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Diress GM, Mohammed AS, Yesuf MH, Minda Z. A case report on acute pulmonary edema induced by adverse drug event immediately after cesarean section. Int J Surg Case Rep 2025; 128:110991. [PMID: 39904275 PMCID: PMC11846577 DOI: 10.1016/j.ijscr.2025.110991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2024] [Revised: 01/28/2025] [Accepted: 01/28/2025] [Indexed: 02/06/2025] Open
Abstract
BACKGROUND Acute pulmonary edema is excessive fluid accumulation in the interstitial and alveolar spaces. Although acute dyspnea during pregnancy and the immediate postpartum period is uncommon, it should alert the attending health professional to several important conditions. CASE PRESENTATION A 23-year-old female patient with Gravida 2 and Para 1 mother presented with acute shortness of breath approximately 1 h after delivery by an emergency cesarean section under spinal anesthesia. Immediately after transferring to the recovery room, her vital signs were Bp, 80/56 mmHg, HR = 64BPM, RR, 18, and oxygen saturation of 95 % while she breathed with room air. Immediately after 1 h, the patient reported a history of mild cough that progressed to severe shortness of breath and chest heaviness while she was lying supine. DISCUSSION Acute pulmonary edema is an infrequent cause of postpartum and pregnancy-related respiratory failure. This potentially fatal condition is characterized by noncompliant or "stiff" lungs and insufficient oxygenation. This condition is linked to widespread alveolar damage and capillary endothelial injury. CONCLUSION Pregnancy-related pulmonary edema, which may occur with or without pre-eclampsia and may happen with a medication adverse effect, is a serious emergency that has a high death rate if left untreated. Appropriate treatment and early screening may improve patient outcomes.
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Affiliation(s)
- Getachew Mekete Diress
- Department of Anesthesia, College of Health Sciences, School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia.
| | | | - Mustofa Hassen Yesuf
- Department of Internal Medicine, Saint Peter Specialized Hospital, Addis Ababa, Ethiopia.
| | - Zewdu Minda
- Department of Anesthesia, Saint Peter Specialized Hospital, Addis Ababa, Ethiopia
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Gülümser C, Yassa M. Clinical management of uterine contraction abnormalities; an evidence-based intrapartum care algorithm. BJOG 2024; 131 Suppl 2:49-57. [PMID: 35415963 DOI: 10.1111/1471-0528.16727] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2021] [Indexed: 11/29/2022]
Abstract
AIM To develop algorithms as decision support tools for identifying, managing and monitoring abnormal uterine activity during labour. POPULATION Women with singleton, term (37-42 weeks) pregnancies in active labour at admission. SETTING Institutional birth settings in low- and middle-income countries (the algorithm may be applicable to any health facility). SEARCH STRATEGY PubMed was searched up to January 2020 using keywords. We also searched The Cochrane Library, and international guidelines from World Health Organization (WHO), National Institute for Health and Care Excellence (NICE), American College of Obstetricians and Gynecologists (ACOG) and French College of Gynaecologists and Obstetricians (CNGOF). CASE SCENARIOS Algorithms were developed for two case scenarios: uterine hypoactivity and excessive uterine contractions. Key themes in the algorithm are: diagnosis, identification of probable causes, assessment of maternal and fetal condition and labour progress, monitoring and management. CONCLUSION The algorithms for uterine hypoactivity and excessive uterine contractions have been developed to facilitate safe and effective management of abnormal uterine activity during labour. Research is needed to assess the views of healthcare professionals and women accessing healthcare to explore the feasibility of implementing these algorithms, and impact on labour outcomes. TWEETABLE ABSTRACT An evidence-based algorithm to support clinical management of abnormal uterine activity during labour.
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Affiliation(s)
- C Gülümser
- Department of Obstetrics and Gynaecology, Yuksek Ihtisas University School of Medicine, Ankara, Turkey
| | - M Yassa
- Department of Obstetrics and Gynaecology, Bahcesehir University Medical Park Maltepe Hospital, İstanbul, Turkey
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Yan QF, Ai L, Huang YM, Wang J, Xiao F, Xu H, Tang XD. Oxytocin infusion dose-response to maintain uterine tone in obese elective cesarean patients: a randomized controlled trial. Front Pharmacol 2024; 15:1361953. [PMID: 38698824 PMCID: PMC11063911 DOI: 10.3389/fphar.2024.1361953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/08/2024] [Indexed: 05/05/2024] Open
Abstract
Background For cesarean delivery (CD), the 90% effective dosage (ED90) of oxytocin for a first bolus has been established. It is not yet known how much oxytocin to inject into obese women undergoing elective discectomy to keep their uterine tone (UT) appropriate. We hypothesized that patients who are overweight need a greater dose of oxytocin infusion; thus, we aimed to determine how the dose-response curve for oxytocin infusion changes following an initial 1 international unit (IU) bolus in obese women undergoing elective CD. Methods One hundred parturients with a body mass index (BMI) greater than 30 kg/m2 were randomly assigned to receive an infusion rate of 14, 18, 22, or 26 IU/h of oxytocin. When the uterine palpation is as hard as touching the forehead or tip of the nose, it is considered sufficient UT according to the criteria used by obstetricians. The median effective dose (ED50) and ED90 values were determined using probit analysis. Results We found the ED50 and ED90 values for the infusion dose of oxytocin were around 11.0 IU/h and 19.1 IU/h, respectively. Each group had a different number of parturients who needed rescued oxytocin: 14 IU/h for six, 18 IU/h for three, one for 22 IU/h, and none for 26 IU/h. The correlation between the frequency of rescued oxytocin administration and the amount of oxytocin infusion needed to avoid uterine atony was statistically significant (p = 0.02). Conclusion The present research showed that the most effective dosage of oxytocin infusion for obese parturients undergoing elective CD is 19.1 IU/h, following an initial loading dose of 1 IU. Patients with obesity should receive a greater dosage of prophylactic oxytocin, and further studies comparing patients with and without obesity (with higher BMI) are required. Clinical Trial Registration https://www.chictr.org.cn/showproj.html?proj=159951, identifier ChiCTR2200059582.
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Affiliation(s)
- Qin-Fang Yan
- Department of Obstetrics and Gynecology, Jiaxing Women and Children's Hospital of Wenzhou Medical University, Jiaxing, China
| | - Ling Ai
- Department of Obstetrics and Gynecology, Jiaxing Women and Children's Hospital of Wenzhou Medical University, Jiaxing, China
| | - Yi-Min Huang
- Department of Obstetrics and Gynecology, Jiaxing Women and Children's Hospital of Wenzhou Medical University, Jiaxing, China
| | - Jianguo Wang
- Department of Center Lab, Jiaxing Women and Children's Hospital of Wenzhou Medical University, Jiaxing, China
| | - Fei Xiao
- Department of Anesthesia, Jiaxing Women and Children's Hospital of Wenzhou Medical University, Jiaxing, China
| | - Huiqin Xu
- Department of Obstetrics and Gynecology, Jiaxing Women and Children's Hospital of Wenzhou Medical University, Jiaxing, China
| | - Xue-Dong Tang
- Department of Obstetrics and Gynecology, Jiaxing Women and Children's Hospital of Wenzhou Medical University, Jiaxing, China
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Afifi AN, Taymour MA, Mahmoud SI, Zolfokar DS, Moghazy Salman MS, El-Hafeez Abd El-Latif AA, El-Khayat WM. WITHDRAWN: The Effect of Preoperative Intravenous Tranexamic Acid Versus Rectal Misoprostol in Reducing Blood Loss During and After Elective Cesarean Delivery in Primigravida: A Double-Blinded, Randomized, Comparative-Placebo Trial. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023:102264. [PMID: 37940041 DOI: 10.1016/j.jogc.2023.102264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 11/10/2023]
Abstract
The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at: https://www.elsevier.com/about/policies/article-withdrawal.
