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Background: Optimizing care during labor protraction is a key strategy for reducing cesareans, especially among people with obesity. The pathophysiology of labor dystocia remains poorly understood, limiting precise interventions targeting the cause of protraction., Methods: In this secondary analysis of nulliparas (n = 92) with obesity (BMI ≥ 30 kg/m 2 ) and spontaneous labor onset, we classified labor into four phenotypes based on duration of protraction and birth route: (1) no protraction, (2) short protraction and vaginal birth, (3) extended protraction meeting criteria for labor arrest, but with eventual progression and vaginal birth, and (4) extended protraction meeting criteria for labor arrest and cesarean birth. Across these phenotypes, we compared MVU, oxytocin dose, and novel measures of uterine responsiveness to oxytocin augmentation (MVU to oxytocin dose ratios)., Results: In our sample, phenotype group 1 comprised 14.1% (n = 13); group 2 comprised 30.4% (n = 28); group 3 comprised 34.8% (n = 32); and group 4 comprised 20.7% (n = 19). Uterine responsiveness to oxytocin, but not MVU, decreased with each labor phenotype. Participants with cesarean birth had the lowest uterine responsiveness to oxytocin., Conclusion: Labor and birth outcomes were associated with measures of uterine responsiveness to oxytocin rather than MVU alone, and thus these may be more clinically appropriate measures for guiding clinical decision-making. Current criteria for labor arrest are likely too stringent for nulliparas with obesity, many of whom appear to progress to safe vaginal birth after longer labor durations. Differences in uterine responsiveness to oxytocin augmentation across the groups suggests underlying physiologic differences in the labor phenotypes, which should drive future research targeting pathophysiology., (© 2023 Wiley Periodicals LLC.)

Dairy cows are predisposed to diseases during the postpartum period. Dystocia has been associated with increased risk for disease, which is likely the result of increased tissue trauma and stress during the prolonged parturition. To attenuate the inflammatory response seen in dystocic animals and improve well-being, we assessed the effects of a glucocorticoid, dexamethasone administered within 12 h after calving. Dystocia was defined as a difficult birth resulting in a prolonged calving (≥70 min after the amniotic sac appears) and was monitored through 3 video cameras in the close-up dry-cow pen. Cows meeting the dystocia definition were randomly assigned to receive a single intramuscular injection of either dexamethasone (DEX; 0.1 mg/kg of body weight; n = 43) or saline (CON, n = 44) within 12 h following a dystocic calving. Serum haptoglobin, blood β-hydroxybutyrate (BHB) concentrations, body temperature, and several behaviors were measured for the first 7 d postpartum. Additionally, milk production and components for the first 120 d were recorded. Using a mixed model, the fixed effects of treatment, parity, calving assistance, and time, along with 2- and 3-way interactions, were analyzed with cow as a random effect. We observed that primiparous DEX cows had greater serum haptoglobin concentrations on d 3 and d 7 postpartum compared with primiparous CON cows. There was no difference between treatment groups for blood BHB concentrations and body temperature. Behavior was altered between treatments, with DEX cows having reduced activity for the first week postpartum, as well as less restlessness and increased lying times on some of the days following calving. Treatment interacted with time for milk yield, such that DEX cows produced 2.7 kg/d less milk than CON cows for the first month following calving. The administration of dexamethasone resulted in changes in behavioral measurements, which could suggest a reduction in discomfort; however, due to the reduction in milk yield for the first month following calving, DEX administration may not be applicable for typical farm use. Additional research is needed to investigate treatments for cows experiencing dystocia without detrimental effects on milk yield., (The Authors. Published by Elsevier Inc. and Fass Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).)

Purpose of This Review: Even today, hundreds of thousands of women die or suffer high levels of morbidity associated with childbirth. One of the most common causes is halted labor progress, or labor dystocia. There have been no developments in the diagnosis or treatment of dystocic deliveries since Friedman designed the Partogram in the 1950s. Oxytocin is the only treatment for dystocic labor. Sometimes, oxytocin is a lifesaver for the woman, especially in severe postpartum hemorrhages. At the same time, it is also one of the most overused drugs in obstetric care. This review article is meant to provide a short overview of the current knowledge of uterine metabolism during labor, uterine lactate production, and its association with labor dystocia. The article also intends to reflect new ways of thinking regarding practical recommendations for treating labor dystocia and offer a look at the future of dystocic labor management.

Objective: To assess the effect of a modified definition of dystocia and of a different timing of interventions during spontaneous labor on the rate of oxytocin use and on its consequences on labor outcome., Methods: We compared oxytocin use and labor outcome before and after the introduction of a new protocol for the management of spontaneous labor. By protocol, oxytocin use and/or artificial rupture of the membranes was restricted to cases without progress in cervical dilatation for≥1h and/or no progress of fetal descent for≥1h at full dilatation. The main outcome measure was the rate of oxytocin use. Secondary outcome criteria were the consequences on labor (duration of labor, tachysystole and uterine hyperstimulation, abnormal fetal heart rate, cesarean delivery rate) and neonatal outcome., Results: Oxytocin use was strongly reduced from 2015 (69.2%) to 2016 (39.8%; P<0.01) and 2017 (31.9%; P<0.01). Abnormal FHR rates decreased simultaneously (respectively 52%, 37% et 29%, P<0.05), as well as uterine hyperstimulation (respectively 33.6%, 21.3% et 23.0%; P<0.05). The cesarean delivery rate did not vary significantly from 2015 (11.5%) to 2016 (8.4%; NS) but it decreased from 2015 to 2017 (11.5% to 2.6%, respectively; P<0.05). No difference was found in postpartum hemorrhage rates or in neonatal outcome. The duration of labor was significantly longer for women who delivered in 2017, compared with 2015 (372 minutes versus 306 minutes, respectively; P<0.05). After multivariate analysis, FHR abnormalities were reduced (aOR 0.65 IC 95% [0.49-0.86]) as well as cesarean deliveries during labor (aOR 0.5 IC 95% [0.26-0.97]) in 2017 only, compared with the reference year 2015., Conclusion: A simple and easy-to-use definition of dystocia and of interventions required during labor allowed a strong reduction of oxytocin use during labor with subsequent benefits such as reduced rates of FHR abnormalities, uterine hyperstimulations and cesarean deliveries, at the cost of a limited prolongation of labor, mainly in nulliparous women., (Copyright © 2020 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Objective: To evaluate whether treatment of slow labor progress among term nulliparous women using a 2-hour partograph action line reduces the incidence of prolonged labor versus a 4-hour action line., Methods: Randomized controlled trial of nulliparous women with a term singleton, non-macrosomic, cephalic fetus in labor attending a university hospital in Nigeria (2008-2015). For labor supervision, women were randomly assigned to the 2-hour (n=320) or 4-hour (n=320) partograph action line group. slow labor progress was treated with oxytocin augmentation The primary outcome was incidence of prolonged labor (>12 hours). Delivery mode, neonatal outcomes, and maternal satisfaction with treatment were secondary outcomes., Results: Prolonged labor rate did not significantly differ between the 2-hour (7/320, 2.2%) and 4-hour (8/320, 2.5%) action line groups. Secondary outcomes did not differ significantly. Oxytocin augmentation to treat slow labor progress was needed for 87 (27.2%) and 61 (19.1%) women in the respective 2- and 4-hour groups (P=0.025). Mean duration of first and second labor stages differed significantly between the groups (P<0.05)., Conclusion: The 2-hour partograph action line did not reduce incidence of prolonged labor relative to the 4-hour action line. Partograph with a 4-hour action line is recommended for labor supervision in all facilities., Clinical Trial Registration: Registered at ClinicalTrials.gov as (https://clinicaltrialsgov/show/NCT02911272)., (© 2020 International Federation of Gynecology and Obstetrics.)

