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1.
J Biochem Mol Toxicol ; 34(1): e22415, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31682045

RESUMEN

The aim of this study was to assess the therapeutic potential of oxytocin and liraglutide (LIR), a GLP-1 analogue, in a rat model of vincristine-induced neuropathy. Rats were injected with vincristine (VCR) at a dose of 4 mg/kg twice a week for 5 weeks. The VCR-administered rats were divided into three groups and received saline, oxytocin, or liraglutide simultaneously with VCR. After the treatment period, electrophysiological, biochemical, histological, and immunohistochemical investigations were performed. Electromyography (EMG) recordings demonstrated significant alterations in the VCR + saline group (p < .001). Also, motor performance was decreased in the VCR + saline group (p < .05). Histologically, the axonal diameter was decreased in all groups. VCR + saline group showed significantly increased lipid peroxidation and decreased nerve growth factor (NGF) expression. However, the administration of oxytocin and liraglutide significantly prevented the EMG alterations, lipid peroxidation, and reduction in neuronal NGF expression. On the basis of these findings, oxytocin and liraglutide may be considered as potential agents for the prevention of VCR-induced neuropathy.


Asunto(s)
Antineoplásicos Fitogénicos/toxicidad , Liraglutida/uso terapéutico , Enfermedades del Sistema Nervioso/tratamiento farmacológico , Oxitocina/uso terapéutico , Vincristina/toxicidad , Animales , Liraglutida/administración & dosificación , Masculino , Enfermedades del Sistema Nervioso/inducido químicamente , Oxitocina/administración & dosificación , Ratas , Ratas Sprague-Dawley
2.
Einstein (Sao Paulo) ; 18: eAO5029, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31721897

RESUMEN

OBJECTIVE: To characterize the use of the drug misoprostol for treatment of postpartum hemorrhage in pregnant women. METHODS: A descriptive observational study was carried out with secondary data from pregnant women who used misoprostol to treat postpartum hemorrhage in a reference public maternity, from July 2015 to June 2017. Clinical and sociodemographic profiles of pregnant women, how misoprostol was used and success rate in controling postpartum hemorrhage were characterized. RESULTS: A total of 717 prescriptions of misoprostol were identified. Of these, 10% were for treatment of postpartum hemorrhage. The majority of pregnant women were young adults, married, with complete high school education, white, residing in urban areas, multiparous (68.1%) and 25% had previous cesarean sections. The mean gestational age was 39 weeks and 51.4% had a cesarean section. There was prophylactic use of oxytocin in 47.2% of women. Treatment of postpartum hemorrhage was successful in 84.7% of women. Of these, 79.2% also used oxytocin and 54.2% methylergonovine. Only 13.5% of pregnant women had less than five prenatal visits, and the main cause of postpartum hemorrhage was uterine atony. There were 13 complications after hemorrhage, 15.3% required blood transfusion and there was one case of maternal death. CONCLUSION: Misoprostol showed to be effective and safe for treating postpartum hemorrhage.


Asunto(s)
Misoprostol/uso terapéutico , Oxitócicos/uso terapéutico , Hemorragia Posparto/tratamiento farmacológico , Adulto , Estudios Transversales , Femenino , Edad Gestacional , Humanos , Metilergonovina/uso terapéutico , Oxitocina/uso terapéutico , Embarazo , Adulto Joven
3.
Medicine (Baltimore) ; 98(47): e17911, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31764790

RESUMEN

OBJECTIVE: To evaluate the efficacy and safety of carbetocin for prevention of postpartum hemorrhage in women undergoing vaginal delivery compared with oxytocin. METHODS: We conducted a systemic literature search in PubMed, the Cochrane Library, and Embase without language restrictions from inception of each of database to November 18th, 2018. Randomized controlled trials with outcome measure of blood loss ≥500 ml were eligible if they compared carbetocin with oxytocin to prevent postpartum hemorrhage during the third stage of labor in women undergoing vaginal delivery. RESULTS: This meta-analysis of 5 randomized controlled trials (30,314 women) indicated that there was no significant difference between carbetocin and oxytocin in blood loss ≥500 ml in women undergoing vaginal delivery (relative risks (RRs), 0.52; 95% confidence intervals (CIs), 0.24 to 1.15; P = .11; I = 69%). Sensitivity analyses showed the same results. No significant differences were found in blood loss ≥1000 ml, use of additional uterotonic agents, blood transfusion, uterine massage, flushing, vomiting, abdominal pain, nausea, dizziness, headache, palpitation, itching, and shivering. CONCLUSIONS: This meta-analysis showed that carbetocin was as effective and safe as oxytocin for prevention of postpartum hemorrhage in women undergoing vaginal delivery, and the choice of carbetocin for routine prophylaxis will depend on cost-effectiveness.


