Continuous Oxytocin Research Articles

Impact of discontinuing oxytocin in active labour on neonatal morbidity: an open-label, multicentre, randomised trial

Oxytocin is effective in reducing labour duration but can be associated with fetal and maternal complications that could potentially be reduced by discontinuing the treatment during labour. We aimed to assess the impact of discontinuing oxytocin during active labour on neonatal morbidity. STOPOXY was a multicentre, randomised, open-label, controlled, superiority trial conducted in 21 maternity units in France. Participants who received oxytocin before 4 cm dilation were randomly assigned 1:1 to either discontinuous oxytocin (oxytocin infusion stopped beyond a cervical dilation equal to or greater than 6 cm) or continuous oxytocin (administration of oxytocin continued until delivery). Randomisation was stratified by centre and parity. The primary outcome, neonatal morbidity, was assessed at birth using a composite variable defined by an umbilical arterial pH at birth less than 7·10, a base excess greater than 10 mmol/L, umbilical arterial lactates greater than 7 mmol/L, a 5-min Apgar score less than 7, or admission to the neonatal intensive care unit. Efficacy and safety was assessed in participants who were randomly assigned (excluding those who withdrew consent or were deemed ineligible after randomisation) and had reached a cervical dilation of at least 6 cm. This trial is registered with ClinicalTrials.gov, NCT03991091. Of 2459 participants randomly assigned between Jan 13, 2020, and Jan 24, 2022, 2170 were eligible to receive the intervention and were included in the final modified intention-to-treat analysis. The primary outcome occurred for 102 (9·6%) of 1067 participants (95% CI 7·9 to 11·5) in the discontinuous oxytocin group and for 101 (9·2%) of 1103 participants (7·6 to 11·0) in the continuous oxytocin group; absolute difference 0·4% (95% CI -2·1 to 2·9); relative risk 1·0 (95% CI 0·8 to 1·4). There were no clinically significant differences in adverse events between the two groups of the safety population. Among participants receiving oxytocin in early labour, discontinuing oxytocin when the active phase is reached does not clinically or statistically significantly reduce neonatal morbidity compared with continuous oxytocin. French Ministry of Health and the Département de la Recherche Clinique et du Développement de l'Assistance Publique-Hôpitaux de Paris.

Continuous vs intermittent induction of labor with oxytocin in nulliparous patients: a randomized controlled trial

Oxytocin is considered the drug of choice for the induction of labor, although the optimal protocol and infusion duration remain to be determined. This study aimed to assess whether the duration of oxytocin infusion increases 24-hour delivery rates and affects the length of time-to-delivery and patient's experience. A randomized controlled trial was performed at a single tertiary medical center, between January 1, 2020 and June 30, 2022. Nulliparous patients with a singleton pregnancy at a vertex presentation and a Bishop score ≥6 were randomly assigned to receive either continuous (16 hours, with a 4 hours pause in between infusions) or intermittent (8 hours, with a 4 hours pause in between infusions) oxytocin infusion, until delivery. In both groups, infusion was halted when signs of maternal or fetal compromise were observed. Randomization was conducted with a computer randomization sequence generation program. The primary outcome was delivery within 24 hours from the first oxytocin infusion and the secondary outcome included time-to-delivery, mode of delivery, and additional maternal and neonatal outcomes. Seventy-two patients per group were randomized to reach 80% statistical power with a 20% difference in the primary outcome according to previous studies. A total of 153 patients were randomized, 72 to the continuous oxytocin infusion group and 81 to the intermittent infusion group. The total oxytocin infusion time was similar between the groups. Patients in the continuous arm were more likely to deliver within 24 hours from oxytocin initiation (79.73% vs 62.96%, P<.05), and had a shorter oxytocin-to-delivery time interval, compared with patients receiving intermittent treatment (9.3±3.7 hours vs 21±11.7 hours, P<.001). Furthermore, time from ruptured membranes to delivery was shorter (9.3±3.7 hours vs 21±11.7 hours; P<.0001) and chorioamnionitis was less frequent (9.46% vs 21%; P<.05) in the continuous compared with the intermittent arm. Cesarean delivery rate was 20% in both groups (P=.226). There was no difference in postpartum hemorrhage, or adverse neonatal outcomes between the groups. Patients receiving continuous oxytocin infusion were more satisfied with the birthing experience. Continuous infusion of oxytocin for labor induction in nulliparous patients with a favorable cervix may be superior to intermittent oxytocin infusion, because it shortens time-to-delivery, decreases chorioamnionitis rate, and improves maternal satisfaction, without affecting adverse maternal or neonatal outcomes.