Aim: To compare the effectiveness of intramuscular hyocine n-butyl bromide (HBB) with placebo for shortening the duration of the first stage of labor in term pregnancies., Methods: A double blind placebo-controlled randomized trial of parturients who presented at term in the active phase of labor was conducted. They were randomly (1:1 ratio) given intramuscular injection of either 40 mg (2 mL) of HBB or 2 mL of water for injection as a placebo. The primary outcome measures were the duration of first and second stages of labor. Subgroup analysis of primigravid and multigravid women were also performed for various outcomes. We did intention-to-treat analysis., Results: Sixty-two women were randomized to each group and none were lost to follow-up. Baseline characteristics were similar between the HBB and placebo groups. The mean duration of first stage of labor was noted to be significantly shorter in the HBB group for both the primigravidas (246.6 ± 21.9 vs 391.8 ± 56.6 min for control; P < 0.001) and for multigravidas (205.9 ± 17.8 vs 323.8 ± 16.0 min for control;P < 0.001).There was also significantly shorter duration of second stage of labor in the HBB group (primigravida: P = 0.013; multigravida: P = 0.016). The duration of third stage of labor, mode of delivery and maternal and/or neonatal outcomes for both classes of parturients were not significantly different., Conclusion: HBB is effective in reducing the first and second stages of labor without adverse maternal or neonatal outcome. HBB does not significantly influence the duration of third stage of labor including mode of delivery. More evidence is needed to further explore the potential useful role of HBB in the active phase of labor., (© 2020 Japan Society of Obstetrics and Gynecology.)

Objective: The post partum use of analgesics in cows has increased in consequence to society's increased awareness of animal welfare. However, it is known that the post partum administration of a subset of nonsteroidal anti-inflammatory drugs to cows may lead to an increased rate of retained placenta. Therefore, the aim of this study was clarify, whether a single administration of meloxicam to cows that experienced dystocia results in an increased rate of this disease., Material and Methods: The study was conducted in 63 Holstein-Friesian cows in 4 farms with random allocation into 2 groups: In animals of the treatment group (n = 27) a single subcutaneous injection of meloxicam (0.5 mg/kg) was administered within 2-8 hours after calving. The animals of the control group (n = 36) received the same volume of a bovine infusion solution (Amynin ® , bovine infusion solution, Boehringer Ingelheim) subcutaneously. A clinical examination of the cows was performed on the day of parturition and on the 21st day post partum. Findings on the days in between were obtained by questioning of the farmers. The exact Fisher-test was calculated in order to test for statistical differences between the treatment and control groups., Results: In cows of the treatment group, retained placenta was not observed more frequently than in cows of the control group., Conclusion and Clinical Relevance: A single administration of meloxicam to cows that experienced dystocia does not increase the incidence of retained placenta., Competing Interests: Die Firma Boehringer Ingelheim hat die Studie finanziell und durch die Bereitstellung von Metacam® unterstützt. Die Autoren bestätigen, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Parturition is often a stressful period, when the incidence of disease is high after calving, which has been associated with an uncontrolled inflammatory response. Therefore, the objective of this study was to test the effect of the administration of a nonsteroidal anti-inflammatory drug (meloxicam) on the behavior, health, and production of peripartum cows. Meloxicam was dosed at 1 mg/kg of body weight, and an empty gel capsule served as a placebo. Both were administered orally with a balling gun. Dairy cows and heifers were randomly assigned to 1 of 3 treatment groups: (1) meloxicam administration before calving, with a placebo administered after calving (MEL-PRE, n = 60), (2) placebo administered before calving, and meloxicam administered after calving (MEL-POST, n = 69), and (3) a placebo administered before calving and after calving (CTL, n = 65). To identify imminent calving events, a vaginal thermometer was inserted approximately 2 wk before the expected calving date and a drop in temperature was used to identify cows close to calving. Calving events were monitored via video cameras, and the amount of time that elapsed between the appearance of the amniotic sac at the vulva until delivery of the calf was used to determine calving difficulty score. Eutocic calving events were defined as cows that calved in ≤70 min, and dystocia was defined as cows that took longer than 70 min to calve. Milk yield and components were measured for the first 15 wk of lactation and accelerometers were used to record activity and lying behaviors. The effects of treatment, breed, parity, calving difficulty, and, when applicable, a repeated measure, along with interaction terms, were analyzed in mixed models. Regardless of the time of administration, dystocic cattle that received meloxicam were less active than dystocic CTL. Dystocic animals displayed more lying bouts on the day of calving and then displayed fewer lying bouts and were less active during the days following calving. No effect of treatment was noted on any health outcomes. Eutocic MEL-PRE animals produced 6.8 kg/d more milk than eutocic CTL. Regardless of calving difficulty, MEL-PRE animals produced more milk fat, protein, and lactose (kg/d) than CTL. In conclusion, meloxicam administration before calving appears promising in increasing milk yield in eutocic cows., (Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.)

