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1.
BMJ ; 373: n716, 2021 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-33853878

RESUMO

OBJECTIVE: To determine whether discontinuing oxytocin stimulation in the active phase of induced labour is associated with lower caesarean section rates. DESIGN: International multicentre, double blind, randomised controlled trial. SETTING: Nine hospitals in Denmark and one in the Netherlands between 8 April 2016 and 30 June 2020. PARTICIPANTS: 1200 women stimulated with intravenous oxytocin infusion during the latent phase of induced labour. INTERVENTION: Women were randomly assigned to have their oxytocin stimulation discontinued or continued in the active phase of labour. MAIN OUTCOME MEASURE: Delivery by caesarean section. RESULTS: A total of 607 women were assigned to discontinuation and 593 to continuation of the oxytocin infusion. The rates of caesarean section were 16.6% (n=101) in the discontinued group and 14.2% (n=84) in the continued group (relative risk 1.17, 95% confidence interval 0.90 to 1.53). In 94 parous women with no previous caesarean section, the caesarean section rate was 7.5% (11/147) in the discontinued group and 0.6% (1/155)in the continued group (relative risk 11.6, 1.15 to 88.7). Discontinuation was associated with longer duration of labour (median from randomisation to delivery 282 v 201 min; P<0.001), a reduced risk of hyperstimulation (20/546 (3.7%) v 70/541 (12.9%); P<0.001), and a reduced risk of fetal heart rate abnormalities (153/548 (27.9%) v 219/537 (40.8%); P<0.001) but rates of other adverse maternal and neonatal outcomes were similar between groups. CONCLUSIONS: In a setting where monitoring of the fetal condition and the uterine contractions can be guaranteed, routine discontinuation of oxytocin stimulation may lead to a small increase in caesarean section rate but a significantly reduced risk of uterine hyperstimulation and abnormal fetal heart rate patterns. TRIAL REGISTRATION: ClinicalTrials.gov NCT02553226.


Assuntos
Cesárea/estatística & dados numéricos , Primeira Fase do Trabalho de Parto , Segunda Fase do Trabalho de Parto , Ocitócicos/administração & dosagem , Ocitocina/administração & dosagem , Adulto , Método Duplo-Cego , Feminino , Frequência Cardíaca Fetal/efeitos dos fármacos , Humanos , Ocitócicos/efeitos adversos , Ocitocina/efeitos adversos , Paridade , Gravidez , Fatores de Tempo
2.
Cochrane Database Syst Rev ; 3: CD001337, 2021 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-33705565

RESUMO

BACKGROUND: Retained placenta is a common complication of pregnancy affecting 1% to 6% of all births. If a retained placenta is left untreated, spontaneous delivery of the placenta may occur, but there is a high risk of bleeding and infection. Manual removal of the placenta (MROP) in an operating theatre under anaesthetic is the usual treatment, but is invasive and may have complications. An effective non-surgical alternative for retained placenta would potentially reduce the physical and psychological trauma of the procedure, and costs. It could also be lifesaving by providing a therapy for settings without easy access to modern operating theatres or anaesthetics. Injection of uterotonics into the uterus via the umbilical vein and placenta is an attractive low-cost option for this. This is an update of a review last published in 2011. OBJECTIVES: To assess the use of umbilical vein injection (UVI) of saline solution with or without uterotonics compared to either expectant management or with an alternative solution or other uterotonic agent for retained placenta. SEARCH METHODS: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (14 June 2020), and reference lists of retrieved studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing UVI of saline or other fluids (with or without uterotonics), either with expectant management or with an alternative solution or other uterotonic agent, in the management of retained placenta. We considered quasi-randomised, cluster-randomised, and trials reported only in abstract form. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and risk of bias, extracted data, and checked them for accuracy. We assessed the certainty of the evidence using the GRADE approach. We calculated pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs), and presented results using 'Summary of findings' tables. MAIN RESULTS: We included 24 trials (n = 2348). All included trials were RCTs, one was quasi-randomised, and none were cluster-randomised. Risk of bias was variable across the included studies. We assessed certainty of evidence for four comparisons: saline versus expectant management, oxytocin versus expectant management, oxytocin versus saline, and oxytocin versus plasma expander. Evidence was moderate to very-low certainty and downgraded for risk of bias of included studies, imprecision, and inconsistency of effect estimates. Saline solution versus expectant management There is probably little or no difference in the incidence of MROP between saline and expectant management (RR 0.93, 95% CI 0.80 to 1.10; 5 studies, n = 445; moderate-certainty evidence). Evidence for the following remaining primary outcomes was very-low certainty: severe postpartum haemorrhage 1000 mL or greater, blood transfusion, and infection. There were no events reported for maternal mortality or postpartum anaemia (24 to 48 hours postnatal). No studies reported addition of therapeutic uterotonics. Oxytocin solution versus expectant management UVI of oxytocin solution might slightly reduce in the need for manual removal compared with expectant management (mean RR 0.73, 95% CI 0.56 to 0.95; 7 studies, n = 546; low-certainty evidence). There may be little to no difference between the incidence of blood transfusion between groups (RR 0.81, 95% CI 0.47 to 1.38; 4 studies, n = 339; low-certainty evidence). There were no maternal deaths reported (2 studies, n = 93). Evidence for severe postpartum haemorrhage of 1000 mL or greater, additional uterotonics, and infection was very-low certainty. There were no events for postpartum anaemia (24 to 48 hours postnatal). Oxytocin solution versus saline solution UVI of oxytocin solution may reduce the use of MROP compared with saline solution, but there was high heterogeneity (RR 0.82, 95% CI 0.69 to 0.97; 14 studies, n = 1370; I² = 54%; low-certainty evidence). There were no differences between subgroups according to risk of bias or oxytocin dose for the outcome MROP. There may be little to no difference between groups in severe postpartum haemorrhage of 1000 mL or greater, blood transfusion, use of additional therapeutic uterotonics, and antibiotic use. There were no events for postpartum anaemia (24 to 48 hours postnatal) (very low-certainty evidence) and there was only one event for maternal mortality (low-certainty evidence). Oxytocin solution versus plasma expander One small study reported UVI of oxytocin compared with plasma expander (n = 109). The evidence was very unclear about any effect on MROP or blood transfusion between the two groups (very low-certainty evidence). No other primary outcomes were reported. For other comparisons there were little to no differences for most outcomes examined. However, there was some evidence to suggest that there may be a reduction in MROP with prostaglandins in comparison to oxytocin (4 studies, n = 173) and ergometrine (1 study, n = 52), although further large-scale studies are needed to confirm these findings. AUTHORS' CONCLUSIONS: UVI of oxytocin solution is an inexpensive and simple intervention that can be performed when placental delivery is delayed. This review identified low-certainty evidence that oxytocin solution may slightly reduce the need for manual removal. However, there are little or no differences for other outcomes. Small studies examining injection of prostaglandin (such as dissolved misoprostol) into the umbilical vein show promise and deserve to be studied further.


