Maternal haemodynamics at elective caesarean section: a randomised comparison of oxytocin 5-unit bolus and placebo infusion with oxytocin 5-unit bolus and 30-unit infusion

McLeod, Graeme; Munishankar, B.; MacGregor, H.; Murphy, Deirdre J.

doi:10.1016/j.ijoa.2009.08.005

Cited by 25 publications

(16 citation statements)

References 11 publications

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“…The resulting concerns led to a call for caution in using intravenous oxytocin in women with unstable cardiovascular conditions such as hypovolaemia, shock, or cardiac disease. A haemodynamic study completed in advance of the Elective caesarean Section Syntocinon Infusion Trial showed that circulatory disturbances in otherwise healthy women occurred secondary to regional anaesthesia and not in response to intravenous bolus oxytocin 30. The current study provides important evidence on the safety of intravenous oxytocin 10 IU administered as a slow bolus injection over one minute after exclusion of women with a history of cardiovascular disease.…”

Section: Discussionmentioning

confidence: 70%

Intramuscular versus intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery: randomised controlled trial

Adnan

Conlan-Trant

McCormick

et al. 2018

BMJ

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ObjectiveTo determine whether intravenous oxytocin is more effective than intramuscular oxytocin at preventing postpartum haemorrhage at vaginal delivery.DesignDouble blind placebo controlled randomised trial.SettingUniversity affiliated maternity unit in the Republic of Ireland.Participants1075 women aged 18 years or older, at term with a singleton pregnancy who were aiming for a vaginal delivery with an actively managed third stage of labour.InterventionsWomen were allocated to an intravenous bolus of oxytocin (10 IU in 1 mL given slowly over one minute) and placebo intramuscular injection (1 mL 0.9% saline) or an intramuscular bolus of oxytocin (10 IU in 1 mL) and placebo intravenous injection (1 mL 0.9% saline given slowly over one minute) at vaginal delivery. Allocation was by a secure web based randomisation service with masking of participants and clinicians to the trial intervention.Main outcome measuresThe primary outcome was postpartum haemorrhage (PPH, measured blood loss ≥500 mL). Secondary outcomes were severe PPH (measured blood loss ≥1000 mL), need for blood transfusion, admission to a high dependency unit, and side effects to oxytocin.ResultsBetween 4 January 2016 and 13 December 2017, 1075 women were randomised and 1035 (96.3%) included in the primary and secondary analyses (517 in the intravenous oxytocin group and 518 in the intramuscular oxytocin group). The incidence of PPH was not significantly lower in the intravenous group (18.8%, 97/517) compared with intramuscular group (23.2%, 120/518): adjusted odds ratio 0.75 (95% confidence interval 0.55 to 1.03). The incidence of severe PPH, however, was significantly lower in the intravenous group (4.6%, 24/517) compared with intramuscular group (8.1%, 42/518): 0.54 (0.32 to 0.91) as was the need for blood transfusion (1.5% v 4.4%, 0.31, 0.13 to 0.70) and admission to a high dependency unit (1.7% v 3.7%, 0.44, 0.20 to 0.98). The number needed to treat to prevent one case of severe PPH was 29 (95% confidence interval 16 to 201) and to prevent one case of blood transfusion was 35 (20 to 121). The incidence of side effects to oxytocin was not increased in the intravenous group compared with intramuscular group (4.1% v 5.2%, 0.75, 0.42 to 1.35).ConclusionIntravenous oxytocin for the third stage of labour results in less frequent severe PPH, blood transfusion, and admission to a high dependency unit than intramuscular oxytocin, and without excess side effects.Trial registrationCurrent Controlled Trials ISRCTN14718882.

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Section: Discussionmentioning

confidence: 70%

Intramuscular versus intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery: randomised controlled trial

Adnan

Conlan-Trant

McCormick

et al. 2018

BMJ

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“…Correspondingly, heart disease was the leading cause of death for women in the United States, killing 289,758 women in 2013 (Xu et al, 2016). CAD-associated hypertension increased dramatically in women after menopause due to reduction in ovarian hormone in older women (McLeod et al, 2010), which could impair baroreflex and autonomic balance by negatively impacting OTergic drive and OT levels in pre-autonomic neurons in rats (De Melo et al, 2016). Declines in OT and OTRs were related to aging-associated acceleration of inflammation and oxidative injuries in the CVS, particularly after menopause (Light et al, 2005).…”

Section: Atherosclerosis and Cardioprotective Effect Of Otmentioning

confidence: 99%

Therapeutic Potential of Oxytocin in Atherosclerotic Cardiovascular Disease: Mechanisms and Signaling Pathways

Wang

Yang

et al. 2019

Front. Neurosci.