Objective: Labor dystocia is an intransigent, high-profile issue in obstetric care. Amniotic fluid lactate (AFL) reflects the uterine metabolic status. High levels associate with subsequent need for operative intervention due to dystocia. In sports medicine, it is known that lactic acid can affect muscular performance and can be decreased by bicarbonate given orally before physical activity., Material and Methods: Two hundred dystocic deliveries were included. At the confirmation of dystocia, the AFL-level was analyzed. Deliveries were randomized to an intake of bicarbonate or not. In the "non-bicarbonate-group", stimulation with oxytocin was started immediately. In the "bicarbonate-group", bicarbonate was given; and oxytocin was started 1 hour after the intake. New sampling of AF was performed after 1 hour in both groups., Outcome Measured: if an oral intake of bicarbonate changes the AFL levels and enhances delivery outcome in dystocic deliveries., Results: Bicarbonate decreases the AFL levels (p < .001). The spontaneous vaginal delivery rate after treatment with bicarbonate was increased (p = .007), without affecting the fetal outcome., Conclusions: An increase of spontaneous vaginal deliveries resulted from bicarbonate ingestion by dystocic women. A decreased level of AFL-level was shown. This simple, low cost treatment has the potential to improve maternal morbidity and satisfaction worldwide.

BACKGROUND The current guideline for oxytocin regimens in the abnormal labor of delivery is continuous infusion. The objective of the present study was to compare effects and safety measures of various available regimens of oxytocin in abnormal labor delivery. MATERIAL AND METHODS In this clinical experimental study, a total of 900 pregnant women admitted for delivery were randomized into 5 group with 162 each. Pregnant women received oxytocin as continuous administration of 16 mU/min (Group I), 1 mU/min (group II), 4 mU/min (group III), 5 mU/min quarter-hourly (group IV), and through a syringe pump (group V). Measurement of the expense of delivery, the ratio of the instrumental delivery, and the other secondary outcome measures was performed to find the best regimen of oxytocin. The 2-tailed paired t test and Mann-Whitney U test following Dunnett's multiple comparison tests were used at 95% confidence level. RESULTS Pulsatile delivery had least risk of instrumental delivery as compared to continuous infusion (p<0.0001, q=6.663) and normal-frequency low-dose (p<0.0001, q=5.638) of oxytocin. The time required from infusion to delivery was longer for group II (p=0.001, q=2.925), group IV (p<0.0001, q=4.829), and group V (p<0.0001, q=41.456) than for group I. The expense of delivery was: group I < group II < group IV < group III < group V. CONCLUSIONS High-dose and pulsatile preparation of oxytocin had reduced risks of operative delivery vs. continuous administration.

Dystocia can be defined broadly as "difficult birth" or more specifically as difficulty in the bitch expelling the pups through the cervix, vagina, and vestibule. It is a fairly common emergency presented to the small animal practitioner with an incidence rate of approximately 5%. The incidence of dystocia is highest in toy and brachycephalic breeds, and occurs frequently in small litters (<3 pups) due to fetal oversize and delayed onset of labor. As duration of labor progresses, the mortality of the pups and even the bitch increases, with the highest number of stillborn pups occurring after 6 hours from the time of active parturition. Practitioners should understand the mechanism of normal parturition so that abnormalities can be readily identified and medical or surgical intervention performed in a safe and timely manner., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: One of the major complications related to delivery is labor dystocia, or an arrested labor progress. Many dystocic deliveries end vaginally after administration of oxytocin, but a large numbers of women with labor dystocia will undergo a long and unsafe parturition. As a result of the exertion required in labor, the uterus produces lactate. The uterine production of lactate is mirrored by the level of lactate in amniotic fluid (AFL)., Objectives: To evaluate whether the level of AFL, analysed in a sample of amniotic fluid collected vaginally at arrested labor when oxytocin was needed, could predict labor outcome in nulliparous deliveries., Methods: A prospective multicentre study including 3000 healthy primiparous women all with a singleton pregnancy, gestational age 37 to 42 weeks and no maternal /fetal chronic and/or pregnancy-related conditions. A spontaneous onset of labor, regular contractions and cervical dilation ≥ 3 cm were required before the women were invited to take part in the study., Results: AFL, analysed within 30 minutes before augmentation, provides information about delivery outcome. Sensitivity for an acute cesarean section according to high (≥10.1mmol/l) or low (< 10.1mmol/l) AFL values was 39.0% (95% CI; 27-50), specificity 90.3% (95% CI; 87-93) PPV 37.3% (95% CI; 27-48) and NPV was 91.0% (95% CI; 88-93). The overall percentage of correct predictions of delivery outcome when the AFL level was used was 83.7%. Deliveries with a high AFL-level correlated with delivery time >12h (p = 0.04), post-partum fever (>38°C, p = 0.01) and post-partum haemorrhage >1.5L (p = 0.04)., Conclusion: The AFL is a good predictor of delivery outcome in arrested nulliparous deliveries. Low levels of AFL may support the decision to continue a prolonged vaginal labor by augmentation with oxytocin. A high level of AFL correlates with operative interventions and post-partum complications., Competing Interests: EWI originally was one of the owners of the patent for the lactate measurement device used in this study. All patent rights were then transferred to ObsteCare AB, and EWI no longer is the patent owner. EWI received in early 2000 a small number of shares in ObsteCare AB, a commercial company that may use the results of this study commercially in the future. Over the past ten years, none of the authors has received any equity, promise of employment or consultancy, or a named position on a company board. None of the authors has been asked by any organisation to write, be named in, or to submit the paper. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials.

Introduction: A protocol including judicious use of oxytocin augmentation was investigated to determine whether it would change how oxytocin was used and eventually influence labor and fetal outcomes., Material and Methods: The population of this cohort study comprised 20 227 delivering women with singleton pregnancies ≥37 weeks, cephalic presentation, spontaneous or induced onset of labor, without previous cesarean section. Women delivering from 2009 to 2013 at Stavanger University Hospital, Norway, were included. Data were collected prospectively. Before implementing the protocol in 2010, oxytocin augmentation was used if progression of labor was perceived as slow. After implementation, oxytocin could only be started when the cervical dilation had crossed the 4-h action line in the partograph., Results: The overall use of oxytocin augmentation was significantly reduced from 34.9% to 23.1% (p < 0.01). The overall frequency of emergency cesarean sections decreased from 6.9% to 5.3% (p < 0.05) and the frequency of emergency cesarean sections performed due to fetal distress was reduced from 3.2% to 2.0% (p = 0.01). The rate of women with duration of labor over 12 h increased from 4.4% to 8.5% (p < 0.01) and more women experienced severe estimated postpartum hemorrhage (2.6% vs. 3.7%; p = 0.01). The frequency of children with pH <7.1 in the umbilical artery was reduced from 4.7% to 3.2% (p < 0.01)., Conclusions: The frequency of emergency cesarean section was reduced after implementing judicious use of oxytocin augmentation. Our findings may be of interest in the ongoing discussion of how the balanced use of oxytocin for labor augmentation can best be achieved., (© 2015 Nordic Federation of Societies of Obstetrics and Gynecology.)

