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1.
J. Pers. Med. ; 14(7): 1-11, jul.2024. ilus, tab
Article de Anglais | CONASS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1563131

RÉSUMÉ

BACKGROUND/OBJECTIVES: Although oxytocin administration is recommended for delayed labor progress, there is no consensus over the preferred optimal dose of oxytocin. We aimed to perform a meta-analysis of pregnancy outcomes comparing high-dose versus low-dose oxytocin regimens for augmentation of delayed labor. METHODS: PubMed, Embase, and Cochrane databases were systematically searched for studies comparing high-dose with low-dose oxytocin for labor augmentation from inception up to May 2023. The outcomes assessed were cesarean rate, instrumental delivery rate, postpartum hemorrhage, neonatal death, and uterine tachysystole. Subgroup analysis was performed with randomized controlled trials (RCTs) and propensity-matched studies. Statistical analysis was performed using Rstudio. Heterogeneity was assessed with I2 statistics, and a random-risk effect was used if I2 > 50%. RESULTS: Twenty-one studies met inclusion criteria, and eighteen were RCTs. A total of 14.834 patients were included, of whom 7.921 (53.3%) received high-dose and 6.913 (46.6%) received low-dose oxytocin during labor augmentation. No statistical differences were found in cesarean delivery, neonatal mortality, postpartum hemorrhage and vaginal instrumentation rate. However, uterine tachysystole incidence was significantly higher with high-dose oxytocin (95% Cl, 1.30-1.94, p = 0.3; 0.6; I2 = 9%). CONCLUSIONS: Labor augmentation with a low-dose oxytocin regimen is effective as with a high-dose regimen, but with significantly less uterine tachysystole events, which can lead to intrauterine and neonatal complications. Our findings suggest that a low-dose regimen may be safe and effective for labor augmentation in medical practice.


Sujet(s)
Grossesse , Ocytocine/administration et posologie , Interprétation statistique de données
2.
Rev. chil. anest ; 51(6): 662-670, 2022. ilus, tab
Article de Espagnol | LILACS | ID: biblio-1572739

RÉSUMÉ

Although the management of postpartum hemorrhage (PPH) has improved in recent years; even today, it continúes to be the leading cause of maternal mortality worldwide, mainly in low-income countries and represents 25%-35% of all pregnancy-related deaths, it is estimated to be responsible for around 143,000 maternal deaths per year. PPH also contributes significantly to maternal morbidity and is one of the main reasons for admission to intensive care and for obstetric hysterectomy in the postpartum period. The causes of PPH are varied and have been classified according to their underlying pathophysiology. Being the first cause of PPH uterine hypotonia/atony (70%-80%), although we must consider that there are other entities that can cause or contribute to acute hemorrhage, management of hypotonia has traditionally been based on uterotonics, so an adjustment to this scheme is suggested, granting a broad vision of the subject.


A pesar de que el manejo de la hemorragia posparto (HPP) ha mejorado en los últimos años; aún en la actualidad, continúa siendo la primera causa de mortalidad materna a nivel mundial principalmente en países de bajos ingresos y representa el 25%-35% de todas muertes relacionadas con el embarazo, se estima que es responsable de alrededor de 143.000 muertes maternas al año. La HPP también contribuye significativamente a la morbilidad materna y es una de las principales razones para la admisión en cuidados intensivos y para la histerectomía obstétrica en el período posparto. Las causas de la HPP son variadas y se han clasificado según su fisiopatología subyacente. Siendo la primera causa de HPP la hipotonía/atonía uterina (70%-80%), aunque debemos tomar en cuenta que existen otras entidades que pueden causar o contribuir a hemorragia aguda, el manejo de la hipotonía se ha basado tradicionalmente en uterotónicos, por lo que se sugiere un ajuste a este esquema otorgando una visión amplia del tema.


Sujet(s)
Humains , Femelle , Grossesse , Soins postopératoires , Ocytocine/administration et posologie , Césarienne/méthodes , Hémorragie de la délivrance/prévention et contrôle , Ocytociques , Inertie utérine , Algorithmes , Ocytocine/analogues et dérivés , Ocytocine/usage thérapeutique , Hémorragie de la délivrance/étiologie
3.
Article de Anglais | MEDLINE | ID: mdl-32937192

RÉSUMÉ

BACKGROUND: One of the most common mental disorders in the perinatal period is postpartum depression (PPD), which is associated with impaired emotional functioning due to alterations in different cognitive aspects including thought and facial emotion recognition (FER). Emotional impairments may affect the interaction and care offered to infants and their later development and therefore interventions with potential to minimize impairments associated with PPD are opportune. Oxytocin (OXT) was shown to have therapeutic properties associated with the promotion of affiliative and pro-social behaviors in different mental disorders. Few studies have assessed its therapeutic potential in PPD. OBJECTIVES: To assess the effects of the acute administration of intranasal OXT (24 IU) on FER of baby faces and negative thoughts after delivery in mothers with and without PPD. METHODS: We conducted a randomized double-blind, placebo-controlled trial with a crossover design involving mothers with PPD (N = 20) and without PPD (N = 35) in the puerperium. Participants completed a static task of FER of baby faces and a questionnaire of post-natal negative thoughts. RESULTS: Mothers with PPD had increased scores of negative thoughts about motherhood/infants, but no impairments in FER, when compared to healthy mothers. OXT had no effects on the rates of correct judgments or response times in the FER task, but was associated with response biases to facial happiness and the reduction of negative thoughts in mothers with PPD. DISCUSSION/CONCLUSION: OXT may have positive effects on maternal affiliative behavior, maternal care, and mother-infant interactions as suggested by changes found in different cognitive aspects, thus minimizing the deleterious effects of PPD on child development.


Sujet(s)
Cognition/effets des médicaments et des substances chimiques , Dépression du postpartum/traitement médicamenteux , Reconnaissance faciale/effets des médicaments et des substances chimiques , Comportement maternel/effets des médicaments et des substances chimiques , Ocytocine , Administration par voie nasale , Adulte , Méthode en double aveugle , Femelle , Humains , Nourrisson , Ocytocine/administration et posologie , Ocytocine/pharmacologie , Période du postpartum/effets des médicaments et des substances chimiques , Grossesse , Comportement social , Enquêtes et questionnaires
4.
Reprod Domest Anim ; 55(12): 1808-1811, 2020 Dec.
Article de Anglais | MEDLINE | ID: mdl-33179824

RÉSUMÉ

The present study compared the quality of sperm collected by artificial vagina or pharmacologically induced ejaculation from a 10-year-old thoroughbred stallion with seminal vesiculitis. The pharmacological protocol involved intravenous administration of detomidine (0.01 mg/kg) and oxytocin (20 IU) and successfully induced ejaculation in all attempts of semen collection. Sperm motility, plasma membrane and acrosome integrity (PMAI), reactive oxygen species (ROS) levels, polymorphonuclear neutrophil (PMN) percentage, and bacterial profiles of fresh and cooled semen (5°C for 24 hr) were evaluated. Semen obtained by the pharmacological method presented reduced seminal volume, decreased PMN percentage and superior sperm motility in cooled samples. Moreover, higher PMAI and lower ROS levels were observed in semen collected by the pharmacological method. Therefore, pharmacologically induced ejaculation is an alternative to obtain semen with minimal contamination and with sperm of superior quality and longevity from stallions with seminal vesiculitis.