Effect of an oxytocin protocol on secondary uterotonic use in patients undergoing Cesarean delivery.

Protocol-driven oxytocin regimens can reduce oxytocin administration compared with a nonprotocol free-flow continuous infusion. Our aim was to compare secondary uterotonic use between a modified "rule of threes" oxytocin protocol and a free-flow continuous oxytocin infusion after Cesarean delivery. We conducted a retrospective before-and-after study to compare patients who underwent Cesarean delivery between 1 January 2010 and 31 December 2013 (preprotocol) with patients who underwent Cesarean delivery between 1 January 2015 and 31 August 2017 (postprotocol). The preprotocol group received free-flow oxytocin administration and the postprotocol group received oxytocin according to a modified rule of threes algorithm. The primary outcome was secondary uterotonic use and the secondary outcomes included blood transfusion, hemoglobin value < 8 g·dL-1, and estimated blood loss. In total, 4,010 Cesarean deliveries were performed in 3,637 patients (2,262 preprotocol and 1,748 postprotocol). The odds of receiving secondary uterotonic drugs were increased in the postprotocol group (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.04 to 1.70; P = 0.02). Patients in the postprotocol group were less likely to receive a blood transfusion. Nevertheless, the two groups were similar for the composite end point of transfusion or hemoglobin < 8 g·dL-1 (OR, 0.86; 95% CI, 0.66 to 1.11; P = 0.25). The odds of an estimated blood loss greater than 1,000 mL were reduced in the postprotocol group (OR, 0.64; 95% CI, 0.50 to 0.84; P = 0.001). Patients in the modified rule of threes oxytocin protocol group were more likely to receive a secondary uterotonic than those in the preprotocol group. Estimated blood loss and transfusion outcomes were similar.

Comparison of delivery outcomes in low-dose and high-dose oxytocin regimens for induction of labor following cervical ripening with a balloon catheter: A retrospective observational cohort study.

A variety of oxytocin regimens are used for labor induction and augmentation. Considering the increasing rates of labor induction, it is important to assess the most optimal oxytocin regimen without compromising maternal and fetal safety. The aim of this study was to compare delivery outcomes of low-dose and high-dose oxytocin induction protocols. This retrospective cohort study of 487 women comparing low-dose oxytocin protocol (n = 280) and high-dose oxytocin protocol (n = 207) in labor induction following cervical ripening by balloon catheter was performed in Helsinki University Hospital after implementation of a new oxytocin induction protocol. The study included two six-month cohorts from 2016 and 2019. Women with vital singleton pregnancies ≥37 gestational weeks, cephalic presentation, and intact amniotic membranes were included. The primary outcome was the rate of vaginal delivery. The secondary outcomes were the rates of maternal and neonatal infections, postpartum hemorrhage, umbilical artery blood pH-value, admission to neonatal intensive care, and induction-to-delivery interval. Statistical analyses were performed by using IBM SPSS Statistics for Windows (Armonk, NY, USA). The rate of vaginal delivery was higher [69.9% (n = 144) vs. 47.9% (n = 134); p<0.004] and the rates of maternal and neonatal infection were lower during the new high-dose oxytocin protocol [maternal infections 13.6% (n = 28) vs. 22.1% (n = 62); p = 0.02 and neonatal infection 2.9% (n = 6) vs. 14.6% (n = 41); p<0.001, respectively]. The rates of post-partum hemorrhage, umbilical artery blood pH-value <7.05 or neonatal intensive care admissions did not differ between the cohorts. The median induction-to-delivery interval was shorter in the new protocol [32.0 h (IQR 18.5-42.7) vs. 37.9 h (IQR 27.8-52.8); p<0.001]. In conclusion, implementation of the new continuous high-dose oxytocin protocol resulted in higher rate of vaginal delivery and lower rate of maternal and neonatal infections. Our experience supports the use of high-dose continuous oxytocin induction regimen with a practice of stopping oxytocin once active labor is achieved, and a 15-18-hour maximum duration for oxytocin induction in the latent phase of labor following cervical ripening with a balloon catheter.