Parturition in cattle is a stressful event for both the dam and the offspring. Stress and pain can alter the energy profile of calves and calving cows, producing a metabolic imbalance at birth. This study aimed to assess the effects of dystocia and oxytocin and calcium infusion on metabolic homeostasis in dairy cows and calves. Thirty Holstein cows and their calves were divided into three groups: an eutocia group (n=10), in which no calving assistance was needed; a dystocia group, which required mild-to-severe obstetric assistance (n=10); and a uterine inertia group, which was treated with oxytocin and calcium (n=10). To assess serum cortisol and blood glucose levels, blood samples were collected during the peripartum period from cows and during the first hour since birth from calves. All groups were hyperglycaemic following parturition. Infusion of oxytocin and calcium resulted in lower maternal glucose concentrations and lower levels of stress than in cows in the dystocia group. Birth condition was significantly associated with blood glucose and cortisol concentrations in calves. Glucose concentration was lower in calves born with oxytocin and calcium infusion than those born with fetal extraction. In conclusion, assisted calving with fetal extraction causes important metabolic changes for the dam and calf. Conversely, the practice of oxytocin and calcium infusion for hypotonic cows has no harmful effects on metabolic balance and can be safely employed as a medical treatment., (British Veterinary Association.)

The use of intravenous artificial oxytocin for augmentation of labour is very common in midwifery care in Sweden. Studies have shown that oxytocin is often administered to women in labour who have no signs of labour dystocia. It was the aim of this study to examine Swedish midwives' views on and experiences of labour augmentation in the context of normal labour. Individual interviews were carried out with 15 midwives from southern Sweden. The material was analysed using qualitative content analysis, which resulted in one theme: sense and sensibility and four main categories: permissible situations, motivating the decision, intervening in the birth process and iatrogenic awareness. The results showed that midwives expressed ambiguity about augmentation of labour. They were of the opinion that oxytocin was used very often and sometimes unnecessarily. There is awareness that interventions to augment labour can result in undesirable effects on the birth process. Despite this, deeper discussion of this problem was avoided in the interviews. Further research should focus on the process involved when midwives weigh pros and cons when deciding to augment labour. More knowledge is also needed about the barriers for optimal care in labour that are inherent in health-care systems., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Nalbuphine is an inexpensive, non-controlled, opioid analgesic that has been in clinical use for decades. A kappa opioid receptor agonist and mu opioid receptor antagonist, nalbuphine causes fewer adverse effects than other opioid analgesics. The author reviews the characteristics of nalbuphine, analyzes studies of nalbuphine in mice and explores the potential use of nalbuphine to treat pain in research mice. In analgesiometric studies in mice, nalbuphine ameliorates both somatic and visceral pain. Nalbuphine seems to have a broad range of safe doses for subcutaneous administration in mice. Unlike non-steroidal anti-inflammatory drugs, nalbuphine does not antagonize prostaglandins or impede labor in mice. Although additional study is needed before clinical use can be recommended, evidence presented here suggests that nalbuphine might be an effective analgesic for dystocia (or difficult birth) and other painful conditions in research mice.

Objective: Standardized oxytocin protocols have been used to improve the safety and quality of obstetric care. We examined rates of chorioamnionitis and labor dystocia requiring cesarean delivery as unintended consequences of the implementation of a low-dose, checklist-based oxytocin protocol., Study Design: We performed a retrospective cohort study of live singleton deliveries that underwent a trial of labor in two 15-month periods, comparing outcomes in those who delivered before to after protocol implementation. Patients and outcomes were identified using a combination of electronic medical records and International Classification of Diseases, 9th Revision, Clinical Modification codes. Time trend analysis was performed to evaluate for secular trends., Results: A total of 8,717 women were included; 5,077 received oxytocin. Despite an unchanged rate of cesarean deliveries from before to after initiation of the protocol (15.15 vs. 14.75%, p = 0.60), deliveries after protocol implementation were generally characterized by higher rates of chorioamnionitis (7.48 vs. 5.97%, p < 0.001), longer median time from admission to delivery (524 vs. 462 minutes, p < 0.001), more cesarean deliveries performed for labor dystocia (50.62 vs. 40.92%, p < 0.001), and fewer cesarean deliveries performed for fetal distress (32.52 vs. 38.67%, p = 0.02)., Conclusion: Low-dose oxytocin protocols are intended to increase safety, but they may have unintended consequences related to prolonged labor, and should be studied before widespread use., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Under adverse obstetrical conditions, appropriate supervision and assistance during the immediate neonatal period are of the utmost importance, especially for weak calves. The aim of this study was to establish the effects of dystocia and oxytocin infusion on neonatal vitality, acid-base balance, and electrolyte and haematological homeostasis of dairy calves. Data were collected for 30 Holstein calves which were allocated to three groups: normal calving (n = 10); dystocia with mild to severe obstetric assistance (n = 10); and uterine inertia treated with oxytocin (n = 10). All 30 calves exhibited normothermia at birth, but had a significant decrease in body temperature after 60 min. Dystocic calves had lower Apgar scores than calves in the other two groups, and had respiratory and metabolic acidosis. Calves from normal calvings had normal blood pH, but base excess below the reference range. The mean partial pressure (Pa) of oxygen of calves whose dam had been treated with oxytocin was lower than that of calves from normal calvings. In all experimental groups, there was improvement in metabolic status in the first 60 min postpartum as PaCO2 values significantly decreased. All calves had normonatraemia, normokalaemia and normochloridaemia during the study period, but calves born to dams treated with oxytocin had a higher sodium concentration than those in the two other groups., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Approximately 60% of women who labour in the USA receive some form of neuraxial analgesia, but concerns have been raised regarding whether it negatively impacts the labour and delivery process. In this review, we attempt to clarify what has been established as truths, falsities and uncertainties regarding the effects of this form of pain relief on labour progression, negative and/or positive. Additionally, although the term 'epidural' has become synonymous with neuraxial analgesia, we discuss two other techniques, combined spinal-epidural and continuous spinal analgesia, that are gaining popularity, as well as their effects on labour progression., (© 2014 Royal College of Obstetricians and Gynaecologists.)