Sujet(s)
Éjaculation/effets des médicaments et des substances chimiques , Imidazoles/usage thérapeutique , Ocytocine/usage thérapeutique , Analyse du sperme/médecine vétérinaire , Acrosome , Animaux , Membrane cellulaire , Maladies de l'appareil génital mâle/traitement médicamenteux , Maladies de l'appareil génital mâle/médecine vétérinaire , Maladies des chevaux/traitement médicamenteux , Equus caballus , Imidazoles/administration et posologie , Mâle , Granulocytes neutrophiles , Ocytocine/administration et posologie , Espèces réactives de l'oxygène/analyse , Sperme/composition chimique , Sperme/cytologie , Sperme/microbiologie , Mobilité des spermatozoïdes
5.
Sci Rep ; 10(1): 19943, 2020 11 17.
Article de Anglais | MEDLINE | ID: mdl-33203885

RÉSUMÉ

Behaviors are shaped by hormones, which may act either by changing brain circuits or by modifying sensory detection of relevant cues. Pup-directed behaviors have been previously shown to change via action of hormones at the brain level. Here, we investigated hormonal control of pup-induced activity in the vomeronasal organ, an olfactory sensory structure involved in the detection of non-volatile chemosignals. Vomeronasal activity decreases as males switch from a pup-aggressive state to a non-aggressive parenting state, after they socially contact a female. RNA sequencing, qPCR, and in situ hybridization were used to identify expression, in the vomeronasal sensory epithelium, of candidate GPCR hormone receptors chosen by in silico analyses and educated guesses. After identifying that oxytocin and vasopressin receptors are expressed in the vomeronasal organ, we injected the corresponding hormones in mice and showed that oxytocin administration reduced both pup-induced vomeronasal activity and aggressive behavior. Conversely, injection of an oxytocin receptor antagonist in female-primed male animals, which normally exhibit reduced vomeronasal activity, significantly increased the number of active vomeronasal neurons. These data link oxytocin to the modulation of olfactory sensory activity, providing a possible mechanism for changes in male behavior after social experience with females.


Sujet(s)
Agressivité/physiologie , Marqueurs biologiques/analyse , Ocytociques/pharmacologie , Ocytocine/pharmacologie , Récepteurs à l'ocytocine/métabolisme , Organe voméronasal/physiologie , Agressivité/effets des médicaments et des substances chimiques , Animaux , Animaux nouveau-nés , Femelle , Mâle , Souris , Ocytociques/administration et posologie , Ocytocine/administration et posologie , RNA-Seq , Organe voméronasal/effets des médicaments et des substances chimiques
6.
Rev. chil. obstet. ginecol. (En línea) ; Rev. chil. obstet. ginecol;85(supl.1): S28-S34, set. 2020. tab
Article de Espagnol | LILACS | ID: biblio-1138646

RÉSUMÉ

INTRODUCCIÖN Y OBJETIVOS: Describir la experiencia de los partos en gestantes con diagnóstico confirmado de COVID 19 mediante RT-PCR asintomáticas o con sintomatología leve y aquellas sin la enfermedad, y determinar la tasa de éxito de parto vaginal en inducción de trabajo de parto. MÉTODOS: Análisis retrospectivo de pacientes que tuvieron su parto entre 15 de Abril y 03 de Julio del 2020 en el Hospital San Juan de Dios. Se incluyeron las pacientes inducidas con Dinoprostona, Oxitocina o ambas de manera secuencial y se dividieron según estatus COVID 19 mediante RT-PCR al ingreso. Se caracterizó demográficamente el grupo de pacientes positivas y se determinaron los datos de ambos grupos en relación a la necesidad de inducción de trabajo de parto y su éxito para parto vaginal. RESULTADOS: De un total de 657 nacimientos, hubo un 9.7% (n=64) de pacientes con COVID 19, de las cuales un 23.4% (n=15) requirió inducción de trabajo de parto, con una tasa de éxito para parto vaginal de un 66.7% (n=10). De estas pacientes, un 50% recibió Oxitocina, un 40% Dinosprostona y un 10% ambos medicamentos de forma secuencial. En las pacientes negativas, hubo un total de 568 nacimientos, con un 29.8% (n=169) de usuarias que requirieron inducción. La tasa de éxito para parto vaginal en este grupo fue de 72.2% (n=122), utilizando un 50% Oxitocina; un 27% Dinoprostona; un 14.8% ambas; y un 8.2% Balón de Cook. CONCLUSIONES: Sabemos que los resultados de este estudio están limitados por el bajo número de pacientes incluidas, sin embargo, podemos observar que, en nuestra experiencia con las pacientes que arrojaron PCR SARS-CoV-2 positivas, asintomáticas o con enfermedad leve, se logró realizar la inducción de trabajo de parto según protocolos habituales, obteniendo porcentajes de éxito para partos vaginales, similares a las pacientes sin la enfermedad.


INTRODUCTION AND OBJECTIVES: Describe the experience of deliveries in pregnant women with a confirmed diagnosis of COVID 19 by asymptomatic RT-PCR or with mild symptoms and those without the disease, and determine the success rate of vaginal delivery in the induction of labor. METHODS: Retrospective study of patients who had their delivery between 15th April and 03rd of July, 2020 in the San Juan de Dios Hospital. Patients induced with Dinoprostone, Oxytocin or both sequentially were included, and were divided according to COVID 19 status by RT-PCR on their admission process. The group of positive patients was demographically characterized and the data of both groups was determined in relation to the need for labor induction and its success for vaginal delivery. RESULTS: Of a total of 657 births, there were 9.7% (n = 64) of patients with COVID 19, of which 23.4% (n = 15) required labor induction, with a success rate for vaginal delivery of 66.7% (n = 10). Of these patients, 50% received Oxytocin, 40% Dinosprostone and 10% both drugs sequentially. In the negative patients, there were a total of 568 births, with 29.8% (n = 169) of users requiring labor induction. The success rate for vaginal delivery in this group was 72.2% (n = 122); 50% using Oxytocin; 27% Dinoprostone; 14.8% using both; and 8.2% using Cook's Catheter. CONCLUSIONS: We know that the results of this study are limited by the low number of patients included, however, in our experience, we can observe that, in patients with SARS-CoV-2 PCR positive, asymptomatic or with mild disease, it was possible to perform induction of labor according to standard protocols, achieving success rates for vaginal deliveries, similar to patients without the disease.