Asunto(s)
Oxitócicos/uso terapéutico , Oxitocina/análogos & derivados , Oxitocina/uso terapéutico , Hemorragia Posparto/prevención & control , Parto Obstétrico , Femenino , Humanos , Embarazo , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
4.
Brain Nerve ; 71(9): 971-980, 2019 Sep.
Artículo en Japonés | MEDLINE | ID: mdl-31506399

RESUMEN

Discrepancies in the efficacy between single-dose and repeated administrations of oxytocin on autism spectrum disorder (ASD) indicate a time-course change in efficacy. However, the hypothesis cannot be tested without a repeatable, objective, and quantitative measurement of the core symptoms of ASD. The author's research group comprehensively examined recently examined reported single-site exploratory (n=18, crossover) and multi-site confirmatory (n=106, parallel-group), double-blind, placebo-controlled trials of six-week intranasal oxytocin (48 IU/day) in adult males with ASD. The outcomes were statistically representative values of the objectively quantified facial expression intensity during a semi-structured social interaction in the Autism Diagnostic Observation Schedule. The quantitative facial expression analyses on data from these two independent clinical trials successfully detected and verified the therapeutic effect of repeated administrations of intranasal oxytocin on autistic features in facial expressions during social interaction. Furthermore, for the first time, the recent study demonstrated a time-course change in the efficacy: deterioration during the repetitive administration phase and preservation during the post-treatment phase. Together with our recent study regarding neurochemical mechanisms of deteriorating efficacy of oxytocin, the findings are expected to promote further development of optimized objective, quantitative, and repeatable outcome measures for autistic social deficits and to establish an optimized regimen of oxytocin treatment in ASD.


Asunto(s)
Trastorno del Espectro Autista/tratamiento farmacológico , Oxitocina/uso terapéutico , Adulto , Método Doble Ciego , Humanos , Masculino , Ensayos Clínicos Controlados Aleatorios como Asunto
5.
BMC Pregnancy Childbirth ; 19(1): 325, 2019 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-31484509

RESUMEN

BACKGROUND: Women with cardiac disease are thought to be at increased risk of post-partum haemorrhage. We sought to assess the estimated blood loss (EBL) in our cohort of women with and without cardiac disease (CD) in a quaternary hospital in the UK. Our population consisted of both congenital and acquired CD; and low risk women who delivered in our unit between 01/01/2012-30/09/2016. METHODS: Data were collected using computerised hospital records. CD was classified according to the modified WHO classification (mWHO). The primary outcome measure was estimated blood loss (mL). RESULTS: A total of 5413 women with a singleton fetus in the cephalic presentation delivered during the study period (159 women with CD and 5254 controls). In the CD group, active management of the third stage of labour was consistent with that used in low risk women in 98% (152/155) of cases. Multivariable analyses demonstrated no significant difference in EBL between women with CD vs controls. The adjusted average blood losses were 247.2 ml, 241.8 ml and 295.9 ml in the control group, mWHO 1-2 and 3-4, respectively (p = 0.165). CONCLUSIONS: Women with CD have comparable EBL to low risk women when management of the active third stage of labour is the same.


Asunto(s)
Cardiopatías/epidemiología , Oxitócicos/uso terapéutico , Oxitocina/uso terapéutico , Hemorragia Posparto/prevención & control , Complicaciones Cardiovasculares del Embarazo/epidemiología , Adulto , Estudios de Casos y Controles , Cesárea , Estudios de Cohortes , Parto Obstétrico , Femenino , Humanos , Tercer Periodo del Trabajo de Parto , Análisis Multivariante , Embarazo , Estudios Retrospectivos , Reino Unido/epidemiología , Adulto Joven
6.
Sex Reprod Healthc ; 21: 21-25, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31395229

RESUMEN

INTRODUCTION: Retained placenta can be defined as lack of expulsion of the placenta within 30 min of delivery of the infant. It is a significant cause of maternal mortality and morbidity throughout the developing world. AIM OF THE WORK: The aim of this study was to compare the efficacy of intra-umbilical vein injection of carbetocin versus oxytocin in the management of retained placenta. PATIENTS AND METHODS: A total of 200 women were included in this study. They were divided into two groups; each 100 women. The first group received intra-umbilical vein injection of 1 mL carbetocin (containing 100 µg carbetocin) diluted in 20 mL normal saline 0.9% and the second group received intra-umbilical vein injection of 20 IU oxytocin diluted in 20 mL normal saline 0.9%. RESULTS: Total blood loss (ml) and duration of the third stage of labor (minutes) were significantly lower in carbetocin group when compared to oxytocin group. Postoperative Hb concentration (g/dl) was significantly higher in carbetocin group. Also there was a highly significant difference between both groups as regard change in Hb concentration (g/dl) with less change in the carbetocin group. The need for additional uterotonic drugs following placental delivery and the occurrence of postpartum hemorrhage and the need for blood transfusion were significantly lower in the carbetocin group. CONCLUSION: Intra-umbilical carbetocin is more effective than intra-umbilical oytocin as a method for management of retained placenta. Intra-umbilical carbetocin seems to have more acceptable hemodynamic safety profile when compared to intra-umbilical oxytocin in the management of retained placenta.