Three-Day Continuous Oxytocin Infusion Attenuates Thermal and Mechanical Nociception by Rescuing Neuronal Chloride Homeostasis via Upregulation KCC2 Expression and Function.

Oxytocin (OT) and its receptor are promising targets for the treatment and prevention of the neuropathic pain. In the present study, we compared the effects of a single and continuous intrathecal infusion of OT on nerve injury-induced neuropathic pain behaviours in mice and further explore the mechanisms underlying their analgesic properties. We found that three days of continuous intrathecal OT infusion alleviated subsequent pain behaviours for 14 days, whereas a single OT injection induced a transient analgesia for 30 min, suggesting that only continuous intrathecal OT attenuated the establishment and development of neuropathic pain behaviours. Supporting this behavioural finding, continuous intrathecal infusion, but not short-term incubation of OT, reversed the nerve injury-induced depolarizing shift in Cl− reversal potential via restoring the function and expression of spinal K+-Cl- cotransporter 2 (KCC2), which may be caused by OT-induced enhancement of GABA inhibitory transmission. This result suggests that only continuous use of OT may reverse the pathological changes caused by nerve injury, thereby mechanistically blocking the establishment and development of pain. These findings provide novel evidence relevant for advancing understanding of the effects of continuous OT administration on the pathophysiology of pain.

PENERAPAN PIJAT OKSITOSIN PADA MASA NIFAS UNTUK MEMPERCEPAT INVOLUSI UTERI DAN MELANCARKAN PENGELUARAN ASI

The postpartum period is a vulnerable period for the mother, because at this time the reproductive organs recover after pregnancy and childbirth. If during recovery there are abnormal changes it will cause complications that can threaten the mother's life. About 60% of maternal deaths occur after delivery of which are caused by complications during the puerperium, one of which is bleeding. To prevent postpartum hemorrhage, you can facilitate the mother to do oxytocin massage, oxytocin massage helps the release of the hormone oxytocin which can cause uterine contractions and affect the process of releasing breast milk smoothly. The purpose of this study was to determine the effectiveness of oxytocin massage on uterine involution and milk ejection. This study refers to the results of a case study of comprehensive midwifery care carried out in Subang with a respondent of one postpartum mother with a background of never getting oxytocin massage in her first child pregnancy and not exclusive breastfeeding, in her second child pregnancy when continuous oxytocin massage has been carried out and causes involution. The mother's uterus becomes normal and faster compared to the first child's puerperium and the release of breast milk becomes smooth, so that the mother avoids postpartum hemorrhage and can breastfeed her baby exclusively.

COMPARISON OF FREQUENCY OF ABNORMAL FETAL HEART RATE IN CONTINUOUS VERSUS DISCONTINUOUS USE OF OXYTOCIN INFUSION FOR AUGMENTATION OF LABOUR