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Affiliation(s)
- Ahmed Nagy Afifi
- Obstetrics and Gynaecology Department, Faculty of Medicine, Kafr el-Sheikh Hospital, Kafr el-Sheikh University, Kafr el-Sheikh, Egypt
| | - Mohammed Ahmed Taymour
- Obstetrics and Gynaecology Department, Faculty of Medicine, Kasr EL-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Safaa Ibrahim Mahmoud
- Obstetrics and Gynaecology Department, Faculty of Medicine, Kasr EL-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Dalia Samir Zolfokar
- Obstetrics and Gynaecology Department, Faculty of Medicine, Kasr EL-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Mona Saad Moghazy Salman
- Obstetrics and Gynaecology Department, Faculty of Medicine, Kasr EL-Ainy Hospital, Cairo University, Cairo, Egypt
| | | | - Waleed Mamdouh El-Khayat
- Obstetrics and Gynaecology Department, Faculty of Medicine, Kasr EL-Ainy Hospital, Cairo University, Cairo, Egypt
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Investigation of The Effects of Oxytocin Administration Timing on Postpartum Hemorrhage during Cesarean Section. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020222. [PMID: 36837424 PMCID: PMC9967335 DOI: 10.3390/medicina59020222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/27/2023]
Abstract
Background and Objectives: To determine and compare the effects of the timing of oxytocin administration (routinely used for intraoperative uterotonic purposes in cesarean section (CS) deliveries in our clinic) on the severity of postpartum hemorrhage following CS. Materials and Methods: All study participants (n = 216) had previous cesarean deliveries, were 38-40 weeks pregnant, and had CS planned under elective conditions. The cases were randomly divided into two groups: one group (n = 108) receiving oxytocin administration before the removal of the placenta (AOBRP) and another group (n = 108) receiving oxytocin administration after the removal of the placenta (AOARP). In all cases, the placenta was removed using the manual traction method. The standard dose of oxytocin is administered as an intravenous (IV) push of 3 international units (IU); simultaneously, 10 IU of oxytocin is added to 1000 cc isotonic fluid and given as an IV infusion at a rate of 250 cc/h. All methods and procedures applied to both groups were identical, except for the timing of administration of the standard oxytocin dose. Age, body mass index (BMI), parity, gestational week, preoperative hemoglobin (HB) and hematocrit (HTC), postoperative 6th and 24th hour HB-HTC, intraoperative hemorrhage, additional uterotonic need during cesarean section, postoperative hemorrhage (number of pads), need for blood transfusion during or after cesarean section, cesarean section time, and postpartum newborn baby weight were evaluated. Results: Age (year), BMI (kg/m2), parity, gestational week, surgical time, and newborn weight (g) did not differ between the groups (p > 0.05). The AOBRP group had significantly higher postoperative 6th hour HB and HTC and postoperative 24th hour HB and HTC values (p < 0.05). The intraoperative hemorrhage level was higher in the AOARP group (p = 0.000). Conclusions: The administration of oxytocin before placenta removal did not change the volume of bleeding in the postoperative period but significantly reduced the volume of bleeding in the intraoperative period. Therefore, in the postoperative period, the HB and HTC values of the AOBRP group were higher than those of the AOARP group.
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Tantry TP, Karanth H, Anniyappa S, Shetty PK, Upadya M, Shenoy SP, Kadam D. Intravenous oxytocin regimens in patients undergoing cesarean delivery: a systematic review and network meta-analysis of cluster-based groups. J Anesth 2022; 37:278-293. [PMID: 36385197 DOI: 10.1007/s00540-022-03132-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/20/2022] [Indexed: 11/17/2022]
Abstract
Information on evaluations of different oxytocin regimens used to prevent post-partum hemorrhage during cesarean delivery is scarce, and there is a lack of statistically pooled results for comparative doses. In this review, we aimed to analyze the effectiveness of different oxytocin regimens used and rank them accordingly. We performed a meta-analysis of randomized controlled trials (RCTs) reporting the incidence of additional uterotonic (AUT) use or amount of blood loss during cesarean delivery, where different oxytocin regimens were compared. Cluster analysis was used to define different clusters of oxytocin therapy based on the identified variable regimens. During the frequentist network meta-analysis, all clusters were compared to bolus clusters of dose range 3-5 IU. Data from 33 RCTs (6741 patients) to 26 RCTs (5422 patients) were assessed for AUT use and blood loss, respectively. Pairwise meta-analysis revealed a significant reduction in the use of AUTs or blood loss was recorded for bolus-infusion combination regimens. The network meta-analysis found that combined bolus-infusion regimens of (i) 3-5 IU and 0.25-1 IU/min or (ii) 3-5 IU and < 0.25 IU/min had statistically significant results for lowest consumption of AUTs (Ranks 1 and 2, respectively); whereas with the latter's use, the lowest blood loss (Rank 2) was observed. In contrast, the dose range, > 5 IU regimen was associated with higher side effects (lowest rank). During cesarean delivery, a significant reduction in the use of AUTs or blood loss (Rank 2) was recorded for bolus-infusion combination regimens. High doses did not have enough evidence to draw meaningful conclusions.
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Affiliation(s)
- Thrivikrama Padur Tantry
- Department of Anaesthesiology, A J Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, 575004, India.
| | - Harish Karanth
- Department of Anaesthesiology, A J Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, 575004, India
| | - Saravana Anniyappa
- Department of Obstetrics and Gynecology, King Khalid University College of Medicine, Abha, Saudi Arabia
| | - Pramal K Shetty
- Department of Anaesthesiology, A J Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, 575004, India
| | - Madhusudan Upadya
- Department of Anaesthesiology, Kasturba Medical College, MAHE, Mangalore, 575001, India
| | - Sunil P Shenoy
- Department of Urology and Transplant Surgery, A J Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, 575004, India
| | - Dinesh Kadam
- Department of Plastic and Reconstructive Surgery, A J Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, 575004, India
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Mohta M, Siddiqui S, Chilkoti GT, Agarwal R. Oxytocin infusion rates for maintaining uterine tone during non-elective cesarean section in laboring patients: a randomized, controlled trial. J Anesth 2022; 36:456-463. [PMID: 35484429 DOI: 10.1007/s00540-022-03067-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Oxytocin infusions for uterine tone maintenance are recommended following initial low oxytocin doses during cesarean section. Very limited literature is available on the optimal infusion rates in laboring patients who have been earlier exposed to oxytocin. METHODS 105 patients, having received oxytocin for induction/augmentation of labor, received oxytocin infusions at rates of 2.5 IU/h (Group 2.5), 5 IU/h (Group 5) or 10 IU/h (Group 10) following 3 IU slow bolus. The primary outcome measure was estimated intraoperative blood loss; secondary outcome measures included uterine tone adequacy, requirements for additional uterotonics, and any side effects. Minor postpartum hemorrhage (PPH) was defined as blood loss > 500 ml and major/severe hemorrhage as blood loss > 1000 ml. RESULTS Group 10 had minimum blood loss (311.1 ± 44.9 ml) and uterotonic requirements compared to other groups (p < 0.001). Group 2.5 had maximum blood loss (549.4 ± 74.3 ml) and uterotonic requirements; Group 5 had intermediate values (402.0 ± 49.5 ml). Twenty-six patients in group 2.5 had minor PPH against only one in group 5 and none in group 10 (p < 0.001). No patient in either group had major PPH. The incidence of hypotension was higher in group 10 than in group 2.5 (p = 0.004). Nausea and vomiting were also more frequent in group 10 than in the other two groups. CONCLUSION Oxytocin infusions at 5 IU/h and 10 IU/h are more effective in reducing blood loss and preventing PPH than 2.5 IU/h. The dose of 10 IU/h, although the most efficacious, is associated with a high incidence of side effects. Hence, further studies are needed to find out the optimal maintenance infusion rate of oxytocin during cesarean section in laboring patients who have received oxytocin earlier.
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Affiliation(s)
- Medha Mohta
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India.
| | - Sheeba Siddiqui
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Geetanjali T Chilkoti
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Rachna Agarwal
- Department of Obstetrics and Gynaecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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Maged AM, Wali AA, Metwally AA, Salah N. The efficacy of misoprostol in reducing intraoperative blood loss in women undergoing elective cesarean section. A systematic review and meta-analysis. J Obstet Gynaecol Res 2022; 48:2038-2070. [PMID: 35661336 DOI: 10.1111/jog.15318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/07/2022] [Accepted: 05/18/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the efficacy of misoprostol to minimized blood loss during and after cesarean delivery (CD). SEARCH STRATEGY Screening of MEDLINE, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials from inception to February 2021 using the keywords related to misoprostol, CD, postpartum hemorrhage, and intraoperative blood loss and their MeSH terms. SELECTION CRITERIA Only RCTs were included. Participants included women undergoing CD whether elective or selective. Thirty studies including 6593 women, 26 in English, 2 in Thai, 1 in French, and 1 in Chinese. DATA COLLECTION AND ANALYSIS Data from all selected studies were extracted independently by two authors. Data extracted included location of the trial, sample size, inclusion and exclusion criteria, participants characteristics, intervention details including timing, dose, and route of drug administration. Outcomes assessed included estimated intraoperative and postoperative blood loss, occurrence of postpartum hemorrhage, the need for additional uterotonics, and hemoglobin difference. MAIN RESULTS Four studies (968 women) compared preoperative to postoperative misoprostol and found a mean difference in intraoperative blood loss of -205.00 (-339.22, -70.77), p = 0.003 and in postoperative blood loss -216.27 (-347.08, -85.46), p < 0.001 and a significantly lower need for additional uterotonics with a risk ratio of 0.54 (0.46, 0.64), p < 0.00001. Twenty-two studies (4701 participants) compared misoprostol to oxytocin. There was a mean difference in intraoperative blood loss of -108.43 (-156.04, -60.82), p < 0.0001. Nine of these trials with 1978 participants evaluated postoperative blood loss. These found a mean difference of -64.12 (-116.19, -12.04) with a p = 0.02. Fourteen trials with 3166 participants measured the difference between preoperative and postoperative hemoglobin. These found a mean difference of -0.25 (-0.35, -0.15) with a p < 0.001. Twenty trials with 4416 participants measured the need for administration of additional uterotonics. These found a risk ratio of 0.62 (0.49, 0.78) with a p value of <0.001. CONCLUSION The combined use of misoprostol and oxytocin during CD is effective in reducing blood loss during and after CD.