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Coronary artery disease (CAD) is a major cardiovascular disease responsible for high morbidity and mortality worldwide. The major pathophysiological basis of CAD is atherosclerosis in association with varieties of immunometabolic disorders that can suppress oxytocin (OT) receptor (OTR) signaling in the cardiovascular system (CVS). By contrast, OT not only maintains cardiovascular integrity but also has the potential to suppress and even reverse atherosclerotic alterations and CAD. These protective effects of OT are associated with its protection of the heart and blood vessels from immunometabolic injuries and the resultant inflammation and apoptosis through both peripheral and central approaches. As a result, OT can decelerate the progression of atherosclerosis and facilitate the recovery of CVS from these injuries. At the cellular level, the protective effect of OT on CVS involves a broad array of OTR signaling events. These signals mainly belong to the reperfusion injury salvage kinase pathway that is composed of phosphatidylinositol 3-kinase-Akt-endothelial nitric oxide synthase cascades and extracellular signal-regulated protein kinase 1/2. Additionally, AMP-activated protein kinase, Ca 2+ /calmodulin-dependent protein kinase signaling and many others are also implicated in OTR signaling in the CVS protection. These signaling events interact coordinately at many levels to suppress the production of inflammatory cytokines and the activation of apoptotic pathways. A particular target of these signaling events is endoplasmic reticulum (ER) stress and mitochondrial oxidative stress that interact through mitochondria-associated ER membrane. In contrast to these protective effects and machineries, rare but serious cardiovascular disturbances were also reported in labor induction and animal studies including hypotension, reflexive tachycardia, coronary spasm or thrombosis and allergy. Here, we review our current understanding of the protective effect of OT against varieties of atherosclerotic etiologies as well as the approaches and underlying mechanisms of these effects. Moreover, potential cardiovascular disturbances following OT application are also discussed to avoid unwanted effects in clinical trials of OT usages.

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“…Both Cecilia, Ghulmiyyah, and partly King, investigated the effect of oxytocin infusion without bolus dose. All of them found that the bolus of oxytocin is not necessary to achieve adequate and wanted uterine contraction and prevent PPH and the smaller dose of oxytocin (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) given as continuous infusion has the same effect as the bigger one [13,16,17]. This should also be taken into the consideration, as previously discussed, cardiovascular changes are observed almost in every patient given at least 5 IU bolus of oxytocin, so the strategy of using only the infusion of oxytocin could be further researched or bolus dose should be as small as possible.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic Dose of Oxytocin for Uterine Atony during Caesarean Delivery: A Systematic Review

Baliulienė

Vitartaitė

Rimaitis

2021

IJERPH

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Objective—to overview, compare and generalize results of randomized clinical trials analyzing different oxytocin doses to prevent postpartum hemorrhage, initiate and maintain uterine contraction after Caesarean delivery. Methods—‘PubMed’, ‘EMBASE’, ‘CENTRAL’, and ‘CINAHL’ electronic databases were searched for clinical trials analyzing the effectiveness of different dose of oxytocin given intravenously during surgery for uterine contraction and to reduce postpartum hemorrhage. A systematic review of relevant literature sources was performed. Results—our search revealed 813 literature sources. A total of 15 randomized clinical trials, comparing different doses of oxytocin bolus and infusion used after caesarean delivery have met the selection criteria. Conclusion—oxytocin bolus 0.5–3 UI is considered an effective prophylactic dose. Recommended effective prophylactic oxytocin infusion dose is 7.72 IU/h, but it is unanswered whether we really need a prophylactic infusion of oxytocin if we choose effective bolus dose size and rate. Adverse hemodynamic effects were observed when a 5 UI oxytocin bolus was used. However, topics such as bolus dose size, infusion dose size and requirement as well as bolus injection rate, still remain unanswered. The doses that are recommended in the guidelines of peripartum hemorrhage prophylaxis are not confirmed by randomized controlled double-blind trials and more research should cover this topic.

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Maternal haemodynamics at elective caesarean section: a randomised comparison of oxytocin 5-unit bolus and placebo infusion with oxytocin 5-unit bolus and 30-unit infusion

Cited by 25 publications

References 11 publications

Intramuscular versus intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery: randomised controlled trial

Intramuscular versus intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery: randomised controlled trial

Therapeutic Potential of Oxytocin in Atherosclerotic Cardiovascular Disease: Mechanisms and Signaling Pathways

Prophylactic Dose of Oxytocin for Uterine Atony during Caesarean Delivery: A Systematic Review

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