Objective: To compare the frequency of abnormal fetal heart rate in continuous versus discontinuous use of oxytocin infusion for augmentation of labour.&#x0D; Study Design: Comparative cross sectional study.&#x0D; Place and Duration of Study: Department of Obstetrics and Gynaecology, Combined Military Hospital Lahore, from Feb to Aug 2018.&#x0D; Methodology: After fulfilling the inclusion criteria, 76 patients were equally divided in two groups A and B. In both groups, at 3 cm dilatation, intravenous infusion of 5 IU oxytocin in 500 cc normal saline was initiated at infusion rate 3.3mIU/minute Carditocography was initiated 10 minutes before infusion and then continued. An increment in infusion of 3.3mIU/minute was done every 20 minutes till 4 to 5 contractions in 10 minutes were achieved. After this, no more increment was done. The maximum rate was 30mIU/minute. Once cervix was 5 cm dilated, infusion was continued in group A and discontinued in group B for 2 hours. Fetal heart rate was noted on cardiotocography from 20 minutes before initiation of infusion till 2 hours after 5cm.&#x0D; Results: Age of the patients was 25.4 ± 3.5 years in group A and 26.1 ± 2.4 years in group B. Mean gestation age was 39.2 ± 1.1 weeks in group A and 38.6 ± 1.3 weeks in group B. Group A had significantly more abnormal fetal heart rate compared to group B (p=0.016).&#x0D; Conclusion: Discontinuous oxytocin infusion in labour showed significantly less abnormal fetal heart rate compared to continuous oxytocin infusion (p=0.016).

CONTINUATION VERSUS DISCONTINUATION OF OXYTOCIN INFUSION THROUGHOUT THE ACTIVE PHASE OF LABOR AND ITS EFFECT ON THE COURSE OF INDUCED LABOR

Background: Oxytocin is an effective commonly used drug for induction of labor, However it is associated with several maternal and neonatal adverse effect. So, controlled dosage is recommended. Objective: To determine the effect of continuation or discontinuation of the infusion of oxytocin on the duration of the active phase of labor and maternal and neonatal complications. Patients and Methods: This was a randomized controlled trial study conducted in the Obstetrics and Gynecology Department of Dikirnis General Hospital from (August 2018 to September 2019). The women participated in this study was divided in 2 groups, each group consists of 100 women [40 of them were nulliparous and 60 were multiparous]: Group (A) received continuous oxytocin infusions throughout labor until the end of labor. Group (B) received oxytocin infusion which was discontinued once the active phase of labor was established (cervix ≥ 6 cm, uterine contraction at a rate of 3-5 per 10 minutes). Results: The active phase of labor was longer by 53 minutes in the discontinued group (primigravida) versus the continued group (primigravida) and was longer by 75 minutes in the discontinued group B (multigravida) versus the continued group A (multigravida). The incidence of intrapartum fetal distress and uterine hyperstimulation were non-significantly greater in the continued than the discontinued group. The mode of delivery, incidence of cesarean deliveries, postpartum hemorrhage, cervical tear and NICU admission were higher in the continued group versus the discontinued group. Conclusion: The duration of active phase of labor prolonged after discontinuing oxytocin infusion. The new protocol may improve labor outcomes and significantly decrease the rate of uterine hyperstimulation, intrapartum fetal distress and decrease cesarean delivery.

CONTINUATION VERSUS DISCONTINUATION OF OXYTOCIN INFUSION THROUGHOUT THE ACTIVE PHASE OF LABOR AND ITS EFFECT ON THE COURSE OF INDUCED LABOR

Background: Oxytocin is an effective commonly used drug for induction of labor, However it is associated with several maternal and neonatal adverse effect. So, controlled dosage is recommended. Objective: To determine the effect of continuation or discontinuation of the infusion of oxytocin on the duration of the active phase of labor and maternal and neonatal complications. Patients and Methods: This was a randomized controlled trial study conducted in the Obstetrics and Gynecology Department of Dikirnis General Hospital from (August 2018 to September 2019). The women participated in this study was divided in 2 groups, each group consists of 100 women [40 of them were nulliparous and 60 were multiparous]: Group (A) received continuous oxytocin infusions throughout labor until the end of labor. Group (B) received oxytocin infusion which was discontinued once the active phase of labor was established (cervix ≥ 6 cm, uterine contraction at a rate of 3-5 per 10 minutes). Results: The active phase of labor was longer by 53 minutes in the discontinued group (primigravida) versus the continued group (primigravida) and was longer by 75 minutes in the discontinued group B (multigravida) versus the continued group A (multigravida). The incidence of intrapartum fetal distress and uterine hyperstimulation were non-significantly greater in the continued than the discontinued group. The mode of delivery, incidence of cesarean deliveries, postpartum hemorrhage, cervical tear and NICU admission were higher in the continued group versus the discontinued group. Conclusion: The duration of active phase of labor prolonged after discontinuing oxytocin infusion. The new protocol may improve labor outcomes and significantly decrease the rate of uterine hyperstimulation, intrapartum fetal distress and decrease cesarean delivery.