Objective: Augmentation with oxytocin during labour has increased in Western obstetrics over the last few decades. The aim of this study was to describe how fathers experienced childbirth when non-progressive labour occurred and augmentation was established., Method: A qualitative descriptive design. Ten fathers were interviewed 4-15 weeks post partum. The interviews were semi-structured and were analyzed using Braun and Clarke's thematic analysis., Results: The analysis revealed three themes and four sub-themes. The themes were: (1) A rational approach to own role, (2) Labour and birth as uncontrollable processes and (3) Relief about the decision of augmentation. The fathers had a rational approach and felt powerless when the process of labour was uncontrollable. They felt they were not able to help their partners in pain when non-progressive labour occurred. They experienced relief when augmentation was established because of the subsequent progression of labour, and because it was then easier to find a role as a helper., Conclusion: This study demonstrates that fathers feel relieved when augumentation is established. In addition, the study underlines that fathers, in order to regain control after experiencing the non-progressive labour, need directions from the midwives to carry out appropriate and usefull tasks., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Objectives: augmented and not augmented women without dystocia were compared to investigate associations between oxytocin and adverse birth outcomes. Augmented women with and without dystocia were compared, to investigate associations between dystocia and adverse birth outcomes., Design: a cohort of low-risk nulliparous women originally included in a randomised controlled trial., Setting: the Department of Obstetrics and Gynaecology, Østfold Hospital Trust, Norway., Participants: the study population consists of 747 well defined low-risk women., Measurements: incidence of oxytocin augmentation, and associations between dystocia and augmentation, and mode of delivery, transfer of newborns to the intensive care unit, episiotomy and postpartum haemorrhage., Findings: of all participants 327 (43.8%) were augmented with oxytocin of which 139 (42.5%) did not fulfil the criteria for dystocia. Analyses adjusted for possible confounders found that women without dystocia had an increased risk of instrumental vaginal birth (OR 3.73, CI 1.93-7.21) and episiotomy (OR 2.47, CI 1.38-4.39) if augmented with oxytocin. Augmented women had longer active phase if vaginally delivered and longer labours if delivered by caesarean section if having dystocia. Among women without dystocia, those augmented had higher body mass index, gave birth to heavier babies, had longer labours if vaginally delivered and had epidural analgesia more often compared to women not augmented., Key Conclusion: in low-risk nulliparous without dystocia, we found an association between the use of oxytocin and an increased risk of instrumental vaginal birth and episiotomy., Implications for Practice: careful attention should be paid to criteria for labour progression and guidelines for oxytocin augmentation to avoid unnecessary use., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: The rate of operative deliveries (both caesarean sections, vacuum extractions and forceps), continues to rise throughout the world. These are associated with significant maternal and neonatal morbidity. The most common reasons for operative births in nulliparous women are labour dystocia (failure to progress), and non-reassuring fetal status. Epidural analgesia has been shown to slow the progress of labour, as well as increase the rate of instrumental deliveries. However, it is unclear whether the use of oxytocin in women with epidural analgesia results in a reduction in operative deliveries, and thereby reduces both maternal and fetal morbidity., Objectives: To determine whether augmentation of women using epidural analgesia with oxytocin will decrease the incidence of operative deliveries and thereby reduce fetal and maternal morbidity., Search Methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2013)., Selection Criteria: All published and unpublished randomised and quasi-randomised trials that compared augmentation with oxytocin of women in spontaneous labour with epidural analgesia versus intent to manage expectantly were included. Cluster-randomised trials were eligible for inclusion but none were identified.Cross-over study designs were unlikely to be relevant for this intervention, and we planned to exclude them if any were identified. We did not include results that were only available in published abstracts., Data Collection and Analysis: The two review authors independently assessed for inclusion the 16 studies identified as a result of the search strategy. Both review authors independently assessed the risk of bias for each included study. Both review authors independently extracted data. Data were checked for accuracy., Main Results: We included two studies, involving 319 women. There was no statistically significant difference between the two groups in either of the primary outcomes of caesarean section (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.42 to 2.12) or instrumental delivery (RR 0.88, 95% CI 0.72 to 1.08). Similarly, there were no statistically significant differences between the two groups in any of the secondary outcomes for which data were available. This included Apgar score less than seven at five minutes (RR 3.06, 0.13 to 73.33), admission to neonatal intensive care unit (RR 1.07, 95% CI 0.29 to 3.93), uterine hyperstimulation (RR 1.32, 95% CI 0.97 to 1.80) and postpartum haemorrhage (RR 0.96, 95% CI 0.58, 1.59)., Authors' Conclusions: There was no statistically significant difference identified between women in spontaneous labour with epidural analgesia who were augmented with oxytocin, compared with those who received placebo. However, due to the limited number of women included in the studies, further research in the form of randomised controlled trials are required.

Parturition is a necessary event for production in dairy cattle, and assistance at calving is common. There is limited use of nonsteroidal antiinflammatory drugs for the alleviation of calving pain and a paucity of research on the effects of these drugs on postpartum health and performance. This randomized triple blind clinical trial involved Holstein cows (n=42) and heifers (n=61) that experienced an assisted parturition. These animals received either 1 injection of meloxicam (0.5mg/kg of body weight) or placebo subcutaneously 24h following calving. Outcome measures included dry matter intake (DMI) and milk production for the first 14d in milk, blood metabolites sampled over 12d, health events for the first 60d in milk, as well as lying and feeding behavior 24h following injection. Continuous data were analyzed using multivariable regression models. Binary outcomes were analyzed using a mixed logistic model with cow modeled using a random intercept. This study failed to show any significant effects of treatment on DMI, milk production, blood metabolites, or health events. A possible explanation for the lack of treatment differences could be that the meloxicam was administered too late after calving. Meloxicam increased feeding time as well as bunk visit frequency in the 24h following injection. Regardless of treatment, animals that had retained fetal membranes produced less milk and had higher serum haptoglobin concentrations. Future research is warranted to examine the effects of antiinflammatory drugs administered closer to the time of calving on health and production., (Copyright © 2013 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.)

