Synthetic Oxytocin Research Articles

Maternal arterial blood gas values during delivery: Effect of mode of delivery, maternal characteristics, obstetric interventions and correlation to fetal umbilical cord blood

Obstetricians routinely use biochemical parameters from non-pregnant women to assess the condition of the laboring mother. However, it is well known that pregnancy leads to significant physiological changes in most organ systems. The aim of this study was to determine normal values for maternal arterial blood gases during vaginal deliveries as compared with control values from planned cesarean sections. We also wanted to elucidate the effect of various maternal characteristics, mode of delivery and obstetric interventions on blood gas values. We carried out a randomly selected, prospective-observational cohort study of 250 women undergoing vaginal delivery and 58 women undergoing planned cesarean section at the Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden. We found significant differences for gestational age, parity, umbilical venous blood pH, pCO2 and lactate values between the two study groups (P<.005). Significantly lower pH, pCO2 , pO2 and sO2 were found in mothers delivering vaginally. Higher base deficit, hemoglobin, bilirubin, potassium, glucose and lactate were found in vaginal deliveries than in planned cesarean sections (P<.02). Maternal body mass index (BMI), smoking and hypertension were not significantly correlated to acid base parameters in women with vaginal deliveries. On the other hand, multiple regression showed significant associations for the use of epidural anesthesia on maternal pH (P<.05) and pO2 (P<.01); and synthetic oxytocin on pCO2 (P=.08), glucose (P<.00) and lactate (P<.02) levels in maternal arterial blood. Maternal arterial pH, pCO2 and lactate values correlated significantly to values in venous umbilical cord blood (P<.000). Maternal arterial blood gas parameters varied significantly according to mode of delivery, the use of epidural anesthesia and synthetic oxytocin.

Obstetric oxytocin exposure and ADHD and ASD among Danish and Finnish children.

Some studies have indicated an increased risk of attention deficit hyperactivity disorder (ADHD) and a small, sex-specific association with autism spectrum disorder (ASD) among children prenatally exposed to obstetric oxytocin. Since oxytocin is widely used in the obstetric ward, these potentially deleterious effects are of concern. Thus, we aimed to examine whether obstetric oxytocin treatment for labour induction or augmentation is associated with ADHD and ASD in offspring born in a two-country design based on data from Denmark and Finland. This population-based study used data from national registers in Denmark and Finland. Singletons born in Denmark 2000-10 (n = 577380) and Finland 1991-2010 (n = 945543), who survived infancy, were followed until 31 December 2015. ADHD and ASD were defined using diagnostic codes. For ADHD, we also included information on prescribed and redeemed ADHD medication in the definition. Hazards ratios (HRs) with 95% confidence intervals (CI), modelled with age as the underlying time scale, were calculated to estimate the associations. Oxytocin was used in 31% and 46% of the included deliveries in Denmark and Finland, respectively. In crude analyses, prenatal oxytocin was associated with an approximately 20% increased risk of ADHD and ASD, but confounder adjustment attenuated the association. The adjusted HR was 1.03, 95% CI 1.01-1.05, for ADHD and 1.05, 95% CI 1.02-1.08, for ASD. The results were similar in across country and gender. We found an association between synthetic oxytocin and ADHD or ASD which is unlikely to reflect a causal association and thus should not support the concern of clinical use. Our results help to allay concerns of obstetric use of oxytocin causing ADHD or ASD.

Brain oxytocin: how puzzle stones from animal studies translate into psychiatry.

The neuropeptide oxytocin has attracted great attention of the general public, basic neuroscience researchers, psychologists, and psychiatrists due to its profound pro-social, anxiolytic, and “anti-stress” behavioral and physiological effects, and its potential application for treatment of mental diseases associated with altered socio-emotional competence. During the last decade, substantial progress has been achieved in understanding the complex neurobiology of the oxytocin system, including oxytocinergic pathways, local release patterns, and oxytocin receptor distribution in the brain, as well as intraneuronal oxytocin receptor signaling. However, the picture of oxytocin actions remains far from being complete, and the central question remains: “How does a single neuropeptide exert such pleotropic actions?” Although this phenomenon, typical for many of about 100 identified neuropeptides, may emerge from the anatomical divergence of oxytocin neurons, their multiple central projections, distinct oxytocin-sensitive cell types in different brain regions, and multiple intraneuronal signaling pathways determining the specific cellular response, further basic studies are required. In conjunction, numerous reports on positive effects of intranasal application of oxytocin on human brain networks controlling socio-emotional behavior in health and disease require harmonic tandems of basic researchers and clinicians. During the COVID-19 crisis in 2020, oxytocin research seems central as question of social isolation-induced inactivation of the oxytocin system, and buffering effects of either activation of the endogenous system or intranasal application of synthetic oxytocin need to be thoroughly investigated.