Association of Oxytocin Rest During Labor Induction of Nulliparous Women With Mode of Delivery

To evaluate the association between temporary cessation in oxytocin infusion (oxytocin rest) and mode of delivery in women undergoing induction of labor with a protracted latent phase. We conducted a retrospective cohort analysis of nulliparous women with term, vertex, singleton gestations who were undergoing induction of labor with continuous oxytocin infusion at a large academic medical center. Episodes of oxytocin rest were identified among patients who were exposed to 8 hours of continuous oxytocin yet remained in latent labor (ie, protracted latent labor). Multivariable logistic regression analysis was performed to estimate the association between duration of oxytocin rest and mode of delivery while adjusting for duration of latent phase, maternal age, gestational age, body mass index, and indications for induction and oxytocin cessation. Maternal and neonatal morbidities were also compared among patients with different durations of oxytocin rest. From January 2012 to December 2016, 1,193 patients met eligibility criteria. Among these patients, 267 patients (22.4%) underwent an oxytocin rest that lasted at least 1 hour. After adjusting for potential confounders, the odds ratios of cesarean delivery for patients with oxytocin rest compared with those with no oxytocin rest were as follows: 1.12 (95% CI 0.79-1.58) for less than 1 hour, 0.78 (95% CI 0.48-1.27) for 1-2 hours, 0.60 (95% CI 0.35-1.04) for 2-8 hours, and 0.43 (95% CI 0.24-0.79) for 8 hours or more. We did not detect an association between oxytocin rest of more than 8 hours and a composite of maternal or neonatal morbidities. An oxytocin rest of at least 8 hours is a clinical tool that may reduce the risk of cesarean delivery among women with protracted latent labor without significantly increasing maternal or neonatal morbidity.

Effects of Intermittent and Continuous Oxytocin Exposure on Myometrial Contractile Activity in Term-Pregnant Rats In Vitro.

Continuous oxytocin exposure to augment labor contractions may cause receptor desensitization and further reduce the uterine response to oxytocin, resulting in an increased risk of uterine atony. This study aimed to investigate and compare the uterine response to continuous and intermittent oxytocin stimulation. We hypothesized that intermittent brief episodes of oxytocin separated by recovery periods rather than continuous oxytocin application improves subsequent uterine contractions. Myometrial strips were isolated from term-pregnant rats (22days of gestation; n = 11), mounted in tissue bath chambers, and exposed to continuous oxytocin (5nM) for 2h or 6 repeated episodes of 10-min oxytocin exposure (5nM) separated by 10min of recovery period in Krebs solution. Contractile parameters (force amplitude, frequency, and integral force) significantly decreased during continuous oxytocin exposure compared with control (n = 11; P < 0.01). Interestingly, myometrial contractility significantly increased during subsequent short intermittent oxytocin exposure which was sustained for 6h compared with control or continuous exposure (n = 11; P < 0.01). Brief intermittent oxytocin stimulations resulted in better uterine response and improved contractile force than continuous exposure, which may be attributed to attenuation of receptor desensitization or recovery of oxytocin receptor function following intermittent exposure. These findings would help maintain adequate strong contractions to avoid postpartum bleeding.