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Affiliation(s)
- Ahmed M Maged
- Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Cairo University, Giza, Egypt
| | - Ahmed A Wali
- Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Cairo University, Giza, Egypt
| | - Ahmed A Metwally
- Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Cairo University, Giza, Egypt
| | - Noha Salah
- Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Cairo University, Giza, Egypt
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Pulse perfusion index for predicting intrapartum fever during epidural analgesia. J Clin Anesth 2022; 80:110852. [PMID: 35489302 DOI: 10.1016/j.jclinane.2022.110852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To assess whether pulse perfusion index (PI) values could be employed to predict intrapartum fever and to provide a cut-off PI value for predicting intrapartum fever occurrence. DESIGN We conducted a single-center, prospective, observational study. SETTING Delivery room at the Department of Obstetrics, Affiliated Hospital of Jiangsu University. PATIENTS 117 parturients who intended to have a vaginal delivery. INTERVENTIONS Each parturient received epidural analgesia. MEASUREMENTS We checked each parturient's tympanic temperature before analgesia (T0), at 1 h (T1) and 2 h (T2) after analgesia, immediately at the end of the second (T3) and third (T4) stages of labor, and at 1 h postpartum (T5). A temperature of ≥38°C was defined as fever. PI, measured on the right second toe, was recorded before analgesia (PI0) and at 10 min (PI10), 20 min (PI20), and 30 min (PI30) after analgesia. The PI change rate was calculated as the incremental change in PI30 from PI0, divided by the PI0. Receiver operating characteristic (ROC) curves were used to verify the utility of the PI30 and PI change rate values for predicting intrapartum fever. MAIN RESULTS We found that peak temperature (TP) occurred at the end of the second or the third stage of labor. Within 30 min after analgesia, the PI showed a significant increase over time and there was a linear correlation between PI30 and TP values (P < 0.001, r = 0.544). The PI10, PI20, PI30 and PI change rate in febrile parturients were higher than those in afebrile parturients (P < 0.001). The area under the ROC (AUROC) for PI30 was 0.818 (P < 0.001) with a cut-off of 9.30. The AUROC of the PI change rate was 0.738 (P < 0.001) with a cut-off of 3.45. CONCLUSIONS PI30 and PI change rate values could be used to predict intrapartum fever in parturients after epidural analgesia.
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Yao R, Zhao W, Gao B, Hu J, Wang T. Microbubble contrast agent SonoVue combined with oxytocin improves the efficiency of high-intensity focused ultrasound ablation for adenomyosis. Int J Hyperthermia 2021; 38:1601-1608. [PMID: 34763594 DOI: 10.1080/02656736.2021.1993357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND To investigate the combined enhancing effects of microbubble-contrast SonoVue and oxytocin on high-intensity focused ultrasound (HIFU) ablation of adenomyosis. METHODS 330 patients with adenomyosis were randomly assigned to SonoVue and oxytocin group (group A, n = 82), oxytocin (group B, n = 85), SonoVue (group C, n = 81), or the control (group D, n = 82) for HIFU ablation. In group A, oxytocin was dripped 0.32 IU/min, and HIFU ablation was started one minute after SonoVue injection. In group B, oxytocin was dripped 0.32 IU/min during ablation. In group C, HIFU ablation was started one minute after SonoVue injection. In group D, neither oxytocin nor SonoVue was applied. The clinical data, treatment results, and complications were analyzed. RESULTS All participants underwent HIFU treatment safely, and the mean energy efficiency factor (EEF) in the four groups was 4.7 ± 0.9J/mm3, 8.5 ± 0.6J/mm3, 8.9 ± 0.7J/mm3, and 12.6 ± 1.8J/mm3, respectively, with the mean ablation time (AT) of 633.7 ± 55.1 s, 874.2 ± 65.6 s, 936.3 ± 85.2 s, and 1103.2 ± 96.2 s, respectively. The non-perfused volume ratios (NPVR) were 90.4 ± 8.8%, 88.7 ± 9.1%, 89.4 ± 7.2%, 80.5 ± 7.9%, respectively. In addition, EEF and AT were the shortest in group A (p < 0.05). NPVR was significantly higher in group A than in the control group D (p < 0.05). The incidence rates of adverse events were not significantly different in the four groups (p > 0.05). CONCLUSIONS Compared to the control group, oxytocin combined with SonoVue in HIFU for adenomyosis can significantly decrease the energy and time needed for the ablation and safely enhance the treatment efficiency by improving the cavitation and heating of HIFU ablation and increasing the non-perfused volume ratio.
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Affiliation(s)
- Ruihong Yao
- Medical Imaging Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wei Zhao
- Medical Imaging Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Bulang Gao
- Medical Imaging Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jihong Hu
- Medical Imaging Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Tao Wang
- Medical Imaging Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
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Phung LC, Farrington EK, Connolly M, Wilson AN, Carvalho B, Homer CSE, Vogel JP. Intravenous oxytocin dosing regimens for postpartum hemorrhage prevention following cesarean delivery: a systematic review and meta-analysis. Am J Obstet Gynecol 2021; 225:250.e1-250.e38. [PMID: 33957113 DOI: 10.1016/j.ajog.2021.04.258] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/14/2021] [Accepted: 04/30/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To compare the available evidence on intravenous oxytocin dosing regimens for the prevention of postpartum hemorrhage following cesarean delivery. DATA SOURCES We searched Ovid MEDLINE, Embase, Global Index Medicus, Cumulative Index of Nursing and Allied Health Literature, Cochrane Controlled Register of Trials, ClinicalTrials.gov, and the International Clinical Trials Registry Platform for eligible studies published until February 2020. STUDY ELIGIBILITY CRITERIA We included any randomized or nonrandomized study published in peer-reviewed journals that compared at least 2 different dosing regimens of intravenous oxytocin for postpartum hemorrhage prevention in women undergoing cesarean delivery. METHODS Two authors independently assessed the eligibility of studies, extracted the data, and assessed the risk of bias. The primary outcome was incidence of postpartum hemorrhage ≥1000 mL. Other review outcomes included use of additional uterotonics, blood loss, and adverse maternal events. Data were analyzed according to the type of intravenous administration (bolus only, infusion only, or bolus plus infusion) and total oxytocin dose. A meta-analysis was performed on randomized trials and the results were reported as risk ratios or mean differences with 95% confidence intervals. The Grading of Recommendations, Assessment, Development, and Evaluations scale was used to rate the certainty of evidence. Findings from dose-finding trials and nonrandomized studies were reported narratively. RESULTS A total of 35 studies (7333 women) met our inclusion criteria and included 30 randomized trials and 5 nonrandomized studies. There were limited data available from the trials for most outcomes, and the results were not conclusive. Compared with bolus plus infusion regimens, bolus only regimens probably result in slightly higher mean blood loss (mean difference, 52 mL; 95% confidence interval, 0.4-104 mL; moderate certainty). Among the bolus plus infusion regimens, initial bolus doses <5 IU may reduce nausea (risk ratio, 0.26; 95% confidence interval, 0.11-0.63; low certainty) when compared with doses of 5-9 IU. Total oxytocin doses of 5-9 IU vs total doses of 10-19 IU may increase the use of additional uterotonics (risk ratio, 13.00; 95% confidence interval, 1.75-96.37; low certainty). Effects on other outcomes were generally inconclusive. CONCLUSION There are limited data available for comparisons of IV oxytocin regimens for postpartum hemorrhage prevention following cesarean delivery. Bolus plus infusion regimens may lead to minor reductions in mean blood loss and initial bolus doses of <5 IU may minimize nausea. Bolus only regimens of 10 IU vs bolus only regimens of 5 IU may decrease the need for additional uterotonics, however, further comparative trials are required to understand the effects on other key outcomes, particularly hypotension.