Assuntos
Ocitócicos/administração & dosagem , Ocitocina/administração & dosagem , Placenta Retida/terapia , Antibacterianos/uso terapêutico , Viés , Transfusão de Sangue/estatística & dados numéricos , Feminino , Humanos , Injeções Intravenosas , Substitutos do Plasma/administração & dosagem , Gravidez , Prostaglandinas/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Cloreto de Sódio/administração & dosagem , Veias Umbilicais
3.
Psychopharmacology (Berl) ; 238(3): 899-911, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33404737

RESUMO

RATIONALE: The majority of preclinical studies assessing treatments for alcohol use disorder use singly housed animals. Because social factors affect ethanol intake, studies investigating such treatments in group-housed animals are needed. OBJECTIVES: We investigated the effects of repeated oxytocin treatment on ethanol intake in socially housed male and female C57BL/6J mice. METHODS: We used the novel "Herdsman" system implementing radiotracking technology to measure individual ethanol intake in group-housed animals. Mice were housed in same-sex groups of 4 per cage and exposed to 3 and 6% ethanol solutions. After baseline drinking was established, half of the animals in each cage received repeated intraperitoneal injections of 3 mg/kg oxytocin. RESULTS: During baseline, females consumed more ethanol than males partly due to greater number of ethanol drinks taken by females. We also observed a gradual development of two peaks of ethanol consumption during the dark phase of the circadian cycle. The effects of oxytocin treatment were short-acting and varied across treatment days. Oxytocin significantly decreased ethanol intake on three out the four treatment days. On the fourth treatment day, oxytocin decreased ethanol intake and water intake. CONCLUSION: The greater intake of ethanol in female mice is associated with the number of drinks taken. Oxytocin treatments not only cause an acute decrease in ethanol consumption, but can also change in efficacy over time. While the oxytocin system remains a promising therapeutic target for alcoholism, studies investigating longer periods of repeated oxytocin treatment and those using additional oxytocin receptor agonists are warranted.


Assuntos
Consumo de Bebidas Alcoólicas/tratamento farmacológico , Alcoolismo/tratamento farmacológico , Comportamento Animal/efeitos dos fármacos , Etanol/administração & dosagem , Ocitocina/farmacologia , Animais , Comportamento de Escolha/efeitos dos fármacos , Relação Dose-Resposta a Droga , Feminino , Injeções Intraperitoneais , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Ocitocina/administração & dosagem , Fatores Sexuais , Fatores de Tempo
4.
J Pregnancy ; 2020: 4985693, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32953176