The objective was to measure the effects of VC (a uterotonic drug with vasodilator effects) in eutocic and dystocic sows, on the acid-base balance and some vitality traits of piglets at birth. Farrowing was induced with prostaglandin F2α. Four groups of sows (20 sows/group) were monitored; Groups 1 and 2 were eutocic sows, whereas Groups 3 and 4 were dam-fetal dystocic sows. Groups 1 and 3 (control) were given saline, whereas Groups 2 and 4 were given VC im (1.66 mg/kg of body weight) after the first piglet was born. Piglets' physio-metabolic performance was monitored peripartum. Treatment with VC reduced (P<0.0001) the percentage of intrapartum stillbirths in sows either with eutocic (5.2 vs. 10.0%) and dystocic (7.6 vs. 16.7%) farrowings and increased (P<0.0001) the number of pigs born alive without any evidence of AFS (89.9 vs. 79.9%, eutocic and 81.6 vs. 65.2%, dystocic). In addition, for the group of pigs with no acute fetal suffering (AFS), VC treatment enhanced survival responses with a half point grater vitality score in Group 4; it also reduced the latency to first teat contact by 6 min (P<0.05) in both treated groups compared to controls; and it improved the condition of the pigs' umbilical cord, with more adhered (98 vs. 86% in eutocic and 88 vs. 80% in dystocic; P<0.05) and less ruptured cords. Moreover, VC reduced the severity of adverse physio-metabolic indicators and the acid-base balance of piglets with AFS at birth by lowering blood lactate (89.8 vs. 93.5 mmol/L in eutocic groups and 94.6 vs. 100.2 mmol/L in dystocic groups; P<0.05), PaCO2 and Ca2+, and by increasing blood pH, HCO3 and PaO2 levels (P<0.05)., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Non-steroidal anti-inflammatory drugs (NSAIDs) have analgesic, anti-inflammatory, anti-endotoxic and anti-pyretic effects in cattle. As such, they could be expected to have significant effects in cows and calves in the post-calving period. This review evaluates the published data on the use of NSAIDs in the dam and its calf after dystocia, the impact of NSAIDs on uterine involution, the restoration of ovarian function and prevention and treatment of the metritis complex, and the benefits of using NSAIDs in the recumbent cow. Overall, the published data are very limited, despite frequent use of NSAIDs by veterinarians in the post-calving cow, and the small number of published studies focus on blanket treatment of calving cows rather than targeted treatment after dystocia. Blanket treatment had no economic benefit; indeed, some studies reported adverse effects, such as pyrexia and increased risk of metritis. There is even less information on the value of treating calves with NSAIDs after dystocia, despite significant tissue damage which may benefit from NSAID use. Appreciably more studies have evaluated the influence of NSAIDs on uterine and ovarian function, but clinical relevance is limited. In cows with a normal puerperium, prolonged treatment with NSAIDs may slow the restoration of normal function, but most reported studies are small and use NSAIDs more frequently and for longer periods than is common in general practice. The evidence of a clinical benefit in cows with puerperal disease is limited and equivocal, and the evidence base for the use of NSAIDs in the treatment of recumbent cows is also small, even though an expert panel concluded that NSAIDs were a key aspect of veterinary treatment of downer cows. The lack of evidence identified by this review supports the contention that NSAIDs are likely to be under-used and sub-optimally prescribed in the post calving period. Further research on the use of NSAIDs in the post-calving cow and calf is required., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Aim: The aim of this study was to evaluate the effectiveness of meperidine, administered during the first stage of labor in patients with uterine dystocia, on the duration of labor and neonatal acid-base status at birth., Material and Methods: We randomly assigned 240 nulliparous women with a singleton pregnancy at term who were diagnosed with uterine dystocia in labor at 4-6-cm cervical dilatation to receive either a single dose of 50 mg meperidine in 10 mL of saline (slow intravenous injection over 2 min) or 10 mL of isotonic saline (control group). The primary outcome measures were duration of labor (from the time of beginning of the intervention to the time of the expulsion of the fetal head) and umbilical cord arterial acid-base status., Results: The evidence revealed no statistically significant difference between the two groups in length of labor (188.2 ± 92.3 min in the meperidine group compared to 205.4 ± 96.1 min in the placebo group, P = 0.159). The pH of the umbilical cord arterial samples was lower in the meperidine group than in the control group, although the difference was not statistically significant (P = 0.089)., Conclusion: Because of the absence of any beneficial effect of meperidine on uterine dystocia, its use in labor should be limited to pain relief in the absence of epidural analgesia., (© 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.)

Physicians and veterinarians often prescribe oxytocin to treat dystocia. However, oxytocin administration to pregnant women or animals is not without risk. In the venue of laboratory animal medicine, the use of oxytocin may present confounding variables to research. Although oxytocin has been studied extensively, many of its physiologic effects and interactions with other hormones remain unclear. Investigator concerns about adverse and confounding effects of oxytocin in their research mice prompted the current review of oxytocin and its use to treat murine dystocia. Well-controlled studies of oxytocin in dystocic mice have not been conducted. However, in humans and other animals, inconsistent and adverse effects are well-documented. Limited knowledge of the complex physiologic and molecular mechanisms of action of oxytocin and scant support for the efficacy of oxytocin in dystocic mice fail to meet the standards of evidence-based veterinary medical practice. The administration of oxytocin is contraindicated in many cases of dystocia in research mice, and its use in dystocic mice may be unfounded. A brief review of oxytocin and the physiologic mechanisms of parturition are provided to support this conclusion. Alternative treatments for murine dystocia are discussed, and a holistic approach is advocated to better serve animal welfare and to safeguard the integrity of valuable research. Laboratory animal veterinarians overseeing the development of guidelines or standard operating procedures for technician or investigator treatment of dystocic mice should understand the effects of oxytocin administration in light of relevant research.

