Modern Conducted Labor is Medically Assisted A

Introduction: First child delivery stage lasts 12-16 hours not including any medications, while the second child delivery stage and grand multiparity last a couple of hours shorter. Oxytocin (Syntocinon®) is drug that facilitates well-fed delivery, therefore, induced labor assisted by peridural lasts approximately 4 hours less than natural labor not supported by any medication. Aim: To make quantitative analysis of the medically assisted childbirth and spontaneous vertex delivery within three years (2014-2016). Methodology: This paper is part of a non-commercial, retrospective, IV phase epidemiological study. The study was conducted at the Clinical Centre “Dr Dragiša Mišović, Dedinje”, Hospital for Gynecology and Obstetrics. The data are obtained from the ZIS Monthly-Yearly Heliant Reports of the Hospital for Gynecology and Obstetrics, Delivery room. Results: In the Clinical Centre “Dr Dragiša Mišović, Dedinje”, Hospital for Gynecology and Obstetrics, Delivery room there is over 2000 childbirths annually. Number of pharmacologically assisted labors was 1290 or (62%) in 2014, in 2015 was 1318 or (61%) and in 2016 was 1286 or (60%).Using syntocinon, there was 585 or (28%) in 2014, in 2015, 513 or (28%) and in 2016, 639 or (30%) cesarean sections, urgent, planned and elective labors. Of the total 80% of newborns received Apgar score 9 (nine). Conclusions: Labor induced by medication is a joint choice of a midwifes and doctors health team because the fl ow of labor can be anticipated and infl uenced at any moment.


INTRODUCTION
Obstetrician prescribes the therapy while the nurse-midwife applies it, as in any other case in medical fi eld.Oxytocin (Syntocinon®) solution for injection / concentrate solution for infusion; 5 i.j./ml; 10 i.j./ml, Novartis Pharma Stein AG) is a synthetic nonapeptide, identical to oxytocin, which is a natural hormone of the pituitary gland rear lobe.It aff ects smooth uterus muscles and causes their contraction, and due to this fact, it is mostly used in obstetrics [1,2,3].As any other drug, it has its own indications and contraindications (table 1).
First child delivery stage lasts 12-16 hours not including any medications, while the second child delivery stage and grand multiparity last a couple of hours shorter [4].Syntocinon is drug that facilitates well-fed delivery, therefore, induced labor assisted by peridural lasts approximately 4 hours less than natural labor not supported by any medication [5].More than 50% of labors are completed by administering some drug because this way can be obtained the necessary strength and the contraction interval, and it is easier and quicker for the mother to pull through certain stages.
Induction involves 5IJ Syntocinon in a 500ml 0.9% NaCl solution 24 ml/h, therefore, it can be increased by half an hour.Naturally, obstetrician prescribes the therapy aft er pregnant woman examination [1].In stimulation, it starts with the completely same therapy, but dose of ml/h is given aft er the gynecological examination, because it indicates labor stage, the extent of dilatation, while cardiotocography (CTG) shows contraction strength level [1].In expulsion Syntocinon is used when contraction tensions are absent or stopped and patient needs help at the fi nal stage.Syntocinon is then administered in a bolus of 5 IU in 20 ml NaCl of 0.9% per 1 ml or 2 ml, as the physician prescribes [1].
Th e induction of the labor shortens the duration of delivery, so it is also significant for the patient and for the entire team and contributes to a better outcome.Nowadays, with the help of pharmacology, more precisely, medication for well-fed delivery and medication for the elimination of pain, future mothers can fi nally enjoy the most precious day of life.It is very important for midwives that the patients suff er less from the pain and that delivery lasts shorter so when the expulsion occurs, they have better cooperation with the mother.Consequently, the outcome of the labor is much more favorable and the Apgar scores i.e. the evaluation of newborns are much better.

AIM
To make quantitative analysis of the medically www.hophonline.orgOxytocin therapeutic indications -induction of childbirth with a clear medical indication; -labor stimulation in individual cases poor contractions of the uterus; -during cesarean section, after childbirth and placental removal; -prevention and therapy of postpartum uterine hemorrhage and uterine atony -in early stages of pregnancy, as an adjuvant therapy in cases of incomplete, preterm or spontaneous abortion.contraindications -oxytocin-susceptibility or any of the other substances included in the drug.
-hypertonic contraction of the uterus, mechanical childbirth obstruction, fetal distress.
-any condition due to the safety of the mother or fetus spontaneous childbirth is not advised and / or the vaginal childbirth is contraindicated: signifi cant cephalopelvic disproportion, fetal malpresentation, placenta previa or vasa previa, placenta abruption, prolapse or presentation of the umbilical cord, excessive stretching of the uterus and reduced uterine resistance to rupture as in multiple pregnancies,), excessive fetal water, in women with a large number of previous grand multiparity, in the presence of scarring on the uterus as a result of extensive surgical interventions, including cesarean section.

Table 1. Oxytocin therapeutic indications and contraindications
assisted childbirth and spontaneous vertex delivery within three years (2014-2016).

METHODOLOGY
Th is paper is part of a non-commercial, retrospective, IV phase epidemiological study.Th e study was conducted at the Clinical Centre "Dr Dragiša Mišović, Dedinje", Hospital for Gynecology and Obstetrics.
Th e data are obtained from the ZIS Monthly-Yearly Heliant Reports of the Hospital for Gynecology and Obstetrics, Delivery room [6,7].

RESULTS
In the Clinical Centre "Dr Dragiša Mišović, Dedinje", Hospital for Gynecology and Obstetrics, Delivery room there is over 2000 childbirths annually (Table 2).

Volume 4 • Number 3 • October 2017 • HOPH
During 3 years, the number of spontaneous labors in vertex position, that is, in non-pharmacologically supported labors was more than 1300 (Table 3).
Approximately 1% are labors without peridural anesthesia, and over 50% of the labors are induced with the help of Syntocinon [6].
Of the total 80% of newborns received Apgar score 9 (nine), to the satisfaction of the entire team of Maternity clinic, including doctors, pediatricians, anesthetists, midwives, anesthetists and pediatric nurses [9].

DISCUSSION
Modern obstetric procedures involve safer and more comfortable childbirths.
Shortening labors of 4 and more hours lowers the trauma of the mother and the child and reduces the possibility of delivery and post-partum complications [2,3].Today, patients are well-informed, pregnant women want to have a more comfortable, possibly pain-free modern well-fed delivery.Th e results of our study are in conformity with other authors, the number of pharmacologically-assisted labors is more than 80% of the total number of childbirths, i.e. labors not infl uenced by pharmacological or any obstetric intervention.
Conducted, modern labor helps to anticipate and infl uence the labor process at any moment.Syntocinon is necessary in pharmacologically-assisted labors whether it is completed operatively or vaginal.In third stage, all women that gave vaginal births receive 5 i.j. of syntocinon to facilitate the uterus contraction and the rapid stopping of bleeding.

CONCLUSION
Labor induced by medication is a joint choice of a midwifes and doctors health team because the fl ow of labor can be anticipated and infl uenced at any moment.