RESUMO

Cervical assessment on the Bishop scale prior to induction of labor (IOL) is one of the strongest prognostic criteria in relation to the success of the procedure. The commonly used preinduction methods are mainly aimed at reducing the percentage of cesarean sections. Our study has analyzed obstetric results of patients who had unripe cervix (Bishop score <7) before IOL and used preinduction (Foley catheter or misoprostol vaginal insert releasing 7 mcg of misoprostol per hour for 24 hours) with obstetric results of patients in whom, due to favourable cervix, only a low-dose infusion of oxytocin was used. We reviewed the medical records of 1010 single pregnancies in whom IOL was performed. We divided the patients into two groups: group A (where preinduction was used) and group B (Bishop score ≥7 points) where preinduction was not used. Patients in group A were more likely to complete the delivery by caesarean section (OR = 4.58, 95% CI 3.22-6.51), and more likely to have events that were indications for operative delivery: unreassuring fetal heart rate trace (OR = 3.29, 95% CI 2.07-5.23) and arrested labor or failed induction (OR = 3.4, 95% CI 2.06-5.62). The groups did not differ in the percentage of vacuum extraction, postpartum haemorrhage, and meconium stained amniotic fluid. In group B, more infants were born with umbilical cord blood pH <7.1 (1.38% vs. 0%), both groups included no deliveries of newborns with Apgar score ≤3 points, the groups did not differ in terms of the percentage of newborns with Apgar score between 4 and 7 at birth (OR = 0.66, 95% CI 0.29-1.49). The immature cervix and the need to use labor preinduction is a risk factor for caesarean section. The necessity of preinduction does not impair neonatological results.


Assuntos
Colo do Útero/fisiologia , Trabalho de Parto Induzido/efeitos adversos , Trabalho de Parto Induzido/métodos , Trabalho de Parto , Adulto , Cesárea/estatística & dados numéricos , Feminino , Humanos , Ocitocina/administração & dosagem , Gravidez , Resultado da Gravidez , Prognóstico , Estudos Retrospectivos , Fatores de Risco
5.
Rev. chil. obstet. ginecol. (En línea) ; 85(supl.1): S28-S34, set. 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1138646

RESUMO

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.


Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Pneumonia Viral/complicações , Complicações Infecciosas na Gravidez/terapia , Complicações Infecciosas na Gravidez/virologia , Infecções por Coronavirus/complicações , Trabalho de Parto Induzido/métodos , Ocitocina/administração & dosagem , Resultado da Gravidez , Dinoprostona/administração & dosagem , Cesárea , Estudos Retrospectivos , Parto Obstétrico , Pandemias , Betacoronavirus
6.
PLoS One ; 15(8): e0237132, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764773

RESUMO

BACKGROUND: The safety of methods of labor induction in women with previous cesarean deliveries is still debated. We investigated perinatal outcomes associated with labor induction among women with a trial of labor after one cesarean delivery. METHODS: This retrospective study included 339 women with a trial of labor after one prior cesarean and a singleton term fetus in cephalic presentation in 2013-2016 in a French maternity unit. Labor induction was performed with oxytocin, artificial rupture of membranes and/or prostaglandin E2, according to the Bishop score. The primary outcome was a composite of uterine rupture, low Apgar score, neonatal resuscitation or admission to a neonatal unit. The secondary outcomes included cesarean delivery after onset of labor, postpartum hemorrhage and maternal hospital stay after delivery. We used logistic regression to estimate odds ratios adjusted (aOR) for potential confounders. RESULTS: In our sample, 67.3% of women had spontaneous labor and 32.7% were induced. More than half of the women received oxytocin during labor regardless of the mode of labor. The proportions of the composite outcome and of cesarean after onset of labor were higher in the induced group compared to the spontaneous group (26.1% vs 15.8%, p = 0.02 and 45.0% vs 27.6%, p<0.01, respectively). There were 9 uterine ruptures (2.6%) and this proportion was higher in the induced group compared to the spontaneous group, although this difference was not statistically significant (3.6% vs 2.2%, p = 0.48). After adjustment, labor induction was associated with higher risks of the composite outcome (aOR = 2.45, 95% CI: 1.29-4.65), cesarean after onset of labor (aOR = 2.06, 95% CI: 1.15-3.68) and maternal hospital stay after delivery ≥6 days (aOR = 6.20, 95% CI: 3.25-11.81). No association was found with postpartum hemorrhage. CONCLUSION: Labor induction after one prior cesarean was associated with a higher risk of adverse perinatal outcome. Nevertheless, the higher proportion of uterine rupture did not differ significantly from that in the spontaneous labor group.


Assuntos
Cesárea/efeitos adversos , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Trabalho de Parto Induzido/efeitos adversos , Ruptura Uterina/epidemiologia , Nascimento Vaginal Após Cesárea/efeitos adversos , Adulto , Índice de Apgar , Dinoprostona/administração & dosagem , Feminino , França/epidemiologia , Humanos , Recém-Nascido , Trabalho de Parto Induzido/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Ocitócicos/administração & dosagem , Ocitócicos/efeitos adversos , Ocitocina/administração & dosagem , Gravidez , Gravidez de Alto Risco , Ressuscitação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Ruptura Uterina/etiologia , Nascimento Vaginal Após Cesárea/métodos , Nascimento Vaginal Após Cesárea/estatística & dados numéricos
7.
PLoS One ; 15(7): e0227941, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32722667