Birth with Synthetic Oxytocin and Risk of Childhood Emotional Disorders: A Danish Population-based Study

Background: Concerns have been raised that synthetic oxytocin, a widely used obstetric tool for labor induction and augmentation, may have deleterious effects on the neuropsychological development of children. Few studies have examined the relationship between oxytocin-stimulated labor and emotional disorders.Methods: We conducted a nationwide register-based cohort study including 677,629 singletons born in Denmark in the years 2000 to 2012 and followed through 2016 (median age = 10.6 years). Data on oxytocin-stimulation were obtained from the Danish Medical Birth Register. Cases of emotional disorders - anxiety, obsessive-compulsive disorder, mood or traumatic stress disorders or a redeemed prescription for a selective serotonin reuptake inhibitor - were identified using Danish patient and prescription registries.Results: Oxytocin was used to stimulate 31% of births, and oxytocin-stimulated labor was not associated with childhood emotional disorders (HR = 1.05, 95% CI 0.99, 1.11) after adjustment for maternal history of psychopathology, antidepressants during pregnancy, cohabitation status, highest educational attainment, smoking status during pregnancy, birth year, and indications for labor stimulation. The crude cox model was also small and close to unity (HR = 1.09, 95% CI 1.03, 1.15).Limitations: About 50% of our population had reached the age of 10 years, but the outcome included disorders with later average debut ages. Oxytocin dosage levels are not recorded in the registers.Conclusions: Our small effect size estimates suggest that perinatal synthetic oxytocin does not contribute to the development of emotional disorders. Current evidence does not warrant revision of guidelines for the use of oxytocin in obstetrics.

Canadian Registered Midwives' Experiences With Nipple Stimulation: An Exploratory Survey in British Columbia and Ontario.

The objective of our study was to explore Canadian registered midwives' (RMs') experiences with nipple stimulation. An online survey was distributed to practising RMs in British Columbia and Ontario. In total 350 RMs completed the survey. Of these, 154 (44%) practised in British Columbia and 196 (56%) practised in Ontario. This represents a response rate of 53.3% and 20.6% in B.C. and Ontario, respectively. Ninety-six percent of those surveyed (337 RMs) reported having advised clients to use nipple stimulation as a means of releasing oxytocin, and 80% (267 RMs) considered nipple stimulation to be effective. Respondents reported 926 protocols for nipple stimulation. The most common indication for nipple stimulation was for labour augmentation, used by 92% of respondents. Nipple stimulation is widely used by RMs practising in British Columbia and Ontario. Survey respondents believed it to be effective and beneficial in mitigating the need for synthetic oxytocin. Survey results showed that the most common indication for nipple stimulation is labour augmentation. Future research should prospectively address the safety and effectiveness of this non-medical method of labour augmentation.

Exclusive Breastfeeding Rates at 6 Weeks Postpartum as a Function of Preconception Body Mass Index Are Not Impacted by Postpartum Obstetrical Practices or Routines.

