrs. In group 1 mean cervical change was 7.5 [range5-7], induction to delivery time was 10.5 hrs. The duration of labour was 7.5 hrs. Analgesic requirements varied in both groups. No patient with PGE2 required pain relief before membrane rupture. In the oxytocin group narcotic analgesia was given from the start of uterine contractions. PGE2 vaginal tablet for induction of labour in case of unfavourable cervix is superior to use of amniotomy and oxytocin. It was found to be safe and effective with minimum of patient interference

number needed to treat and time to relinquish oxytocin. A randomized clinical trail

To evaluate the use of oral misoprostol for cervical ripening and labor induction in term pregnancy with intact and ruptured membranes, we selected two hundred primigravidae at term admitted to El Shatby maternity hospital fulfilling our selection criteria. All subjects were randomly assigned to receive either 100ug misoprostol orally that was repeated every 4 hours till adequate contraction pattern occured or to receive 2 mIU/minute of oxytocin that was increased at 30 minutes interval till adequate contraction pattern was achieved. The mean induction-delivery time was significantly shorter in the misoprostol group, [t=12.36, 4.69 and 6.067 for all women, women with intact membranes and women with premature rupture of membranes respectively]. The percentage of normal vaginal delivery was significantly higher in the misoprostol group, [X2 =10.6, 2.915 and 10.0 respectively]. The duration of the 3rd stage was significantly shorter for the misoprostol group, [t = 4.26, 2.019 and 0.928 respectively]. There was no significant difference between the two studied groups as regards abnormal fetal heart rate, the occurrence of hypertonus, the percentage of retained placenta and the occurrence of post-partum hemorrhage. Apgar score and neonatal admition to neonatal intensive care unit were not significantly different between the two studied groups. Oral misoprostol is superior over oxytocin in labor acceleration in both women with intact or rupture membranes

Neonatal and maternal hyponatremia: comparison of oxytocin in dextrose 5 % infusion with oxytocin in saline infusion for induction of labor

We performed a randomized controlled trial of a total of 200 women in labor divided into two equal groups, to determine prospectively the relation between maternal and cord serum sodium levels and the effect of intravenous Oxytocin infusion in either dextrose 5 percent or saline. There was no maternal or neonatal hyponatremia in the saline group. Oxytocin in 5 percent Glucose infusion caused statistically significant depression of maternal and cord serum sodium levels, compared to those of the saline group. Eight newborns in dextrose 5 percent group [8 percent] had definite hyponatremia [< 130mmol/L]. We observed significant negative correlation between cord serum sodium and both the dose of Oxytocin and volume of glucose solution infused in the dextrose 5 percent group. Comparing the serum sodium levels in mothers and newborns between those women who received volumes of saline or dextrose 5 percent less than 1000ml and those who received more than 1000ml revealed statistically significant depression of serum sodium level in only more than 1000 ml dextrose 5 percent group. We recommended that caution should be exercised in prescribing intravenous Oxytocin therapy during labor and, if more than 1000ml of fluids are required, sodium should be included

Oxitocina intrafunicular Vs. sistémica en el manejo de la tercera etapa del parto eutócico

Durante la tercera etapa del parto, el alumbramiento se presenta la mayoría de la morbilidad por hemorragia, muchos autores han utilizado por vía intrafunicular oxitocina para su manejo y para el de la retención placentaria, con resultados positivos y negativos. Nosotros tratamos de demostrar si en realidad la oxitocina por vía intrafunicular modificaba en grado alguno el alumbramiento, durante partos eutócicos, encontrando que es el volumen inyectado del vehículo (SSN) y no el efecto farmacológico de la oxitocina lo que contribuye a la disminución del tiempo y de sangrado

Prostaglandin E2 gel for cervical priming and induction of labour in unfavourable cervical state.

To know the safety and efficacy of intracervical prostaglandin E2 gel over conventional intravenous infusion of oxytocin for priming and induction of labour, a prospective study was undertaken in 96 cases selected at random for both study and control series consisting 48 cases in each group with definite indication for termination of pregnancy having unfavourable cervical state. Periodic clinical assessment in different groups following the procedure revealed that by the end of 12 hours, 39 cases in the study and 28 cases in the control group had uterine contraction. Foetal heart rate abnormality was more marked in the oxytocin group (1.56% in the study group and 20.31% in the control group) while increase in Bishop's cervical scoring was noticed more often in the prostaglandin group. By the end of 12 hours of initiation of therapy, 17 cases in the study group and only 3 cases in the control group had spontaneous vaginal delivery. There was significant shortening of instillation and delivery interval in PGE2 group. The number of caesarean section in the study group was only 16.66% in comparison to 25% in the control group. Analysing the efficacy of the procedures adopted, the success rate in the prostaglandin group was 91.66% in contrast to 64.58% in the oxytocin group.

Neonatal hyperbilirubinemia following the use of oxytocin in labour

90 full term pregnant mothers aged 18-35 years with non-complicated normal pregnancy, they were divided into 3 groups: - 30 patients were given syntocinon drip for induction of labour. - 30 patients were given syntocinon for acceleration of labour. - 30 patients had spontaneous labour and not given syntocinon and considered as control group. Mothers with possible maternofetal blood group iso immunisation were excluded. The babies were healthy full term with gestational age of 38-41 weeks, birth weight of 2.8-3.8 Kg, and with Apgar score of 7 or more at one minute. Blood sample was taken from the newborn at birth and after 72 hours for total bilirubin level. It was found that all cases of the first group showed highly significant results when compared to the control group. In the second group the results are not highly significant when compared to the control group. Oxytocin may induce neonatal hyperbilirubinemia in cases of induced labour of normal pregnant women. It is advisable to avoid unnecessary use of oxytocin in labour unless it is really indicated and to keep its total dose to a minimum and to limit the volume of the infusion to be as small as possible to avoid the risk of water intoxication

Etiology of neonatal jaundice in hospital and home deliveries

To study the etiology of neonatal jaundice in hospital and home delivered babies, 748 mother/baby pairs from a private clinic and 245 babies delivered in two rural communities in the same calender year, were studied within 24 hours of brith. The results show a marked difference in the incidence of jaundice in babies delivered at home and in the clinic. A marked increase was also observed in babies born in the clinic during the months of July to September and bout in the community between April to June. Possible explainations have been discussed