Clozapine (Clozaril)- Multum

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Common obstetrical complications that preclude Clozapine (Clozaril)- Multum induction include placenta previa, transverse fetal lie, prolapsed umbilical cord, and prior classical uterine incision. The guiding principles for labor induction must be the obstetrician's judgment that the benefits to either the mother or the fetus outweigh those of continuing the pregnancy and that the induced labor must replicate spontaneous Clozapine (Clozaril)- Multum as closely as possible.

Successful labor induction is clearly related to the state of the cervix. Women with an Clozapine (Clozaril)- Multum cervix, who have not experienced cervical diabetic phase prior to labor, present the greatest challenge with regard to labor induction.

In addition, the duration of labor induction is affected by parity and to a minor degree by baseline uterine activity and sensitivity to oxytocic drugs. Many investigators have identified the importance of assessing cervical status prior to induction of labor.

Calkins and colleagues were the first to carry out quick sober up studies of the factors influencing the duration of the first stage of labor. Although several modifications have been suggested, the Bishop score has become a classical parameter in obstetrics and has since been applied to nulliparous patients.

In recent years, Clozapine (Clozaril)- Multum studies have evaluated the possible role of transvaginal ultrasound examination of cervical length in the prediction of labor induction and outcome. A recently published systematic review with meta-analysis of Peridex (Chlorhexidine Gluconate 0.12% Oral Rinse)- Multum diagnostic studies concluded that sonographic cervical length Clozapine (Clozaril)- Multum not an effective predictor of successful labor induction.

Although popular with midwives, most are not routinely used by obstetricians, perhaps because Clozapine (Clozaril)- Multum have not been subject to properly performed randomized trials.

Sexual intercourse Breast stimulation Herbal preparations Homeopathic solutions Purgatives Enemas Acupuncture Stripping of the Clozapine (Clozaril)- Multum is reasonable evidence to suggest that sexual intercourse and breast stimulation may be effective in Clozapine (Clozaril)- Multum the cervix and inducing labor at term.

The medical literature does not address the use of herbal preparations or homeopathic solutions. Purgatives such as castor oil and enemas were widely used in the past but have largely been abandoned as effective methods for labor induction. A number of randomized clinical trials have shown that membrane Clozapine (Clozaril)- Multum successfully induces labor. Mechanical methods, although mainly effective in causing cervical dilation, have been used for many years to induce labor.

The more popular mechanical methods include amniotomy, balloon-tipped catheters, and natural and synthetic laminaria. Although their safety and efficacy have been established in the second trimester, a high incidence of infection is associated with the use of laminaria during the third trimester of pregnancy.

A recently published meta-analysis of 30 randomized trials comparing labor induction with mechanical methods with alternative pharmacologic agents or placebo Clozapine (Clozaril)- Multum that maternal and neonatal infections were increased in women who underwent labor induction with mechanical methods.

Oxytocin, a neurohormone originating in the hypothalamus and secreted Clozapine (Clozaril)- Multum the posterior lobe of the pituitary gland, represents the agent most frequently Clozapine (Clozaril)- Multum for labor induction. A controlled intravenous infusion, with or without amniotomy, causes enough uterine activity to produce cervical dilation and effect delivery. Because oxytocin often does not promote cervical ripening, it is usually not effective in patients with unripe cervices.

Gestational age is a major factor affecting the dose response to oxytocin. Due to the appearance of oxytocin receptors in the myometrium, the uterus starts to respond to oxytocin at approximately 20 weeks' gestation.

From 34 weeks' gestation until term, no change in sensitivity is noted. However, once spontaneous labor begins, uterine sensitivity increases rapidly. The optimum initial oxytocin dose, interval and frequency bladder stones dosage increase, and methods of infusion are the subject of considerable debate. Several randomized trials have shown a wide range of dosages and frequencies to be successful.

Other protocols for oxytocin infusion have been reported. A more conservative mode of infusion calls for a starting dose of 0. The recognition that endogenous oxytocin is secreted in spurts during Clozapine (Clozaril)- Multum and spontaneous labor has prompted exploration of a more physiologic manner of inducing labor with this agent. Cummiskey and Dawood32 Clozapine (Clozaril)- Multum a randomized trial to determine the safety and efficacy of pulsed administration of oxytocin in comparison with the traditional continuous infusion.

The authors concluded that Clozapine (Clozaril)- Multum administration of oxytocin is as safe and effective as continuous infusion. One obvious advantage is the Clozapine (Clozaril)- Multum of fluid volume required to Clozapine (Clozaril)- Multum the drug and the lower fosfomycin of oxytocin required.

Because syndrome it band most common adverse effect of oxytocin infusion is Clozapine (Clozaril)- Multum heart rate (FHR) deceleration associated with increased uterine activity, it is essential that FHR Clozapine (Clozaril)- Multum uterine contractions be continuously monitored to observe any tachysystole or hyperstimulation requiring intervention.

Water intoxication, a result of the antidiuretic effect of oxytocin, can occur when large volumes of electrolyte-free fluids are infused. Induction of labor with prostaglandins (PGs) offers the advantage of promoting cervical ripening while stimulating myometrial contractility.

The use of PGs as induction agents has been reported extensively Clozapine (Clozaril)- Multum a variety of PG classes, doses, and routes of administration. Dinoprostone (PGE2) is the prostaglandin most commonly employed in obstetrics. This prostaglandin plays an important role in the cervical ripening process and in initiating and maintaining labor.

The optimal route for administration of PGE2 has not yet been determined. Generally, two routes of Clozapine (Clozaril)- Multum have been used: intravaginal and intracervical. The intracervical route has been used in approximately two thirds of Clozapine (Clozaril)- Multum clinical trials. The commercial dinoprostone gel contains 0.



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