Sujet(s)
Humains , Femelle , Grossesse , Nouveau-né , Adolescent , Adulte , Adulte d'âge moyen , Jeune adulte , Pneumopathie virale/complications , Complications infectieuses de la grossesse/thérapie , Complications infectieuses de la grossesse/virologie , Infections à coronavirus/complications , Accouchement provoqué/méthodes , Ocytocine/administration et posologie , Issue de la grossesse , Dinoprostone/administration et posologie , Césarienne , Études rétrospectives , Accouchement (procédure) , Pandémies , Betacoronavirus
7.
J Neurosci ; 40(29): 5669-5680, 2020 07 15.
Article de Anglais | MEDLINE | ID: mdl-32571836

RÉSUMÉ

The rostral agranular insular cortex (RAIC) is a relevant structure in nociception. Indeed, recruitment of GABAergic activity in RAIC promotes the disinhibition of the locus ceruleus, which in turn inhibits (by noradrenergic action) the peripheral nociceptive input at the spinal cord level. In this regard, at the cortical level, oxytocin can modulate the GABAergic transmission; consequently, an interaction modulating nociception could exist between oxytocin and GABA at RAIC. Here, we tested in male Wistar rats the effect of oxytocin microinjection into RAIC during an inflammatory (by subcutaneous peripheral injection of formalin) nociceptive input. Oxytocin microinjection produces a diminution of (1) flinches induced by formalin and (2) spontaneous firing of spinal wide dynamic range cells. The above antinociceptive effect was abolished by microinjection (at RAIC) of the following: (1) L-368899 (an oxytocin receptor [OTR] antagonist) or by (2) bicuculline (a preferent GABAA receptor blocker), suggesting a GABAergic activation induced by OTR. Since intrathecal injection of an α2A-adrenoceptor antagonist (BRL 44408) partially reversed the oxytocin effect, a descending noradrenergic antinociception is suggested. Further, injection of L-368899 per se induces a pronociceptive behavioral effect, suggesting a tonic endogenous oxytocin release during inflammatory nociceptive input. Accordingly, we found bilateral projections from the paraventricular nucleus of the hypothalamus (PVN) to RAIC. Some of the PVN-projecting cells are oxytocinergic and destinate GABAergic and OTR-expressing cells inside RAIC. Aside from the direct anatomic link between PVN and RAIC, our findings provide evidence about the role of oxytocinergic mechanisms modulating the pain process at the RAIC level.SIGNIFICANCE STATEMENT Oxytocin is a neuropeptide involved in several functions ranging from lactation to social attachment. Over the years, the role of this molecule in pain processing has emerged, showing that, at the spinal level, oxytocin blocks pain transmission. The present work suggests that oxytocin also modulates pain at the cortical insular level by favoring cortical GABAergic transmission and activating descending spinal noradrenergic mechanisms. Indeed, we show that the paraventricular hypothalamicnucleus sends direct oxytocinergic projections to the rostral agranular insular cortex on GABAergic and oxytocin receptor-expressing neurons. Together, our data support the notion that the oxytocinergic system could act as an orchestrator of pain modulation.


Sujet(s)
Cortex cérébral/physiologie , Inflammation/physiopathologie , Neurones/physiologie , Nociception/physiologie , Ocytocine/physiologie , Animaux , Cortex cérébral/cytologie , Cortex cérébral/effets des médicaments et des substances chimiques , Formaldéhyde/administration et posologie , Neurones GABAergiques/physiologie , Inflammation/induit chimiquement , Mâle , Voies nerveuses/cytologie , Voies nerveuses/physiologie , Nociception/effets des médicaments et des substances chimiques , Ocytocine/administration et posologie , Noyau paraventriculaire de l'hypothalamus/cytologie , Noyau paraventriculaire de l'hypothalamus/physiologie , Rat Wistar
8.
Horm Behav ; 122: 104733, 2020 06.
Article de Anglais | MEDLINE | ID: mdl-32179059

RÉSUMÉ

A growing body of literature suggests that OT administration may affect not only prosocial outcomes, but also regulate adversarial responses in the context of intergroup relations. However, recent reports have challenged the view of a fixed role of OT in enhancing ingroup favoritism and outgroup derogation. Studying the potential effects of OT in modulating threat perception in a context characterized by racial miscegenation (Brazil) may thus afford additional clarification on the matter. In a double-blind, placebo-controlled study, White Brazilian participants completed a first-person shooter task to assess their responses towards potential threat from racial ingroup (White) or outgroup (Black) members. OT administration enhanced the social salience of the outgroup, by both increasing the rate at which participants refrained from shooting unarmed Black targets to levels similar to White targets, and by further increasing the rate of correct decisions to shoot armed Black targets (versus White armed targets). In summary, our results indicate that a single dose of OT may promote accurate behavioral responses to potential threat from members of a racial outgroup, thus offering support to the social salience hypothesis.


Sujet(s)
Crime , Ocytocine/pharmacologie , Relations raciales , Comportement social , Perception sociale/effets des médicaments et des substances chimiques , Adolescent , Adulte , Agressivité/effets des médicaments et des substances chimiques , Agressivité/psychologie , 38410/psychologie , Brésil/ethnologie , Crime/ethnologie , Crime/psychologie , Méthode en double aveugle , Armes à feu , Processus de groupe , Humains , Mâle , Ocytocine/administration et posologie , Relations raciales/psychologie , Racisme/psychologie , Cognition sociale/ethnologie , Perception sociale/ethnologie , Perception sociale/psychologie , 38413/psychologie , Jeune adulte
9.
Arch Dis Child Fetal Neonatal Ed ; 105(1): 14-17, 2020 Jan.
Article de Anglais | MEDLINE | ID: mdl-31072967