RESUMO

OBJECTIVE: To compare synthetic oxytocin infusion regimens used during labour, calculate the International Units (IU) escalation rate and total amount of IU infused over eight hours. DESIGN: Observational study. SETTING: Twelve countries, eleven European and South Africa. SAMPLE: National, regional or institutional-level regimens on oxytocin for induction and augmentation labour. METHODS: Data on oxytocin IU dose, infusion fluid amount, start dose, escalation rate and maximum dose were collected. Values for each regimen were converted to IU in 1000ml diluent. One IU corresponded to 1.67µg for doses provided in grams/micrograms. IU hourly dose increase rates were based on escalation frequency. Cumulative doses and total IU amount infused were calculated by adding the dose administered for each previous hour. Main Outcome Measures Oxytocin IU dose infused. RESULTS: Data were obtained on 21 regimens used in 12 countries. Details on the start dose, escalation interval, escalation rate and maximum dose infused were available from 16 regimens. Starting rates varied from 0.06 IU/hour to 0.90 IU/hour, and the maximum dose rate varied from 0.90 IU/hour to 3.60 IU/hour. The total amount of IU oxytocin infused, estimated over eight hours, ranged from 2.38 IU to 27.00 IU, a variation of 24.62 IU and an 11-fold difference. CONCLUSION: Current variations in oxytocin regimens for induction and augmentation of labour are inexplicable. It is crucial that the appropriate minimum infusion regimen is administered because synthetic oxytocin is a potentially harmful medication with serious consequences for women and babies when inappropriately used. Estimating the total amount of oxytocin IU received by labouring women, alongside the institution's mode of birth and neonatal outcomes, may deepen our understanding and be the way forward to identifying the optimal infusion regimen.


Assuntos
Trabalho de Parto , Ocitócicos/administração & dosagem , Ocitocina/administração & dosagem , Esquema de Medicação , Europa (Continente) , Feminino , Humanos , Trabalho de Parto Induzido , Guias de Prática Clínica como Assunto , Gravidez
8.
Nat Commun ; 11(1): 2783, 2020 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-32494001

RESUMO

Oxytocin may have promise as a treatment for neuropsychiatric disorders. Its therapeutic effect may depend on its ability to enter the brain and bind to the oxytocin receptor. To date, the brain tissue penetrance of intranasal oxytocin has not been demonstrated. In this nonhuman primate study, we administer deuterated oxytocin intranasally and intravenously to rhesus macaques and measure, with mass spectrometry, concentrations of labeled (exogenously administered) and endogenous oxytocin in 12 brain regions two hours after oxytocin administration. Labeled oxytocin is quantified after intranasal (not intravenous) administration in brain regions (orbitofrontal cortex, striatum, brainstem, and thalamus) that lie in the trajectories of the olfactory and trigeminal nerves. These results suggest that intranasal administration bypasses the blood-brain barrier, delivering oxytocin to specific brain regions, such as the striatum, where oxytocin acts to impact motivated behaviors. Further, high concentrations of endogenous oxytocin are in regions that overlap with projection fields of oxytocinergic neurons.


Assuntos
Encéfalo/metabolismo , Ocitocina/administração & dosagem , Ocitocina/farmacologia , Coloração e Rotulagem , Administração Intranasal , Animais , Encéfalo/efeitos dos fármacos , Relação Dose-Resposta a Droga , Feminino , Limite de Detecção , Macaca mulatta , Masculino , Ocitocina/líquido cefalorraquidiano
9.
Nat Hum Behav ; 4(6): 646-655, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32514040

RESUMO

In an influential paper, Kosfeld et al. (2005) showed that intranasal administration of oxytocin (OT) increases the transfers made by investors in the trust game-suggesting that OT increases trust in strangers. Subsequent studies investigating the role of OT in the trust game found inconclusive effects on the trusting behaviour of investors but these studies deviated from the Kosfeld et al. study in an important way-they did not implement minimal social contact (MSC) between the investors and the trustees in the trust game. Here, we performed a large double-blind and placebo-controlled replication study of the effects of OT on trusting behaviour that yields a power of more than 95% and implements an MSC condition as well as a no-social-contact (NoC) condition. We find no effect of OT on trusting behaviour in the MSC condition. Exploratory post hoc analyses suggest that OT may increase trust in individuals with a low disposition to trust in the NoC condition, but this finding requires confirmation in future research. PROTOCOL REGISTRATION: The stage 1 protocol for this Registered Report was accepted in principle on 19 October 2018. The protocol, as accepted by the journal, can be found at https://doi.org/10.6084/m9.figshare.11980368.


Assuntos
Ocitocina/farmacologia , Confiança , Administração Intranasal , Adolescente , Adulto , Método Duplo-Cego , Jogos Experimentais , Humanos , Masculino , Ocitocina/administração & dosagem , Reprodutibilidade dos Testes , Confiança/psicologia , Adulto Jovem
10.
Artigo em Inglês | MEDLINE | ID: mdl-32527660

RESUMO

This chapter aims to provide an evidence-based approach to cervical-ripening methods and induction of labor in high-, middle-, and low-income countries. We will review the epidemiology of induction and will also review pharmacological and mechanical methods of cervical-ripening as well as oxytocin for induction. Lastly, we will review current guidelines of when to determine an induction to be failed.