Objective: To describe an extensive process to implement guidelines for oxytocin use during labor and to report its effects on compliance to clinical practice guidelines after 1 year., Study Design: A multifaceted strategy was developed to involve all obstetric staff and identify possible local barriers to change in advance. The process lasted for more than 1 year., Main Outcome Measures: To describe the implementation of oxytocin use according to the new guidelines, and to compare management in clinical practice with guideline recommendations from audits performed before and after the project., Results: Identification of possible barriers to change, academic detailing, audits with feedback, and local opinion leaders were important factors for a successful process. Documentation of the indication for oxytocin use increased from 54% before, to 86% after the completion of the project (P<0.01). The percentage of incidents in which oxytocin augmentation was started before the diagnosis of labor dystocia was reduced from 40% to 11% (P<0.01). Improvement was found in the documentation of cardiotocography (from 5% to 58%, P<0.01) and contraction frequency at the start of the infusion (from 23% to 63%, P<0.01)., Conclusions: Our multifaceted strategy involved all obstetric staff, lasted for more than a year, and improved management of oxytocin use according to clinical guidelines. Established rules for documentation were used as a check list to monitor oxytocin use. However, audits with feedback need to continue for medical safety, and have been planned to take place every 6 months., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Sixty hybrid Yorkshire-Landrace penned sows, 30 with eutocic farrowing and 30 experiencing a dystocic parturition, were studied to evaluate the obstetric and neonatal outcomes to low doses of oxytocin administered at advanced stages of parturition. Animals in each group were randomly subdivided into 2 subgroups: 15 eutocic and 15 dystocic sows received oxytocin 0.083 IU/kg (equivalent to 1 IU/12 kg body weight), administered intramuscularly after the delivery of the 5th piglet; the other 15 eutocic and 15 dystocic sows received saline solution intramuscularly at the same time. Oxytocin decreased the number of intrapartum deaths by approximately 50% (P = 0.002). No piglet was born dead from the saline- and oxytocin-treated eutocic sows. The highest viability score was observed among piglets born to eutocic sows treated with oxytocin. In summary, this dose schedule would help to decrease the number of stillbirths in both eutocic and dystocic farrowing sows.

A total of 220 cows and heifers were treated with 3 mg/kg ketoprofen immediately after calving and 24 hours later, and 227 were left untreated as controls. The treated animals tended to have a lower incidence of retained fetal membranes and were 1.7 times less likely to develop the condition than the untreated animals. The treatment did not affect the incidence of milk fever, the endometritis score or the presence of a corpus luteum by 20 to 25 days after calving, and did not affect the cows' early lactation milk yield. There was no particular level of dystocia or periparturient conditions other than retained fetal membranes for which there might be a reproductive or productive advantage following the use of ketoprofen. The intervals from calving to first insemination or to pregnancy, the numbers of inseminations per pregnancy and the pregnancy rate to first insemination were also unaffected by ketoprofen treatment.

Objective: To investigate the use of oxytocin for augmentation of labor and its relation to labor progress and delivery outcome., Design and Setting: A retrospective observational study undertaken in a Swedish hospital during 2000-2001., Sample: Singleton pregnancies at > or = 37 weeks of gestation with cephalic presentation and spontaneous onset of labor., Methods: Data were collected from 1,263 clinical records. The partogram was used to diagnose labor dystocia (LD)., Main Outcome Measures: Prevalence of oxytocin administration, LD and operative delivery., Results: Oxytocin was administered to 55% of the women (75% of primiparas and 38.1% of multiparas); a majority did not meet LD criteria. LD frequency was 19.8% (32.7% in primiparas and 7.4% in multiparas). Oxytocin was started both 'too early' and 'too late' in relation to the diagnosis of LD. Cesarean section (CS) was performed on 17.1% of primiparous and 2.4% of multiparous oxytocin recipients with LD, compared to 2.3 and 1.5%, respectively, of oxytocin recipients without diagnosed LD., Conclusions: Oxytocin augmentation was undertaken in an unstructured manner; some women were inadequately treated and others were treated unnecessarily. Oxytocin recipients with LD underwent operative delivery to a higher extent than oxytocin recipients without LD, suggesting that the main reason for CS was the underlying problem of LD rather than the oxytocin augmentation itself.

The aim of the study was to evaluate oxidative stress around parturition in normally calved and dystocia-affected buffaloes and the clinical efficacy of vitamin E and selenium (Se) in reducing the effects in buffaloes suffering from dystocia. Plasma cortisol concentration, erythrocytic malondialdehyde (MDA) level and superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities were evaluated in dystocia-affected (supplemented (n = 8) and unsupplemented (n = 5) with vitamin E and Se) and normally calved (unsupplemented; n = 6) buffaloes. The decline in plasma cortisol concentration, MDA level and SOD activity was greater in the group of dystocia-affected buffaloes supplemented with vitamin E and Se (78.62 +/- 2.7%, 13.38 +/- 9.75% and 28.83 +/- 7.72%, respectively) than in the unsupplemented group (54.33 +/- 12.62%, 3.48 +/- 4.16% and 17.69 +/- 12.93%, respectively). These results suggests that supplementation with antioxidants like vitamin E and Se may be beneficial in reducing oxidative stress in dystocia-affected buffaloes in the immediate postpartum period.

Aims: The aim of this study was to determine during which phase of delivery augmentation is started when used and to establish any correlation that might exist between the oxytocin infusion and the evaluations by primiparas themselves of their labour pain, strength of contractions and fatigue. In addition, we wanted to determine any differences in duration between labour with and labour without augmentation. We finally wanted to measure the incidence of instrumental deliveries, perineal trauma and neonatal outcome among the augmented vs. the non-augmented groups., Background: The most commonly diagnosed complication in primiparas is ineffective contractions or protracted labour, otherwise known as dystocia, which literally means arrested or prolonged labour. Different treatments have been tried during the active phase of labour as well as the second stage of labour. The most common treatment today is amniotomy, often used in combination with an intravenous oxytocin infusion., Materials and Methods: The study was conducted at the hospital in Ostersund in central Sweden from August 1998 to September 1999. Consecutive primiparas giving birth at full-term were selected to the study. The inclusion criteria were an uncomplicated pregnancy and a spontaneous single delivery with head presentation. The total number of participants was 164., Results: The results showed that 50 of 164 primiparas needed no augmentation, while 88 were augmented during the active phase and 26 during the second stage of labour. The duration of the active phase [median (md) 4 hours 45 minutes, 6 hours 49 minutes and 6 hours 20 minutes respectively for the different groups, P = 0.03], the time between full dilation of the cervix and the start of the second stage (md 20 minutes, 30 minutes and 60 minutes respectively, P = 0.012) and the duration of the second stage of labour (md 40 minutes, 44 minutes and 60 minutes respectively, P = 0.04) were significantly longer in the augmented groups. Operative deliveries, too, were more frequent in the augmented groups. There was a significantly higher rate of perineotomies in the group augmented during the second stage of labour. There were, however, no differences in Apgar score <7 at 1 minute. pH in the umbilical cord and the base deficit were higher in the group which were augmented during the second stage of labour (P = 0.02 and P = 0.06 respectively). Women describing their impression of the experience as a whole generally gave it a high rating, but women who were augmented during the second stage of labour gave the experience a significantly lower score (P = 0.01)., Conclusion: Augmentation is used in unusually prolonged deliveries. We did not find that augmentation involved a higher frequency of perineal trauma, although it was correlated with a higher frequency of operative deliveries. There was no correlation between the oxytocin infusion and the primiparas' descriptions of the strength of contractions, pain and fatigue, although greater use of epidurals was observed in women with augmented labour. The number of nulliparas in this study was too small to analyse the incidence of ruptures in the sphincter or draw conclusions about differences between the groups with regard to Apgar scores or metabolic acidosis., Relevance to Clinical Practice: In clinical practice, good routines concerning oxytocin augmentation are crucial. Interventions as oxytocin augmentation seem to cause harm to mother and child. To evaluate interventions continuously in obstetric care is therefore important.

