Up-Regulation of Oxytocin Receptor Expression at Term Is Related to Maternal Body Mass Index

Garabedian, Matthew; Hansen, Wendy F.; McCord, Lauren A.; Manning, Mark; O’Brien, John; Curry, Thomas E.

doi:10.1055/s-0032-1329179

Cited by 20 publications

(13 citation statements)

References 31 publications

(41 reference statements)

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“…The hormonal milieu of an obese woman appears to interact with oxytocin regulation and response, and/or affect myometrium contractility. It is possible that increased BMI leads to variation in expression and function of the oxytocin receptor of the human myometrium [15], which explains the higher doses of oxytocin required in obese patients. Further, leptin, methyl palmitate, and apelin are overexpressed in obese women, and have all been shown to impact myometrium contractility [12][13][14].…”

Section: Discussionmentioning

confidence: 99%

“…Increasing evidence suggests that a complex interplay of hormonal modulators produced in adipose tissue could inhibit myometrial contractility [12][13][14]. In vitro studies also suggest that oxytocin receptor expression and/or function is affected by body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) and that oxytocin response is somehow blunted by obesity [15]. Indeed, treatment of protracted labor with oxytocin has been shown to be less effective in obese patients [16].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cumulative oxytocin dose during induction of labor according to maternal body mass index

Roloff

Peng

Sánchez-Ramos

et al. 2015

Intl J Gynecology & Obste

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cumulative oxytocin dose during induction of labor according to maternal body mass index

Roloff

Peng

Sánchez-Ramos

et al. 2015

Intl J Gynecology & Obste

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“…Although the exact mechanism remains unclear, the hormonal milieu of obese women, which appears to interact with oxytocin regulation and response, may affect myometrium contractility, as well as the variation in expression and function of the oxytocin receptor of the human myometrium caused by increased BMI. [ 17 ] This may explain in part why obese women may have a longer labor. Unfortunately, we did not have a sufficient number of very obese women for a stratified analysis for labor progression by BMI.…”

Section: Discussionmentioning

confidence: 99%

The expected labor progression after labor augmentation with oxytocin: A retrospective cohort study

et al. 2018

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ObjectiveTo describe labor progression patterns with oxytocin for augmentation in women who achieve vaginal delivery; and to determine how long one should wait with effective uterine contraction before labor arrest can be diagnosed.DesignPopulation-based retrospective cohort study.PopulationThe final sample involved 8,988 women with singleton gestation, term live birth, vertex presentation, no previous cesarean section, vaginal delivery, and neonatal Apgar score at 5 minutes at 7 or higher, and complete information on oxytocin augmentation in 2005–2007.MethodsLinear interpolation was used from the vaginal exam records for each woman to estimate the cervical dilation when oxytocin was started and the highest dose was first reached by parity. We used survival methods to estimate quartiles of the traverse time distributions of cervical dilation.Main outcome measuresDuration of labor under oxytocin augmentation.ResultsWhen oxytocin was just started, it took a long time to observe cervical dilation. The 50th(95th) centiles of the time interval from 4 to 5 cm, 5 to 6 cm, and 6 to 10 cm dilation were 2.9(8.8) hr, 1.7(5.8) hr, and 2.1(6.0) hr in nulliparas; and 3.1(10.1) hr, 1.9(8.0) hr, and 1.7(6.2) hr in multiparas. After effective uterine contractions were achieved under oxytocin, labor progressed much faster. The corresponding values were 0.7(2.4)hr, 0.5(1.5)hr, and 0.5(1.5)hr in nulliparas; and 0.6(1.9)hr, 0.4(1.1)hr, and 0.4(0.9)hr in multiparas. Low- and high-dose oxytocin regimens had similar effects on labor.ConclusionWhen oxytocin is just started for labor augmentation in early first stage, it may take up to 10 hours for the cervix to dilate by 1 cm. Once effective uterine contractions are achieved and the cervix is dilated more than 5 cm, cervical dilation to the next centimeter occurs within 2 hrs in both nulliparas and multiparas in 95% of the cases. High- and low-dose oxytocin had a similar impact on labor progression in augmented labor.

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“…In vitro studies suggest that oxytocin receptor expression is affected by BMI, and oxytocin response is blunted by obesity. 57 Several studies have demonstrated that as BMI increases, oxytocin requirement increases. [50][51][52][53] In a retrospective study of singleton, term (≥37 weeks) pregnant patients who received augmentation after spontaneous labor (n = 413), obese patients trended toward more cumulative oxytocin (minimum: 24.7 ± 100.5 mU among patients with a BMI of 18.50-24.99 kg/m 2 ; maximum: 1580.5 ± 2530.5 mU among patients with a BMI of 35.00-39.99 kg/m 2 ; P = 0.09).…”

Section: Oxytocinmentioning

confidence: 99%

“…Another important consideration in oxytocin management is body mass index (BMI). In vitro studies suggest that oxytocin receptor expression is affected by BMI, and oxytocin response is blunted by obesity 57 . Several studies have demonstrated that as BMI increases, oxytocin requirement increases 50–53 .…”

Section: Augmentation Techniquesmentioning

confidence: 99%

Evidence Based Management of Labor

Zambrano Guevara,

Buckheit,

Kuller

et al. 2024

Obstetrical &Amp; Gynecological Survey

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Importance Induction of labor (IOL) is a common obstetric intervention. Augmentation of labor and active management of the second stage is frequently required in obstetric practice. However, techniques around labor and induction management vary widely. Evidence-based practice regarding induction and labor management can reduce birth complications such as infection and hemorrhage and decrease rates of cesarean delivery. Objective To review existing evidence on IOL and labor management strategies with respect to preparing for induction, cervical ripening, induction and augmentation, and second stage of labor techniques. Evidence acquisition Review of recent original research, review articles, and guidelines on IOL using PubMed (2000–2022). Results Preinduction, pelvic floor training and perineal massage reduce postpartum urinary incontinence and perineal trauma, respectively. Timely membrane sweeping (38 weeks) can promote spontaneous labor and prevent postterm inductions. Outpatient Foley bulb placement in low-risk nulliparous patients with planned IOL reduces time to delivery. Inpatient Foley bulb use beyond 6 to 12 hours shows no benefit. When synthetic prostaglandins are indicated, vaginal misoprostol should be preferred. For nulliparous patients and those with obesity, oxytocin should be titrated using a high-dose protocol. Once cervical dilation is complete, pushing should begin immediately. Warm compresses and perineal massage decrease risk of perineal trauma. Conclusion and relevance Several strategies exist to assist in successful IOL and promote vaginal delivery. Evidence-based strategies should be used to improve outcomes and decrease risk of complications and cesarean delivery. Recommendations should be shared across interdisciplinary team members, creating a model that promotes safe patient care. Target Audience Obstetricians and gynecologists, family physicians Learning Objectives Discuss the current evidence and best practices regarding prelabor interventions to improve delivery outcomes; describe evidence-based methods of cervical ripening; outline data-driven practices to progress induction; and explain methods to improve birth outcomes and reduce risks in the second stage of labor.

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Up-Regulation of Oxytocin Receptor Expression at Term Is Related to Maternal Body Mass Index

Abstract: Oxytocin receptor, but not connexin-43, expression is related to BMI, suggesting an alteration in oxytocin receptor expression or function related to obesity.

Cited by 20 publications

References 31 publications

Cumulative oxytocin dose during induction of labor according to maternal body mass index

Cumulative oxytocin dose during induction of labor according to maternal body mass index

The expected labor progression after labor augmentation with oxytocin: A retrospective cohort study

Evidence Based Management of Labor

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