Asunto(s)
Oxitócicos/uso terapéutico , Oxitocina/análogos & derivados , Oxitocina/uso terapéutico , Retención de la Placenta/tratamiento farmacológico , Hemorragia Posparto/prevención & control , Adulto , Transfusión Sanguínea , Volumen Sanguíneo , Método Doble Ciego , Femenino , Hemoglobinas/metabolismo , Humanos , Inyecciones Intravenosas , Oxitócicos/administración & dosificación , Oxitocina/administración & dosificación , Oxitocina/efectos adversos , Embarazo , Estudios Prospectivos , Venas Umbilicales , Adulto Joven
7.
Drug Des Devel Ther ; 13: 2381-2391, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31409972

RESUMEN

Purpose: To present a new ocular nebulization therapy for the treatment of dry eye disease (DED) and investigate the efficacy of vitamin B12 (VB12) and oxytocin (OXT) nebulization with clinical parameters and in vivo confocal microscopy (IVCM). Patients and methods: Thirty-eight patients with DED were enrolled, with 19 receiving VB12 nebulization and 19 receiving OXT nebulization twice weekly for 3 months. Clinical signs and symptoms including Ocular Surface Disease Index, self-assessment of light sensitivity and dryness, tear meniscus height, tear break-up time (BUT), and corneal staining, along with IVCM data of basal epithelial cell density, sub-basal dendritic cell (DC) density, nerve density, and nerve tortuosity were acquired at baseline, 1 month, and 3 months after starting treatment. Results: Patients treated with VB12 improved significantly in all signs and symptoms except for nerve tortuosity during the three-month treatment, while OXT demonstrated similar effects apart from BUT and nerve tortuosity. VB12 group revealed a higher BUT at 1 month and 3 months with a higher basal epithelial cell density at 3 months compared with OXT group, and a lower DC density was observed in OXT group at 1 month. Change of basal epithelial cell density was more significant at 3 months in VB12 group, with OXT group showing a significantly higher DC reduction at 1 month. Conclusion: The nebulization therapy delivering VB12 and OXT appears to be effective in improving the symptoms and signs of dry eye, with a relatively stronger effect of BUT elevation and epithelial repair in VB12 and anti-inflammation in OXT nebulization.


Asunto(s)
Córnea/efectos de los fármacos , Síndromes de Ojo Seco/tratamiento farmacológico , Oxitocina/uso terapéutico , Vitamina B 12/uso terapéutico , Anciano , Estudios de Cohortes , Córnea/patología , Síndromes de Ojo Seco/diagnóstico , Femenino , Humanos , Masculino , Microscopía Confocal , Persona de Mediana Edad , Oxitocina/administración & dosificación , Estudios Prospectivos , Vitamina B 12/administración & dosificación
8.
Int J Hyperthermia ; 36(1): 761-767, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31431080

RESUMEN

Objective: This study evaluated the effect of oxytocin administration prior to microwave ablation (MWA) of hypervascular uterine fibroids. Methods: Thirty-two patients with 38 hypervascular uterine fibroids (Adler blood flow grade 3) were equally apportioned to receive intravenous oxytocin infusion (0.32 U/min) 20 min before ultrasound-guided percutaneous MWA, or no oxytocin (control). Changes in Adler blood supply grade and myoma volume were observed via color Doppler ultrasonography (CDU). All patients underwent quantitative ablation with single or double needle and microwave power 50 W (180 s). Treatment continued for those who did not reach the therapeutic goal. The myoma necrotic volume was evaluated by contrast-enhanced ultrasound. Ablation rate was the percent of MRI nonenhanced myoma volume after treatment, relative to myoma volume before treatment, 2 days after surgery. Results: Twenty minutes after oxytocin administration, CDU showed significant decrease of blood vessels in myomas, and Adler blood supply decreased from grade 3 to grade 1 or grade 0 in 10 and 9 myomas, respectively. Myoma volumes were reduced by 2.12 ± 0.24%. Necrotic volumes in the oxytocin (control) groups were 36.96 ± 2.78 cm3 (22.68 ± 3.38 cm3) and ablation rates were 95.4 ± 2.7% (85.7 ± 3.3%; t = 12.68, 8.866, p = 0.001, both). No serious complication was noted. Conclusion: Intravenous oxytocin administered before percutaneous MWA of hypervascular uterine fibroids can effectively block the blood supply vessels of the myoma, reduce the heat sink effect, and thereby increase the ablation volume and improve the local therapeutic effect.