Assuntos
Maturidade Cervical/efeitos dos fármacos , Trabalho de Parto Induzido , Ocitócicos/farmacologia , Ocitocina/farmacologia , Maturidade Cervical/fisiologia , Dinoprostona , Feminino , Humanos , Ocitócicos/administração & dosagem , Ocitocina/administração & dosagem , Gravidez
11.
Artigo em Inglês | MEDLINE | ID: mdl-32402601

RESUMO

The physiology of the third stage of labour is described. Active management reduces the risk of postpartum haemorrhage (PPH), due to the use of a uterotonic agent. Intramuscular Oxytocin 10 IU has the highest efficacy and lowest side effect profile, although ergometrine, carbetocin and misoprostol are also effective. The appropriate uterotonic in different settings such as home birth by unskilled attendants and at caesarean section is discussed. For the latter, there is less consensus on the optimal dose/route of oxytocin, this topic remaining on the research agenda. Delayed cord clamping enables transfusion of blood to the neonate and is recommended rather than early clamping. Controlled cord traction should only be performed by skilled birth attendants and confers minimal advantage in preventing retained placenta. The importance of early recognition of PPH, and preparedness, is emphasised. An approach to medical and surgical management of PPH is presented.


Assuntos
Terceira Fase do Trabalho de Parto/fisiologia , Tocologia , Placenta Retida/prevenção & controle , Hemorragia Pós-Parto/prevenção & controle , Cesárea , Ergonovina/administração & dosagem , Feminino , Humanos , Recém-Nascido , Misoprostol/administração & dosagem , Ocitócicos/administração & dosagem , Ocitocina/administração & dosagem , Gravidez
12.
BMC Womens Health ; 20(1): 108, 2020 05 19.
Artigo em Inglês | MEDLINE | ID: mdl-32429977

RESUMO

BACKGROUND: Around 90% of postmenopausal women are suffering from vaginal atrophy. This study aimed to evaluate the effect of oxytocin vaginal gel on vaginal atrophy among postmenopausal women. METHODS: This was a randomized controlled trial that was conducted on 96 postmenopausal women who suffered from vaginal atrophy. The inclusion criteria were: literate women, age 40-60, at least 1 year passed from their last menstrual period or the level of FSH > 40 IU, monogamous women with the sexual relationship. Women in the intervention group, requested to use one applicator of 400 IU oxytocin gel per night and women in the placebo group used placebo each night. The subjective symptoms of vaginal atrophy, vaginal PH, maturation index were measured before and after the intervention. RESULTS: The number of superficial cells was increased significantly in the oxytocin group compared to placebo (38.7 ± 7.18 vs. 3.69 ± 2.76, p = 0.0001), while the number of parabasal cells was decreased significantly in the oxytocin compared to placebo after the intervention. The improvement of the maturation index was more dominant in the oxytocin group (increased from 7.76 ± 4.68 to 52.48 ± 7.54) in comparison to the placebo group (increased from 8.58 ± 4.35 to 13.25 ± 5.06). The PH of the vagina decreased significantly in the oxytocin group in comparison to the placebo group (p = 0.0001). After 8 weeks, 88.6 and 7.1% of women in the oxytocin and placebo groups did not show the severe symptoms of vaginal atrophy (p = 0.001). CONCLUSION: The results of this study showed that eight- week intervention with oxytocin vaginal gel (400 IU) could significantly improve the vaginal maturation index, subjective symptoms of vaginal atrophy and reduce the PH of the vagina. Using this medication in women who have a contraindication for hormone therapy is recommended. TRIAL REGISTRATION: IRCT20160602028220N2.


Assuntos
Atrofia/tratamento farmacológico , Ocitocina/administração & dosagem , Pós-Menopausa/efeitos dos fármacos , Vagina/efeitos dos fármacos , Vagina/patologia , Cremes, Espumas e Géis Vaginais/administração & dosagem , Doenças Vaginais/tratamento farmacológico , Administração Intravaginal , Idoso , Método Duplo-Cego , Feminino , Humanos , Irã (Geográfico) , Pessoa de Meia-Idade , Ocitocina/uso terapêutico , Resultado do Tratamento , Cremes, Espumas e Géis Vaginais/uso terapêutico , Doenças Vaginais/patologia
13.
Psychopharmacology (Berl) ; 237(7): 2031-2042, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32388622

