Concentrated Oxytocin Research Articles

Prevalence of use of highly concentrated oxytocin or "pepper injection" in labor among clinicians undergoing emergency obstetric training in Sierra Leone.

To examine the awareness, prevalence of use, and knowledge of risks of pepper injection (PI), an injection of highly concentrated oxytocin used to augment or induce labor, among clinicians. An anonymous pre- and post-workshop evaluation conducted among 227 clinicians participating in emergency obstetric and newborn care training in Sierra Leone from June to October 2018. Overall, 225 participants completed the surveys. Of these, 198 (88.0%) of clinicians reported awareness of PI, and 123 (54.7%) self-reported prior use, which was highest among midwives (94/129; 72.9%). Before EmONC training, 82 (36.4%) clinicians reported that they were likely to use PI; this decreased to 39 (17.3%) after training (P<0.05). The mean number of participants correctly identifying risks of PI increased from 149 (66.2%) to 204 (90.7%) after training (P<0.05). There was widespread awareness of PI use among clinicians, and prevalent self-reported prior use among midwives. Risk awareness improved after EmONC training, and the proportion of clinicians reporting likelihood of future use decreased. Improper use of oxytocin may be a major contributor to maternal and newborn morbidity and mortality in Sierra Leone. Initiatives to educate clinicians and to regulate and stop the practice are needed.

Vaginal misoprostol versus concentrated oxytocin for midtrimester labor induction: a retrospective chart review

Objectives: To date, no studies have compared misoprostol versus concentrated oxytocin without concomitant use of vaginal prostaglandins for pregnancy interruption in the midtrimester. We sought to compare efficacy and safety of these two regimens to improve patient counseling and outcomes.

Preclinical Toxicity Screening of Intrathecal Oxytocin in Rats and Dogs

Anatomic, physiologic, and behavioral studies in animals suggest that spinally released oxytocin should produce analgesia in humans and may also protect from chronic pain after injury. In this article, the authors report preclinical toxicity screening of oxytocin for intrathecal delivery. Intrathecal oxytocin, 11 μg (6 U) or vehicle, was injected intrathecally in 24 rats, followed by frequent behavioral assessment and histologic examination of spinal contents 2 or 14 days after injection. In three dogs, a range of intrathecal oxytocin doses (18 to 550 μg in 0.5 ml) was injected followed by physiologic, biochemical, and behavioral assessments. Ten dogs were then randomized to receive five daily injections of intrathecal oxytocin, 550 μg in 0.5 ml, or vehicle with similar assessments and, necropsy and histologic analysis were conducted 2 days later. In rats, intrathecal oxytocin resulted in transient scratching and itching behaviors, without other differences from vehicle. There was no behavioral, gross anatomic, or histologic evidence of neurotoxicity. Dose ranging in dogs suggested mild effects on motor tone, blood pressure, and heart rate at the 550 μg dose. Repeated boluses in dogs did not produce behavioral, biochemical, neurological, gross anatomic, or histologic evidence of neurotoxicity. Substances, including natural neurotransmitters, may be toxic when administered in pharmacologic doses in the spinal cord. This preclinical toxicity screen in two species suggests that bolus injections of oxytocin in concentrations up to 1,100 μg/ml are unlikely to cause neurotoxicity. The authors also support cautious clinical application of intrathecal oxytocin under regulatory supervision.

Misoprostol versus High Dose Oxytocin and Laminaria in Termination of Pregnancy in Second Trimester Pregnancies.