Asunto(s)
Ultrasonido Enfocado de Alta Intensidad de Ablación , Leiomioma/tratamiento farmacológico , Leiomioma/cirugía , Microondas/uso terapéutico , Oxitócicos/uso terapéutico , Oxitocina/uso terapéutico , Neoplasias Uterinas/tratamiento farmacológico , Neoplasias Uterinas/cirugía , Adulto , Femenino , Humanos , Resultado del Tratamiento , Ultrasonografía Doppler en Color
10.
BMC Pregnancy Childbirth ; 19(1): 238, 2019 Jul 09.
Artículo en Inglés | MEDLINE | ID: mdl-31288780

RESUMEN

BACKGROUND: There are several international guidelines on oxytocin regimens for induction and augmentation of labour, but no agreement on a standardised regimen in Germany. This study collated and reviewed the oxytocin regimens used for labour augmentation in university hospitals, with the long-term aim of contributing to the development of a national clinical guideline. METHODS: Germany has 34 university hospital compounds, representing 39 maternity units. In this observational study we asked units to provide standard operational procedures on oxytocin augmentation during labour or provide the details in a structured survey. Data were collected on the dosage of oxytocin, type and volume of solutions used, indications and contraindications for use and discontinuation, case-specific administration, and on who developed the procedures. Findings were analysed descriptively. RESULTS: A total of 35 (90%) units participated in this study. Standard operating procedures were available in 24 units (69%), seven units (20%) did not have procedures and information was missing from four units (11%). Midwives participated in the development of standard operating procedures in 15 units (43%). Infusions were most commonly prepared using six units of oxytocin in 500 ml 0.9% normal saline solution (12 mU/ml). The infusions were started at 120 mU/hour and increased by 120 mU/hour at 20-min intervals up to a maximum dosage of 1200 mU/hour. The most common indication for use was delayed progress in labour. Infusions were stopped when uterine contractions became hypertonic and/or the fetal heart rate showed signs of distress. Most of the practices described aligned with international guidance. All units used reduced oxytocin dosages for women with a history of previous caesareans section, as recommended in the international guidelines, and restrictive use was advised in multiparous women. The main difference between units related to combined use of amniotomy and oxytocin, recommended by three guidelines but used in only four maternity units (11%). CONCLUSIONS: While there was considerable variation in the oxytocin augmentation procedures, most but not all practices used in these 35 German maternity units were comparable. Establishing a national guideline on the criteria for and administration of oxytocin for augmentation of labour would eliminate the observed differences and minimise risk of administration and medication error.


Asunto(s)
Hospitales Universitarios/estadística & datos numéricos , Trabajo de Parto Inducido/estadística & datos numéricos , Oxitócicos/uso terapéutico , Oxitocina/uso terapéutico , Adulto , Femenino , Alemania , Hospitales Universitarios/normas , Humanos , Trabajo de Parto Inducido/métodos , Trabajo de Parto Inducido/normas , Oxitócicos/normas , Oxitocina/normas , Guías de Práctica Clínica como Asunto , Embarazo , Encuestas y Cuestionarios
11.
Anaesthesia ; 74(10): 1305-1319, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31347151

RESUMEN

It is routine to give a uterotonic drug following delivery of the neonate during caesarean section. However, there is much heterogeneity in the relevant research, which has largely been performed in low-risk elective cases or women with uncomplicated labour. This is reflected in considerable variation in clinical practice. There are significant differences between dose requirements during elective and intrapartum caesarean section. Standard recommended doses are higher than required, with the potential for acute cardiovascular adverse effects. We recommend a small initial bolus dose of oxytocin, followed by a titrated infusion. The recommended doses of oxytocin may have to be increased in women with risk factors for uterine atony. Carbetocin at equipotent doses to oxytocin has similar actions, while avoiding the requirement for a continuous infusion after the initial dose and reducing the need for additional uterotonics. As with oxytocin, carbetocin dose requirements are higher for intrapartum caesarean sections. A second-line agent should be considered early if oxytocin/carbetocin fails to produce good uterine tone. Women with cardiac disease may be very sensitive to the adverse effects of oxytocin and other uterotonics, and their management needs to be individualised.


Asunto(s)
Cesárea , Oxitócicos/uso terapéutico , Adulto , Consenso , Femenino , Guías como Asunto , Humanos , Recién Nacido , Oxitócicos/efectos adversos , Oxitocina/efectos adversos , Oxitocina/análogos & derivados , Oxitocina/uso terapéutico , Embarazo
12.
Qual Life Res ; 28(11): 2919-2928, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31227958