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Affiliation(s)
- Laura C Phung
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.
| | - Elise K Farrington
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Mairead Connolly
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Alyce N Wilson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; School of Population and Global Health, Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Brendan Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
| | - Caroline S E Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia; School of Population and Global Health, Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Melbourne, Australia
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Severe acute coronary syndrome after carbetocin injection during caesarean delivery: a case report. Eur J Anaesthesiol 2021; 38:899-901. [PMID: 34226421 DOI: 10.1097/eja.0000000000001463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Kumari P, Kumar A, Sinha C, Kumar A, Sk A, Vamshi C. Cesarean section in COVID-19 patient with mitral stenosis: Fast-track spinal anesthesia is an option. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2021; 39:3-4. [PMID: 38620902 PMCID: PMC8114145 DOI: 10.1016/j.tacc.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/24/2021] [Accepted: 04/27/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Poonam Kumari
- Department of Anesthesiology, All India Institute of Medical Sciences, Patna, India
| | - Amarjeet Kumar
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Patna, India
| | - Chandni Sinha
- Department of Anesthesiology, All India Institute of Medical Sciences, Patna, India
| | - Ajeet Kumar
- Department of Anesthesiology, All India Institute of Medical Sciences, Patna, India
| | - Arun Sk
- Department of Anesthesiology, All India Institute of Medical Sciences, Patna, India
| | - Chethan Vamshi
- Department of Anesthesiology, All India Institute of Medical Sciences, Patna, India
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Torloni MR, Siaulys M, Riera R, Cabrera Martimbianco AL, Leite Pacheco R, Latorraca CDOC, Widmer M, Betrán AP. Timing of oxytocin administration to prevent post-partum hemorrhage in women delivered by cesarean section: A systematic review and metanalysis. PLoS One 2021; 16:e0252491. [PMID: 34081734 PMCID: PMC8174699 DOI: 10.1371/journal.pone.0252491] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/17/2021] [Indexed: 11/19/2022] Open
Abstract
Background There is no consensus on the best timing for prophylactic oxytocin administration during cesarean section (CS) to prevent post-partum hemorrhage (PPH). Objectives Assess the effects of administrating prophylactic oxytocin at different times during CS. Methods We searched nine databases to identify relevant randomized controlled trials (RCT). We pooled results and calculated average risk ratios (RR), mean differences (MD), and 95% confidence intervals (CI). We used GRADE to assess the overall evidence certainty. Results We screened 13,389 references and included four trials. We found no statistically significant differences between oxytocin given before versus after fetal delivery on PPH (RR 0.60, 95%CI 0.15–2.47; 1 RCT, N = 300) or nausea/vomiting (RR 1.21, 95%CI 0.69–2.13; 1 RCT, N = 300). There was a significant reduction in the need for additional uterotonics when oxytocin was given immediately before uterine incision versus after fetal delivery (RR 0.37, 95%CI 0.18–0.73; I2 = 0%; 2 RCTs; N = 301). Oxytocin given before fetal delivery significantly reduced intra-operative blood loss (MD -146.77mL, 95%CI -168.10 to -125.43; I2 = 0%; 3 RCTs, N = 601) but did not change the incidence of blood transfusion (RR 0.50, 95%CI 0.13–1.95; I2 = 0%; 2 RCTs, N = 301) or hysterectomy (RR 3.00; 95%CI 0.12–72.77; I2 = 0%; 2 RCTs, N = 301). One trial (N = 100) compared prophylactic oxytocin before versus after placental separation and found no significant differences on PPH, additional uterotonics, or nausea/vomiting. Conclusions In women having pre-labor CS, there is limited evidence indicating no significant differences between prophylactic oxytocin given before versus after fetal delivery on PPH, nausea/vomiting, blood transfusion, or hysterectomy. Earlier oxytocin administration may reduce the volume of blood loss and need for additional uterotonics. There is very limited evidence suggesting no significant differences between prophylactic oxytocin given before versus after placental separation on PPH, need for additional uterotonic, or nausea/vomiting. The overall certainty of the evidence was mostly low or very low due to imprecision. Protocol: CRD42020186797.
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Affiliation(s)
- Maria Regina Torloni
- Department of Obstetrics, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil
- Evidence Based Healthcare Postgraduation Program, Department of Medicine, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Monica Siaulys
- Department of Anesthesiology, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil
| | - Rachel Riera
- Evidence Based Healthcare Postgraduation Program, Department of Medicine, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Center of Health Technology Assessment, Hospital Sirio-Libanês, São Paulo, SP, Brazil
| | - Ana Luiza Cabrera Martimbianco
- Evidence Based Healthcare Postgraduation Program, Department of Medicine, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Universidade Metropolitana de Santos (UNIMES), Santos, SP, Brazil
| | - Rafael Leite Pacheco
- Evidence Based Healthcare Postgraduation Program, Department of Medicine, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Centro Universitário São Camilo, São Paulo, SP, Brazil
| | | | - Mariana Widmer
- Department of Reproductive Health and Research, World Health Organization, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Ana Pilar Betrán
- Department of Reproductive Health and Research, World Health Organization, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
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Mansour MK, Dehelia M, Hydoub YM, Kousa O, Hassan B. Oxytocin-Induced Acute Pulmonary Edema: A Case Report and Literature Review. Cureus 2021; 13:e15067. [PMID: 34141511 PMCID: PMC8206651 DOI: 10.7759/cureus.15067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The use of intravenous (IV) oxytocin has been commonly associated with the development of nausea, vomiting, headache, flushing, and hypotension. To date, only a few previously published studies have linked the administration of IV oxytocin, in high doses exceeding 15 mU/min, with the development of acute pulmonary edema. In this article, we aim to report the rare occurrence of acute pulmonary edema following administration of IV oxytocin at a small dose of 2 mU/min, in a 20-year-old pregnant female, to allow its recognition and prompt treatment by the clinician caring for the patient.
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Affiliation(s)
| | - Mohamed Dehelia
- Internal Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, ARE
| | | | - Omar Kousa
- Internal Medicine, Creighton University, Omaha, USA
| | - Babar Hassan
- Pulmonology, Sheikh Shakhbout Medical City, Abu Dhabi, ARE
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16
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Mohta M, Chowdhury RB, Tyagi A, Agarwal R. Efficacy of different infusion rates of oxytocin for maintaining uterine tone during elective caesarean section: A randomised double blind trial. Anaesth Intensive Care 2021; 49:183-189. [PMID: 33934618 DOI: 10.1177/0310057x20984480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Most research in this field has focused on finding oxytocin doses for initiating uterine contractions. Only limited data are available regarding the optimal rate of oxytocin infusion to maintain adequate uterine tone. This randomised, double blind study included 120 healthy term pregnant patients with uncomplicated, singleton pregnancy undergoing elective caesarean section under spinal anaesthesia. Following an initial 1 IU bolus, the patients received oxytocin infusion at 1.25 IU/hour (group 1.25), 2.5 IU/hour (group 2.5) or 5.0 IU/hour (group 5) for four hours. Uterine tone was assessed as adequate or inadequate at various intervals. If found inadequate, additional uterotonics were administered. Estimated blood loss was mean (standard deviation) 499 (172) ml, 454 (117) ml and 402 (151) ml in groups 1.25, 2.5 and 5, respectively (P value groups 1.25 versus 5 = 0.012). Oxytocin infusion at 5 IU/hour resulted in a significantly lower incidence of minor postpartum haemorrhage, defined as blood loss greater than 500 ml, than 1.25 IU/hour (P = 0.009). No patient had major/severe haemorrhage (>1000 ml blood loss). No significant difference was seen in haemoglobin levels (P = 0.677) and uterine tone. Fifteen, six and nine patients, respectively, required additional oxytocin (P = 0.151). The incidence of tachycardia (P = 0.726), hypotension (P = 0.321) and nausea/vomiting (P = 0.161) was comparable. To conclude, 5 IU/hour was more effective than 1.25 IU/hour in reducing total blood loss and the incidence of minor postpartum haemorrhage. Thus 5 IU/hour appears to be an optimal oxytocin infusion rate following 1 IU slow intravenous oxytocin injection for the maintenance of adequate uterine contraction in patients undergoing elective caesarean section under spinal anaesthesia.
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Affiliation(s)
- Medha Mohta
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Rohit B Chowdhury
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Asha Tyagi
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Rachna Agarwal
- Department of Obstetrics and Gynaecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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17
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Risk Factors for Atonic Postpartum Hemorrhage: A Systematic Review and Meta-analysis. Obstet Gynecol 2021; 137:305-323. [PMID: 33417319 DOI: 10.1097/aog.0000000000004228] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/29/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To identify and quantify risk factors for atonic postpartum hemorrhage. DATA SOURCES PubMed, CINAHL, EMBASE, Web of Science, and and ClinicalTrials.gov databases were searched for English language studies with no restrictions on date or location. Studies included randomized trials, prospective or retrospective cohort studies, and case-control studies of pregnant patients who developed atonic postpartum hemorrhage and reported at least one risk factor. METHODS OF STUDY SELECTION Title, abstract, and full-text screening were performed using the Raayan web application. Of 1,239 records screened, 27 studies were included in this review. Adjusted or unadjusted odds ratios (ORs), relative risks, or rate ratios were recorded or calculated. For each risk factor, a qualitative synthesis of low and moderate risk of bias studies classifies the risk factor as definite, likely, unclear, or not a risk factor. For risk factors with sufficiently homogeneous definitions and reference ranges, a quantitative meta-analysis of low and moderate risk of bias studies was implemented to estimate a combined OR. TABULATION, INTEGRATION, AND RESULTS Forty-seven potential risk factors for atonic postpartum hemorrhage were identified in this review, of which 15 were judged definite or likely risk factors. The remaining 32 assessed risk factors showed no association with atonic postpartum hemorrhage or had conflicting or unclear evidence. CONCLUSION A substantial proportion of postpartum hemorrhage occurs in the absence of recognized risk factors. Many risk factors for atonic hemorrhage included in current risk-assessment tools were confirmed, with the greatest risk conferred by prior postpartum hemorrhage of any etiology, placenta previa, placental abruption, uterine rupture, and multiple gestation. Novel risk factors not currently included in risk-assessment tools included hypertension, diabetes, and ethnicity. Obesity and magnesium were not associated with atonic postpartum hemorrhage in this review. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42020157521.
