***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Objectives Intrathecal sufentanil provides analgesia comparable to epidural bupivacaine for the first stage of labor . Both epidural local anesthetics and intrathecal opioid reduce some parameters of the neuroendocrine response to labor pain and the reflex release of oxytocin in animals . In humans , epidural local anesthetics only reduce the spurt release of oxytocin . This study compared the effect of intrathecal sufentanil and epidural bupivacaine administration on the plasma concentration of oxytocin and cortisol in women with labor pain during the first stage of labor . Methods Thirty healthy parturients requesting analgesia were enrolled in this r and omized and open-label study . Each patient was in spontaneous labor at greater than 5 cm cervical dilatation . Using a combined spinal and epidural technique , patients received either intrathecal sufentanil 10 μg ( SUF = intrathecal sufentanil group ) or epidural plain bupivacaine 0.25 % , 12 mL ( BUPIV = epidural bupivacaine group ) . Analgesia was assessed using a visual analog scale , and blood sample s for oxytocin and cortisol plasma concentration measurements were collected immediately before analgesia and 15 , 30 , 60 , and 90 minutes after induction of the analgesia . Plasma cortisol and oxytocin concentrations were determined by specific radioimmunoassay . The values were expressed as mean ± SEM . Results Intrathecal sufentanil provided faster and more complete analgesia within 15 and 30 minutes of its administration , compared with epidural bupivacaine . Plasma oxytocin concentrations were similar in the 2 groups before analgesia ( 7.24 ± 2.1 and 6.6 ± 3.1 pg/mL SUF and BUPIV , respectively ) . It decreased significantly in the SUF and increased in the BUPIV after analgesic administration . Cortisol concentrations were elevated in both groups before analgesia ( 51.6 ± 5.3 and 54.2 ± 4.8 μg/dL SUF and BUPIV , respectively ) . Both analgesic treatments significantly decreased the plasma cortisol levels . Conclusions Intrathecal sufentanil analgesia decreases plasma concentrations of oxytocin and cortisol in women with labor pain during the first stage of labor , but epidural bupivacaine only reduced the cortisol concentration 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 / Methods In this clinical experimental study , a total of 900 pregnant women admitted for delivery were r and omized 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 OBJECTIVE The objective was to test the safety and efficacy of a pulsatile oxytocin infusion protocol in which a computer-controlled pump adjusts the oxytocin dose rate on the basis of uterine activity . STUDY DESIGN A total of 358 women were enrolled in , and 310 completed , a prospect i ve , r and omized clinical trial comparing three protocol s for the induction of labor with oxytocin : aggressively managed continuous infusion , conservatively managed continuous infusion , and computer-controlled pulsatile infusion . Results were analyzed with Student t and chi 2 " goodness-of-fit " tests . RESULTS Mean doses of oxytocin  in the group receiving pulsed oxytocin were approximately 20 % of the dose rates in the continuous infusion protocol s. All protocol s effectively established labor in the majority of patients , although nulliparous women with unfavorable Bishop scores were more likely to fail to establish labor within a 24-hour period when treated with the aggressive continuous protocol . There were no differences in the rates of cesarean section , hyperstimulation , blood gases , or Apgar scores among the three treatment groups . CONCLUSIONS  Oxytocin  dosage was minimized by use of a computer-controlled pump . With the exception of aggressively managed nulliparous women , there were no differences in the percentages of patients with successful inductions among the three protocol s. The percentage of successful inductions was lower for aggressively managed nulliparous women than for other patient and protocol groups OBJECTIVE To determine whether pulsatile oxytocin infusion improves delivery outcome in women requiring induction or augmentation of labor . STUDY DESIGN Two related r and omized controlled trials undertaken in 2 inner-city United Kingdom university hospitals ( IS RCT N72773405 ; http://www.is rct n.org/ ) . Women were r and omly assigned to a pulsatile or continuous infusion protocol . PRIMARY OUTCOME cesarean section rate ( induction trial ) ; operative delivery rate ( augmentation trial ) . RESULTS For induction , cesarean section rates were similar in women receiving pulsatile ( n = 264 , 38.3 % ) vs continuous infusion of oxytocin ( n = 257 ; 37.7 % ; risk ratio , 1.01 ; 95 % confidence interval , 0.81 - 1.26 ; P = .903 ) , but associated with increased " infusion to time of delivery " intervals ( P < .001 ) in the pulsatile group . For augmentation , pulsatile infusion result ed in higher operative delivery rates ( 70.1 % , n = 251 ) vs continuous infusion ( 62.7 % , n = 249 ; risk ratio , 1.12 ; 95 % confidence interval , 0.99 - 1.27 ; P = .077 ) and increased neonatal morbidity . CONCLUSION For induction , pulsatile infusion of oxytocin is effective , but conferred little clinical benefit . Pulsatile infusion is not recommended for augmentation In a prospect i ve r and omized study , 20 patients with term pregnancies underwent induction of labor with either continuous or pulsed ( every 8 minutes ) intravenous oxytocin infusion . There were no significant differences with respect to induction-labor interval , induction-delivery interval , cesarean section rates , need for pain relief and Apgar scores . Sixty percent of patients receiving continuous oxytocin infusion developed uterine hyperstimulation but only 10 % receiving pulsed oxytocin did so . However , the difference was not significant . The mean + /- SEM total amount of oxytocin  given by continuous infusion was 4237 + /- 1066 mU which was 70 % more than by pulsatile infusion ( 2454 + /- 808 mU ) . The highest rate of oxytocin infused was significantly lower by pulsatile administration ( 5.2 + /- 0.8 mU/min ) than by continuous infusion ( 9.2 + /- 1.8 mU/min , p = less than 0.05 ) . Our study demonstrates that pulsed administration of oxytocin every 8 minutes is as effective and safe as continuous intravenous infusion of oxytocin for induction of labor , requires less  oxytocin  with therefore , a wider margin of safety and is consistent with the pulsatile release of oxytocin during normal labor The incidences of postpartum haemorrhage and retained placenta have decreased with the use of synthetic oxytocin and controlled cord traction . Whether such treatment is valuable is open to question because of the lack of clinical and physiological studies . The physiological effects of synthetic oxytocin on plasma concentrations of oxytocin and events during delivery were assessed . Plasma oxytocin concentration was determined in serial sample s during the late second stage and throughout the third stage of labour in 25 women . Ten women received combined ergotamine and synthetic oxytocin intramuscularly and 15 were not treated . The geometric mean plasma oxytocin concentration significantly increased in the women given oxytocin when measured before and after delivery of the fetal anterior shoulder ( 3.1 ( SD 2.0 ) pmol/l before and 15.9 ( 2.7 ) pmol/l after ) . Six of the women who did not receive treatment showed a significant increase in geometric mean plasma oxytocin concentration before and after delivery of the fetal shoulder ( 3.2 ( 2.0 ) pmol/l before and 6.4 ( 2.0 ) pmol/l after ) and nine did not show an increase ( geometric mean 2.4 ( 3.1 ) pmol/l before and 2.2 ( 2.2 ) pmol/l after ) . Of these nine women , two had an  abnormal third stage of delivery ; one woman had a postpartum haemorrhage  and one required manual removal of the placenta . As it is impossible to predict which women will show a rise in the plasma concentration of endogenous oxytocin  , intramuscular oxytocin should be given routinely BACKGROUND Cesarean section is associated with delayed mother-infant interaction because neither the mother nor the father routinely maintains skin-to-skin contact with the infant after birth . The aim of the study was to explore and compare parent-newborn vocal interaction when the infant is placed in skin-to-skin contact either with the mother or the father immediately after a planned cesarean section . METHODS A total of 37 healthy infants born to primiparas were r and omized to 30 minutes of skin-to-skin contact either with fathers or mothers  after an initial 5 minutes of skin-to-skin contact with the mothers