RESUMEN

PURPOSE: Quality of life (QoL) is greatly impaired in major depressive disorder (MDD). These impairments are not fully accounted for by symptom severity, may persist beyond depressive episodes, and are a risk factor for poor outcomes. MDD is often associated with prominent neuroendocrine changes and increased risk of chronic disease. However, there is a lack of research examining whether biological factors are related to QoL in MDD. This research examined relationships between cortisol, oxytocin, symptom severity, and QoL in MDD. METHODS: Sixty adults meeting DSM-5 criteria for MDD and 60 healthy controls provided morning plasma samples which were analysed for cortisol and oxytocin levels, and completed measures of QoL and psychopathology. RESULTS: Participants with MDD had lower QoL than controls. Cortisol correlated negatively with overall QoL and all QoL domains. Oxytocin correlated positively with overall QoL, and Psychological and Social-Relationships domains. Additionally, cortisol levels were inversely related to psychological QoL, and oxytocin was positively related to social QoL, after controlling for symptom severity and demographic variables. CONCLUSIONS: This study provides novel evidence linking neuroendocrine pathways to particular domains of QoL in MDD. The results indicate that activity of the hypothalamic-pituitary-adrenal axis is linked to poor psychological QoL, and that oxytocin is important to social QoL, independently of severity of psychopathology. Biopsychosocial approaches to QoL associated with mental health conditions may lead to greater understanding of the underlying mechanisms and to improved, tailored interventions.


Asunto(s)
Trastorno Depresivo Mayor/tratamiento farmacológico , Hidrocortisona/uso terapéutico , Oxitocina/uso terapéutico , Calidad de Vida/psicología , Adolescente , Adulto , Anciano , Trastorno Depresivo Mayor/psicología , Femenino , Humanos , Hidrocortisona/farmacología , Masculino , Persona de Mediana Edad , Oxitocina/farmacología , Adulto Joven
13.
Psychopharmacology (Berl) ; 236(11): 3329-3339, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31201477

RESUMEN

RATIONALE AND OBJECTIVE: The presence of three conspecifics prevents stress-induced decreases in newly proliferated cells and neuroblasts in mouse dentate gyrus (DG). In this study, we sought to determine how many conspecifics are required to exert these protective effects against stress. In addition, we manipulated the physiological status of those conspecifics in the context of their stress-buffering effects and used airborne oxytocin exposure as a substitute for the presence of conspecifics. MATERIALS AND METHODS: Bromodeoxyuridine staining was used to indicate the newly proliferated cells and co-staining with doublecortin to reveal the proliferative neuroblasts. RESULTS: Presentation of three intact and lipopolysaccharide-treated conspecifics prevented the stress-induced decreases in the number of newly proliferated cells and neuroblasts in DG. Presentation of one saline- or oxytocin (OT)-treated conspecific did not exert observable stress-buffering effects. In contrast, airborne oxytocin prevented the stress-induced decreases in DG cell proliferation and early neurogenesis, while pretreatment with L-371,257, a selective OT receptor antagonist, abolished the buffering effects of OT. CONCLUSIONS: Physical interaction with the conspecifics and conspecifics' sickness, at best, play a minor role in mediating the buffering effects against stress-induced decreases in DG cell proliferation or early neurogenesis. Moreover, stress-buffering effects are negligible with the presence of only one conspecific. Finally, airborne OT produced stress-buffering effects possibly via its stimulation of OT receptors. Oxytocin merits further study as a substitute for the stress-buffering effects of companions.


Asunto(s)
Proliferación Celular/fisiología , Células-Madre Neurales/fisiología , Neurogénesis/fisiología , Estrés Psicológico/prevención & control , Animales , Recuento de Células/métodos , Proliferación Celular/efectos de los fármacos , Giro Dentado/citología , Giro Dentado/efectos de los fármacos , Giro Dentado/fisiología , Masculino , Ratones , Ratones Endogámicos BALB C , Células-Madre Neurales/efectos de los fármacos , Neurogénesis/efectos de los fármacos , Estrés Oxidativo/efectos de los fármacos , Estrés Oxidativo/fisiología , Oxitocina/farmacología , Oxitocina/uso terapéutico , Estrés Psicológico/fisiopatología , Estrés Psicológico/psicología
14.
Afr Health Sci ; 19(1): 1517-1524, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31148979

RESUMEN

Background: Adjunctive uterotonic in patients at risk of primary post-partum haemorrhage may reduce its incidence. Objective: To compare the effectiveness and safety of adjunctive rectal misoprostol with adjunctive intravenous oxytocin for the prevention of primary post-partum haemorrhage in at risk patients. Materials and methods: A total of 122 patients with risk factors for uterine atony were allocated to receive either 600µg of rectal misoprostol (n= 61) or 20IU of oxytocin infusion (n=61) after routine management of third stage of labour. Post-partum blood loss was measured using differential delivery towel and pad weighing. Results: There was similarity in the estimated post-partum blood loss, with no significant difference in the mean post-partum hematocrit levels between the adjunctive rectal misoprostol group and oxytocin infusion group (P=0.712). There was no difference in the need for additional intervention of uterotonics between the two groups. There were however, higher incidences of shivering and pyrexia among those that received misoprostol compared with the oxytocin group. Conclusion: Rectal misoprostol is as effective and safe as oxytocin when used as an adjunctive uterotonic in preventing primary post-partum haemorrhage in patients with risk factors for uterine atony after active management of third stage of labour.