The Effect of Intermittent Oxytocin Pretreatment on Oxytocin-induced Contractility of Human Myometrium In Vitro

(Anesth Analg. 2019;128(4):671–678. Doi:10.1213/ANE.0000000000002834) Uterine atony is the leading cause of postpartum hemorrhage, which is responsible for nearly a quarter of maternal deaths worldwide. One risk factor for uterine atony is exposure to large quantities of oxytocin during labor induction and augmentation. Compared with nonlaboring women delivering via cesarean, laboring women who receive oxytocin augmentation require 9 times more oxytocin in order to achieve adequate uterine tone during cesarean delivery (CD). Previous studies have compared a pulsatile oxytocin administration technique with continuous infusion in terms of time from initiation of infusion to delivery, but none have compared these techniques in terms of postpartum hemorrhage rate. This study aimed to compare intermittent oxytocin pretreatment with continuous oxytocin for effect on subsequent oxytocin-induced myometrial contractility.

The Effect of Intermittent Oxytocin Pretreatment on Oxytocin-Induced Contractility of Human Myometrium In Vitro.

Prolonged continuous oxytocin administration during labor may induce oxytocin receptor desensitization, which attenuates the response of the myometrium to further oxytocin, increasing the risk of postpartum hemorrhage. The literature comparing pulsatile (intermittent) versus continuous oxytocin administration for induction and augmentation of labor is inconsistent with regard to maternal outcomes. We aimed to determine the effect of intermittent versus continuous oxytocin preexposure on myometrial responsiveness to subsequent oxytocin. We hypothesized that intermittent oxytocin pretreatment would result in superior subsequent oxytocin-induced contractility than continuous oxytocin pretreatment. This in vitro study was undertaken using myometrium obtained from women undergoing elective cesarean deliveries. Each myometrial strip was mounted in an individual organ bath with physiological salt solution under homeostatic conditions and allocated to one of 3 groups: (1) control (no pretreatment); (2) continuous (pretreatment with oxytocin 10(-5) M for 2 hours); or (3) intermittent (pretreatment with alternating oxytocin 10 M and physiological salt solution every 15 minutes, for 2 hours). After pretreatment, dose-response testing to oxytocin 10(-5) to 10(-5) M was performed and contractile parameters were measured. The primary outcome was motility index (MI, amplitude × frequency) of contractions. Eighteen women were recruited, and 86 successful experiments were performed (control n = 29, continuous n = 28, intermittent n = 29). The means (standard errors) of MI (√g·contractions/10 min) in the control, continuous, and intermittent groups were 2.34 (0.09), 1.78 (0.09), and 2.13 (0.11), respectively. The MI was significantly reduced in the continuous group when compared to the control (estimated difference [95% confidence interval {CI}], -0.56 [-0.81 to -0.31]; P < .01) and intermittent group (estimated difference [95% CI], -0.35 [-0.62 to -0.08]; P = .01). There was no significant difference in MI between the intermittent and control group (estimated difference [95% CI], -0.21 [-0.51 to 0.09]; P = .17). Human myometrium remains more responsive to subsequent oxytocin after intermittent compared to continuous exposure to oxytocin, most likely due to reduction in oxytocin receptor desensitization, or facilitation of receptor resensitization in the intermittent group. Hence, intermittent oxytocin administration during labor warrants further investigation as a technique to preserve uterine oxytocin responsiveness.

Comparison of the effect of carbetocin versus oxytocin during cesarean section in women with high risk of postpartum hemorrhage