RÉSUMÉ

OBJECTIVE: To assess whether oxytocin administered before clamping the umbilical cord modifies the volume of placental transfusion. DESIGN: Randomised controlled trial. METHODS: Mothers of term infants born vigorous by vaginal delivery with informed consent provided in early labour were randomly assigned to oxytocin (10 IU) given intravenously within 15 s of birth (group 1) or after clamping the umbilical cord 3 min after delivery (group 2). Soon after birth, all infants were weighed using a 1 g precision scale and subsequently placed on the mother's abdomen or chest. At 3 min, in both groups, the cord was clamped and cut, and the weight was again obtained. The primary outcome (volume of placental transfusion) was estimated by the difference in weights. RESULTS: 144 patients were included. There were no differences in the primary outcome: infants in group 1 (n=70) gained a mean weight of 85.9 g (SD 48.3), and in group 2 (n=74) 86.7 g (SD 49.6) (p=0.92). No differences were found in secondary outcomes, including newborns' haematocrit and bilirubin concentrations and severe maternal postpartum haemorrhage. On the advice of the Data and Safety Monitoring Committee, the trial was stopped due to futility at 25% of the planned sample size. CONCLUSIONS: When umbilical cord clamping is delayed for 3 min, term newborn infants born vigorous receive a clinically significant placental transfusion which is not modified by the administration of intravenous oxytocin immediately after birth. TRIAL REGISTRATION NUMBER: NCT02618499.


Sujet(s)
Constriction , Ocytociques/administration et posologie , Ocytocine/administration et posologie , Circulation placentaire , Période du postpartum , Cordon ombilical , Adulte , Bilirubine/sang , Poids de naissance , Accouchement (procédure) , Femelle , Hématocrite , Maternités (hôpital) , Humains , Nouveau-né , Injections veineuses , Mâle , Hémorragie de la délivrance/prévention et contrôle , Grossesse , Facteurs temps , Prise de poids
10.
PLoS One ; 14(11): e0215718, 2019.
Article de Anglais | MEDLINE | ID: mdl-31751343

RÉSUMÉ

BACKGROUND: The metabolic activity of endogenous nitric oxide (NO) and the medical use of nitrovasodilatory drugs like isosorbide dinitrate have been shown to be potential inducers inducers of cervical ripening prior to surgical evacuation of the uterus. OBJECTIVE: To assess the therapeutic efficacy and safety of combined isosorbide dinitrate-oxytocin in the management of intrauterine foetal death (IUFD). METHODS: Sixty women with IUFD after 20 weeks of gestation requesting uterine evacuation were randomly selected to receive isosorbide dinitrate gel solution (80 mg/1.5 mL; n = 30) or misoprostol gel solution (100 mcg/1.5 mL; n = 30) every 3 h with a maximum of four doses or until a Bishop score >7 was reached. Subsequently, patients received a high dose of intravenous oxytocin until complete uterus evacuation was achieved. Therapeutic efficacy was evaluated by mean the relative risk of the foetal expulsion based on comparison of event rates, and the proportion of women induced to labor at 7, 10 and 15 h after the administration of isosorbide dinitrate or misoprostol. Safety was assessed on the basis of woman´s vital signs and evaluation of adverse effects, including headache, abdominal pain, pelvic pain, lower back pain, nausea, dizziness and vomiting. RESULTS: The foetal expulsion rate using the isosorbide dinitrate-oxytocin combination was approximately 4.4 times, and at least 2.1 times, the foetal expulsion rate with the misoprostol-oxytocin regimen at any given point in time. The proportion of women achieved vaginal delivery at 15 hours was 100% for the isosorbide dinitrate-oxytocin group and 86.7% for the misoprostol-oxytocin group. The average delivery induction interval was significantly lower when isosorbide dinitrate-oxytocin was used (8.7 ± 3.1 h) than when misoprostol-oxytocin (11.9 ± 3.1 h) was used. A total of 20% of patients in the isosorbide dinitrate-oxytocin group recorded headache, and no cases of uterine tachysystole, haemorrhage or coagulopathy were recorded. CONCLUSION: This study indicates that intravaginal isosorbide dinitrate followed by intravenous oxytocin was more effective than the conventional method used to induce labour in the medical management of foetal death in pregnancies after 20 weeks of gestation. TRIAL REGISTRATION: Clinicaltrials.gov NCT02488642.


Sujet(s)
Maturation du col utérin/effets des médicaments et des substances chimiques , Mort foetale , Dinitrate isosorbide/administration et posologie , Accouchement provoqué/méthodes , Misoprostol/administration et posologie , Ocytocine/administration et posologie , Administration par voie vaginale , Adulte , Accouchement (procédure) , Méthode en double aveugle , Femelle , Humains , Perfusions veineuses , Dinitrate isosorbide/effets indésirables , Misoprostol/effets indésirables , Ocytociques/administration et posologie , Ocytociques/effets indésirables , Ocytocine/effets indésirables , Grossesse , Études prospectives , Facteurs temps , Jeune adulte
11.
PLoS One ; 14(10): e0222981, 2019.
Article de Anglais | MEDLINE | ID: mdl-31574114

RÉSUMÉ

OBJECTIVE: We assessed the impact of intravenous (IV) infusion versus intramuscular (IM) oxytocin on postpartum blood loss and rates of postpartum hemorrhage (PPH) when administered during the third stage of labor. While oxytocin is recommended for prevention of PPH, few double-blind studies have compared outcomes by routes of administration. METHODS: A double-blind, placebo-controlled randomized trial was conducted at a hospital in Argentina. Participants were assigned to receive 10 IU oxytocin via IV infusion or IM injection and a matching saline ampoule for the other route after vaginal birth. Blood loss was measured using a calibrated receptacle for a 1-hour minimum. Shock index (SI) was also calculated, based on vital signs measurements, and additional interventions were recorded. Primary outcomes included: the frequency of blood loss ≥500ml and mean blood loss. RESULTS: 239 (IV infusion) and 241 (IM) women were enrolled with comparable baseline characteristics. Mean blood loss was 43ml less in the IV infusion group (p = 0.161). Rates of blood loss ≥500ml were similar (IV infusion = 21%; IM = 24%, p = 0.362). Women in the IV infusion group received significantly fewer additional uterotonics (5%), than women in the IM group (12%, p = 0.007). Women with PPH in the IM group experienced a larger increase in SI after delivery, which may have influenced recourse to additional interventions. CONCLUSIONS: The route of oxytocin administration for PPH prevention did not significantly impact measured blood loss after vaginal birth. However, differences were observed in recourse to additional uterotonics, favoring IV infusion over IM. In settings where IV lines are routinely placed, oxytocin infusion may be preferable to IM injection.


