Labor augmentation strategies: What's the evidence?

Labor augmentation is a commonly used strategy in obstetrics to make labor more efficient or to increase the chance of achieving a vaginal delivery. Intravenous infusion of synthetic oxytocin and early amniotomy are the most widely used methods, but there is considerable variation in how they are used in clinical practice. There remain significant differences in the timing, dosing, and administration of synthetic oxytocin across institutions. The use and timing of amniotomy is similarly controversial. Much of the clinical variation in augmentation practices stem from the significant heterogeneity that exists in the literature, as well as the lack of an optimal strategy that has been subjected to the scientific scrutiny needed to prove its superiority in both efficacy and safety. Further research is needed to allow for better standardized care of women presenting in spontaneous labor.

Ocitocina sintética e a aceleração do parto: reflexões sobre a síntese e o início do uso da ocitocina em obstetrícia no Brasil / Synthetic oxytocin and hastening labor: reflections on the synthesis and early use of oxytocin in Brazilian obstetrics

Resumo O artigo reflete sobre o processo de medicalização do parto, tendo como foco específico o desenvolvimento da ocitocina sintética em 1953. Investiga a vida social da ocitocina, isto é, sua sintetização, estabilização e uso em obstetrícia para acelerar o trabalho de parto. Por meio do levantamento em dois periódicos brasileiros de obstetrícia da época, é analisado o início do uso da ocitocina sintética no Brasil, a partir do final da década de 1950, e os argumentos dos obstetras acerca da recomendação ou não desse uso. É observada, nesse período, a centralidade cada vez maior do obstetra no parto, bem como a recomendação do uso encadeado de diferentes intervenções - com destaque para a ocitocina - visando menor tempo de trabalho de parto.

Abstract This article reflects on the medicalization of childbirth, focusing on the development of synthetic oxytocin in 1953. Specifically addressed is the social life of oxytocin; in other words, its synthesis, stabilization, and use in obstetrics to hasten labor. Two Brazilian obstetrics journals of this era were surveyed to analyze the early use of synthetic oxytocin in Brazil in the late 1950s, along with obstetric arguments for or against its use. Notable in this period is the increasingly central role of the obstetrician in childbirth, as well as the recommendation to use different interventions linked together (particularly oxytocin) to shorten labor.

Synthetic oxytocin and hastening labor: reflections on the synthesis and early use of oxytocin in Brazilian obstetrics. / Ocitocina sintética e a aceleração do parto: reflexões sobre a síntese e o início do uso da ocitocina em obstetrícia no Brasil.

This article reflects on the medicalization of childbirth, focusing on the development of synthetic oxytocin in 1953. Specifically addressed is the social life of oxytocin; in other words, its synthesis, stabilization, and use in obstetrics to hasten labor. Two Brazilian obstetrics journals of this era were surveyed to analyze the early use of synthetic oxytocin in Brazil in the late 1950s, along with obstetric arguments for or against its use. Notable in this period is the increasingly central role of the obstetrician in childbirth, as well as the recommendation to use different interventions linked together (particularly oxytocin) to shorten labor.

O artigo reflete sobre o processo de medicalização do parto, tendo como foco específico o desenvolvimento da ocitocina sintética em 1953. Investiga a vida social da ocitocina, isto é, sua sintetização, estabilização e uso em obstetrícia para acelerar o trabalho de parto. Por meio do levantamento em dois periódicos brasileiros de obstetrícia da época, é analisado o início do uso da ocitocina sintética no Brasil, a partir do final da década de 1950, e os argumentos dos obstetras acerca da recomendação ou não desse uso. É observada, nesse período, a centralidade cada vez maior do obstetra no parto, bem como a recomendação do uso encadeado de diferentes intervenções ­ com destaque para a ocitocina ­ visando menor tempo de trabalho de parto.

Amniotic membrane sweeping.

Amniotic membrane sweeping or stripping is a safe and effective method of labor induction supported by national obstetrical organizations. While its use dates back to antiquity by both midwives and physicians there are still areas that need further research to define its role in induction of labor. A review of the literature reveals that amniotic membrane sweeping is a safe, effective, and inexpensive method of labor induction. It can be done in the outpatient setting with minimal risks so long as it is avoided in patients with contraindications. Amniotic membrane sweeping can be performed in Group B Streptococcus-positive women with studies showing no increase in untoward outcomes. However, there is no data in women infected with HIV or hepatitis.

'Forbidden points' in pregnancy: no plausible mechanism for risk.

It has been suggested that acupuncture may pose particular risks during pregnancy: by enhancing oxygenation to the developing embryo (presumably via increasing blood flow to the uterus); by affecting the level of maternal progesterone in early pregnancy; or by stimulating uterine contractions. This article examines the proposed risks and fails to find any plausible physiological mechanism for them.

Forbidden points' in pregnancy: historical wisdom?

Within the acupuncture literature there is debate on the safety of using specific acupuncture points during pregnancy. Termed 'forbidden' or contraindicated, they refer to acupuncture points that can be used to induce labour but may also include points with no known inducing or labour-enhancing effects. Recommendations range from avoiding these acupuncture points at any time in pregnancy to statements that despite the warnings in the literature, these points are not contraindicated during a normal pregnancy. This discussion paper examines the historical use of contraindicated points, the physiology of the pregnant body and the effect of these points during research trials. It is hoped that this will encourage further discussion and provide a background for practitioners to make informed choices about how they use these points in clinical practice.

Textual research on Pang Anshi's case record of acupuncture treatment for difficult labor.

Ancient works on women's diseases of successive ages were studied on the question Pang Anshi's acupuncturing the point "Hukou" at the dorsal aspect between the thumb and index finger to cure a case of difficult labor. Query is put forward on the absence of such case report in all those books through deliberated investigation of relevant medical literatures. It is concluded that Pang's case report is convincing and is worthy of attention.

[Evolution of actual methods for the induction of labour]. / Evolution des méthodes actuelles de déclenchement du travail.

At first reserved for the most serious illnesses of pregnancy, the techniques of artificial induction of labour have seen their indications and methods modified with the passing years. This brief account tries to relate the course of some of these techniques still used to-day. Out of the mechanical procedures formerly imposed by the necessity to end quickly a dangerous labour or a dangerous pregnancy, only remains some adjuvant measures linked with medical treatments, which are nowadays universally and widely used. Perhaps the old dream to control the parturition is not so far off now to be a reality, but a shadow is becoming apparent: the temptation of a total control and of a limitless interventionism.

Amniotomy to induce labor.

Amniotomy to induce labor is used frequently. The potential risks compared with potential benefits of artificial rupture of membranes have caused the popularity of amniotomy to vary in the last two centuries. Although there are little data available from prospective randomized studies regarding the effectiveness of amniotomy alone to induce labor, several series have showed success in its use. In addition, no well-accepted, prospectively randomized study is available comparing the effectiveness of amniotomy to oxytocin for induction of labor. The most effective combination of amniotomy with uterotonic agents to induce labor is still a fertile area for investigation.