RESUMO

RATIONALE: Cocaine use disorder (CUD) is associated with dysregulation of the hypothalamic-pituitary-adrenal axis, which plays a critical role in the human stress response. Men and women with CUD differ in reactivity to social stressors. The hypothalamic neuropeptide oxytocin is involved in anxiolytic and natural reward processes, and has shown therapeutic potential for addictive disorders and stress reduction. OBJECTIVES: To examine the impact of oxytocin (oxytocin (OXY) vs. placebo (PBO)) and gender (female (F) vs. male (M)) on response to a social stress task in individuals with CUD. To explore whether ovarian hormones moderate this stress response. METHODS: One hundred twelve adults with CUD were randomized to receive 40 IU intranasal oxytocin (n = 56) or matching placebo (n = 56). Forty minutes after drug administration, participants were exposed to a social stressor. Generalized linear mixed models were used to examine neuroendocrine (cortisol) and subjective (craving, stress) response at pre-stressor, stressor + 0, + 10, + 30, + 60 min. RESULTS: Gender moderated the effect of oxytocin on neuroendocrine response (p = 0.048); women receiving oxytocin (F + OXY) showed blunted cortisol response compared to the other three groups (F + PBO; M + OXY; M + PBO). There was a main effect of gender on subjective stress response; women reported greater stress following the stressor compared to men (p = 0.016). Oxytocin had no significant effect on craving or stress, and gender did not moderate the effect of oxytocin on either measure. Higher endogenous progesterone was associated with lower craving response in women (p = 0.033). CONCLUSIONS: Oxytocin may have differential effects in men and women with CUD. Women may be at greater risk for relapse in response to social stressors, but ovarian hormones may attenuate this effect.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/tratamento farmacológico , Hormônios Esteroides Gonadais/sangue , Ovário/metabolismo , Ocitocina/administração & dosagem , Caracteres Sexuais , Estresse Psicológico/tratamento farmacológico , Administração Intranasal , Adulto , Transtornos Relacionados ao Uso de Cocaína/sangue , Método Duplo-Cego , Estradiol/sangue , Feminino , Humanos , Hidrocortisona/sangue , Sistema Hipotálamo-Hipofisário/efeitos dos fármacos , Sistema Hipotálamo-Hipofisário/metabolismo , Masculino , Pessoa de Meia-Idade , Ovário/efeitos dos fármacos , Sistema Hipófise-Suprarrenal/efeitos dos fármacos , Sistema Hipófise-Suprarrenal/metabolismo , Progesterona/sangue , Estresse Psicológico/sangue , Resultado do Tratamento , Adulto Jovem
14.
Artigo em Inglês | MEDLINE | ID: mdl-32360367

RESUMO

Augmentation of labour aims at improving the efficiency of uterine contractions in order to reduce maternal and foetal adverse outcomes associated with prolonged labour. This review covers the current best practice for different methods of augmentation of labour, namely, artificial rupture of membranes and oxytocin infusion as a prevention of, or therapy for, prolonged labour. The review highlights essential practice points and identifies knowledge gaps for future research in this important area of clinical obstetric practice.


Assuntos
Ocitócicos/farmacologia , Ocitocina/farmacologia , Contração Uterina/efeitos dos fármacos , Feminino , Humanos , Trabalho de Parto Induzido , Ocitócicos/administração & dosagem , Ocitocina/administração & dosagem , Gravidez , Cuidado Pré-Natal , Fatores de Tempo
15.
Nat Biomed Eng ; 4(5): 544-559, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32341538

RESUMO

Monolayers of cancer-derived cell lines are widely used in the modelling of the gastrointestinal (GI) absorption of drugs and in oral drug development. However, they do not generally predict drug absorption in vivo. Here, we report a robotically handled system that uses large porcine GI tissue explants that are functionally maintained for an extended period in culture for the high-throughput interrogation (several thousand samples per day) of whole segments of the GI tract. The automated culture system provided higher predictability of drug absorption in the human GI tract than a Caco-2 Transwell system (Spearman's correlation coefficients of 0.906 and 0.302, respectively). By using the culture system to analyse the intestinal absorption of 2,930 formulations of the peptide drug oxytocin, we discovered an absorption enhancer that resulted in a 11.3-fold increase in the oral bioavailability of oxytocin in pigs in the absence of cellular disruption of the intestinal tissue. The robotically handled whole-tissue culture system should help advance the development of oral drug formulations and might also be useful for drug screening applications.


Assuntos
Composição de Medicamentos , Avaliação Pré-Clínica de Medicamentos , Robótica , Técnicas de Cultura de Tecidos/métodos , Administração Oral , Animais , Transporte Biológico/efeitos dos fármacos , Células CACO-2 , Humanos , Absorção Intestinal , Jejuno/fisiologia , Ocitocina/administração & dosagem , Ocitocina/farmacocinética , Ocitocina/farmacologia , Permeabilidade , Reprodutibilidade dos Testes , Suínos , Interface Usuário-Computador
16.
J. negat. no posit. results ; 5(4): 428-435, abr. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-194046

RESUMO

OBJETIVO: Demostrar la efectividad del alumbramiento dirigido con oxitocina vía intraumbilical en sala de partos del Hospital "Dr. José María Carabaño Tosta", en Maracay Estado Aragua, Venezuela. Tipo de estudio: Diseño transversal, realizado entre febrero-agosto del 2019. MATERIAL Y MÉTODOS: 50 pacientes manejadas con alumbramiento dirigido con 10 UI de oxitocina a través de la vena umbilical (grupo experimental) del extremo placentario y 50 pacientes manejadas con alumbramiento espontáneo (grupo control). Se comparó el tiempo de alumbramiento, perdidas hemáticas y evolución clínica. RESULTADOS: Grupo expuesto: tiempo medio de alumbramiento 3,52 minutos, volumen medio del sangrado 112,8 ml y valor medio de hemoglobina-hematocrito pre y post parto 11,01 gr/dl-34,3% y 10,7 gr/dl-32,4% respectivamente. Grupo control: tiempo medio de alumbramiento 13,02 minutos, volumen medio del sangrado 232,7 ml y valor medio de hemoglobina-hematocrito pre y post parto 11,3 gr/dl-34,9% y 10,1 gr/dl-31,2 respectivamente. El grupo expuesto no presento complicaciones, mientras que el 4% del grupo control presentó hipotonía uterina y hemorragia post parto. CONCLUSIÓN: En el grupo expuesto el alumbramiento fue significativamente más rápido y las perdidas hemáticas fueron significativamente menores (p: 0,000). Se concluye que el alumbramiento dirigido con oxitocina vía intraumbilical es más efectivo comparado con el alumbramiento espontáneo. No aplicar alumbramiento dirigido es un procedimiento que lleva a mayor riesgo de hemorragias puerperales y complicaciones obstétricas