Objective: Women with overweight/obesity have significantly lower rates of exclusive breastfeeding (EBF) at 6 weeks postpartum compared with women of normal weight. We sought to determine whether differences in Baby-Friendly Hospital Initiative (BFHI) adherence, obstetric practices, or social support explain these weight-related EBF disparities. Methods: One hundred forty-two healthy women who intended EBF (61 normal weight, 50 overweight, and 31 obese by preconception body mass index [BMI]) were enrolled in a cross-sectional study. Obstetric data were collected and participants completed modified Infant Feeding Practices Study II surveys at 6 weeks postpartum. Results: Women with obesity were significantly less likely to undergo spontaneous labor and more likely to receive synthetic oxytocin and epidural anesthesia compared with women with overweight or normal weight. Women who were overweight were less likely to report extended family support for breastfeeding compared with women with obesity or normal weight; however, BFHI components and composite BFHI score did not differ by maternal BMI. Furthermore, regardless of BMI, women with greater adherence to BFHI practices were more likely to be EBF at 6 weeks postpartum (p-value <0.001). Nonetheless, at 6 weeks postpartum, women with obesity were expressing milk more frequently and less likely to have met their own breastfeeding goals compared with women with overweight and normal weight. Conclusions: Differences in EBF rates by BMI were not explained by BFHI adherence or obstetric practices. These data suggest physiological differences, rather than intrapartum practices and support services, may explain differences in EBF rates by maternal overweight/obesity.

General methods for measuring and comparing medical interventions in childbirth: a framework

BackgroundThe continue increase of interventions during labour in low risk population is a controversial issue of the current obstetric literature, given the lack of evidence demonstrating the benefits of unnecessary interventions for women or infants’ health. This makes it important to have approaches to assess the burden of all medical interventions performed.MethodsExploiting the nature of childbirth intervention as a staged process, we proposed graphic representations allowing to generate alternative formulas for the simplest measures of the intervention intensity namely, the overall and type-specific treatment ratios. We applied the approach to quantify the change in interventions following a protocol termed Comprehensive Management (CM), using data from Robson classification, collected in a prospective longitudinal cohort study carried out at the Obstetric Unit of the Cà Granda Niguarda Hospital in Milan, Italy.ResultsFollowing CM a substantial reduction was observed in the Overall Treatment Ratio, as well as in the ratios for augmentation (amniotomy and synthetic oxytocin use) and for caesarean section ratio, without any increase in neonatal and maternal adverse outcomes. The key component of this reduction was the dramatic decline in the proportion of women progressing to augmentation, which resulted not only the most practiced intervention, but also the main door towards further treatments.ConclusionsThe proposed framework, once combined with Robson Classification, provides useful tools to make medical interventions performed during childbirth quantitatively measurable and comparable. The framework allowed to identifying the key components of interventions reduction following CM. In its turn, CM proved useful to reduce the number of medical interventions carried out during childbirth, without worsening neonatal and maternal outcomes.

Oxytocin and the role of “regulator of emotions”: Definition, neurobiochemical and clinical contexts, practical applications and contraindications

In the field of neuroscience applied to emotions and affects, some hormones have been studied for their relational and social activation capacity. Among these, the peptide hormone called oxytocin, long known for the induction of birth contractions and other physiological functions, is involved in attachment, confidence and reduction of anxiety, facilitating the stability of emotional relationships and therefore loyalty and love. Therapeutic uses are then proposed for synthetic oxytocin for eating disorders, substance addictions and even autism. In the following review, the primary experimental evidence and the possible side effects are proposed again, orienting the study on more detailed specific investigations.

An association of intrapartum synthetic oxytocin dosing and the odds of developing autism.

A case-control study was performed to determine whether an association exists between exposure to synthetic oxytocin and a subsequent autism spectrum disorder diagnosis; 171 children under age 18 meeting Diagnostic and Statistical Manual of Mental Disorders (5th ed.) autism spectrum disorder criteria were compared to 171 children without autism spectrum disorder diagnosis matched by gender, birth year, gestational age, and maternal age at birth. A conditional logistic regression model was used to examine the association of clinical variables and autism spectrum disorder. Significantly elevated odds ratios for autism spectrum disorder were associated with first-time Cesarean section (odds ratio = 2.56), but not a repeat Cesarean section. Odds ratios were also significantly elevated for subjects whose mother’s body mass index was 35 or higher at birth (odds ratio = 2.34) and subjects in which the reason for delivery was categorized as “fetal indication” (odds ratio = 2.00). When controlling for these and other variables, the odds of developing autism spectrum disorder were significantly elevated in males with long duration of exposure (odds ratio = 3.48) and high cumulative dose of synthetic oxytocin (odds ratio = 2.79). No significant associations of synthetic oxytocin dosing and autism spectrum disorder were noted in female subjects. The association of elevated autism spectrum disorder odds found with high duration and high cumulative dose synthetic oxytocin in male subjects suggests the need for further investigation to fully elucidate any cause and effect relationship.Lay abstractOxytocin is a hormone naturally produced in the human body that can make the womb (uterus) contract during labor. Manufactured oxytocin is frequently given to mothers in labor to strengthen the contractions or in some cases to start labor. This study compared children with a diagnosis of autism and children without autism to see whether children with autism received more oxytocin during labor. The odds of a child having an autism diagnosis were significantly higher if the delivery was a first-time Cesarean section, if the mother had a body mass index of 35 or higher, or if the reason for delivery were a range of fetal problems that made delivery necessary. It was found that boys who were exposed to oxytocin for longer periods of time during labor and received higher total doses of oxytocin had significantly higher odds of developing autism. There were no significant associations of oxytocin dosing and autism noted in female children. As this is the first study to look at any relationship between the dose of oxytocin received during labor and the odds of developing autism, further study needs to be done to determine whether there is any cause and effect relationship. Thus, at this time, there is no recommended change in clinical practice.