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18
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Khamidullina Z, Myrzabekova A, Syzdykova A. UTEROTONIC DRUGS IN THE PREVENTION OF POSTPARTUM HEMORRHAGES. REPRODUCTIVE MEDICINE 2020. [DOI: 10.37800/rm2020-1-37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In the world practice, hemorrhages in obstetrics take leading positions within the causes of maternal morbidity and mortal ity. 800 women die every day due to childbirth complications under the data of the World Health Organization. The majority of maternal deaths occur during the perinatal period, usually within 24 hours postpartum. It is possible to prevent most of them. Lack of adequate pre-conceptional training, uncompensated extragenital diseases increase the percentage of pathological births. Consequently, practicing obstetricians-gynecologists have to face such childbirth complications as postpartum hemorrhage with increasing frequency. Uterine atonia is the main cause of postpartum hemorrhages. Uterotonic drugs administration enables to re- duce the risk of postpartum atonic hemorrhages. Particular attention should be paid to postpartum hemorrhage prevention, i.e. the use of uterotonic drugs as an integral part of the active management during the third period in natural labor and caesarean section.
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19
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Weeks AD, Fawcus S. Management of the third stage of labour: (for the Optimal Intrapartum Care series edited by Mercedes Bonet, Femi Oladapo and Metin Gülmezoglu). Best Pract Res Clin Obstet Gynaecol 2020; 67:65-79. [PMID: 32402601 DOI: 10.1016/j.bpobgyn.2020.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/18/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
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.
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Affiliation(s)
- Andrew D Weeks
- Department of Women's and Children's Health, Liverpool Women's Hospital and University of Liverpool for Liverpool Health Partners, Sanyu Research Unit, Liverpool Women's Hospital, Crown Street, Liverpool, L8 7SS, UK.
| | - Susan Fawcus
- Department of Obstetrics and Gynaecology, University of Cape Town, H floor Old Main Building, Grooteschuur Hospital, Anzio Road, Observatory, Cape Town 7925, South Africa.
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Zhao N, Xu J, Li XG, Walline JH, Li YC, Wang L, Zhao GS, Xu MJ. Hemodynamic characteristics in preeclampsia women during cesarean delivery after spinal anesthesia with ropivacaine. World J Clin Cases 2020; 8:1444-1453. [PMID: 32368536 PMCID: PMC7190954 DOI: 10.12998/wjcc.v8.i8.1444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/05/2020] [Accepted: 04/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Very few studies have been published on the hemodynamic changes associated with spinal anesthesia induced with ropivacaine during cesarean deliveries in preeclamptic women. AIM To record and analyze hemodynamic data in women with preeclampsia undergoing cesarean delivery after spinal anesthesia induced with ropivacaine. METHODS Ten eligible women with preeclampsia were enrolled in this prospective observational study. Spinal anesthesia was performed with 2.4 mL of 0.5% ropivacaine. Hemodynamic changes were then analyzed at multiple time points. The hemodynamic responses to vasopressor interventions and uterotonic agents, as well as maternal and neonatal outcomes were also recorded. RESULTS Stable hemodynamic trends were observed in this study. Cardiac output (CO) and stroke volume increased mildly during surgery. In contrast, mean arterial pressure and systemic vascular resistance showed a moderate decrease from induction until the end of surgery. Central venous pressure dramatically increased after delivery. Oxytocin administration was associated with the most significant hemodynamic fluctuations during surgery, namely, an increase in CO and heart rate. Phenylephrine intervention was only required in three patients, and caused an increase in mean arterial pressure and systemic vascular resistance along with a decrease in heart rate, stroke volume, and CO. No maternal and neonatal complications were observed during this study, except transient episodes of hypotension. CONCLUSION Spinal anesthesia for caesarian delivery with ropivacaine in women with preeclampsia is linked to modest hemodynamic changes of no clinical significance in this study. Careful cardiovascular monitoring is still recommended, particularly after the delivery of the fetus or the use of oxytocin.
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Affiliation(s)
- Na Zhao
- Department of Anesthesiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
| | - Jin Xu
- Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiao-Guang Li
- Department of Anesthesiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
| | - Joseph Harold Walline
- Accident and Emergency Medicine Academic Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong 9990777, China
| | - Yi-Chong Li
- Department of Clinical Research and Epidemiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Lin Wang
- Department of Anesthesiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
| | - Guo-Sheng Zhao
- Department of Anesthesiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
| | - Ming-Jun Xu
- Department of Anesthesiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
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Pakniat H, Chegini V, Shojaei A, Khezri MB, Ansari I. Comparison of the Effect of Intravenous Tranexamic Acid and Sublingual Misoprostol on Reducing Bleeding After Cesarean Section: A Double-Blind Randomized Clinical Trial. J Obstet Gynaecol India 2019; 69:239-245. [PMID: 31178639 DOI: 10.1007/s13224-018-1181-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 09/17/2018] [Indexed: 11/26/2022] Open
Abstract
Purpose To evaluate the effects of intravenous tranexamic acid (TA) and sublingual misoprostol on reducing bleeding after cesarean section. Materials One hundred and fifty-eight participants with term pregnancies scheduled for cesarean section were randomly divided into two groups. In M group, two sublingual misoprostol pills (400 mg) were administrated, immediately after the delivery. In TA group, ten minutes before skin incision, TA ampoule (1 g) was injected. In both groups, immediately after the delivery, 20 units of oxytocin in 1 L ringer lactate with speed of 1000 CC/h was injected. At the end of the operation, the amount of bleeding was measured based on the number of small and large gauzes, the blood in the suction container and the difference of patient's hemoglobin before and 24 h after surgery. Results Hemoglobin level reduction in the TA group was higher than the M group (- 2.45 ± 0.84 vs - 2.14 ± 1.38 g/dL) (P < 0.001). Furthermore, number of used gauze and blood suction in the TA group was significantly higher compared to sublingual misoprostol (4.67 ± 1.34 vs 3.25 ± 1.31 and 260.25 ± 79.06 vs 193.94 ± 104.79 cc, respectively) (P < 0.001). Mean blood pressure during the entire duration of surgery in the TA group decreased significantly as compared to the M group (P < 0.001). Conclusion Total bleeding was significantly lower in sublingual misoprostol as compared to the tranexamic acid group. Furthermore, in misoprostol group hemodynamic variables were stabilized greater than tranexamic acid group. Registration Number IRCT201708308611N6.
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Affiliation(s)
- Hamideh Pakniat
- 1Department of Obstetrics and Gynecology, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Venus Chegini
- 1Department of Obstetrics and Gynecology, Qazvin University of Medical Sciences, Qazvin, Iran
| | | | - Marzieh Beigom Khezri
- 3Department of Anesthesiology, Qazvin University of Medical Sciences, Shahid Bahonar Ave, PO Box 3419759811, Qazvin, Iran
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Zanos P, Georgiou P, Weber C, Robinson F, Kouimtsidis C, Niforooshan R, Bailey A. Oxytocin and opioid addiction revisited: old drug, new applications. Br J Pharmacol 2018; 175:2809-2824. [PMID: 28378414 PMCID: PMC6016632 DOI: 10.1111/bph.13757] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 02/01/2017] [Accepted: 02/13/2017] [Indexed: 12/28/2022] Open
Abstract
Opioid addiction has devastating health and socio-economic consequences, and current pharmacotherapy is limited and often accompanied by side effects, thus novel treatment is warranted. Traditionally, the neurohypophyseal peptide oxytocin (OT) is known for its effects on mediating reward, social affiliation and bonding, stress and learning and memory. There is now strong evidence that OT is a possible candidate for the treatment of drug addiction and depression-addiction co-morbidities. This review summarizes and critically discusses the preclinical evidence surrounding the consequences of pharmacological manipulation of the oxytocinergic system on opioid addiction-related processes, as well as the effects of opioids on the OT system at different stages of the addiction cycle. The mechanisms underlying the effects of OT on opioid addiction, including OT' interaction with the monoaminergic, glutamatergic, opioidergic systems and its effect on the amygdala, the hypothalamic-pituitary-adrenal axis and on memory consolidation of traumatic memories, are also reviewed. We also review clinical evidence on the effects of intranasal OT administration on opioid-dependent individuals and discuss the therapeutic potential along with the limitations that accompany OT-based pharmacotherapies. Review of these studies clearly indicates that the OT system is profoundly affected by opioid use and abstinence and points towards the OT system as an important target for developing pharmacotherapies for the treatment of opioid addiction and co-existing affective disorders, thereby preventing relapse. Therefore, there is a clear need for clinical studies assessing the efficacy of OT-based pharmacotherapies in opioid addiction. LINKED ARTICLES This article is part of a themed section on Emerging Areas of Opioid Pharmacology. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v175.14/issuetoc.
