Uterine complications

Uterine contractions and fetal heart rate should be monitored during oxytocin administration (SEDA-13, 1310) (1,2). There is no significant increase in uterine complications or in fetal morbidity or mortality in women with a previous cesarean section, although oxytocin-treated patients had a higher rate of failed trial of labor for reasons that are unclear (3). Oxytocin is structurally similar to vasopressin, and like the latter has water-retaining properties when used in pharmacological doses. 

When oxytocin is used judiciously, serious toxicity is rare. The toxicity that does occur is due either to excessive stimulation of uterine contractions or to inadvertent activation of vasopressin receptors. Excessive stimulation of uterine contractions before delivery can cause fetal distress, placental abruption, or uterine rupture. These complications can be detected early by means of standard fetal monitoring equipment. High concentrations of oxytocin with activation of vasopressin receptors can cause excessive fluid retention, or water intoxication, leading to hyponatremia, heart failure, seizures, and death. Bolus injections of oxytocin can cause hypotension. To avoid hypotension, oxytocin is administered intravenously as dilute solutions at a controlled rate. 

Al-Hussaini TK. Uterine rupture in second trimester abortion in a grand multiparous woman. A complication of misoprostol and oxytocin. Eur J Obstet Gynecol Reprod Biol 2001 96(2) 218-9. 

Gherman RB, McBrayer S, Browning J. Uterine rupture associated with vaginal birth after cesarean section a complication of intravaginal misoprostol Gynecol Obstet Invest 2000 50(3) 212-3. 

In 56 women (18-20 weeks gestation), treated at the Marie Stopes Chnic in Jodhpur, India, who underwent termination of pregnancy with 0.1% ethacridine lactate 150 ml injected into the intrauterine extra-amniotic space and in whom intravenous oxytocin was used to expedite the dehvery of the abortus, ethacridine lactate induced successful abortion in 52 cases (1). Abortion failure occurred in the other four cases because of transverse lie of fetus (n = 2), cervical dystocia (n = 1), and uterine inertia (n = 1). In 41 women the abortion occurred at 12-24 hours after induction (mean 20 hours) which was shorter than that of previous reports (29.5-38 hours). There were complications in six cases three women had cervical tears and three had incomplete expulsion. There was one case each of severe bleeding and vaginal laceration. There were no cases of sepsis. The authors concluded that ethacridine lactate performed better than other instillation abortion methods. 

Dilute solutions of 1-10% formalin have been instilled into the bladder to treat inoperable profusely bleeding tumors or intractable hemorrhagic cystitis. Anuria was a severe complication. This was due either to edematous obstruction of the ureter or to tubular or papillary necrosis, probably caused by systemic absorption. Bladder perforation with intraperitoneal spillage, peritonitis, and finally death was described in an elderly patient with a carcinoma of the uterine cervix (SEDA-11, 476). 

The possibility of increased maternal mortality is a topic of debate. In 1979 there were 150 maternal deaths (0.27 per 1000 births) in Germany, of which 15-25% were apparently related to regional anesthesia, with such complications as hypotension, systemic toxicity, total spinal block, hematoma, catheter rupture, and uterine injury (SED-12, 253) (154). However, obstetric regional... 

There are few complications from amniocentesis. Occasionally a bloody tap is made. The blood may come from the uterine wall, the placenta, or even the fetus. Determination of fetal hemoglobin can be used to help ascertain the source if it is important to do so. 

M7. Martin, J. D., Davis, R. E., and Stenhouse, N., Serum folate activity and vitamin-B12 concentration in pregnancy complicated by bacteriuria or uterine bleeding. /. Obstet. Gynaecol. Br. Commonw. 74, 697-701 (1967). 

AUGMENTATION OF DYSFUNCTIONAL LABOR To augment hypotonic contractions in dysfunctional labor, it rarely is necessary to exceed an infusion rate of 10 mlU/min, and doses of >20 mlU/min rarely are effective when lower concentrations fail. Potential complications of overstimulation include trauma of the mother or fetus due to forced passage through an incompletely dilated cervix, uterine rupture, and compromised fetal oxygenation due to decreased uterine perfusion. Oxytocin usually is effective when there is a prolonged latent phase of cervical dilation and when, in the absence of cephalopelvic disproportion, there is an arrest of dilation or descent. 

IM. Short half-life. Mean time to abortion is 16 hours. Incomplete abortion. Nausea, vomiting, fever. Uterine rupture, perforation, inflammation, cramps, CNS, cardiovascular and respiratory complications. U 0 20% saline solution is preferred for abortion. Consider alternatives for women with previous C sections. 

Uterine stimulants for labor induction should always be used under the direct supervision of a qualified and experienced individual. If used improperly, these herbs could potentially lead to such complications as uterine hypercontractility, uterine rupture, and maternal hypotension (Kelsey and Prevost 1994). 

There have been complications reported in association with the use of trisacryl gelatin microspheres. De Blok et al. reported a case of fatal sepsis after uterine artery embolization performed with this agent. In this case, diffuse necrosis of the vaginal wall and cervix was found, attributed to distal penetration of spheres measuring 500-700 p in diameter... 

A complication rate of 8.7% was reported in the literature [56-59]. This includes contrast-induced, puncture and embolization related complications. The reported complications related to the embolization include foot ischemia, bladder necrosis, rectal wall necrosis, nerve injury and uterine necrosis. These complications are caused by non-targeted vessel embolization. 

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