Sujet(s)
Accouchement (procédure)/effets indésirables , Voies d'administration de substances chimiques et des médicaments , Ocytocine/administration et posologie , Hémorragie de la délivrance/traitement médicamenteux , Adulte , Argentine/épidémiologie , Méthode en double aveugle , Femelle , Humains , Perfusions veineuses/effets indésirables , Injections musculaires/méthodes , Travail obstétrical/effets des médicaments et des substances chimiques , Hémorragie de la délivrance/épidémiologie , Hémorragie de la délivrance/physiopathologie , Période du postpartum/effets des médicaments et des substances chimiques , Grossesse
12.
Rev Colomb Obstet Ginecol ; 70(2): 103-114, 2019 06.
Article de Anglais | MEDLINE | ID: mdl-31613075

RÉSUMÉ

OBJECTIVE: To describe the characteristics of the labor induction process associated with the excess number of cesarean sections in women subjected to this intervention. METHODS: Descriptive historical. cohort that included pregnant women without a history of previous cesarean section, with single term pregnancy and cephalic presentation who were subjected to labor induction in a Level III com- plexity hospital in Medellín, Colombia, during the time period between May 2015 and October 2016. Consecutive sampling was used. Measured variables were maternal age, parity, gestational age, indica- tion for labor induction, cervical favorability, time of induction, quality of uterine activity achieved, type of delivery, and time point during induction when the decision of cesarean section was made. The clinical practice guidelines of international organizations of the specialty and the new guides arising from the 2012 proposal of limiting the first cesarean section were used in order to define ad- herence to the recommendations for induction. RESULTS: Of the 2402 births, 289 which met the inclusion criteria were selected. Cesarean section was performed in 48% of the women subjected to induction, 60.8% nulliparous and 32.1% multiparous. Of those with unfavorable cervix, 72.2% received oxytocin for cervical maturation. Of the women subjected to delivery induction, 108 (37%) underwent cesarean section due to a diagnosis of failed induction. This was considered inadequate in all of them, considering that the diagnosis was made before reaching a dilatation of 6 cm in 88 (81.5%), with intact membranes in 67 (62%), with no uterine activity in 42 (38.9%), with poor quality uterine activity in 23 (21.3%) and in 55 (61%) who did not have at least 24 hours of latent phase before undergoing cesarean section. CONCLUSIONS: Failure to adhere to the recommendations for adequate induction was found, added to a mistaken diagnosis of failed induction.


TITULO: CUMPLIMIENTO INADECUADO DE LAS RECOMENDACIONES PARA EL PROCESO DE LA INDUCCIÓN DEL TRABAJO DE PARTO COMO DESENCADENANTE DE LA CESÁREA EN MUJERES CON EMBARAZO SIMPLE A TÉRMINO. ESTUDIO DESCRIPTIVO. OBJETIVO: describir las características del proceso de inducción del trabajo de parto relacionadas con el exceso de cesáreas en las mujeres a quienes se les realiza este procedimiento. METODOS: cohorte histórica descriptiva en la que se incluyeron las gestantes sin antecedente de cesárea, con embarazo único, a término y presentación cefálica, sometidas a inducción del trabajo de parto en un hospital de tercer nivel de complejidad, en Medellín, Colombia, en el periodo de mayo de 2015 a octubre de 2016. Se excluyeron mujeres con feto muerto antes de la inducción. Muestreo consecutivo. Se midieron: edad materna, paridad, edad gestacional, indicación de la inducción del trabajo de parto, favorabilidad del cérvix, tiempo de la inducción, calidad de la actividad uterina lograda, tipo de parto, momento de la inducción en que se decide la cesárea. Para definir el cumplimiento de las recomendaciones de inducción se tuvieron como referencia las guías de práctica clínica de organizaciones internacionales de la especialidad y las nuevas directrices generadas en la propuesta de reducción de la primera cesárea del año 2012. Se utilizó estadística descriptiva. RESULTADOS: de 2402 nacimientos se seleccionaron 289 que cumplieron con los criterios de inclusión. Se realizó cesárea al 48 % de las gestantes, a 60,8 % de las nulíparas y a 32,1 % de las multíparas sometidas a inducción. El 72,2 % de las que tenían cérvix desfavorable recibieron oxitocina como método de maduración cervical. A 108 (37 %) de las mujeres llevadas a inducción de parto se les realizó cesárea por diagnóstico de inducción fallida que se consideró inadecuado en todas ellas, ya que el diagnóstico se realizó antes de alcanzar 6 cm de dilatación en 88 (81,5 %), con membranas íntegras en 67 (62 %), sin actividad uterina en 42 (38,9 %), con actividad uterina de mala calidad en 23 (21,3 %) y 55 (61 %), no tuvieron al menos 24 horas de fase latente antes de realizar la cesárea. CONCLUSIONES: se encontró falta de cumplimiento de las recomendaciones para una adecuada inducción que lleva a un diagnóstico errado de inducción fallida.


Sujet(s)
Césarienne/statistiques et données numériques , Adhésion aux directives/statistiques et données numériques , Accouchement provoqué/statistiques et données numériques , Travail obstétrical/physiologie , Adulte , Colombie , Femelle , Humains , Ocytociques/administration et posologie , Ocytocine/administration et posologie , Parité , Guides de bonnes pratiques cliniques comme sujet , Grossesse , Études rétrospectives , Facteurs temps , Jeune adulte
13.
Exp Brain Res ; 237(11): 2995-3010, 2019 Nov.
Article de Anglais | MEDLINE | ID: mdl-31515587

RÉSUMÉ

The search for new ligands to treat neuropathic pain remains a challenge. Recently, oxytocin has emerged as an interesting molecule modulating nociception at central and peripheral levels, but no attempt has been made to evaluate the effect of recurrent oxytocin administration in neuropathic pain. Using male Wistar rats with spinal nerve ligation, we evaluated the effects of recurrent spinal (1 nmol; given by lumbar puncture) or peripheral (31 nmol; given by intraplantar injection in the ipsilateral paw to spinal nerve ligation) oxytocin administration on pain-like behavior in several nociceptive tests (tactile allodynia and thermal and mechanical hyperalgesia) on different days. Furthermore, we used an electrophysiological approach to analyze the effect of spinal 1 nmol oxytocin on the activity of spinal dorsal horn wide dynamic range cells. In neuropathic rats, spinal or peripheral oxytocin partially restored the nociceptive threshold measured with the von Frey filaments (tactile allodynia), Hargreaves (thermal hyperalgesia) and Randall-Selitto (mechanical hyperalgesia) tests for 12 days. These results agree with electrophysiological data showing that spinal oxytocin diminishes the neuronal firing of the WDR neurons evoked by peripheral stimulation. This effect was associated with a decline in the activity of primary afferent Aδ- and C-fibers. The above findings show that repeated spinal or peripheral oxytocin administration attenuates the pain-like behavior in a well-established model of neuropathic pain. This study provides a basis for addressing the therapeutic relevance of oxytocin in chronic pain conditions.