Background:In 2 recent decades, found drug regimen to induce abortion that are more effective than surgery. Prostaglandins especially misoprostol, oxytocin and osmotic dilators such as laminaria use for termination but the best method is unknown. Therefore we aimed to assess the comparison between the Misoprostol regimen and the highly concentrated oxytocin with laminaria regimen in second trimester of pregnancy termination.Methods:In this randomized clinical trial, 100 women with gestational age 14 to 24 week coming to hospital due to termination of pregnancy in the absence of uterine contractions and items of exclusion criteria enrolled to study and randomly assign to 2 groups and received misoprostol (group 1) or oxytocin (group 2). Data collected with use of observation, examination and demographic checklist. In group 1, in admission time and then every 6 hour patients received 200 µgr misoprostol until start the pain or vaginal bleeding or abortion in 48 hr. in group 2, patients first received laminaria in cervix with duration of 6 hr and then oxytocin 50 unit in 500 cc normal saline in 3 hr. after 1 hr rest, oxytocin dosage elevated as multiple into 2 and continue until termination or maximum dose of 300 u in 500 cc normal saline. Data entered to SPSS software version 16 and analyzed with use of descriptive methods and also Chi-square and T-test.Results:In each group enrolled 50 women that approximately no different in baseline characteristic. Number of abortion in misoprostol group was more than oxytocin group (P<0.001) and duration of abortion also was shorter than oxytocin in misoprostol group (P<0.001). Side effects in 23 (46%) women in misoprostol group were seen but no side effect seen in oxytocin group. Complementally interventions was seen in 31 women (60%) in misoprostol group versus 32 women (62%) in oxytocin group but this difference was not significant (P>0.05).Conclusion:This study demonstrated that misoprostol is effective than oxytocin in termination of pregnancy but with attention to limitation of this study include of limited abortion causes due to legal laws, additional studies on different doses of misoprostol and oxytocin due to achieve to suitable regimen with lower side effects recommended.

Multiple-dose vaginal misoprostol and single-dose misoprostol plus oxytocin for termination of second-trimester pregnancy

ObjectiveTo compare 2 different methods—multiple doses of misoprostol and a combination of misoprostol and oxytocin—for termination of pregnancy in the second trimester. MethodsBetween 2006 and 2008, 120 women undergoing termination of second-trimester pregnancy in 2 hospitals in Kermanshah, Iran, were enrolled in a randomized trial comparing 2 treatments. In each treatment group, an initial vaginal dose of 600μg of misoprostol was placed in the posterior fornix. After 6hours, an intravenous infusion of concentrated oxytocin was given to women in group A, and 400μg of vaginal misoprostol was given every 6hours to women group B, up to a maximum of 4 doses. The outcomes were compared via χ2 and independent t tests. ResultsWithin 30hours, 96.7% of women in group A and 96.7% of women in group B delivered successfully. The average duration between induction and delivery time was 12.3±6.0hours in group A and 12.1±6.0hours in group B (P>0.05). ConclusionThe use of misoprostol with oxytocin, and multiple doses of misoprostol gave similar results for termination of pregnancy in the second trimester.

High-dose vaginal misoprostol versus concentrated oxytocin plus low-dose vaginal misoprostol for midtrimester labor induction: A randomized trial

This study was undertaken to compare the efficacy and side effects of a high-dose vaginal misoprostol regimen to concentrated intravenous oxytocin plus low-dose vaginal misoprostol for midtrimester labor induction. Women at 14 to 24 weeks, with obstetric or fetal indications for delivery and no prior cesarean, were randomly assigned to receive either vaginal misoprostol 600 microg x 1, then 400 microg every 4 hours x 5 (group 1) or escalating dose-concentrated oxytocin infusions (277-1667 mU/min) plus vaginal misoprostol 400 microg x 1, then 200 microg every 6 hours x 2, then 100 microg x 1 (group 2). Analysis was by intent to treat. Primary outcomes were live birth rate and induction-to-delivery interval. The intended sample size was 70 women per group; however, the trial was terminated at the initial interim analysis because of a highly significant difference in 1 of the primary study outcomes. Twenty women were assigned to group 1 and 18 were assigned to group 2. Median induction-to-delivery interval was significantly shorter in group 1 (12 hours, range 4-44 hours) versus group 2 (18 hours, range 7-36 hours; P = .01). Induction success rate at 12 hours was significantly higher in group 1 (60%) compared with group 2 (22%, P = .02). No significant difference was noted in the live birth rate between groups 1 and 2 (13%, 0%, P = .16). The incidence of retained placenta requiring curettage, chorioamnionitis, intrapartum fever, nausea, emesis, and diarrhea were similar between both groups. Compared with concentrated oxytocin plus low-dose vaginal misoprostol, high-dose vaginal misoprostol significantly shortens midtrimester labor inductions.

