Labor and delivery

Urine toxicology screens from the mothers and infants were obtained during the labor and delivery and/or postnatal periods. 

The lower birth weight of infants of mothers who consume 300 mg or more of caffeine per day is due entirely to retarded fetal growth. There is no evidence that premature labor and delivery are associated with caffeine during pregnancy. 

Some of these natural products—and drugs made from them—are known collectively as the ergot alkaloids, and have found use in medicine. Ergonovine, for example, is a selective stimulant for contraction of uterine muscle and is used in conjunction with labor and delivery. A mixture of hydrogenated ergot alkaloids—reduced at the 9,10-position—has found... 

Labor and delivery - The use of flumazenil to reverse the effects of benzodiazepines used during labor and delivery is not recommended because the effects of the drug in the newborn are unknown. 

Labor and delivery - Use of 2 active sympathomimetics inhibits uterine... 

Cesarean section 10 mg. DepoDwr should not be administered to women for vaginal labor and delivery. 

Epidural use in labor and delivery - 10 to 15 meg administered with 10 mL bupivacaine 0.125% with or without epinephrine. Mix and... 

For preoperative analgesia, as a supplement to balanced analgesia, to surgical and postsurgical anesthesia and for obstetrical analgesia during labor and delivery. 

Labor and delivery - May produce fetal bradycardia, respiratory depression, apnea, cyanosis, and hypotonia in the neonate. Maternal administration of naloxone during labor has normalized these effects in some cases. Use with caution in women delivering premature infants. 

Labor and delivery - Safety and efficacy have not been established. 

Labor and deiivery and iactation - Use in labor and delivery and lactation is contraindicated. 

Labor and delivery - Misoprostol can induce or augment uterine contractions. A major adverse effect of the obstetrical use of misoprostol is hyperstimulation of the uterus, which may progress to uterine tetany with marked impairment of uteroplacental blood flow, uterine rupture (requiring surgical repair, hysterectomy, and/or salpingo-oophorectomy), or amniotic fluid embolism. 

Labor and delivery - Because of the possibility of hemolytic anemia caused by immature erythrocyte enzyme systems (glutathione instability), the drug is contraindicated in pregnant patients at term (38 to 42 weeks gestation), during labor and delivery, or when the onset of labor is imminent. 

Maternal dosing (IV) - During labor and delivery, administer IV zidovudine at 2 mg/kg (total body weight) over 1 hour followed by a continuous IV infusion of 1 mg/kg/h (total body weight) until clamping of the umbilical cord. 

Since propranolol crosses the placenta and enters the fetal circulation, fetal cardiac responses to the stresses of labor and delivery will be blocked. Additionally, propranolol crosses the blood-brain barrier and is associated with mood changes and depression. School difficulties are commonly associated with its use in children. Propranolol may also cause hypoglycemia in infants. 

Epidural anesthesia is especially useful in obstetrics. Excellent analgesia occurs and the patient remains awake. Analgesia by the epidural route can be provided for labor and delivery or for cesarean section. Bupivacaine in lower concentrations has the advantage of providing excellent analgesia while minimally reducing motor strength. 

Oxytocin also stimulates contraction of uterine smooth muscle in late phases of pregnancy. See Chapter 62 for a full discussion of the use of oxytocin in labor and delivery. 

Observation Weight gain and feed intake of dams. Onset of labor and delivery, Dystocia, prolonged and delayed labor, litter size pup weight, survival rate at birth and on 4, 14, and 21 days post partum... 

Epidural anesthesia—injection of local anesthetic into the space external to the dural sac that encloses the spinal cord, enabling nerves to the pelvis to be selectively anesthetized during obstetrical labor and delivery... 

In the cardiovascular system, arrhythmias and, in extreme situations, arrest may occur, usually secondary to the combination of seizure activity and anesthetic agent. The mortality rate per course of ECT treatments is in the range of 1 per 10,000 or 0.01%. This risk is less than the overall morbidity and mortality rate (i.e., 3 to 9 per 10,000) seen in severely depressed patients who go untreated or receive inadequate medication trials, and is less than the anesthetic risk for labor and delivery during childbirth. Thus, those who receive an adequate trial of ECT may actually be at a reduced risk of dying from a variety of causes. 

Oxytocin is a peptide hormone secreted by the posterior pituitary that participates in labor and delivery and elicits milk ejection in lactating women. During the second half of pregnancy, uterine smooth muscle shows an increase in the expression of oxytocin receptors and becomes increasingly sensitive to the stimulant action of endogenous oxytocin. Pharmacologic concentrations of oxytocin powerfully stimulate uterine contraction. 

The clinical importance of a differential nerve block is that certain sensory modalities may be blocked without the loss of motor function. Fortuitously, the most susceptible modality is pain because analgesia is usually the desired effect. If the dosage and administration of the anesthetic is optimal, it will produce analgesia without any significant loss of skeletal muscle function. This fact may be advantageous if motor function is required, such as during labor and delivery.14 If... 

Well, at least I could be in control of how the rest of the day would go. I planned to go home and experience early labor in my favorite environment. But my doctor s office was actually in the hospital where I was going to deliver and the doctor felt I should be a direct admit." I didn t agree. I explained that this wasn t how my labor was supposed to go. I had been with plenty of women whose water broke and we stayed at home and took their temperature for hours to watch for infection before they were ready to go to the hospital. But somehow, I was on my way to the labor and delivery room without any real contractions. 

Each of my experiences with labor and delivery was unique. With my first, I had an induction at forty weeks because my fluid was low. It was a long induction, over thirty hours, and I had an epidural the moment I started feeling contractions at all. As a result. I didn t feel much of the labor, and my husband and I could focus on the amazing experience of watching our daughter s birth. I had attended many hundreds of births by then, butthere is nothing quite like the firsttimeyou lay eyes on your own child and hold her in your arms. 

Gravett et al. recently published further work that targets some of the areas most amenable to early detection and intervention during pregnancy, labor, and delivery, as a step toward alleviating the disease burden of these illnesses globally (46). Early metabolomic/proteomic evaluation could theoretically lead to a marked reduction in adverse pregnancy outcome. 

Several classes of inborn errors of metabolism in addition to inborn errors of urea synthesis can cause neonatal hyperammonemia. These include organic acidurias, fatty acid oxidation defects, amino acidopathies, and mitochondrial respiratory chain disorders. All of these disorders have a number of features in common. Labor and delivery tend to be normal, and there are no predisposing risk factors. Clinical features present after 24 h of life and are progressive. They are inherited, and thus a family history of previously affected children or neonatal deaths may be present. While most are inherited in an autosomally recessive manner, ornithine tran-scarbamoylase (OTC) deficiency is X linked, and a family history of affected males in the maternal pedigree is not uncommon. 

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