after birth . The newborns ' and parents ' vocal interaction were recorded on a videotape and audiotape . The following variables were explored : newborns ' and parents ' soliciting , newborns ' crying and whining , and parental speech directed to the other parent and to the newborn . RESULTS Newborns ' soliciting increased over time ( p=0.032 ) . Both fathers and mothers in skin-to-skin contact communicated more vocally with the newborn than did fathers ( p=0.003 ) and mothers ( p=0.009 ) without skin-to-skin contact . Fathers in skin-to-skin contact also communicated more with the mother ( p=0.046 ) and performed more soliciting responses than the control fathers ( p=0.010 ) . Infants in skin-to-skin contact with their fathers cried significantly less than those in skin-to-skin contact with their mothers ( p=0.002 ) and shifted to a relaxed state earlier than in skin-to-skin contact with mothers ( p=0.029 ) . CONCLUSIONS Skin-to-skin contact between infants and parents immediately after planned cesarean section promotes vocal interaction . When placed in skin-to-skin contact and exposed to the parents ' speech , the infants initiated communication with soliciting calls with the parents within approximately 15 minutes after birth . These findings give reason to encourage parents to keep the newborn in skin-to-skin contact after cesarean section , to support the early onset of the first vocal communication In a r and omized study , 94 patients with term pregnancies underwent augmentation of labor with either continuous or pulsed ( every 8 minutes ) intravenous oxytocin infusion . There were no significant differences with respect to the maternal characteristics , cervical dilatation and effacement , induction-to-labor interval , induction-to-delivery interval , cesarean section rate , analgesia for labor , or low Apgar scores . No hyperstimulation was noted in either group . In each group , 20 % of the patients had dysfunctional labor patterns , with coupling and tripling of the uterine contractions . The mean ± SEM oxytocin  administered in the pulsed-infusion group was significantly lower than that in the continuous-infusion group ( 2.1 ± 0.4 versus 4.1 ± 0.4 mU/minute ; P < .001 ) . The mean ± SEM total amount of oxytocin  administered was 1300 ± 332 mU for the pulsed group and 1803 ± 302 mU for the continuous group , indicating that lower amounts of oxytocin were required for pulsed administration . Our study demonstrates that pulsatile administration of oxytocin is similar in efficacy to our st and ard continuous oxytocin infusion and requires a lower total amount and rate of oxytocin administered , which may afford a greater margin of safety OBJECTIVE Previous publications have suggested that high levels of lactate in amniotic fluid ( AF ) correlate with dysfunctional labor . The aim of this study was to investigate whether lactate concentration in AF together with the partogram is a 
    Output:
    
Results Basal levels of oxytocin increased 3–4-fold during pregnancy .
Oxytocin pulses also occurred in the third stage of labour associated with placental expulsion .
Oxytocin peaks during labour did not correlate in time with individual uterine contractions , suggesting additional mechanisms in the control of contractions .
Oxytocin levels were also raised in the cerebrospinal fluid during labour , indicating that oxytocin is released into the brain , as well as into the circulation .
Oxytocin released into the brain induces beneficial adaptive effects during birth and postpartum .
Oxytocin levels following infusion of synthetic oxytocin up to 10 mU/min were similar to oxytocin levels in physiological labour .
Oxytocin levels doubled in response to doubling of the rate of infusion of synthetic oxytocin .
Conclusions Plasma oxytocin levels increase gradually during pregnancy , and during the first and second stages of labour , with increasing size and frequency of pulses of oxytocin .
A large pulse of oxytocin occurs with birth .
Oxytocin in the circulation stimulates uterine contractions and oxytocin released within the brain influences maternal physiology and behaviour during birth .
Oxytocin given as an infusion does not cross into the mother ’s brain because of the blood brain barrier and does not influence brain function in the same way as oxytocin during normal labour does