A monoclonal antibody raised against a synthetic oxytocin peptide stains mouse hypothalamic neurones.

A monoclonal antibody against oxytocin was generated in 7a5 hybridoma cells derived from myeloma cells and lymphocytes from the spleen of mice immunised with a synthetic oxytocin peptide. The 7a5 monoclonal antibody bound with oxytocin in enzyme-linked immunosorbent assays. 7a5 cell growth medium was diluted up to 5000-fold and used for immunohistochemistry. First, to test the specificity of the 7a5 antibody against oxytocin, we stained brain tissues of oxytocin knockout mice, comprising mice in which the first exon of the oxytocin-neurophysin gene is deleted. No 7a5 immunoreactivity was detected in the paraventricular nucleus (PVN) of the hypothalamus of oxytocin knockout mice; however, this area was strongly stained with the anti-vasopressin polyclonal antibody, HM07. Tissue preparations of the wild-type mouse PVN and supraoptic nucleus (SON) displayed 7a5 immunoreactivity that was indistinguishable from the staining produced with an anti-oxytocin polyclonal antibody, HM06. The immunoreactivity of HM06 in the PVN was similar to that of an anti-oxytocin monoclonal antibody, PS38. We then examined the cross-reactivity of 7a5 with arginine vasopressin. The majority of cell soma and processes stained by 7a5 were not co-stained with the vasopressin antibody in SON and PVN regions. Furthermore, the suprachiasmatic nucleus was stained by the vasopressin antibody but not by 7a5. These results demonstrate that 7a5 is a new anti-oxytocin monoclonal antibody recognising oxytocin and not vasopressin; therefore, 7a5 can be used to investigate the role of oxytocin in the brain.

The Effects of Synthetic Oxytocin Given at Birth on Postpartum Period: Traditional Review

The Effects of Synthetic Oxytocin Given at Birth on Postpartum Period: Traditional Review