Comparative efficacy of high dose vaginal misoprostol versus concentrated oxytocin + low dose vaginal misoprostol for mid-trimester labor induction

Comparative efficacy of high dose vaginal misoprostol versus concentrated oxytocin + low dose vaginal misoprostol for mid-trimester labor induction

The contribution of laminaria placement for cervical ripening in second trimester termination of pregnancy induced by intra-amniotic injection of prostaglandin F 2alpha followed by concentrated oxytocin infusion

Objective: Our purpose was to determine whether intracervical placement of laminaria stalks would improve the effectiveness of inducing termination of pregnancies in the second trimester by intra-amniotic injection of prostaglandin F 2alpha. Study design: This is a prospective randomized clinical trial conducted at Gynecology Department, Lis Maternity Hospital. Fifty women admitted for indicated second trimester pregnancy termination were randomly assigned to receive either intracervical placement of laminaria ( n=25) or not ( n=25), with concurrent use of intra-amniotic injection of prostaglandin F 2alpha and concentrated oxytocin. The outcome measures were: time from induction to delivery and the side effects and complications of treatment. Results: There was no significant difference in the mean interval from induction to delivery in the laminaria and no laminaria groups, being 20±1.3 (8–30) h versus 19±1.0 (8–26) h , respectively. In addition, this interval was not different in subgroups of primiparas or multiparas. Other outcome measures such as retained placenta (4% in both groups), post-partum hemorrhage (4% in both groups) gastro-intestinal side effects, fever, and use of analgesia were not significantly different between both groups. Conclusion: We found no additional value in placing laminaria stalks when using intra-amniotic injection of prostaglandin F 2alpha followed by concentrated oxytocin infusion for second trimester termination of pregnancy.

Vaginal misoprostol versus concentrated oxytocin plus vaginal PGE 2 for second-trimester labor induction

Vaginal misoprostol versus concentrated oxytocin plus vaginal PGE 2 for second-trimester labor induction

High-Dose Oral Misoprostol for Mid-Trimester Pregnancy Interruption

Objective: To evaluate the efficacy of high-dose oral misoprostol for mid-trimester pregnancy interruption. Methods: We reviewed our experience with high-dose oral misoprostol for mid-trimester pregnancy interruption from November 1995 to May 1999. Patients undergoing labor induction for intrauterine fetal demise or medically indicated pregnancy termination at 13–32 weeks of gestation with a non-dilated cervix were evaluated. Patients received 400 µg misoprostol orally every 4 h. Women undelivered within 24 h were considered failures and were treated with high-dose oxytocin as previously described. For comparison, a group of women treated with high-dose oxytocin were evaluated. Results: Forty-seven pregnancies were managed with misoprostol (n = 23) or high-dose oxytocin regimen (n = 24). Both groups were similar with respect to induction indication, gestational age, maternal age/parity, laminaria use, and initial cervical dilation. Induction-to-delivery interval (mean ± SD) was significantly shorter in the misoprostol cohort (15.2 ± 6.7 h) compared with those treated with oxytocin (21.7 ± 11.0 h; p = 0.02). Additionally, a significantly greater percentage of women treated with misoprostol delivered within 24 h (91.0%) compared with the oxytocin group (62.0%; p = 0.04). Adverse outcomes and side effects were not significantly different between the study groups. Conclusion: High-dose oral misoprostol is more effective than concentrated oxytocin infusion for mid-trimester pregnancy interruption.

439 Comparative efficacy of high-dose vaginal misoprostol versus concentrated oxytocin plus low-dose vaginal PGE2 for mid-trimester labor induction

439 Comparative efficacy of high-dose vaginal misoprostol versus concentrated oxytocin plus low-dose vaginal PGE2 for mid-trimester labor induction

Laminaria versus extra-amniotic saline solution infusion for cervical ripening in second-trimester labor inductions

Objective: The aim of this study was to determine which cervical ripening method, laminaria placement or extra-amniotic saline solution infusion, was associated with the shorter interval from induction to delivery in the second trimester. Study Design: Women admitted for indicated second-trimester labor induction with an unfavorable cervix were randomly assigned to receive either intracervical placement of laminaria (n = 25) or extra-amniotic saline solution infusion (n = 25) with concurrent concentrated oxytocin and vaginally administered prostaglandin E2 (10 mg every 6 hours). Treatment success was defined as an interval from induction to delivery of ≤24 hours. Results: Maternal age, race, parity, gestational age, and initial cervical dilatation were similar between the groups. Indications for uterine evacuation were also similar and included fetal death (n = 7), aneuploidy (n = 20), fetal structural anomaly (n = 18), and maternal indications (n = 4). There was no difference in the mean intervals from induction to delivery (laminaria, 16 ± 8 hours, vs extra-amniotic saline solution infusion, 17 ± 10 hours) or the number of treatment successes (laminaria, n = 23, vs extra-amniotic saline solution infusion, n = 21). Retained placenta, live birth, and hemorrhage occurred with similar frequencies in the two groups. Conclusion: Relative to laminaria, extra-amniotic saline solution infusion did not shorten the induction-to-delivery interval in women undergoing indicated second-trimester labor induction with concentrated oxytocin and low-dose vaginally administered prostaglandin E2. (Am J Obstet Gynecol 2001;184:1145-8.)

