Intrapartum oxytocin: time to focus on longer term consequences?

Carbetocin at elective caesarean section: a sequential allocation trial to determine the minimum effective dose in obese women

“…However, more recently the ED 90 (95%CI) of carbetocin was found to be 14.8 (13.7–15.8) μg in women with a BMI < 40 kg.m −2 who had no previous exposure to oxytocin . A recent international consensus statement provides guidance on the use of uterotonic agents at caesarean section . The potential for a reduced dose requirement of < 100 μg for low‐risk women having elective caesarean section was acknowledged, as well as the possible need for higher doses of uterotonics in at‐risk women.…”

Carbetocin compared with oxytocin in non-elective Cesarean delivery: a systematic review, meta-analysis, and trial sequential analysis of randomized-controlled trials

“…Problems with the external validity of the pharmacodynamic data relating to oxytocin, and the absence of relevant pharmacokinetic data, contribute to clinical uncertainty about the optimal dosing strategies in this context. 29 The thoroughness of the database searches and the retrieval of some raw data strengthen the validity of the analysis. There was, however, high heterogeneity (I 2 , 90.60%) between studies for the primary outcome.…”

Oxytocin-induced birth causes sex-specific behavioral and brain connectivity changes in developing rat offspring

“…Oxt, acting through the Oxt receptor (Oxtr), is essential for the maturation of social behaviors during development, and is an important neurotransmitter for modulating trust, compassion, and empathy behaviors. 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 Despite knowledge of these recently discovered critical roles of Oxt in human behavior, and evidence for transplacental transfer of maternally administered Oxt, 14 , 29 , 30 , 31 a fundamental question still remains unanswered: can maternally administered Oxt affect oxytocinergic signaling in the developing brain? This lack of knowledge is concerning because Oxtr is a G-protein coupled receptor that is highly susceptible to desensitization and downregulation upon prolonged stimulation with Oxt, 32 , 33 such as during prolonged administration for the management of labor.…”

“…Most studies on Oxt use focus solely on obstetric outcomes and immediate neonatal wellbeing without assessment of the long-term neurodevelopmental impact of such interventions. 27 , 28 Furthermore, given its ubiquitous use and the artificially elevated Oxt environment during the perinatal period (i.e., prophylactic use in postpartum hemorrhage), clinical studies with an Oxt-naive control group are challenging, if not impossible. Not surprisingly, there is a dearth of high quality evidence regarding neurodevelopmental health of children after induced birth with Oxt.…”