Objectives To compare the hemodynamic effects of oxytocin and carbetocin and to assess the efficacy of these two drugs in terms of blood loss and the additional uterotonic needed in cesarean section in women with high risk of primary postpartum hemorrhage (PPH). Background Prevention of PPH is a major issue owing to its effect on maternal morbidity and mortality. Although oxytocin is the most widely accepted uterotonic agent, carbetocin can be given as an intravenous bolus instead of continuous oxytocin infusion. Patients and methods This is a prospective, randomized controlled study conducted from March 2016 and October 2017 within the Department of Obstetrics and Gynecology in Menoufia University Hospitals. The study included 100 pregnant women with high risk of PPH; women were divided randomly into group A, which received oxytocin infusion of 20 international units, and group B, which received 100 μg carbetocin as an intravenous bolus. Results Regarding the hemodynamic effects, there was a significant lower reduction in blood pressure within the oxytocin group. Significantly more women needed additional uterotonic agents in the oxytocin group. Uterine fundal level was significantly below 2 cm from the umbilical point in carbetocin group. The mean cost in oxytocin group is lower with a highly significant difference. Conclusion Single injection of carbetocin has more safe hemodynamic profile and less need of uterotonics, but the introduction of oxytocin appears to provide improved clinical outcomes along with cost savings.

Continuous oxytocin versus intermittent oxytocin for induction of labor: a randomized study

Objective: To assess whether intermittent usage of oxytocin infusion increases the duration of the active phase of labor and reduces maternal and neonatal complications or not.Materials and Methods: A prospective randomized controlled study was conducted of 200 consenting women with singleton pregnancy in the vertex position undergoing labor induction or augmentation at the Zeynep Kamil Maternity and Children’s Training and Research Hospital. Participants with cervical dilation of 3 cm were randomized to either continued or intermittent oxytocin infusion when cervical dilation reached 5 cm. The primary outcome measures were the duration of the active phase of labor, defined as the period of labor from 5 cm of cervical dilation to vaginal delivery. Secondary outcomes were the duration of oxytocin infusion, mode of delivery, hyperstimulation, abnormalities in fetal heart rate, perineal tears, and neonatal outcomes.Results: The median duration of the active phase for the women with a vaginal delivery was longer in the intermittent oxytocin group than the continued oxytocin group, but it was not statistically significant (median, 6.91 vs. 7.58 h, p = .37). There was a significant difference in the duration of oxytocin infusion (median, 12.38 h in the intermittent group vs. 15.79 h in the continued group, p = .005). The incidence of uterine hyperstimulation was significantly greater in the continued group (21.1%) than the intermittent oxytocin group (3.8%) (p=.001).Conclusions: Intermittent usage of oxytocin infusion seems to make labor less complicated without lengthening duration of labor.

Continuous versus pulsatile oxytocin administration for the augmentation of labour

Reason for withdrawal from publication This review is no longer going to be prepared by the review team and the protocol has now been withdrawn from publication in the Cochrane Library.

In patients undergoing induction for a second-trimester fetal demise, does the use of high-dose oxytocin reduce the incidence of retained placenta?

Evidence-Based Answer Ten units oxytocin intramuscularly during the third stage of labor may decrease the incidence of placental retention, whereas a continuous oxytocin infusion (started with a misoprostol induction) does not appear to help. Third-stage oral misoprostol and oxytocin via umbilical vein postdelivery also do not appear to decrease the incidence of placenta retention (SOR: B, RCTs).