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Affiliation(s)
- Panos Zanos
- School of Biosciences and Medicine, Faculty of Health and Medical SciencesUniversity of SurreyGuildfordSurreyUK
- Department of PsychiatryUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - Polymnia Georgiou
- School of Biosciences and Medicine, Faculty of Health and Medical SciencesUniversity of SurreyGuildfordSurreyUK
- Department of PsychiatryUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - Carol Weber
- School of Biosciences and Medicine, Faculty of Health and Medical SciencesUniversity of SurreyGuildfordSurreyUK
| | - Fiona Robinson
- Surrey and Borders Partnership NHS Foundation TrustChertseySurreyUK
| | | | | | - Alexis Bailey
- School of Biosciences and Medicine, Faculty of Health and Medical SciencesUniversity of SurreyGuildfordSurreyUK
- Institute of Medical and Biomedical EducationSt George's University of LondonLondonUK
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Ch’Ng SS, Lawrence AJ. Investigational drugs for alcohol use disorders: a review of preclinical data. Expert Opin Investig Drugs 2018; 27:459-474. [DOI: 10.1080/13543784.2018.1472763] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Sarah S Ch’Ng
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Andrew J Lawrence
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
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Abstract
Cardiac arrest in pregnancy is a rare and frightening event. Although not every obstetrician will encounter cardiac arrest in pregnancy during their career, it is imperative to be prepared to manage this acute emergency. The management is particularly complex due to maternal physiologic changes from pregnancy and the simultaneous management of two patients, the mother and fetus. In 2010, the American Heart Association released their first scientific statement on guidelines for management of cardiac arrest in pregnancy that has since been updated in 2015. All providers who care for pregnant patients should be aware of these guidelines and ready to manage cardiac arrest in pregnancy because correct and timely interventions can affect real world outcomes.
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Affiliation(s)
- Jacqueline Kikuchi
- Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814
| | - Shad Deering
- Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814.
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Muttenthaler M, Andersson Å, Vetter I, Menon R, Busnelli M, Ragnarsson L, Bergmayr C, Arrowsmith S, Deuis JR, Chiu HS, Palpant NJ, O'Brien M, Smith TJ, Wray S, Neumann ID, Gruber CW, Lewis RJ, Alewood PF. Subtle modifications to oxytocin produce ligands that retain potency and improved selectivity across species. Sci Signal 2017; 10:10/508/eaan3398. [PMID: 29208680 DOI: 10.1126/scisignal.aan3398] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Oxytocin and vasopressin mediate various physiological functions that are important for osmoregulation, reproduction, cardiovascular function, social behavior, memory, and learning through four G protein-coupled receptors that are also implicated in high-profile disorders. Targeting these receptors is challenging because of the difficulty in obtaining ligands that retain selectivity across rodents and humans for translational studies. We identified a selective and more stable oxytocin receptor (OTR) agonist by subtly modifying the pharmacophore framework of human oxytocin and vasopressin. [Se-Se]-oxytocin-OH displayed similar potency to oxytocin but improved selectivity for OTR, an effect that was retained in mice. Centrally infused [Se-Se]-oxytocin-OH potently reversed social fear in mice, confirming that this action was mediated by OTR and not by V1a or V1b vasopressin receptors. In addition, [Se-Se]-oxytocin-OH produced a more regular contraction pattern than did oxytocin in a preclinical labor induction and augmentation model using myometrial strips from cesarean sections. [Se-Se]-oxytocin-OH had no activity in human cardiomyocytes, indicating a potentially improved safety profile and therapeutic window compared to those of clinically used oxytocin. In conclusion, [Se-Se]-oxytocin-OH is a novel probe for validating OTR as a therapeutic target in various biological systems and is a promising new lead for therapeutic development. Our medicinal chemistry approach may also be applicable to other peptidergic signaling systems with similar selectivity issues.
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Affiliation(s)
- Markus Muttenthaler
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland 4072, Australia. .,Faculty of Chemistry, Institute of Biological Chemistry, University of Vienna, 1090 Vienna, Austria
| | - Åsa Andersson
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Irina Vetter
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland 4072, Australia.,School of Pharmacy, The University of Queensland, Brisbane, Queensland 4104, Australia
| | - Rohit Menon
- Department of Behavioral and Molecular Neurobiology, Regensburg Center of Neuroscience, University of Regensburg, 93053 Regensburg, Germany
| | - Marta Busnelli
- CNR-Institute of Neuroscience, 20129 Milan, Italy.,Department of Biotechnology and Translational Medicine, University of Milan, 20129 Milan, Italy
| | - Lotten Ragnarsson
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Christian Bergmayr
- Center for Physiology and Pharmacology, Medical University of Vienna, 1090 Vienna, Austria
| | - Sarah Arrowsmith
- Department of Cellular and Molecular Physiology, Harris-Wellbeing Preterm Birth Centre, Institute of Translational Medicine, University of Liverpool, Liverpool L69 3BX, UK
| | - Jennifer R Deuis
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Han Sheng Chiu
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Nathan J Palpant
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Margaret O'Brien
- National Centre for Biomedical Engineering Science, National University of Ireland, Galway H91 CF50, Ireland
| | - Terry J Smith
- National Centre for Biomedical Engineering Science, National University of Ireland, Galway H91 CF50, Ireland
| | - Susan Wray
- Department of Cellular and Molecular Physiology, Harris-Wellbeing Preterm Birth Centre, Institute of Translational Medicine, University of Liverpool, Liverpool L69 3BX, UK
| | - Inga D Neumann
- Department of Behavioral and Molecular Neurobiology, Regensburg Center of Neuroscience, University of Regensburg, 93053 Regensburg, Germany
| | - Christian W Gruber
- Center for Physiology and Pharmacology, Medical University of Vienna, 1090 Vienna, Austria.,School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Richard J Lewis
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Paul F Alewood
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland 4072, Australia.
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26
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Lier H, von Heymann C, Korte W, Schlembach D. Peripartum Haemorrhage: Haemostatic Aspects of the New German PPH Guideline. Transfus Med Hemother 2017; 45:127-135. [PMID: 29765296 DOI: 10.1159/000478106] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/07/2017] [Indexed: 12/30/2022] Open
Abstract
Summary Peripartum haemorrhage remains one of the main causes of maternal mortality world-wide. The German, Austrian and Swiss Societies of Gynaecology and Obstetrics have updated the current guidelines for the treatment of peripartum haemorrhage together with the German Society of Anaesthesiology and Intensive Care Medicine and the Society of Thrombosis and Haemostasis Research. The recommendations have been the result of a thorough review of the available scientific literature and a consensus process involving all members of the guideline group. A key element of the anaesthesiological and haemostatic management is the development of a multidisciplinary standard operating procedure combining surgical as well as medical and haemostatic treatments depending on the severity of bleeding. The guideline underscores the value of clinical and laboratory diagnostics of peripartum haemorrhage as early as possible, even pre-emptively. This allows for an early identification of causes of bleeding and a specific treatment. The guideline comprises evidence-based recommendations for the use of uterotonics, tranexamic acid and blood products such as factor concentrates, fresh frozen plasma, platelet concentrates, packed red blood cells, recombinant activated factor VII and desmopressin. In addition, recommendations for blood conservation strategies involving the use of cell salvage, permissive hypotension and transfusion triggers are given.
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Affiliation(s)
- Heiko Lier
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, Cologne, Germany
| | - Christian von Heymann
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Wolfgang Korte
- Centre for Laboratory Medicine and Haemostasis and Haemophilia Centre, St. Gallen, Switzerland
| | - Dietmar Schlembach
- Department of Obstetrics and Gynaecology, Vivantes Klinikum Neukölln, Berlin, Germany
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Duffield A, McKenzie C, Carvalho B, Ramachandran B, Yin V, El-Sayed YY, Riley ET, Butwick AJ. Effect of a High-Rate Versus a Low-Rate Oxytocin Infusion for Maintaining Uterine Contractility During Elective Cesarean Delivery: A Prospective Randomized Clinical Trial. Anesth Analg 2017; 124:857-862. [PMID: 28212181 DOI: 10.1213/ane.0000000000001658] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Oxytocin is routinely used as prophylaxis against uterine atony. During elective cesarean delivery (CD), an oxytocin bolus is used to initiate adequate uterine tone, followed by an oxytocin infusion to maintain uterine contractility. However, it is unclear whether oxytocin maintenance infusion rate influences total estimated blood loss (EBL). METHODS We performed a prospective, randomized, double-blind trial in 51 women undergoing elective CD. Women were randomly assigned to receive an oxytocin maintenance infusion of 2.5 or 15 U/h. All women received an oxytocin 1 U bolus to initiate adequate uterine tone. The primary outcome was EBL. EBL values between groups were compared using a Mann-Whitney U test; P < .05 as statistically significant. The median EBL difference with 95% confidence intervals was also calculated. Secondary outcomes included adequacy of uterine tone, use of additional uterotonics, and oxytocin-related side effects, including hypotension. RESULTS Of 51 women, 24 received a low-rate infusion and 27 received a high-rate infusion. Median (interquartile range) EBL values in the low-rate and high-rate groups were 634 (340-886) mL versus 512 (405-740) mL, respectively (P = .7). The median difference in EBL between groups was 22 mL; 95% confidence interval = -158 to 236 mL. The rate of postpartum hemorrhage did not differ between groups (low-rate group: 4/24 [16.7%] versus high-rate group: 4/26 [15.4%]). There were no between-group differences over time (first 20 minutes after commencing infusion) in the incidence of adequate uterine tone (P = .72) or hypotension (P = .32). CONCLUSIONS Among women undergoing elective CD receiving an oxytocin maintenance infusion, EBL and uterine tone did not differ between women receiving 2.5 U/h oxytocin and those receiving 15 U/h oxytocin. Our findings suggest that efficacy can be obtained with a low oxytocin maintenance infusion rate; however, dose-finding studies are needed to determine the infusion rate that optimizes drug efficacy while minimizing side effects.