Asunto(s)
Misoprostol/administración & dosificación , Oxitócicos/administración & dosificación , Oxitocina/administración & dosificación , Hemorragia Posparto/prevención & control , Administración Intravenosa , Administración Rectal , Adulto , Parto Obstétrico , Esquema de Medicación , Femenino , Humanos , Incidencia , Tercer Periodo del Trabajo de Parto , Misoprostol/uso terapéutico , Oxitócicos/uso terapéutico , Oxitocina/uso terapéutico , Hemorragia Posparto/epidemiología , Embarazo , Factores de Riesgo , Resultado del Tratamiento
15.
Artículo en Inglés | MEDLINE | ID: mdl-31164260

RESUMEN

Every six minutes, a mother dies from post-partum haemorrhage (PPH) in low- and middle-income countries, often in the prime of her life and often leaving behind a young family. To prevent PPH, the routine administration of a uterus-contracting ('uterotonic') agent is a standard practice across the world. Oxytocin is the standard uterotonic agent recommended for this purpose, and is recommended for all women giving birth. Oxytocin is problematic as it requires cold storage and transport, and in low-resource settings, the cold chain is not commonly available. Hence, using heat-stable carbetocin in these settings can be advantageous. Heat-stable carbetocin is a promising alternative to oxytocin. Because of its heat stability, it can overcome the persistent problems with oxytocin quality as it does not require cold chain for storage and transport. Considering the totality of the evidence, it appears to have some additional desirable effects compared with oxytocin and a very favourable side effect profile similar to oxytocin. However, because carbetocin costs 20 times more than oxytocin and is not widely available yet, oxytocin remains the mainstay for prevention of PPH. However, this may change as WHO has signed a memorandum of understanding with the manufacturer to provide carbetocin for the public sector of LMIC at a similar price level to that of oxytocin. Currently, carbetocin is being registered in 90 low- and middle-income countries to be made available and improve access to this life-saving uterotonic agent.


Asunto(s)
Oxitócicos , Oxitocina/análogos & derivados , Hemorragia Posparto , Femenino , Humanos , Oxitócicos/economía , Oxitócicos/uso terapéutico , Oxitocina/economía , Oxitocina/uso terapéutico , Parto , Hemorragia Posparto/tratamiento farmacológico , Embarazo
16.
Rev. chil. obstet. ginecol. (En línea) ; 84(3): 196-207, jun. 2019. tab, graf
Artículo en Español | LILACS | ID: biblio-1020637

RESUMEN

RESUMEN Una complicación frecuente del postparto es la depresión, con una prevalencia del 10 al 20% a nivel mundial. La oxitocina ha sido reconocida como un potente neuromodulador presente en la respuesta materna y la vinculación con su recién nacido. El uso de oxitocina sintética intraparto es una práctica frecuente. Objetivo: Relacionar la exposición a oxitocina sintética intraparto con el riesgo de depresión postparto en mujeres atendidas en un hospital público del sur de Chile, durante los años 2014-2015. Material y método: Estudio cuantitativo de cohorte, analítico, prospectivo. Muestreo no probabilístico, consecutivo a 58 mujeres desde el último trimestre de la gestación hasta las doce semanas postparto, midiendo el riesgo de depresión mediante la escala de Edimburgo. Se relacionaron variables bio-psicosociales y perinatales, con un nivel de significación <0,05. Aprobado por comité de ética. Resultados: La edad promedio fue 26,07 años, la mayoría había cursado enseñanza media, desempeñándose en quehaceres domésticos, con atención sanitaria gratuita y poseían una percepción de buen apoyo social. En los aspectos perinatales el 63,7 % se expusieron a oxitocina sintética. El riesgo de depresión se observó en un 12,07%. Las dosis y tiempo de exposición, al igual que el tipo de parto no resultaron estadísticamente significativos para el riesgo de depresión. Factores protectores y de riesgo psicosociales como perinatales, tampoco demostraron diferencias. Conclusiones: En este grupo, no se encontró asociación estadística entre la exposición a oxitocina intraparto con la sintomatología de depresión en el periodo de posparto, medida a través de la escala de Edimburgo.


