Oxytocin Augmentation in Spontaneously Laboring, Nulliparous Women: Multilevel Assessment of Maternal BMI and Oxytocin Dose

Carlson, Nicole S.; Corwin, Elizabeth J.; Lowe, Nancy K.

doi:10.1177/1099800417701831

Cited by 30 publications

(27 citation statements)

References 32 publications

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“…21,22 It has also been shown that leptin, which has an inhibitory effect on the myometrium, is produced by adipose tissue and therefore is present in higher concentrations with increasing BMI. 9,[22][23][24] There may also be changes in the expression of function of the oxytocin receptor, as it has been shown that variants in the oxytocin receptor gene expression may lead to variable responses during labor. 16,25,26 Furthermore, an increase in oxytocin receptor expression and decrease in receptor sensitivity have been seen with increasing BMI.…”

Section: Resultsmentioning

confidence: 99%

The Effect of Maternal Obesity on Oxytocin Requirements to Achieve Vaginal Delivery

2019

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Objective Our objective was to determine if obese women are more likely to require oxytocin rates > 20 mU/min to achieve vaginal delivery, compared with normal weight women. Study Design This is a retrospective cohort study of deliveries at the MedStar Washington Hospital Center and MedStar Georgetown University Hospital. Results There were 4,284 births included in the analysis. Thirty-three per cent of deliveries were among women classified as overweight (body mass index [BMI] 25–29.9 kg/m2) and 58% were among women classified as obese (BMI >30.0 kg/m2), 12% were classified as class III obesity (BMI >40 kg/m2). Overall 110 (2.6%) women required an oxytocin rate of >20 mU/min. Doses of oxytocin >20 mU/min for women in the overweight, class I obesity, and class II obesity groups were 2.6, 1.9, and 1.6%, respectively. Deliveries among women with class III obesity had a significantly longer duration of oxytocin exposure (10.7 hours) compared with the normal weight group (8.2 hours, p < 0.001), and had a higher maximum rate of oxytocin compared (10 mU/min) to normal weight women (8 mU/min, p < 0.001). Conclusion Obese women are more likely to require oxytocin rates more than 20 mU/min, higher doses of oxytocin, and greater duration of oxytocin exposure to achieve a vaginal delivery.

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Section: Resultsmentioning

confidence: 99%

The Effect of Maternal Obesity on Oxytocin Requirements to Achieve Vaginal Delivery

2019

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“…Currently, the safety and optimal use of labor interventions like oxytocin augmentation has not been established among women who are obese, although it is known that these women more often show poor response to oxytocin augementation and require higher titrations of oxytocin to achieve vaginal birth, even after spontaneous labor onset . Oxytocin use is associated with uterine tachysystole with fetal distress, and has been linked to multiple maternal and neonatal complications, prompting its classification as one of the 12 most dangerous medications used in a hospital .…”

Section: Discussionmentioning

confidence: 99%

Labor Intervention and Outcomes in Women Who Are Nulliparous and Obese: Comparison of Nurse‐Midwife to Obstetrician Intrapartum Care

Carlson¹,

Corwin²,

Lowe³

2017

J Midwife Womens Health

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Background Women who are obese have slower labors than women of normal weight, and show reduced response to interventions designed to speed labor progress like oxytocin augmentation and artificial rupture of membranes. The optimal labor management for these women has not been described. Methods This retrospective cohort study compared 2 propensity score-matched groups of women (N = 360) who were healthy, nulliparous, spontaneously laboring, and obese (body mass index 30 kg/m2). Labors were managed by either a certified nurse-midwife (CNM) or an obstetrician at one hospital from 2005 through 2012. Comparisons were made on a range of labor processes and outcomes. Results Women who were obese and cared for in labor by CNMs were 87.0% less likely to have operative vaginal birth (adjusted odds ratio [aOR], 0.15; 95% confidence interval [CI], 0.06–0.41) and 76.3% less likely to have third- or fourth-degree perineal lacerations (aOR, 0.31; 95% CI, 0.13–0.79) compared to a matched group of women who were obese and had similarly sized neonates but who were cared for by obstetricians. The rates of unplanned cesarean birth, postpartum hemorrhage, maternal intrapartum fever, and neonatal intensive care unit admission were similar between groups. CNM patients were significantly less likely than patients of obstetricians to have labor anesthesia, synthetic oxytocin augmentation, or intrauterine pressure catheters. By contrast, CNM patients were significantly more likely than patients of obstetricians to use physiologic labor interventions, including intermittent fetal monitoring, ambulation, and hydrotherapy. Discussion In women with spontaneous labor onset who were healthy, obese, and nulliparous, watchful waiting and use of physiologic labor interventions, characterizing CNM intrapartum care, were associated with outcomes that were similar to, or better than, those of women who were obese and exposed to more high-technology interventions characterizing intrapartum care by obstetricians. In women who were obese, physiologic labor interventions were safe for both mothers and neonates.

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“…After controlling for maternal, fetal, and labor characteristics, BMI alone explained 16.56% (95% Confidence Interval (CI)13.7-20.04) of the variance in hourly oxytocin doses. The authors concluded, obesity contributes to blunting of myometrial contractility and therefore a response to oxytocin [8]. This effect was seen in Hill M et al study as well.…”

Section: Resultsmentioning

confidence: 53%

Oxytocin and obesity: 2015-2017 literature review on oxytocin use in obese women

Kernberg¹

2017

Clin Sci Res Rep

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As obesity becomes more prevalent, research regarding oxytocin use is increasing as well. A literature review from 2015-2017 assessing oxytocin use in obesity highlighted this evolving field. Body Max Index (BMI) alone appears to contribute to blunted myometrial and therefore contractile responses seen in obese women. The interplay of elevated progesterone and leptin contribute to this phenomenon, and maybe explain the elevated oxytocin dosing seen amongst this population. None the less, the effects of obesity on the mode of delivery is still controversial, with some investigators claiming the interval from induction to delivery, delivery within 24 hours, vaginal delivery within 24 hours, and the cesarean delivery rate did not vary between stratified classes of obesity. Conversely, the authors concluded that as BMI increases the women undergoing induction with misoprostol have a longer time to delivery, require greater quantities of misoprostol, longer duration of oxytocin, and increased cesarean section rates. Amongst the literature, there is a consistent message that obese women are somehow different. Investigating the information retrospectively highlights areas, which necessitate prospective trails and assessment.

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Oxytocin Augmentation in Spontaneously Laboring, Nulliparous Women: Multilevel Assessment of Maternal BMI and Oxytocin Dose

Cited by 30 publications

References 32 publications

The Effect of Maternal Obesity on Oxytocin Requirements to Achieve Vaginal Delivery

The Effect of Maternal Obesity on Oxytocin Requirements to Achieve Vaginal Delivery

Labor Intervention and Outcomes in Women Who Are Nulliparous and Obese: Comparison of Nurse‐Midwife to Obstetrician Intrapartum Care

Oxytocin and obesity: 2015-2017 literature review on oxytocin use in obese women

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