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Affiliation(s)
- Adrienne Duffield
- From the *Department of Anesthesiology, Perioperative, and Pain Medicine and †Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
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Vallera C, Choi LO, Cha CM, Hong RW. Uterotonic Medications: Oxytocin, Methylergonovine, Carboprost, Misoprostol. Anesthesiol Clin 2017; 35:207-219. [PMID: 28526143 DOI: 10.1016/j.anclin.2017.01.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Uterine atony is a common cause of primary postpartum hemorrhage, which remains a major cause of pregnancy-related mortality for women worldwide. Oxytocin, methylergonovine, carboprost, and misoprostol are commonly used to restore uterine tone. Oxytocin is the first-line agent. Methylergonovine and carboprost are both highly effective second-line agents with severe potential side effects. Recent studies have called into question the effectiveness of misoprostol as an adjunct to other uterotonic agents, but it remains a useful therapeutic in resource-limited practice environments. We review the current role these medications play in the prevention and treatment of uterine atony.
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Affiliation(s)
- Cristianna Vallera
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 3325, Los Angeles, CA 90095-7403, USA.
| | - Lynn O Choi
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 3325, Los Angeles, CA 90095-7403, USA
| | - Catherine M Cha
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 3325, Los Angeles, CA 90095-7403, USA
| | - Richard W Hong
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 3325, Los Angeles, CA 90095-7403, USA
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29
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Nathan HL, Cottam K, Hezelgrave NL, Seed PT, Briley A, Bewley S, Chappell LC, Shennan AH. Determination of Normal Ranges of Shock Index and Other Haemodynamic Variables in the Immediate Postpartum Period: A Cohort Study. PLoS One 2016; 11:e0168535. [PMID: 27997586 PMCID: PMC5173287 DOI: 10.1371/journal.pone.0168535] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 12/02/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine the normal ranges of vital signs, including blood pressure (BP), mean arterial pressure (MAP), heart rate (HR) and shock index (SI) (HR/systolic BP), in the immediate postpartum period to inform the development of robust obstetric early warning scores. STUDY DESIGN We conducted a secondary analysis of a prospective observational cohort study evaluating vital signs collected within one hour following delivery in women with estimated blood loss (EBL) <500ml (316 women) delivering at a UK tertiary centre over a one-year period. Simple and multiple linear regression were used to explore associations of demographic and obstetric factors with SI. RESULTS Median (90% reference range) was 120 (100-145) for systolic BP, 75 (58-90) for diastolic BP, 90 (73-108) for MAP, 81 (61-102) for HR, and 0.66 (0.52-0.89) for SI. Third stage Syntometrine® administration was associated with a 0.03 decrease in SI (p = 0.035) and epidural use with a 0.05 increase (p = 0.003). No other demographic or obstetric factors were associated with a change in shock index in this cohort. CONCLUSION This is the first study to determine normal ranges of maternal BP, MAP, HR and SI within one hour of birth, a time of considerable haemodynamic adjustment, with minimal effect of demographic and obstetric factors demonstrated. The lower 90% reference point for systolic BP and upper 90% reference point for HR correspond to triggers used to recognise shock in obstetric practice, as do the upper 90% reference points for systolic and diastolic BP for obstetric hypertensive triggers. The SI upper limit of 0.89 in well postpartum women supports current literature suggesting a threshold of 0.9 as indicating increased risk of adverse outcomes.
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Affiliation(s)
- Hannah L. Nathan
- Women’s Health Academic Centre, King’s College London, London, United Kingdom
| | - Kate Cottam
- Women’s Health Academic Centre, King’s College London, London, United Kingdom
| | | | - Paul T. Seed
- Women’s Health Academic Centre, King’s College London, London, United Kingdom
| | - Annette Briley
- Women’s Health Academic Centre, King’s College London, London, United Kingdom
| | - Susan Bewley
- Women’s Health Academic Centre, King’s College London, London, United Kingdom
| | - Lucy C. Chappell
- Women’s Health Academic Centre, King’s College London, London, United Kingdom
| | - Andrew H. Shennan
- Women’s Health Academic Centre, King’s College London, London, United Kingdom
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Lakshmi SJD, Abraham R. Role of Prophylactic Tranexamic Acid in Reducing Blood Loss during Elective Caesarean Section: A Randomized Controlled Study. J Clin Diagn Res 2016; 10:QC17-QC21. [PMID: 28208943 PMCID: PMC5296516 DOI: 10.7860/jcdr/2016/21702.9050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 09/30/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Obstetric haemorrhage accounts for 20-25% of maternal mortality and morbidity. Anti-fibrinolytics are being widely used in field of surgery. It is also used to reduce heavy menstrual blood loss. AIM To analyse the effectiveness of Tranexamic Acid (TXA) in reducing blood loss during elective caesarean section. MATERIALS AND METHODS This interventional, randomized, parallel group study was done in the Department of Obstetrics and Gynaecolgy, PSG IMSR, Coimbatore, from June 2014 to May 2015. It was conducted on 120 women undergoing caesarean section. They were allocated to either Study or Control group by computer generated random number tables. TXA was given prior to surgery in study group in addition to the routine care {10 units of oxytocin added to the intravenous drip soon after baby delivery} whereas, the control group had routine care alone. Blood loss was measured in both groups by gravimetric method. Haemoglobin before and after surgery was estimated and the percentage of difference was compared. STATISTICAL ANALYSIS Primary outcome variables were volume of blood loss and percentage fall in haemoglobin before and after surgery. Secondary outcomes were duration of surgery, proportion of subjects with >500ml of blood loss, need for additional uterotonics and side effects. Unpaired t-test and Chi-square test were used to compare the outcome variables. RESULTS There was significant reduction in blood loss calculated from placental delivery till end of surgery: 347.17ml in study group versus 517.72ml in control group (p<0.001). Another parameter studied was the percentage of fall in haemoglobin before and after surgery and the number of subjects who had more than 10% fall in haemoglobin. 9.3% of subjects in study group and 39% of subjects in control group had more than 10% fall in haemoglobin (p<0.01). There were no immediate post-operative complications to the mother and neonate. CONCLUSION TXA significantly reduced the amount of blood loss during Lower Segment Caesarean Section (LSCS). Use of TXA was not associated with adverse effects. Thus, TXA can be used safely and effectively in subjects undergoing LSCS.
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Affiliation(s)
- SJ Dhivya Lakshmi
- Junior Resident, Department of Obstetrics and Gynecology, Peelamedu Samanaidu Govindasaminaidu Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Reena Abraham
- Professor, Department of Obstetrics and Gynecology, Peelamedu Samanaidu Govindasaminaidu Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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The management of third stage of labour in women with heart disease needs more attention. Int J Cardiol 2016; 223:23-24. [DOI: 10.1016/j.ijcard.2016.08.178] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 08/07/2016] [Indexed: 12/21/2022]
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Sentilhes L, Merlot B, Madar H, Sztark F, Brun S, Deneux-Tharaux C. Postpartum haemorrhage: prevention and treatment. Expert Rev Hematol 2016; 9:1043-1061. [PMID: 27701915 DOI: 10.1080/17474086.2016.1245135] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Postpartum hemorrhage (PPH) is one of the leading causes of maternal death and severe maternal morbidity worldwide and strategies to prevent and treat PPH vary among international authorities. Areas covered: This review seeks to provide a global overview of PPH (incidence, causes, risk factors), prevention (active management of the third stage of labor and prohemostatic agents), treatment (first, second and third-line measures to control PPH), by also underlining recommendations elaborated by international authorities and using algorithms. Expert commentary: When available, oxytocin is considered the drug of first choice for both prevention and treatment of PPH, while peripartum hysterectomy remains the ultimate life-saving procedure if pharmacological and resuscitation measures fail. Nevertheless, the level of evidence for preventing and treating PPH is globally low. The emergency nature of PPH makes randomized controlled trials (RCT) logistically difficult. Population-based observational studies should be encouraged as they can usefully strengthen the evidence base, particularly for components of PPH treatment that are difficult or impossible to assess through RCT.
