The Pathophysiology of Labor Dystocia: Theme with Variations

Kissler, Katherine; Hurt, K. Joseph

doi:10.1007/s43032-022-01018-6

Cited by 21 publications

(20 citation statements)

References 138 publications

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“…Given our findings that the risk of cesarean birth in this group was independent of MVU, we suggest alternative measures that incorporate both oxytocin dose and uterine activity may more accurately characterize uterine activity in the context of augmentation and be more useful for treatment algorithms (Frey et al, 2014;Kissler, 2021;Kissler et al, 2020;Kissler & Hurt, 2022). In addition, uterine electromyography may detect nuances in uterine contractility that may differentiate the underlying cause of labor dystocia and predict how an individual will respond to oxytocin augmentation (Kissler et al, 2020).…”

Section: Discussionmentioning

confidence: 95%

The Relationship Between Uterine Activity, Oxytocin Dosing, Labor Progress, and Mode of Birth in Nulliparas with Obesity: Minimal Usefulness of Montevideo Unit Measurement

Kissler

Hernandez

Carlson

2023

Biological Research For Nursing

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Background Maternal obesity and cesarean birth disproportionately affect Black parturients; thus, prevention of cesarean birth is a key modifiable factor to improve pregnancy outcomes and reduce disparities. The primary driver of unplanned cesarean birth among people with higher body mass index is prolonged labor duration. However, strategies to optimize outcomes in these situations have not been established. We aimed to evaluate the influence of oxytocin augmentation on uterine activity and labor progression in nulliparas with obesity. Methods This secondary analysis involved nulliparas with obesity (BMI ≥30 kg/m2) who had spontaneous labor onset followed by oxytocin augmentation and an intrauterine pressure catheter. Using Linear Mixed Models, we evaluated relationships between uterine activity measured in Montevideo units (MVU), oxytocin dose, and rate of cervical dilation normalized by labor duration. Results In this diverse sample (35.6% Caucasian, 16.11% African American, 40.2% Hispanic) of nulliparas with obesity ( n = 87; BMI 35.54 ± 4.38 kg/m2), 31% ended labor with cesarean birth. Among those with vaginal birth, only 13% had MVU ≥200 prior to the final 2 hours of labor. MVUs were only minimally responsive to oxytocin dose and were not associated with labor progression nor birth route. Conclusion MVU measurements may not be useful to diagnose labor arrest in nulliparas with obesity. Optimizing care for birthing people with obesity is essential for improving perinatal outcomes and for reducing racial health disparities.

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Section: Discussionmentioning

confidence: 95%

The Relationship Between Uterine Activity, Oxytocin Dosing, Labor Progress, and Mode of Birth in Nulliparas with Obesity: Minimal Usefulness of Montevideo Unit Measurement

Kissler

Hernandez

Carlson

2023

Biological Research For Nursing

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“…Lastly, research must be intensified on the pathophysiology of prolonged labour, on promising new treatments, and on how to bridge the evidence-practice gap (fig 1). 56 Improved understanding of causes of prolonged labour may lead to effective, individualised management 23. Also, after 70 years of use, a thorough understanding of the potential effects of oxytocin augmentation when administered restrictively, rather than near routinely, is long overdue.…”

Section: Towards Timely Safe and Respectful Care Everywherementioning

confidence: 99%

“…However, the commonest cause of prolonged labour is inefficient uterine contractions (fig 1). 2 For women with weak uterine contractions, synthetic oxytocin may increase the power of contractions, but there are associated risks, including hyperstimulation, stillbirth, and neonatal complications. 45678910 Furthermore, caesarean section may still be required, and evidence that synthetic oxytocin reduces the risk of caesarean section is scarce 56.…”

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confidence: 99%

Inconsistent definitions of labour progress and over-medicalisation cause unnecessary harm during birth

Maaløe,

Kujabi,

Nathan

et al. 2023

BMJ

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“…Phasic uterine contractions are the essential part of parturition for birthing and minimizing postpartum hemorrhage (23–25). Abnormal uterine contractions can lead to labor complications (26, 27) resulting in high risks of maternal mortality and morbidity. It can also cause preterm birth (28, 29), which is the leading cause of infant mortality and morbidity (28, 29).…”

Section: Introductionmentioning

confidence: 99%

Modeling Normal Mouse Uterine Contraction and Placental Perfusion with Non-invasive Longitudinal Dynamic Contrast Enhancement MRI

Cortes,

Stapleton,

Schwab

et al. 2024

Preprint

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The placenta is a transient organ critical for fetal development. Disruptions of normal placental functions can impact health throughout an individual's entire life. Although being recognized by the NIH Human Placenta Project as an important organ, the placenta remains understudied, partly because of a lack of non-invasive tools for longitudinally evaluation for key aspects of placental functionalities. Non-invasive imaging that can longitudinally probe murine placental health in vivo are critical to understanding placental development throughout pregnancy. We developed advanced imaging processing schemes to establish functional biomarkers for non-invasive longitudinal evaluation of placental development. We developed a dynamic contrast enhancement magnetic resonance imaging (DCE-MRI) pipeline combined with advanced image process methods to model uterine contraction and placental perfusion dynamics. Our novel imaging pipeline uses subcutaneous administration of gadolinium for steepest-slope based perfusion evaluation. This enables non-invasive longitudinal monitoring. Additionally, we advance the placental perfusion chamber paradigm with a novel physiologically-based threshold model for chamber localization and demonstrate spatially varying placental chambers using multiple functional metrics that assess mouse placental development and continuing remodeling throughout gestation. Lastly, using optic flow to quantify placental motions arisen from uterine contractions in conjunction with time-frequency analysis, we demonstrated that the placenta exhibited asymmetric contractile motion.

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The Pathophysiology of Labor Dystocia: Theme with Variations

Cited by 21 publications

References 138 publications

The Relationship Between Uterine Activity, Oxytocin Dosing, Labor Progress, and Mode of Birth in Nulliparas with Obesity: Minimal Usefulness of Montevideo Unit Measurement

The Relationship Between Uterine Activity, Oxytocin Dosing, Labor Progress, and Mode of Birth in Nulliparas with Obesity: Minimal Usefulness of Montevideo Unit Measurement

Inconsistent definitions of labour progress and over-medicalisation cause unnecessary harm during birth

Modeling Normal Mouse Uterine Contraction and Placental Perfusion with Non-invasive Longitudinal Dynamic Contrast Enhancement MRI

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