Sujet(s)
Comportement animal/effets des médicaments et des substances chimiques , Hyperalgésie/traitement médicamenteux , Névralgie/traitement médicamenteux , Nociception/effets des médicaments et des substances chimiques , Ocytocine/pharmacologie , Animaux , Modèles animaux de maladie humaine , Injections musculaires , Injections rachidiennes , Mâle , Ocytocine/administration et posologie , Rats , Rat Wistar
14.
Reprod Domest Anim ; 54(9): 1230-1235, 2019 Sep.
Article de Anglais | MEDLINE | ID: mdl-31243815

RÉSUMÉ

This study compared the effects of intravaginal and intravenous routes of oxytocin (OT) administration in 46 oestrous-induced Santa Inês ewes (6-day treatment with progestin-releasing intravaginal sponges and a single injection of 200 IU of eCG at the time of sponge removal) that underwent transcervical embryo recovery 6-7 days after oestrous onset and mating. All ewes received 37.5 µg of d-cloprostenol via latero-vulvar route, and 1 mg of oestradiol benzoate i.m. 16 hr before and 50 IU of OT 20 min before non-surgical embryo recovery (NSER), with OT being administered intravenously (n = 21) or intravaginally (n = 21). An overall oestrous response was 95.6% (44/46), and adequate cervical retraction could be accomplished in 78.6% (33/42) of ewes. The percentage of successful NSER procedures was 57% (24/42) or 72.7% (24/33) of animals with sufficient cervical retraction. The duration of NSER procedure averaged 28 min (range: 17-40 min) and ~96% of flushing fluid could be recovered (range: 85%-100%). Out of 18 ewes that could not undergo NSER, 12 (66.6%) presented various anatomical barriers, whilst the other 33.4% did not present these barriers and still could not be traversed. Excluding the ewes with those anatomical features, the overall success rate of NSER was 80% (24/30). The route of OT administration had no effect on NSER efficiency or the ease with which transcervical embryo flushing was performed. Both routes of OT administration can be used for cervical dilation protocol. Discarding ewes with anatomical features precluding cervical penetration is highly recommended to increase the efficacy of NSER in sheep.


Sujet(s)
Administration par voie vaginale , Administration par voie intraveineuse/médecine vétérinaire , Premier stade du travail/effets des médicaments et des substances chimiques , Ocytocine/administration et posologie , Animaux , Col de l'utérus/anatomie et histologie , Transfert d'embryon/méthodes , Transfert d'embryon/médecine vétérinaire , Synchronisation de l'oestrus/effets des médicaments et des substances chimiques , Femelle , Ocytocine/pharmacologie , Grossesse , Ovis aries
15.
Rev Esc Enferm USP ; 52: e03371, 2018 Nov 23.
Article de Anglais, Portugais, Espagnol | MEDLINE | ID: mdl-30484484

RÉSUMÉ

OBJECTIVE: To describe obstetric practices in planned home births, assisted by qualified professionals in Brazil. METHOD: This is a descriptive study, with data collected in an online bank maintained by 49 professionals from December 2014 to November 2015, in which the target population was women and newborns assisted in home births. Data were analyzed through descriptive statistics. RESULTS: A total of 667 women and 665 newborns were included. Most of the women gave birth at home (84.4%), in a nonlithotomic position (99.1%); none underwent episiotomy; 32.3% had intact perineum; and 37.8% had first-degree lacerations, some underwent amniotomy (5.4%), oxytocin administration (0.4%), and Kristeller's maneuver (0.2%); 80.8% of the women with a previous cesarean section had home birth. The rate of transfer of parturients was 15.6%, of puerperal women was 1.9%, and of neonates 1.6%. The rate of cesarean section in the parturients that started labor at home was 9.0%. CONCLUSION: The obstetric practices taken are consistent with the scientific evidence; however, unnecessary interventions are still performed. The rates of cesarean sections and maternal and neonatal transfers are low. Home can be a place of birth option for women seeking a physiological delivery.


Sujet(s)
Césarienne/statistiques et données numériques , Accouchement (procédure)/méthodes , Accouchement à domicile/statistiques et données numériques , Transfert de patient/statistiques et données numériques , Adulte , Amniotomie/statistiques et données numériques , Brésil , Accouchement (procédure)/statistiques et données numériques , Femelle , Humains , Nouveau-né , Mâle , Adulte d'âge moyen , Profession de sage-femme/statistiques et données numériques , Infirmières et infirmiers/statistiques et données numériques , Ocytocine/administration et posologie , Médecins , Grossesse , Études prospectives
16.
Acta sci. vet. (Online) ; 46(supl): Pub. 335, 2018. ^iilus
Article de Portugais | VETINDEX | ID: vti-734619

RÉSUMÉ

Background: Several reproductive diseases can prevent ejaculation by the traditional method of collection. Neoplasias as squamous cell carcinoma is the most common tumor of the external genitalia of horses and its lesions usually prevent copulation. The pharmacological induction of ejaculation is an important alternative technique to obtain and preserve the genetic material of stallions incapable of ejaculating by traditional methods of semen collection. However, the protocols currently used have shown questionable results and new protocols are needed in order to increase the success rates. The aim of this study is to report the success of a new protocol in inducing ejaculation when oral imipramine and intravenous oxytocin and detomidine were administrated in a Crioulo stallion.Case: A 9-year-old Crioulo stallion was admitted at the Veterinary Hospital of the São Paulo State University, FMVZUNESP, Botucatu, Brazil, with a history of a mass located on the glans and body of the penis. The histopathological exam confirmed the diagnostic of Squamous cell carcinoma and penectomy was performed. After 10 days of surgery the stallion was submitted to 5 different protocols with 3 days interval between the follow protocols: Imipramine+Xylazine; Imipramine+ Xylazine+Oxytocin; Imipramine+Detomidine and Imipramine+Detomidine+Oxytocin.Discussion: The traditional protocol of pharmacologically-induced ejaculation with imipramine hydrochloride (3 mg/kg/v.o) and xylazine hydrochloride (0.66 mg/kg/iv) was not successful even when oxytocin (20 UI/iv) was added to this protocol. Administration of imipramine hydrochloride (3 mg/kg/v.o) two hours prior to administration of detomidine hydrochloride (0.02 mg/kg/i.v) also did not result in ejaculation. However, administration of imipramine hydrochloride (3 mg/kg/v.o) 2 h prior to administration of detomidine hydrochloride (0.02 mg/kg/i.v) associated with oxytocin (20 U.I/i.v) resulted in ejaculation.[...](AU)