Objective: To test the safety and efficacy of prostaglandin E(2) (PgE(2)) as a treatment for dystocia in spontaneous labour., Design: Randomised, double-blind, placebo-controlled trial., Setting: Multicentre study in nine university-affiliated hospitals in Canada. Population Three hundred and thiry-two nulliparous women with spontaneous labour at term., Methods: Women who had progressed < 2 cm of cervical dilation in the 4 hours following the diagnosis of labour were randomly assigned to receive a single dose of either 1 mg (n= 112) or 2 mg (n= 111) PgE(2) vaginal gel or placebo gel (n= 109)., Main Outcome Measures: The primary outcome was resolution of dystocia, defined as a change in cervical dilatation of >0.5 cm per hour in the 6 hours following gel administration. Secondary outcomes were progress of labour, uterine hyperstimulation (more than five contractions in 10 minutes or a contraction lasting more than 2 minutes), use of oxytocin, method of delivery, maternal and neonatal morbidity., Results: Dystocia resolved more often after PgE(2) 1 mg (49%), RR 1.53 (95% CI 1.1, 2.1) and PgE(2) 2 mg (49%), RR 1.5 (CI 1.1, 2.1), compared with placebo (32%). Hyperstimulation was increased after PgE(2) 2 mg treatment (15%), RR 5.6 (95% CI 1.7, 18), but not after PgE(2) 1 mg (5.4%), RR 1.9 (CI 0.50, 7.6) when compared with placebo (2.8%). There was an increase in caesarean sections performed in the second stage of labour in the PgE(2) groups versus placebo. There were no differences in measures of maternal or neonatal morbidity., Conclusion: A single 1-mg dose of PgE(2) vaginal gel is more effective than placebo in resolving dystocia, without increasing uterine hyperstimulation, but may be associated with an increase in the incidence of second stage caesarean section.

Objective: This study was undertaken to evaluate whether the administration of meperidine decreases the length of labor in patients with a diagnosis of dystocia during the first stage of labor., Study Design: Women with term singleton pregnancies who received a diagnosis of dystocia and required an active management of labor were randomly assigned to receive either 100 mg of meperidine or placebo. The primary outcome measure was length of labor., Results: Four hundred seven pregnant women were included. There were no significant statistical differences between meperidine and placebo groups in length of labor and operative delivery rates such as forceps and cesarean section by intention-to-treat analysis. Low Apgar scores, umbilical artery acidosis, and admission to neonatal care units were increased in the meperidine group., Conclusion: Because of the absence of any benefits in patients with dystocia in labor and the presence of harmful effects on neonatal outcomes, meperidine should not be used during labor for this specific indication.

Objective: A preliminary assessment of the ability of Atosiban to alleviate uterine hyperactivity during active labor., Methods: Fifteen consecutive women with uterine hyperactivity during active labor were included in this prospective observational study. Atosiban was given as a single or repeated intravenous bolus dose (6.75 mg in 0.9 mL NaCl solution) if hyperactivity was not alleviated within 5 minutes with "intrauterine resuscitation" measures., Results: Alleviation of uterine activity was achieved in 14 out of 15 cases and was almost immediate in the responders. Alleviation of accompanying fetal heart rate abnormalities was achieved in 13 out of 14 cases. In 7 of 15 women a cesarean section was performed, eventually. Atosiban was well tolerated by all women and no side effects were noted. There were no 5 minutes Apgar scores of less than 7. There were no cases of neonatal asphyxia or neonatal mortality., Conclusion: Atosiban may be an effective treatment of uterine hyperactivity during active labor.

Kasuistics of Zoo animals with dystocia (Anoa, Giraffe, Snow goat, Scimitar horned Antelope, Bactrian camel, Tiger, Diana monkey) treated with special pharmaceuticals (glukokortikoids, cienbuterol, denaverine, carbetocin) and distance injections by blow darts are introduced. These procedures are described as very effective and save methods of obstetrics especially in Zoo animals.

Objective: To compare the benefits of one-to-one nurse labor support with the benefits of usual intrapartum nursing care in women stimulated with oxytocin., Design: A secondary analysis of a randomized controlled trial., Setting: A 637-bed university hospital., Participants: One hundred nulliparous women 37 weeks or more gestation, carrying singletons, in labor with vertex presentation, stimulated with oxytocin, less than 5 cm dilated at baseline, and not scheduled for cesarean delivery or induction nor having paid labor support present., Interventions: One-to-one care consisted of the presence of a nurse during labor and birth who provided emotional support, physical comfort, and instruction on relaxation and coping techniques. Usual care consisted of care for 2-3 laboring women with supportive activities varying by nurse., Main Outcome Measure: Cesarean delivery., Results: A beneficial trend because of one-to-one nurse support, with a 56% reduction in risk of total cesarean deliveries [RR of experimental vs. control = 0.44 (95% confidence interval = 0.19 to 1.01)]., Conclusion: The beneficial trend in reducing cesarean deliveries attributed to one-to-one nursing in women stimulated with oxytocin suggests that continuous support by intrapartum nursing staff may benefit women stimulated with oxytocin during labor.