Misoprostol versus concentrated oxytocin plus low-dose PGE 2 for mid-trimester pregnancy termination: A trial stopped

Misoprostol versus concentrated oxytocin plus low-dose PGE 2 for mid-trimester pregnancy termination: A trial stopped

Second trimester pregnancy termination including fetal death: comparison of five different methods

Objective: To compare the efficacy of methods for second trimester pregnancy termination. Methods: A prospective randomized study of women undergoing pregnancy termination between 14 and 28 weeks gestation. Three hundred and forty patients with poor cervical condition (Bishop score ≤ 4) in whom one of five termination methods were used were assessed: (i) extraamniotic administration of ethacridine lactate (82 patients); (ii) intracervical prostaglandin (PG) E 2 gel (100 patients); (iii) intravenous infusion of concentrated oxytocin (36 patients); (iv) vaginal misoprostol (49 patients); and (v) balloon insertion (73 patients). Oxytocin infusion was used in all but concentrated oxytocin group to augment labor, when necessary. Patients in whom effective uterine contractions and cervical dilatation was not obtained within 48 h with the primary termination method were registered as failures. Results: The efficacy of each method were evaluated in terms of abortion within time. Abortion within 48 h were achieved in 98.8% ( 81 82 ) of the patients in ethacridine group; 97.3% ( 35 36 ) of the patients in concentrated oxytocin group; 90.0% ( 90 100 ) of the patients in PGE 2 group; 97.2% ( 71 73 ) of the patients in balloon group; 77.5% ( 38 49 ) of the patients in misoprostol group ( P = 0.000, P < 0.01, Wilcoxon (Gehan) statistic). The overall median induction-abortion interval ± S.D. (in h) in each group were as follows: ethacridine lactate: 15.7 ± 9.6, PGE 2 gel: 20.0 ± 14.5, concentrated oxytocin: 12.2 ± 14.4, misoprostol: 24.0 ± 22.2, balloon: 16.0 ± 15.4 (one way ANOVA, P = 0.003, P < 0.01). Conclusion: In comparison with the five methods, the use of extraamniotic ethacridine, intravenous concentrated oxytocin, and balloon was found to provide more effective treatment than intracervical PGE 2 and misoprostol in terms of achievement of abortion within 24 and 48 h.

Concentrated oxytocin plus low-dose prostaglandin E 2 compared with prostaglandin E 2 vaginal suppositories for second-trimester pregnancy termination

To examine the efficacy and side effects of concentrated oxytocin plus low-dose prostaglandin (PG) E2 compared with a standard dose of vaginal PGE2 for second-trimester pregnancy termination. Patients with obstetric or fetal complications were randomly assigned to receive either a 20-mg PGE2 vaginal suppository every 4 hours (n = 81) or a concentrated oxytocin infusion plus a 10-mg PGE2 vaginal suppository every 6 hours (n = 73). Treatment success was defined as delivery (or imminent delivery) within 24 hours of therapy. Women who failed their assigned regimen were crossed to the alternate method. Indications for delivery were similar in the two groups. The success rate with oxytocin was 89%, compared with 81% with vaginal PGE2 (relative risk 0.92, 95% confidence interval 0.8-1.04; P = .2). Maternal fever (P < .001), nausea (P = .02), and vomiting (P = .003) occurred significantly more often in women who received a 20-mg PGE2 vaginal suppository every 4 hours. Concentrated oxytocin plus low-dose PGE2 should be considered as an alternative to vaginal PGE2 for indicated second-trimester pregnancy termination.