Key comparison study on peptide purity - synthetic oxytocin

Under the auspices of the Protein Analysis Working Group (PAWG) of the Comité Consultatif pour la Quantité de Matière (CCQM) a key comparison, CCQM-K115.b, was coordinated by the Bureau International des Poids et Mesures (BIPM) and the Chinese National Institute of Metrology (NIM). Seven Metrology Institutes or Designated Institutes and the BIPM participated. Participants were required to assign the mass fraction of oxytocin (OXT) present as the main component in the comparison sample for CCQM-K115.b. The comparison samples were prepared from synthetic OXT purchased from a commercial supplier and used as provided without further treatment or purification.OXT was selected to be representative of the performance of a laboratory's measurement capability for the purity assignment of chemically synthesized peptides of known sequence, with one cross-link and up to 5 kDa. It was anticipated to provide an analytical measurement challenge representative for the value-assignment of compounds of broadly similar structural characteristics.The majority of participants used amino acid analysis (PICAA) or quantitative nuclear magnetic resonance (PICqNMR) spectroscopy with a correction for structurally-related peptide impurities approach as the amount of material that has been provided to each participant (25 mg) is insufficient to perform a full mass balance based characterization of the material by a participating laboratory. The coordinators, both the BIPM and the NIM, were the laboratories to use the mass balance approach as they had more material available.It was decided to propose KCRVs for both the OXT mass fraction and the mass fraction of the peptide related impurities as indispensable contributor regardless of the use of PICAA, PICqNMR or mass balance to determine the OXT purity. This allowed participants to demonstrate the efficacy of their implementation of the approaches used to determine the OXT mass fraction. In particular, it allows participants to demonstrate the efficacy of their implementation of peptide related impurity identification and quantification.More detailed studies on the identification/quantification of peptide related impurities and the hydrolysis efficiency revealed that the integrity of the impurity profile of the related peptide impurities obtained by the participant is crucial for the impact on accuracy of the OXT mass fraction assignment.The assessment of the mass fraction of peptide impurities is based on the assumption that only the Largest Consistent Subset (LCS) of results is taken for the calculation of the KCRVPepImp by use of the weighted mean. The KCRVPepImp of 31.6 mg/g is associated with a small corresponding expanded uncertainty of ±1.4 mg/g (k =2) providing a more realistic basis of evaluation for the capabilities of the participants to identify/quantify peptide related impurities. Inspection of the degree of equivalence plots for the mass fraction of peptide impurities and additional information obtained from the peptide related impurity profile indicates that in many cases the major related peptide impurities have been identified and quantified.The approach selected to obtain a KCRVOXT for the mass fraction of OXT is based on random-effects meta-analysis (DerSimonian-Laird (DSL) variance-weighted mean). The DSLmean takes into account the uncertainties of the results while introducing sufficient excess variance to allow for their observed dispersion resulting in a larger expanded uncertainty U(KCRVOXT). The KCRVOXT for CCQM-K115.b is 787.2 mg/g with a corresponding expanded uncertainty of the KCRVOXT of ±12.9 mg/g. All OXT mass fraction results except the result of NMIM are in agreement with the KCRVOXT. It should be pointed out that the mass balance approaches show smaller uncertainties than PICAA or PICqNMR approaches. Mass balance approaches seem to produce slightly higher OXT mass fractions while PICAA approaches deliver slightly lower OXT mass fractions.Main textTo reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.The final report has been peer-reviewed and approved for publication by the CCQM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

Pilot study on peptide purity—synthetic oxytocin

Under the auspices of the Protein Analysis Working Group (PAWG) of the Comité Consultatif pour la Quantité de Matière (CCQM) a pilot study, CCQM-P55.2.b, was coordinated by the Bureau International des Poids et Mesures (BIPM) and the Chinese National Institute of Metrology (NIM). Three Metrology Institutes or Designated Institutes and the BIPM participated. Participants were required to assign the mass fraction of oxytocin (OXT) present as the main component in the comparison sample for CCQM-P55.2.b. The comparison samples were prepared from synthetic OXT purchased from a commercial supplier and used as provided without further treatment or purification.OXT was selected to be representative of the performance of a laboratory's measurement capability for the purity assignment of chemically synthesized peptides of known sequence, with one cross-link and up to 5 kDa. It was anticipated to provide an analytical measurement challenge representative for the value-assignment of compounds of broadly similar structural characteristics.The majority of participants used quantitative nuclear magnetic resonance (PICqNMR) spectroscopy with a correction for structurally-related peptide impurities. Other participants provided results obtained by peptide impurity corrected amino acid analysis (PICAA) or Inductively coupled plasma mass spectrometry (PICICP). It was decided to assign reference values based on the KCRVs of CCQM-K115.b for both the OXT mass fraction and the mass fraction of the peptide related impurities as indispensable contributor regardless of the use of PICAA, mass balance or any other approach to determine the OXT purity. This allowed participants to demonstrate the efficacy of their implementation of the approaches used to determine the OXT mass fraction. In particular, it allows participants to demonstrate the efficacy of their implementation of peptide related impurity identification and quantification.More detailed studies on the identification/quantification of peptide related impurities and the hydrolysis efficiency revealed that the integrity of the impurity profile of the related peptide impurities obtained by the participant is crucial for the impact on accuracy of the OXT mass fraction assignment.The assessment of the mass fraction of peptide impurities is based on the assumption that only the Largest Consistent Subset (LCS) of results is taken for the calculation of the KCRVPepImp by use of the weighted mean. The KCRVPepImp of 31.6 mg/g is associated with a small corresponding expanded uncertainty of ±1.4 mg/g (k = 2) providing a more realistic basis of evaluation for the capabilities of the participants to identify/quantify peptide related impurities. Inspection of the degree of equivalence plots for the mass fraction of peptide impurities and additional information obtained from the peptide related impurity profile indicates that in many cases the major related peptide impurities have been identified and quantified.The approach selected to obtain a KCRVOXT for the mass fraction of OXT is based on random-effects meta-analysis (DerSimonian-Laird (DSL) variance-weighted mean). The DSLmean takes into account the uncertainties of the results while introducing sufficient excess variance to allow for their observed dispersion resulting in a larger expanded uncertainty U(KCRVOXT). The KCRVOXT for CCQM-K115.b is 787.2 mg/g with a corresponding expanded uncertainty of the KCRVOXT of ±12.9 mg/g. It should be pointed out that the mass balance approaches show smaller uncertainties than PICAA, PICqNMR or PICICP approaches. Inspection of the degree of equivalence plots for CCQM-P55.2.b for the mass fraction of OXT shows that all results, except the UME qNMR result, agree with the reference value.Main textTo reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.The final report has been peer-reviewed and approved for publication by the CCQM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