OBJECTIVE: To demonstrate effectiveness of third stage of labor directed with intraumbilical oxytocin in the delivery room at Hospital "Dr. José María Carabaño Tosta", in Maracay, Aragua, Venezuela. Type of study: Cross-sectional, carried out between February-August 2019. MATERIALS AND METHODS: 50 patients managed with third stage of labor led with 10 IU oxytocin through the umbilical vein (exposed group) and 50 patients managed with spontaneous third stage of labor (control group). We compared time of birth, blood loss and clinical outcome. RESULTS: Exposed group: 3.52 minutes average delivery time, average volume of the bleeding 112.8 ml and mean hemoglobin hematocrit value pre and post-delivery 11,01 gr/dl-34,3% and 10.7 gr/dl-32,4% respectively. CONTROL GROUP: 13,02 minutes average delivery time, average volume of bleeding 232,7 ml and mean hemoglobin hematocrit value pre and post-partum 11.3 gr/dl-34,9% and 10.1 gr/dl-31,2% respectively. The exposed group did not present any complication, while 4% of the control group presented uterine hypotonia and post-partum hemorrhage. CONCLUSION: In the experimental group, the birth was significantly quicker and the lost blood were significantly lower (p: 0.000). We concluded that placenta with oxytocin via umbilical is more effective compared with spontaneous labor. There is no reason not to perform third stage of labor oxitocine in order to decrease obstetric hemorrhage risk and further complications


Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto Jovem , Adulto , Ocitocina/administração & dosagem , Parto Obstétrico/métodos , Trabalho de Parto Induzido/métodos , Hemorragia Pós-Parto/prevenção & controle , Estudos Transversais , Cordão Umbilical/efeitos dos fármacos , Complicações do Trabalho de Parto/tratamento farmacológico , Ocitócicos/farmacocinética
17.
Nat Commun ; 11(1): 1160, 2020 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-32127545

RESUMO

Could nose-to-brain pathways mediate the effects of peptides such as oxytocin (OT) on brain physiology when delivered intranasally? We address this question by contrasting two methods of intranasal administration (a standard nasal spray, and a nebulizer expected to improve OT deposition in nasal areas putatively involved in direct nose-to-brain transport) to intravenous administration in terms of effects on regional cerebral blood flow during two hours post-dosing. We demonstrate that OT-induced decreases in amygdala perfusion, a key hub of the OT central circuitry, are explained entirely by OT increases in systemic circulation following both intranasal and intravenous OT administration. Yet we also provide robust evidence confirming the validity of the intranasal route to target specific brain regions. Our work has important translational implications and demonstrates the need to carefully consider the method of administration in our efforts to engage specific central oxytocinergic targets for the treatment of neuropsychiatric disorders.


Assuntos
Encéfalo/efeitos dos fármacos , Circulação Cerebrovascular/efeitos dos fármacos , Ocitocina/administração & dosagem , Administração Intranasal , Administração Intravenosa , Adulto , Tonsila do Cerebelo/irrigação sanguínea , Encéfalo/irrigação sanguínea , Método Duplo-Cego , Frequência Cardíaca/efeitos dos fármacos , Humanos , Imagem por Ressonância Magnética , Masculino , Nebulizadores e Vaporizadores , Ocitocina/sangue , Ocitocina/farmacocinética , Placebos , Adulto Jovem
18.
Arch Gynecol Obstet ; 301(3): 643-653, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32124015