ABSTRACT Depression is a frequently-seen postpartum complication, with 10-20% prevalence worldwide. Oxytocin has been recognized as a powerful neuromodulator and is present in the mothers' response and bonding with their newborn. Use of intrapartum synthetic oxytocin is a common practice. Objective. To study potential connections between administration of intrapartum synthetic oxytocin and risk of postpartum depression in women from a public hospital in southern Chile, from 2014 to 2015. Material and method. Analytical, prospective cohort study with a consecutive sampling of 58 women, since their third trimester of pregnancy to twelve weeks after birth, using the Edinburgh Postnatal Depression Scale (EPDS). Biopsychosocial and perinatal variables were analyzed (significance level < 0.05). This study was approved by the hospital ethics committee. Results. Average age was 26.07 years. Most of them had attended high school and were homemakers, had free health care and reported a good social support network. 63.7% received synthetic oxytocin. Risk of postpartum depression was 12.07%. Protective factors, and psychosocial and perinatal risk factors, as well as dosage and exposure time, were not statistically significant. Conclusion. According to EPDS, this group showed no statistical relationship between administration of intrapartum oxytocin and postpartum depression symptoms.


Asunto(s)
Humanos , Femenino , Embarazo , Recién Nacido , Adolescente , Adulto , Oxitocina/efectos adversos , Depresión Posparto , Oxitocina/uso terapéutico , Chile , Depresión Posparto/complicaciones , Parto
17.
Int J Gynaecol Obstet ; 146(1): 56-64, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31049950

RESUMEN

BACKGROUND: Several uterotonic options exist for prevention of postpartum hemorrhage (PPH); hence, cost-effectiveness is an important decision-making criterion affecting uterotonic choice. OBJECTIVE: To conduct a systematic review of cost-effectiveness of uterotonics for PPH prevention to support a WHO guideline update. SEARCH STRATEGY: We searched major databases from 1980 to June 2018 and the National Health Services Economic Evaluation (NHS EED) database from inception (1995) to March 2015 for eligible studies. SELECTION CRITERIA: We included comparative economic evaluations, cost-utility analyses, and resource-utilization studies. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed studies and extracted data organized by birth mode and setting. MAIN RESULTS: We included 15 studies across all income categories that compared misoprostol versus no uterotonic (five studies) or versus oxytocin (one study), carbetocin versus oxytocin (eight studies), and one study comparing numerous uterotonics. In specific low-resource contexts, we found reasonably good evidence that misoprostol was cost-effective compared with no uterotonic. In the context of cesarean delivery, carbetocin was more cost favorable than oxytocin but certainty of this evidence was low. CONCLUSIONS: Evidence on the cost-effectiveness of various uterotonic agents was not generalizable. As the number of competing uterotonics increases, rigorous economic evaluations including contextual factors are needed.


Asunto(s)
Misoprostol/economía , Oxitócicos/economía , Oxitocina/análogos & derivados , Hemorragia Posparto/prevención & control , Estudios de Casos y Controles , Análisis Costo-Beneficio , Femenino , Humanos , Misoprostol/uso terapéutico , Oxitócicos/uso terapéutico , Oxitocina/economía , Oxitocina/uso terapéutico , Embarazo
18.
Psychopharmacology (Berl) ; 236(9): 2613-2622, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30923836

RESUMEN

RATIONALE: The neuropeptide oxytocin (OXT) has emerged as a potential therapeutic intervention in the treatment of both alcohol use disorder (AUD) and stress-related psychiatric illnesses. OBJECTIVES: The present study evaluates the effects of systemically administered (intraperitoneal (i.p.)) OXT treatment on alcohol relapse-like behavior in male and female mice. METHODS: Adult male and female C57BL/6J mice were trained to lever respond in operant conditioning chambers for alcohol in daily self-administration sessions. Once lever responding and alcohol intake stabilized, mice were tested under extinction conditions for 14 days before reinstatement testing. All mice underwent stress-induced reinstatement testing using either predator odor (2,3,5-trimethyl-3-thiazoline (TMT)) or the α-2 adrenergic receptor agonist yohimbine. In study 1, mice were exposed to TMT for 15 min and then immediately placed into operant conditioning chambers to examine alcohol-seeking behavior under extinction conditions. At 30 min prior to test session, separate groups of mice were injected with vehicle or OXT (0.1, 0.5, 1 mg/kg). In study 2, mice were injected with yohimbine (0.3, 0.625 mg/kg) 1 h prior to reinstatement testing. At 30 min post-yohimbine injection, mice are injected (i.p.) with vehicle or OXT (1 mg/kg). RESULTS: OXT attenuated alcohol-seeking behavior in a dose-related manner in male and female mice in response to acute challenge with a predator odor. Additionally, OXT administration produced a similar decrease in alcohol relapse-like behavior triggered by the pharmacological stressor yohimbine in both sexes. CONCLUSIONS: Systemic oxytocin administration attenuates stress-induced reinstatement of alcohol seeking in male and female mice.