Induction of labour should be offered to all women at term: AGAINST: Induction of labour should not be offered to all women at term: first, do no harm.

Induction of labour can improve maternal and neonatal outcomes. However, more and more women without medical risks or complications are being induced. Although induction at term could prevent rare cases of fetal death, all induced women will be exposed to potential disadvantages. Women whose labours are induced have a higher risk of postpartum haemorrhage, uterine rupture, hyperstimulation resulting in fetal distress, and perineal injuries (Miller et al. Lancet 2016;388:2176–92). Furthermore, more women need pain medication and have limited freedom of movement, a longer labour, and a negative birth experience. There is increasing evidence that suggests negative consequences of synthetic oxytocin administration. This may influence maternal–fetal bonding, the maternal psyche, and neonatal preparation on being born. A large cohort study found higher rates of jaundice, feeding problems, infections, metabolic disorders, and eczema up to 5 years of age among children born after induced labour (Peters et al. Birth 2018;45:347–57). Induction of labour has been associated with reduced caesarean section (CS) rates in some randomised controlled trials (RCTs) but not in cohort studies (Rydahl et al. JBI Database System Rev Implement Rep 2019;17:170–208). The study population in these RCTs is often rather different than the general population. Additionally, before a major intervention (induction) is offered to reduce another intervention (CS), effective non-medical physiological approaches should be implemented first. An example of this very effective strategy is providing continuous support during labour (Bohren et al. Cochrane Database Syst Rev 2017;[7]:CD003766). This has been shown to reduce CS rates by 25%. Further, women who receive continuous support are 10% less likely to have an instrumental birth, 31% less likely to report a negative childbirth experience, and 10% less likely to need intrapartum pain medication, and labours are on average 0.69 hours shorter. Moreover, babies are 38% less likely to have a 5-minute Apgar score of ≤7. In spite of these very good outcomes, most women do not receive continuous support during labour. Another big problem of inducing more women is the increased pressure on maternity healthcare resources, which are already constrained in many countries. Women who are induced occupy hospital beds, sometimes for several days, before labour starts. This means not only an enormous increase of workload for the healthcare workers but also reduces access for women with acute risks or complications. As a consequence, the availability of staff to provide non-medical approaches such as continuous support and to focus on prevention will become even more restricted than it is already. Most women prefer giving birth without interventions and value having a positive childbirth experience in addition to healthy outcomes (Downe et al. PLoS One 2018;13:e0194906). Induction of labour often results in a cascade of interventions that are neither pleasant nor empowering for women. Minimising obstetric interventions and giving support to childbearing women improves maternal experiences of childbirth and enhances empowerment. Offering induction to all women at term ignores the principles of the Hippocratic oath, ‘first, do no harm’ and should therefore only be reserved for women with a clear medical indication. None declared. A completed disclosure of interests form is available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Effects of oxytocin administration on milk yield and milk composition of West African Dwarf does