Midtrimester pregnancy termination: A randomized trial of prostaglandin E 2 versus concentrated oxytocin

OBJECTIVES: The purpose of this study was to determine whether a concentrated oxytocin infusion can reliably effect uterine evacuation in the midtrimester and whether such an infusion is associated with fewer side effects than prostaglandin E 2 vaginal suppositories. TUDY DESIGN: Patients received either prostaglandin E 2 ( n = 42) or oxytocin ( n = 45) for indicated midtrimester abortions in a prospective, randomized trial. Treatment consisted of either prostaglandin E 2 vaginal suppositories (one every 4 hours) or infusions of an escalating concentration of oxytocin (one every 4 hours). Unless delivery had occurred or was imminent after 24 hours, the agent was considered to have failed, and patients were crossed to the alternative method. RESULTS: Delivery indications were similar between the two groups. There were 6 (14%) first-agent failures with prostaglandin E 2 and 9 (20%) with oxytocin ( p = 0.48). Considering the failures and subsequent crossovers, 103 patient trial regimens were completed. Fever, nausea, vomiting, and diarrhea were more frequent with prostaglandin E 2 ( p < 0.005). CONCLUSIONS: Concentrated oxytocin is a satisfactory alternative to prostaglandin E 2 for midtrimester abortion. ( Am J Obstet Gynecol 1992;167:1112–6.)

Mid-Second-Trimester Labor Induction: Concentrated Oxytocin Compared With Prostaglandin E2 Vaginal Suppositories

A concentrated oxytocin infusion and prostaglandin E2 (PGE2) vaginal suppositories were compared in a retrospective analysis for indicated abortion in the mid-second trimester (17-24 weeks' gestation). Eighty-one women underwent second-trimester pregnancy termination, 59 by PGE2 suppositories and 22 by concentrated oxytocin infusion. Success was achieved by PGE2 in 93% (55 of 59) and oxytocin in 91% (20 of 22). The mean duration of labor was 13.1 hours with PGE2 and 8.2 hours with oxytocin. The mean dose of PGE2 was 65.2 mg; of oxytocin, 200 units. Women who received PGE2 experienced nausea (46%), vomiting (37%), fever (64%), and diarrhea (20%) despite appropriate premedication. Few side effects occurred in the women who were treated with oxytocin. We conclude that concentrated oxytocin infusion seems to be a reasonable alternative to PGE2 vaginal suppositories for induction of labor in the mid-second trimester.

The interaction of arginine vasopressin and oxytocin with bovine adrenal medulla cells

Binding of [3H]arginine vasopressin (AVP) and [3H]oxytocin to primary monolayer cultures of bovine adrenal chromaffin cells was time-dependent, and the binding sites for each peptide were specific and saturable. Studies with the V1 AVP antagonist d(CH2)5Tyr(Me)2-AVP, the V2 agonist 1-deamino-8-D-AVP and the V2 antagonist d(CH2)5D-Leu2,Val4-AVP indicated that the AVP receptor was V1 in specificity. Scatchard plots showed that each ligand interacted with a single high-affinity, low-capacity binding site: oxytocin dissociation constant (Kd) 0.29 +/- 0.02 nmol/l, maximum binding capacity (Bmax) 7.6 +/- 0.2 fmol/10(6) cells (or 4500 +/- 102 sites/cell) (n = 3); AVP Kd 0.09 +/- 0.02 nmol/l, Bmax 5.1 +/- 0.63 fmol/10(6) cells (or 3050 +/- 318 sites/cell) (n = 3). Although forskolin in concentrations from 1 nmol/l to 1 mmol/l stimulated cyclic AMP (cAMP) production in isolated chromaffin cells, this did not result in detectable catecholamine release. Neither AVP nor oxytocin in concentrations between 10 pmol/l and 10 mumols/l stimulated cAMP production in these cells. Vasopressin in concentrations as low as 10 pmol/l stimulated a sixfold increase in total inositol phosphates; the dose-response curve was triphasic. Oxytocin had little effect on total inositol phosphate accumulation at low concentrations, but concentrations above micromolar stimulated total inositol phosphate production approximately fourfold. There was no measurable release of catecholamines in response to either peptide. The physiological consequences of these AVP-induced changes in inositol phosphate concentrations remain to be elucidated.

Prostaglandin E2 vaginal suppository as a midtrimester abortifacient

The efficacy of prostaglandin E2 (PGE2) vaginal suppositories as an abortifacient was evaluated in 40 women between 16 and 20 weeks' gestation. All pregnancies were successfully terminated with a mean time of 12.7 hours (S.D. 5.7). Eight patients (20 per cent) were treated with oxytocin augmentation after spontaneous rupture of the membranes during PGE2 vaginal suppository therapy. Gastrointestinal side effects and drug fever were frequent but self-limiting. The success of this approach eliminates amniocentesis for drug instillation as well as the supplementary use of intravenous oxytocin in high concentrations and/or intracervical laminaria.