PRECONDITIONING HUMAN STEM CELLS WITH OXYTOCIN TO OPTIMIZE CELL THERAPY FOR THE TREATMENT OF CARDIOVASCULAR DISEASE

BACKGROUND: An important issue limiting cell therapy in the treatment of infarcted heart is the extensive loss of transplanted cells. Manipulation of the cells prior to the transplantation has been proposed in order to improve their biologic and functional properties through enhancement of cell survival, homing, retention, differentiation or proliferation. METHODS: The objective was to optimize human stem cells using a novel strategy of preconditioning with oxytocin (OT) and their preparation for clinical applications with improved viability and therapeutic function. Human mesenchymal stem cells (hMSC) were treated with OT from 0.1 nM to 1 mM (range of physiological and pharmacological doses) with either short bursts or continuously to determine the conditions with highest responsiveness. OT signalling pathways were investigated according to phosphorylation of proteins or activation of specific effectors. The LIVE/DEAD assay kit assessed cellular viability. Multilineage differentiation was confirmed by in vitro assays for tri-potentiality based on adipogenesis (oil red staining) and osteogenesis (alizarin staining). Phenotype and surface markers were evaluated by standard fluorescence-activated cell sorting techniques to validate changes in protein expression following OT treatment at different time points/conditions. RESULTS: OT receptor mRNAwas found in hMSC by RT-PCR and proteins byWestern blotting.OT rapidly (5-15minutes) and significantly increased phosphorylation of PI3K/AKT (1,6 fold) and ERK1/2 (3,0 folds) all P<0.05, both pathways involved in cell survival. OT improved survival of hMSC exposed to hypoxia and serum starvation culture conditions mimicking myocardial infarct (P<0.05). OT treatment did not alter differentiation potential as demonstrated by adipogenesis and osteogenesis. In fact, results showed that continuous OT treatment promoted adipogenic differentiation (p<0.05). Similarly, OT continuous treatment demonstrated favorable effects on osteogenesis.Multipotent hMSCwere negative for: CD14,CD34, CD45 andCD133; and positive for: CD44, CD73, CD29, CD166 and CD105; OT treatment did not affect the phenotype of hMSC up to the second passage. OT treated hMSC maintained their growth capacity for cell expansion in vitro. CONCLUSION: Human MSC express OT-receptor functioning with a rapid and strong response to OT exposure as demonstrated by activation of survival signaling pathways, enhancing the capacity of stem cells to resist ischemic conditions. Besides having prosurvival and cytoprotective effects, OT preconditioning supports the cells to maintain their stemness and promote their differentiation and proliferation potential for post-engraftment function. Ex vivo cellular preconditioning with OT represents an attractive strategy to improve hMSC survival and reparative potential without the need for genetic manipulation. FRQS, HSF, Montreal University

Which Uterotonic Is Better to Prevent the Postpartum Hemorrhage? Latest News in Terms of Clinical Efficacy, Side Effects, and Contraindications: A Systematic Review

Postpartum hemorrhage (PPH) is a potentially fatal complication of vaginal and cesarean deliveries. The active management of the third stage of labor provides administration of prophylactic uterotonic drugs just before or immediately after delivery, since they reduce the risk of PPH by 60%. Overview on all available uterotonics for PPH prevention to clarify indications and contraindications in choice among drugs. Systematic review of the literature. Oxytocin is the first choice for PPH prophylaxis. Ergot alkaloids, syntometrine, and prostaglandins are second-line uterotonic agents. Misoprostol is not effective as oxytocin but it may be used when the latter is not available. Carbetocin should be used instead of continuous oxytocin infusion in elective cesarean sections for PPH prevention and to decrease the need for therapeutic uterotonics. Prophylactic oxytocics should be offered routinely in the third stage of labor in all women. The prophylactic use of uterotonics should be individualized.

A Randomized Clinical Trial on the Need of Continuing Oxytocin Infusion in Active Phase of Induced Labour

Objective : To evaluate the effect of continuation and discontinuation of oxytocin infusion on maternal and neonatal outcome once the active phase of labour is established. Methods: This is a prospective randomized clinical trial on 100 pregnant women in whom labour was induced on obstetric ground in our institute. Patients were randomly divided in two groups. In the first group oxytocin infusion continued throughout labour and in the second group oxytocin infusion discontinued after establishment of active phase of labour. Result: Consumption of total oxytocin dose, induction-delivery interval, uterine hyperstimulation, caesarean section rate were significantly less in oxytocin discontinued group. Concurrently in oxytocin-continued group rate of postpartum hemorrhage (PPH), neonatal asphyxia, hyperbillirubinemia were higher in comparison to oxytocindiscontinued group. Conclusion : Continuous oxytocin infusion during active phase of labour increases chance of caesarean section, PPH and also of neonatal asphyxia, hyperbillirubenemia. Discontinuation of oxytocin infusion reduces labour risk and gives good neonatal outcome. DOI: http://dx.doi.org/10.11566/cmoshmcj.v12i2.35 Chatt Maa Shi Hosp Med Coll J 2013; 12(2): 23-30