Abstract Incomplete evacuation of milk from the alveoli during milking leads to reduced milk yield and milk quality. This makes it imperative to search for means of enhancing complete removal of milk from the udder. The study was carried out to determine the effects of oxytocin (OT) administration on milk yield and milk composition of twenty one lactating West African Dwarf (WAD) does. The 21 does were grouped into three treatment groups of seven animals each, homogeneous by weight and parity, and fed 0.3–0.5 kg and 1 kg/head/day concentrate and Panicum maximum respectively and they have free access to water until the end of the experiment. Does were administered oxytocin intramuscularly for 12 weeks according to the dose assigned to each group: 0, 2, and 4 IU respectively. The experiment commenced five days post-partum. Does were injected with 1 IU synthetic oxytocin in the evening (7:00 pm) of weekly separation from their kids and hand milked to empty their udders. After 12 h of separation, the does were injected with the appropriate dose of oxytocin and hand milked. Weekly data were collected on milk yield, fat, protein, lactose, total solids, moisture, ash, solids-not-fat, milk pH and titratable acidity. Data were subjected to Analysis of Variance using the General Linear Model for repeated measures in Analytical Computer Package, Version 5.02 (SYSTAT, 1992). Milk yield was significantly (P

Maternal plasma levels of oxytocin during physiological childbirth \u2013 a systematic review with implications for uterine contractions and central actions of oxytocin

BackgroundOxytocin is a key hormone in childbirth, and synthetic oxytocin is widely administered to induce or speed labour. Due to lack of synthetized knowledge, we conducted a systematic review of maternal plasma levels of oxytocin during physiological childbirth, and in response to infusions of synthetic oxytocin, if reported in the included studies.MethodsAn a priori protocol was designed and a systematic search was conducted in PubMed, CINAHL, and PsycINFO in October 2015. Search hits were screened on title and abstract after duplicates were removed (n = 4039), 69 articles were examined in full-text and 20 papers met inclusion criteria. As the articles differed in design and methodology used for analysis of oxytocin levels, a narrative synthesis was created and the material was categorised according to effects.ResultsBasal levels of oxytocin increased 3–4-fold during pregnancy. Pulses of oxytocin occurred with increasing frequency, duration, and amplitude, from late pregnancy through labour, reaching a maximum of 3 pulses/10 min towards the end of labour. There was a maximal 3- to 4-fold rise in oxytocin at birth. 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.ConclusionsPlasma 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.

Postpartum kanamanın önlenmesi ve tedavisinde kullanılan sentetik oksitosinin postpartum depresyon ile ilişkisi

Objective:The aim of this study was to examine the relationship between postpartum synthetic oxytocin administration and the development of depressive and anxiety disorders after delivery.Materiyal and methods: We hypothesized that women exposed to postpartum exogenous oxytocin would have a reduced risk of postpartum depressive and anxiety disorders compared with those without exposure. The cases were examined under two groups as "Oxytocin users" (n = 100) and "Control" (n = 100) groups . Oxytocin group was given introvenous oxytocin just after the delivery for postpartum hemorrhage prevention and treatment. Questionnaires of depression and maternal anxiety were performed at the sixth week after the delivery. Results: The incidence of depression (4%) in the oxytocin group was significantly lower than the control group (14%) (p: 0.026, p &amp;lt;0.05). Patients who do not use oxytocin have a 3.9-fold greater risk of developing depression. We identified a relationship between using oxytocin for postpartum hemorragie and decreased postpartum depressive symptoms. Conclusion: Our findings suggest using exogenous oxytocin may contribute to postpartum symptoms of depression and anxiety among women. Future research should watch the longitudinal role of exogenous oxytocin in maternal mood and anxiety, the safety of high-dose long-term use of oxytocin.

Obstetric Synthetic Oxytocin Use and Subsequent Hyperactivity/Inattention Problems in Danish Children

(Acta Obstet Gynecol Scand. 2018;97:880–889) Synthetic oxytocin is commonly used to induce or augment labor. One report found that oxytocin augmentation of spontaneous labor occurred in almost 50% of deliveries in the United States. However, the widespread use of synthetic oxytocin for labor augmentation may be associated with adverse outcomes. For instance, uterine hyperstimulation and low Apgar scores have previously been reported. Oxytocin does cross the placenta and in a study of pregnant rats it was found to have a detrimental effect on central nervous system development of the offspring. Previous studies examining any potential effects of oxytocin use on attention deficit/hyperactivity disorder have had varying results. The objective of this population-based study was to examine the association between synthetic oxytocin use during labor and hyperactivity/inattention problems in the children.