Sujet(s)
Animaux , Mâle , Equus caballus , Éjaculation , Activation chimique , Imipramine/administration et posologie , Ocytocine/administration et posologie , Hypnotiques et sédatifs/administration et posologie
17.
Acta sci. vet. (Impr.) ; 46(supl): Pub.335-2018. ilus
Article de Portugais | VETINDEX | ID: biblio-1458002

RÉSUMÉ

Background: Several reproductive diseases can prevent ejaculation by the traditional method of collection. Neoplasias as squamous cell carcinoma is the most common tumor of the external genitalia of horses and its lesions usually prevent copulation. The pharmacological induction of ejaculation is an important alternative technique to obtain and preserve the genetic material of stallions incapable of ejaculating by traditional methods of semen collection. However, the protocols currently used have shown questionable results and new protocols are needed in order to increase the success rates. The aim of this study is to report the success of a new protocol in inducing ejaculation when oral imipramine and intravenous oxytocin and detomidine were administrated in a Crioulo stallion.Case: A 9-year-old Crioulo stallion was admitted at the Veterinary Hospital of the São Paulo State University, FMVZUNESP, Botucatu, Brazil, with a history of a mass located on the glans and body of the penis. The histopathological exam confirmed the diagnostic of Squamous cell carcinoma and penectomy was performed. After 10 days of surgery the stallion was submitted to 5 different protocols with 3 days interval between the follow protocols: Imipramine+Xylazine; Imipramine+ Xylazine+Oxytocin; Imipramine+Detomidine and Imipramine+Detomidine+Oxytocin.Discussion: The traditional protocol of pharmacologically-induced ejaculation with imipramine hydrochloride (3 mg/kg/v.o) and xylazine hydrochloride (0.66 mg/kg/iv) was not successful even when oxytocin (20 UI/iv) was added to this protocol. Administration of imipramine hydrochloride (3 mg/kg/v.o) two hours prior to administration of detomidine hydrochloride (0.02 mg/kg/i.v) also did not result in ejaculation. However, administration of imipramine hydrochloride (3 mg/kg/v.o) 2 h prior to administration of detomidine hydrochloride (0.02 mg/kg/i.v) associated with oxytocin (20 U.I/i.v) resulted in ejaculation.[...]


Sujet(s)
Mâle , Animaux , Equus caballus , Éjaculation , Activation chimique , Hypnotiques et sédatifs/administration et posologie , Imipramine/administration et posologie , Ocytocine/administration et posologie
18.
Proc Natl Acad Sci U S A ; 114(34): 9044-9049, 2017 08 22.
Article de Anglais | MEDLINE | ID: mdl-28784762

RÉSUMÉ

The neurohormone oxytocin is a key player in the modulation of reproductive and social behavioral traits, such as parental care. Recently, a correlation between different forms of oxytocin and behavioral phenotypes has been described in the New World Monkeys (NWMs). Here, we demonstrate that, compared with the Leu8OXT found in most placental mammals, the Cebidae Pro8OXT and Saguinus Val3Pro8OXT taxon-specific variants act as equi-efficacious agonists for the Gq-dependent pathway but are weaker agonists for the ß-arrestin engagement and subsequent endocytosis toward the oxytocin receptor (OXTR). Upon interaction with the AVPR1a, Pro8OXT and the common Leu8OXT yielded similar signaling profiles, being equally efficacious on Gq and ß-arrestin, while Val3Pro8OXT showed reduced relative efficacy toward ß-arrestin. Intranasal treatment with either of the variants increased maternal behavior and also promoted unusual paternal care in rats, as measured by pup-retrieval tests. We therefore suggest that Val3Pro8OXT and Pro8OXT are functional variants, which might have been evolutionarily co-opted as an essential part of the adaptive genetic repertoire that allowed the emergence of taxon-specific complex social behaviors, such as intense parental care in the Cebidae and the genus Saguinus.


Sujet(s)
Comportement animal/effets des médicaments et des substances chimiques , Comportement maternel/effets des médicaments et des substances chimiques , Ocytocine/pharmacologie , Comportement paternel/effets des médicaments et des substances chimiques , Administration par voie nasale , Animaux , Animaux nouveau-nés , Femelle , Variation génétique , Cellules HEK293 , Humains , Mâle , Ocytocine/administration et posologie , Ocytocine/génétique , Platyrrhini , Rats , Récepteurs à l'ocytocine/agonistes , Récepteurs à l'ocytocine/génétique , Récepteurs à l'ocytocine/métabolisme , Transduction du signal/effets des médicaments et des substances chimiques , Transduction du signal/génétique
19.
Cochrane Database Syst Rev ; 4: CD011491, 2016 Apr 14.
Article de Anglais | MEDLINE | ID: mdl-27078125