RESUMO

BACKGROUND: Clinical studies and trials have shown that oxytocin can effectively reduce postpartum bleeding, whether by intramuscular (IM) injection or intravenous (IV) injection. These two methods are widely used in the prevention and treatment for the third stage of childbirth. However, it is unclear whether the subtle differences between the mode of these routes have any effect on maternal outcomes. OBJECTIVES: To systematically evaluate the efficacy and safety of oxytocin administered intramuscularly or intravenously for prophylactic management of the third stage of labor after vaginal birth. METHODS: Computerized retrieval of PubMed, the Cochrane Library, Web of Science, Embase, and ClinicalTrials.gov was conducted to collect randomized controlled trials (RCT) on the effects of IM and IV oxytocin on the third stage of labor. After independent literature screening, data extraction and evaluation of the bias risk of included studies by two evaluators, RevMan 5.3 software was used for a meta-analysis. RESULTS: Six studies with 7734 women were included in this study. Meta-analysis results showed that: the severe postpartum hemorrhage (PPH) rate [risk ratio (RR) 1.54, 95% confidence interval (95% CI) 1.08-2.20, P = 0.02], PPH rate (RR 1.31, 95% CI 1.11-1.55, P = 0.001), incidence of blood transfusion (RR 2.30, 95% CI 1.35-3.93, P = 0.002) and the need of manual removal of placenta (RR 1.44, 95% CI 1.05-1.96, P = 0.02) for IM group were higher than IV group, but there were no significant differences in the use of additional uterotonics (P = 0.31) and the incidence of serious maternal morbidity and adverse effects between two groups. None of the included studies reported maternal death. CONCLUSION: For clinical practice, intravenous injection oxytocin 10 IU may be a good, safe option in the management of the third stage of labor. Medical conditions, available resources, adverse effects, and women' s preferences should also be considered. If an IV line is already in place at delivery, IV administration may be preferable to IM injection.


Assuntos
Terceira Fase do Trabalho de Parto/efeitos dos fármacos , Ocitócicos/uso terapêutico , Ocitocina/administração & dosagem , Ocitocina/uso terapêutico , Administração Intravenosa , Adolescente , Adulto , Feminino , Humanos , Injeções Intramusculares , Pessoa de Meia-Idade , Ocitócicos/farmacologia , Ocitocina/farmacologia , Gravidez , Adulto Jovem
19.
PLoS One ; 15(3): e0229692, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32191722

RESUMO

It has been demonstrated that secretion of several hormones can be classically conditioned, however, the underlying brain responses of such conditioning have never been investigated before. In this study we aimed to investigate how oxytocin administration and classically conditioned oxytocin influence brain responses. In total, 88 females were allocated to one of three groups: oxytocin administration, conditioned oxytocin, or placebo, and underwent an experiment consisting of three acquisition and three evocation days. Participants in the conditioned group received 24 IU of oxytocin together with a conditioned stimulus (CS) during three acquisition days and placebo with the CS on three evocation days. The oxytocin administration group received 24 IU of oxytocin and the placebo group received placebo during all days. On the last evocation day, fMRI scanning was performed for all participants during three tasks previously shown to be affected by oxytocin: presentation of emotional faces, crying baby sounds and heat pain. Region of interest analysis revealed that there was significantly lower activation in the right amygdala and in two clusters in the left superior temporal gyrus in the oxytocin administration group compared to the placebo group in response to observing fearful faces. The activation in the conditioned oxytocin group was in between the other two groups for these clusters but did not significantly differ from either group. No group differences were found in the other tasks. Preliminary evidence was found for brain activation of a conditioned oxytocin response; however, despite this trend in the expected direction, the conditioned group did not significantly differ from other groups. Future research should, therefore, investigate the optimal timing of conditioned endocrine responses and study whether the findings generalize to other hormones as well.


Assuntos
Encéfalo/efeitos dos fármacos , Encéfalo/fisiologia , Condicionamento Clássico/efeitos dos fármacos , Condicionamento Clássico/fisiologia , Ocitocina/administração & dosagem , Ocitocina/fisiologia , Estimulação Acústica , Choro , Expressão Facial , Feminino , Neuroimagem Funcional , Humanos , Imagem por Ressonância Magnética , Sprays Nasais , Percepção da Dor/efeitos dos fármacos , Percepção da Dor/fisiologia , Estimulação Luminosa , Saliva/metabolismo , Método Simples-Cego , Adulto Jovem
20.
Exp Anim ; 69(3): 345-353, 2020 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-32213759

RESUMO

Oxytocin, a posterior pituitary hormone, causes the contraction of the mammary myoepithelial cells that surround the acini. This ejects milk from the acini into the primary mammary ducts. The milk ejection responses by oxytocin have not yet been exactly evaluated in mice. Thus, we present a novel method for quantitatively evaluating oxytocin-induced milk ejection in anesthetized lactating mice. We cannulated the mammary duct, administered oxytocin intraperitoneally or intravenously, and collected and measured the ejected milk. Intraperitoneal oxytocin administration (150 mU) induced continuous but oscillatory milk ejection. Repeated intravenous administration of 1.5 mU of oxytocin elicited repeated transient milk ejection. The volume of the ejected milk as a proportion of the stored volume just before each ejection (rather than ejection volume itself) was an expedient and reliable parameter representing the potency of ejection. The oxytocin sensitivity of mice at day 18 of lactation was determined from a sigmoidal dose-response curve as ED50 ≈ 2.69 mU. Based on this dose-response relationship, the specific activity of the oxytocin receptor agonists (Thr4, Gly7)-oxytocin and WAY 267464 were estimated as 976 and 6.87 U/mg, respectively. The assay presented here could be useful for physiological and pharmacological investigations of oxytocin-induced milk ejection.


Assuntos
Lactação/efeitos dos fármacos , Ocitocina/farmacologia , Animais , Relação Dose-Resposta a Droga , Feminino , Camundongos Endogâmicos C57BL , Ocitocina/administração & dosagem
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