Systematic Review of the Relationship Between Oxytocin and Postpartum Depression

To describe the relationship between the hormone oxytocin (OT), which is often used in labor and birth, and postpartum depression symptoms. Systematic review of literature. Emory University School of Nursing. Limited to participants who were in the postpartum period. Five databases (PubMed, Web of Science, Embase, PsycInfo, and CINAL) were searched in December 2018 using keywords postpartum depression, postnatal depression, oxytocin, synthetic oxytocin, Syntocinon, Duratocin, and Pitocin. Articles were eligible for inclusion if they included peer-reviewed quantitative findings from human studies detailing any relationship between the OT system and postpartum (1-year postbirth) and depression symptoms. Exclusion criteria included abstracts without full peer-reviewed publication; theoretical, case study, or review articles; exclusively prenatal; included depression measurements for more than 1-year postpartum or explored only the OTX genotype. The Newcastle-Ottawa Scale assessed quality of nonrandomized studies, and the revised Cochrane Collaboration risk-of-bias (RoB 2) tool assessed randomized, controlled trials. The initial search yielded 618 records. After removing duplicates and applying inclusion–exclusion criteria, 19 remained. Three study areas emerged: correlation of maternal endogenous OT levels with postpartum depression symptoms, association of peripartum intravenous synthetic OT (Pitocin) exposure with postpartum depression symptoms, and postpartum intranasal OT exposure as treatment for postpartum depression. In the endogenous correlation group (n = 12), 9 studies reported plasma OT levels inversely correlated with postpartum depression symptoms, 1 found a positive relationship, and 1 no association. Oxytocin administration in labor had a positive correlation with postpartum depression symptoms in 2 studies, a negative in 1, and no relationship in a 3rd. Three randomized, controlled trials of intranasal synthetic oxytocin as a treatment modality were nonsignificant. Overall, it appears that higher endogenous oxytocin levels are associated with fewer postpartum depression symptoms. Hospital and office nurses can educate and encourage activities already established as increasing oxytocin, including breastfeeding, skin-to-skin contact, and other bonding activities. More research is needed to know effects of peripartum oxytocin administration on mood, but nurses should use only as medically indicated. Last, there is no currently evidence to suggest intranasal OT as an effective treatment modality.

The effect of labor medications on normal newborn behavior in the first hour after birth: A prospective cohort study

BackgroundSkin-to-skin contact after birth between mother and baby has immediate and long-term advantages. Widström's 9 Stages of Newborn Behavior offer an opportunity to evaluate a baby in the natural, expected and optimal habitat. Intrapartum drugs, including fentanyl administered via epidural and synthetic oxytocin (synOT), have been studied in relation to neonatal outcomes with conflicting results. AimsDetermine the effects of common intrapartum medications on the instinctive behavior of healthy newborns during the first hour after birth through a prospective cohort study. Study designVideo record newly-born term infants during the first hour after birth while in skin-to-skin contact with mother. Code and analyze videos using Widström's 9 Stages; compare with the labor medications mothers received. SubjectsConvenience sample of sixty-three low-income mothers self-selected to labor with or without intrapartum analgesia. Outcome measuresDuration of time infants spend in each of Widström's 9 Stages for four cohorts: 1) exposed to no synOT or epidural fentanyl during labor, 2) exposed to fentanyl (but not synOT), 3) exposed synOT (but not fentanyl), 4) exposed to both fentanyl and synOT. ResultsA strong inverse correlation was found between intrapartum exposure to fentanyl and synOT and the normal behavior of an infant, as measured by time in each Stage. ConclusionsIntrapartum exposure to the drugs fentanyl and synOT is associated with altered newborn infant behavior, including suckling, while in skin-to-skin contact with mother during the first hour after birth. Widström's 9 Stages offer an opportunity to analyze newborn behavior whilst in the optimal habitat of the infant.