RÉSUMÉ

BACKGROUND: Postpartum haemorrhage (PPH) is the single leading cause of maternal mortality worldwide. Most of the deaths associated with PPH occur in resource-poor settings where effective methods of prevention and treatment - such as oxytocin - are not accessible because many births still occur at home, or in community settings, far from a health facility. Likewise, most of the evidence supporting oxytocin effectiveness comes from hospital settings in high-income countries, mainly because of the need of well-organised care for its administration and monitoring. Easier methods for oxytocin administration have been developed for use in resource-poor settings, but as far as we know, its effectiveness has not been assessed in a systematic review. OBJECTIVES: To assess the effectiveness and safety of oxytocin provided in non-facility birth settings by any way in the third stage of labour to prevent PPH. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, the WHO International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov (12 November 2015), and reference lists of retrieved reports. SELECTION CRITERIA: All published, unpublished or ongoing randomised or quasi-randomised controlled trials comparing the administration of oxytocin with no intervention, or usual/standard care for the management of the third stage of labour in non-facility birth settings were considered for inclusion.Quasi-randomised controlled trials and randomised controlled trials published in abstract form only were eligible for inclusion but none were identified. Cross-over trials were not eligible for inclusion in this review. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for eligibility, assessed risk of bias and extracted the data using an agreed data extraction form. Data were checked for accuracy. MAIN RESULTS: We included one cluster-randomised trial conducted in four rural districts in Ghana that randomised 28 community health officers (CHOs) (serving 2404 potentially eligible pregnant women) to the intervention group and 26 CHOs (serving 3515 potentially eligible pregnant women) to the control group. Overall, the trial had a high risk of bias. CHOs delivered the intervention in the experimental group (injection of 10 IU (international units) of oxytocin in the thigh one minute following birth using a prefilled, auto-disposable syringe). In the control group, CHOs did not provide this prophylactic injection to the women they observed. CHOs had no midwifery skills and did not in any way manage the birth. All other CHO activities (outcome measurement, data collection, and early treatment and referral when necessary) were identical across the control and oxytocin CHOs.Although only one of the nine cases of severe PPH (blood loss greater or equal to 1000 mL) occurred in the oxytocin group, the effect estimate for this outcome was very imprecise and it is uncertain whether the intervention prevents severe PPH (risk ratio (RR) 0.16, 95% confidence interval (CI) 0.02 to 1.30; 1570 women (very low-quality evidence)). Similarly, because of the lack of cases of severe maternal morbidity (e.g. uterine rupture) and maternal deaths, it was not possible to obtain effect estimates for those outcomes (both very low-quality evidence).Oxytocin compared with the control group decreased the incidence of PPH (> 500 mL) in both our unadjusted (RR 0.48, 95% CI 0.28 to 0.81; 1569 women) and adjusted (RR 0.49, 95% CI 0.27 to 0.90; 1174 women (both low-quality evidence)) analyses. There was little or no difference between the oxytocin and control groups on the rates of transfer or referral of the mother to a healthcare facility (RR 0.72, 95% CI 0.34 to 1.56; 1586 women (low-quality evidence)), stillbirths (RR 1.27, 95% CI 0.67 to 2.40; 2006 infants (low-quality evidence)); andearly infant deaths (0 to three days) (RR 1.03, 95% CI 0.35 to 3.07; 1969 infants (low-quality evidence)). There were no cases of needle-stick injury or any other maternal major or minor adverse event or unanticipated harmful event. There were no cases of oxytocin use during labour.There were no data reported for some of this review's secondary outcomes: manual removal of placenta, maternal anaemia, neonatal death within 28 days, neonatal transfer to health facility for advanced care, breastfeeding rates. Similarly, the women's or the provider's satisfaction with the intervention was not reported. AUTHORS' CONCLUSIONS: It is uncertain if oxytocin administered by CHO in non-facility settings compared with a control group reduces the incidence of severe PPH (>1000 mL), severe maternal morbidity or maternal deaths. However, the intervention probably decreases the incidence of PPH (> 500 mL).The quality of the one trial included in this review was limited because of the risk of attrition and recruitment biases related to limitations in the follow-up of pregnant women in both arms of the trials and some baseline imbalance on the size of babies at birth. Additionally, there was serious imprecision of the effect estimates for most of the primary outcomes mainly because of the size of the trial, very few or no events and CIs around both relative and absolute estimates of effect that include both appreciable benefit and appreciable harm.Although the trial presented data both for primary and secondary outcomes, it seemed to be underpowered to detect differences in the primary outcomes that are the ones more relevant for making judgments about the potential applicability of the intervention in other settings (especially severe PPH).Therefore, taking into account the extreme setting where the intervention was implemented, the limited role of the CHO in the trial and the lack of power for detecting effects on primary (relevant) outcomes, the applicability of the evidence found seems to be rather limited.Further well-executed and adequately-powered randomised controlled trials assessing the effects of using oxytocin in pre-filled injection devices or other new delivery systems (spray-dried ultrafine formulation of oxytocin) on severe PPH are urgently needed. Likewise, other important outcomes like possible adverse events and acceptability of the intervention by mothers and other community stakeholders should also be assessed.


Sujet(s)
Ocytociques/administration et posologie , Ocytocine/administration et posologie , Hémorragie de la délivrance/prévention et contrôle , Santé en zone rurale , Adulte , Agents de santé communautaire/statistiques et données numériques , Femelle , Ghana , Humains , Grossesse , Essais contrôlés randomisés comme sujet
20.
Rev. bras. saúde mater. infant ; 16(1): 29-37, Jan.-Mar. 2016. tab
Article de Portugais | LILACS, BVSAM | ID: lil-778390

RÉSUMÉ

Objetivos: analisar os fatores associados à violência obstétrica de acordo com as práticas não recomendadas na assistência ao parto vaginal em uma maternidade escola e de referência da Cidade do Recife. Métodos: estudo transversal, prospectivo, com 603 puérperas, realizado entre agosto a dezembro de 2014. Os dados sociodemográficos, clínicos e de acesso à assistência foram obtidos através dos prontuários e de entrevistas com as pacientes. A prevalência da violência obstétrica foi baseada nas recomendações da Organização Mundial da Saúde sobre as práticas recomendadas para a assistência ao parto vaginal. Para análise dos fatores associados utilizou-se a regressão multivariada de Poisson, considerou-se p<5 por cento. Os dados foram analisados no Stata 12.1 SE. Resultados: a prevalência da violência obstétrica foi de 86,57 por cento. As práticas prejudiciais mais frequentes foram os esforços de puxo (65 por cento), a administração de ocitocina (41 por cento) e o uso rotineiro da posição supina/litotomia (39 por cento). Apenas as variáveis não possuir ensino médio completo (p=0,022) e ter sido assistido por um profissional médico (p<0,001) apresentaram associação significante com a violência obstétrica. Conclusões: o grande número de intervenções obstétricas utilizadas consiste em um ato de violência obstétrica e demonstram que apesar do incentivo do Ministério da Saúde para uma assistência humanizada os resultados ainda estão longe do recomendado.


Objectives: to examine factors associated with obstetric abuse according to practices not recommended for vaginal birth care at a maternity teaching and referral hospital in the city of Recife, Brazil. Methods: a prospective cross-sectional study with 603 puerperal women conducted between August and December 2014. The socio-demographic, clinical and access to care data were obtained from medical records and interviews with patients. The prevalence of obstetric abuse was based on the recommendations of the World Health Organization regarding practices recommended for vaginal birth care. Associated factors were investigated using Poisson's multivariate regression, with a level of significance of p<5 percent. Data were analyzed using Stata 12.1 SE. Results: the prevalence of obstetric abuse was 86.57 percent. The most frequent harmful practices were forced pulling (65 percent), administration ofoxytocin (41 percent) and routine use of the supine/lithotomy position (39 percent). The only variables significantly associated with obstetric abuse were not having graduated high school (p=0.022) and having been attended by a medical professional (p<0.001). Conclusions: the large number of obstetric interventions used amounts to obstetric abuse and shows that, despite the Ministry of Health's promotion of humane care, results fall far short of these recommendations.


Sujet(s)
Humains , Femelle , Grossesse , Maternités (hôpital) , Obstétrique , Ocytocine/administration et posologie , Supination , Profession de sage-femme , Travail obstétrical , Violence , Brésil , Études transversales , Organisation mondiale de la santé , Dossiers médicaux
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