Asunto(s)
Consumo de Bebidas Alcohólicas/tratamiento farmacológico , Consumo de Bebidas Alcohólicas/psicología , Conducta Adictiva/tratamiento farmacológico , Conducta Adictiva/psicología , Etanol/administración & dosificación , Oxitocina/uso terapéutico , Animales , Condicionamiento Operante/efectos de los fármacos , Condicionamiento Operante/fisiología , Extinción Psicológica/efectos de los fármacos , Extinción Psicológica/fisiología , Femenino , Masculino , Ratones , Ratones Endogámicos C57BL , Oxitocina/farmacología , Autoadministración
19.
MCN Am J Matern Child Nurs ; 44(3): 128-136, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30888987

RESUMEN

OBJECTIVE: Develop a multidisciplinary, consensus-driven, evidence-based approach to oxytocin use, while adhering to national guidelines. DESIGN: This was a quality improvement project that used the Plan Do Study Act method to create cycles of change over several years. To initiate discussion, a survey was administered at a social event for providers from divergent community practices that addressed the controversial aspects of oxytocin use. Graphic feedback was provided showing divergences between answers and the evidence. The perinatal team directed design and implementation of this project with specific involvement of a nurse quality improvement coordinator and nurse educator. MEASURES: Process, outcome, and balancing measures were used to evaluate the program. Process measure: use of a standardized order-set. OUTCOME MEASURE: rate of adherence to the resultant protocol. Balancing measures: 1) maximum oxytocin dose, 2) time from oxytocin initiation to birth, 3) cesarean birth rates, and 4) Apgar scores. RESULTS: An initial increase in adherence to the protocol decreased with the loss of the "paper" order-set. Adherence improved when computerized physician order entry was adjusted: 2006: 73%, 2007: 95%; 2011: 57%, 2013: 100% (p = 0.007, 2006 vs. 2007) (p < 0.001, 2006 vs. 2013). Compliance with the protocol was associated with a decrease in maximum oxytocin dose and in time between oxytocin initiation and birth (p < 0.001). CONCLUSION: Consistency and safety in patient care can be accomplished using literature-based evidence and active consensus building among members of the perinatal team. A standardization process must be integrated into the electronic medical record to become a sustained part of a practice culture.


Asunto(s)
Enfermería Basada en la Evidencia/métodos , Oxitocina/uso terapéutico , Técnica Delfos , Guías como Asunto/normas , Humanos , Oxitocina/administración & dosificación , Mejoramiento de la Calidad , Encuestas y Cuestionarios
20.
Pain ; 160(5): 1146-1155, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30920428

RESUMEN

Oxytocin reduces primary sensory afferent excitability and produces analgesia in part through a peripheral mechanism, yet its actions on physiologically characterized, mechanically sensitive afferents in normal and neuropathic conditions are unknown. We recorded intracellularly from L4 dorsal root ganglion neurons characterized as low-threshold mechanoreceptors (LTMRs) or high-threshold mechanoreceptors (HTMRs) in female rats 1 week after L5 partial spinal nerve injury or sham control (n = 24 rats/group) before, during, and after ganglionic perfusion with oxytocin, 1 nM. Nerve injury desensitized and hyperpolarized LTMRs (membrane potential [Em] was -63 ± 1.8 mV in sham vs -76 ± 1.4 mV in nerve injury; P < 0.001), and sensitized HTMRs without affecting Em. In nerve-injured rats, oxytocin depolarized LTMRs towards normal (Em = -69 ± 1.9 mV) and, in 6 of 21 neurons, resulted in spontaneous action potentials. By contrast, oxytocin hyperpolarized HTMRs (Em = -68 ± 2.7 mV before vs -80 ± 3.2 mV during oxytocin exposure; P < 0.01). These effects were reversed after removal of oxytocin, and oxytocin had minimal effects in neurons from sham surgery animals. Sensory afferent neurons immunopositive for the vasopressin 1a receptor were larger (34 ± 6.3 µm, range 16-57 µm) than immunonegative neurons (26 ± 3.4 µm, range 15-43 µm; P < 0.005). These data replicate findings that neuropathic injury desensitizes LTMRs while sensitizing HTMRs and show rapid and divergent oxytocin effects on these afferent subtypes towards normal, potentially rebalancing input to the central nervous system. Vasopressin 1a receptors are present on medium to large diameter afferent neurons and could represent oxytocin's target.


Asunto(s)
Ganglios Espinales/patología , Nociceptores/efectos de los fármacos , Oxitocina/uso terapéutico , Traumatismos de los Nervios Periféricos/patología , Células Receptoras Sensoriales/efectos de los fármacos , Tacto , Potenciales de Acción/efectos de los fármacos , Vías Aferentes/fisiopatología , Animales , Modelos Animales de Enfermedad , Estimulación Eléctrica , Femenino , Mecanorreceptores/efectos de los fármacos , Nociceptores/fisiología , Oxitocina/farmacología , Umbral del Dolor/efectos de los fármacos , Traumatismos de los Nervios Periféricos/fisiopatología , Ratas , Ratas Sprague-Dawley , Receptores de Vasopresinas/metabolismo , Células Receptoras Sensoriales/fisiología
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