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Affiliation(s)
- Loïc Sentilhes
- a Department of Obstetrics and Gynecology , Bordeaux University Hospital, University of Bordeaux , Bordeaux , France
| | - Benjamin Merlot
- a Department of Obstetrics and Gynecology , Bordeaux University Hospital, University of Bordeaux , Bordeaux , France
| | - Hugo Madar
- a Department of Obstetrics and Gynecology , Bordeaux University Hospital, University of Bordeaux , Bordeaux , France
| | - François Sztark
- b Department of Anesthesiology , Bordeaux University Hospital, University of Bordeaux , Bordeaux , France
| | - Stéphanie Brun
- a Department of Obstetrics and Gynecology , Bordeaux University Hospital, University of Bordeaux , Bordeaux , France
| | - Catherine Deneux-Tharaux
- c INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité , Paris Descartes University , Paris , France
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Xiao W, Wang T, Fu W, Wang F, Zhao L. Regional cerebral oxygen saturation guided cerebral protection in a parturient with Takayasu's arteritis undergoing cesarean section: a case report. J Clin Anesth 2016; 33:168-72. [PMID: 27555157 DOI: 10.1016/j.jclinane.2016.02.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 01/28/2016] [Accepted: 02/18/2016] [Indexed: 11/19/2022]
Abstract
The objective of this case report is to present the successful use of regional cerebral oxygen saturation (rScO2) monitoring guided cerebral protection for cesarean delivery in a parturient with Takayasu's arteritis at 38weeks' gestation. The parturient presented with impaired cerebral and renal perfusion. Titrated epidural anesthesia was performed. During the procedure, we used rScO2 guided cerebral protection strategies, which helped to optimize cerebral oxygen delivery and prevent cerebral complications.
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Affiliation(s)
- Wei Xiao
- Department of Anesthesiology, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China.
| | - Tianlong Wang
- Department of Anesthesiology, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China.
| | - Wenya Fu
- Department of Anesthesiology, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China.
| | - Fengying Wang
- Department of Obstetrics and Gynecology, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China.
| | - Lei Zhao
- Department of Anesthesiology, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China.
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Sen S, Chatterjee S, Mazumder P, Mukherji S. Epidural anesthesia: A safe option for cesarean section in parturient with severe pulmonary hypertension. J Nat Sci Biol Med 2016; 7:182-5. [PMID: 27433072 PMCID: PMC4934111 DOI: 10.4103/0976-9668.184708] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Rheumatic heart disease is the most common cardiac disease complicating pregnancy in developing countries. Heart disease accounts for 15% pregnancy-related mortality. In the presence of maternal heart disease, the circulatory changes of pregnancy may result in exacerbation of the hemodynamic perturbations due to complex cardiac valvular lesions leading to decompensation or death of mother or fetus. Determining the ideal anesthetic technique for cesarean section in the presence of complex cardiac conditions remains a much debated topic. General anesthesia is associated with a further increase in pulmonary pressure in response to laryngoscopy and intubation along with myocardial depression by anesthetic agents. Neuraxial blockade may lead to decrease in systemic vascular resistance and cardiac output. We report the successful anesthetic management of a parturient suffering from rheumatic heart disease with multivalvular lesions resulting in severe pulmonary hypertension under epidural anesthesia with good maternal and neonatal outcome. Successful management requires vigilant perioperative monitoring and thorough knowledge of the hemodynamics of complex cardiac valvular disease.
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Affiliation(s)
- Sreyashi Sen
- Department of Anaesthesiology, Medical College, Kolkata, West Bengal, India
| | - Sourav Chatterjee
- Department of Anaesthesiology, Medical College, Kolkata, West Bengal, India
| | - Pinaki Mazumder
- Department of Anaesthesiology, Medical College, Kolkata, West Bengal, India
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Löytved-Hardegg JJ, Brunner M, Ries JJ, von Felten S, Heugel C, Lapaire O, Voekt C, Hösli I. Replacement of oxytocin bolus administration by infusion: influences on postpartum outcome. Arch Gynecol Obstet 2016; 293:1219-25. [PMID: 26538357 PMCID: PMC4863908 DOI: 10.1007/s00404-015-3916-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 10/12/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE Postpartum haemorrhage (PPH) represents a leading cause of maternal morbidity and mortality. Giving oxytocin after birth reduces the risk for PPH. It has never been tested whether different methods of oxytocin administration affect the maternal outcome. This study aims to compare the infusion versus the bolus application of oxytocin after singleton vaginal delivery. METHODS This retrospective monocentre study compares the incidence of clinically relevant postpartum complications in women receiving 5 IE of oxytocin as a bolus or as a 100 ml-infusion over 5 min, given immediately after birth. Included were women delivering singletons vaginally at term. We used propensity score weighting to compare outcomes between women receiving bolus and infusion and to minimize the selection bias in this retrospective cohort. RESULTS 1765 patients were included. Patient characteristics were balanced. We found no significant differences for the combined overall postpartum adverse outcome (the incidence of PPH, manual removal of the placenta and/or curettage). For the single outcomes, we observed a significantly higher frequency of manual removal of the placenta (Odds ratio 1.47, 95 % CI 1.02-2.13) and a slightly higher but clinically not relevant estimated blood loss (Relative effect 1.05, 95 % CI 1.01-1.10) in the infusion group. CONCLUSION The data show a tendency towards more complications in the infusion group. It is related to a more frequent need for manual removal of the placenta.
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Affiliation(s)
- Julia J Löytved-Hardegg
- Department of Obstetrics, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Mirjam Brunner
- Department of Obstetrics, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Jean-Jacques Ries
- Cantonal Hospital of Aarau, Women's Hospital, Tellstrasse, 5001, Aarau, Switzerland
| | - Stefanie von Felten
- Clinical Trial Unit, University Hospital of Basel, Schanzenstrasse 55, 4031, Basel, Switzerland
| | - Christina Heugel
- Department of Obstetrics, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Olav Lapaire
- Department of Obstetrics, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Cora Voekt
- Hospital of Grabs, Women's Hospital, Spitalstrasse 44, 9472, Grabs, Switzerland
| | - Irene Hösli
- Department of Obstetrics, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
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Pantoja T, Abalos E, Chapman E, Vera C, Serrano VP, Cochrane Pregnancy and Childbirth Group. Oxytocin for preventing postpartum haemorrhage (PPH) in non-facility birth settings. Cochrane Database Syst Rev 2016; 4:CD011491. [PMID: 27078125 PMCID: PMC8665833 DOI: 10.1002/14651858.cd011491.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
- Tomas Pantoja
- Pontificia Universidad Católica de ChileDepartment of Family Medicine, Faculty of MedicineCentro Medico San Joaquin, Vicuña Mackenna 4686MaculSantiagoChile
| | - Edgardo Abalos
- Centro Rosarino de Estudios Perinatales (CREP)Moreno 878, 6th floorRosarioSanta FeArgentinaS2000DKR
| | - Evelina Chapman
- Free time independent Cochrane reviewer24 de septiembre 675 9 piso CTucumànTucumànArgentina4000
| | - Claudio Vera
- Faculty of Medicine, Pontificia Universidad Católica de ChileDivision of Obstetrics and Gynecology, Evidence Based Health Care ProgramLira 85 5to pisoSantiagoRMChile
| | - Valentina P Serrano
- Pontificia Universidad Católica de ChileDepartment of Nutrition, Diabetes and MetabolismSantiagoChile
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Beaudry S, Pick J, Heerdt PM. Non-invasive cardiac output monitoring for cesarean delivery under epidural anesthesia in a patient with Marfan syndrome and cardiomyopathy. Int J Obstet Anesth 2016; 25:82-5. [PMID: 26718697 DOI: 10.1016/j.ijoa.2015.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 09/27/2015] [Accepted: 11/08/2015] [Indexed: 10/22/2022]
Abstract
Maternal cardiac output and stroke volume increase significantly at the time of cesarean delivery. Parturients with baseline myocardial dysfunction are at increased risk of cardiovascular decompensation in the peripartum period and close hemodynamic monitoring is warranted. We report our use of intraoperative non-invasive cardiac output monitoring during cesarean delivery under epidural anesthesia in a 24-year-old woman with dilated cardiomyopathy secondary to Marfan syndrome, aortic arch, aortic valve and mitral valve replacements and a left ventricular ejection fraction of 37%. Three distinct hemodynamic trends were noted. After achieving adequate surgical anesthesia with 2% lidocaine 20mL, cardiac output and stroke volume rose for approximately 20min from baseline values of 6.3L/min and 69mL, respectively, to 9L/min and 107mL. Values subsequently trended down and remained depressed for nearly 20min following delivery. The lack of immediate post-delivery increases in both cardiac output and stroke volume were attributed to acute blood loss, intravascular volume depletion from fluid restriction, and slow infusion of oxytocin. By the end of surgery, cardiac output and stroke volume ultimately increased by 66% and 84% of baseline values, respectively. Systemic blood pressure, heart rate and cardiac output did not appear to correlate despite the use of phenylephrine to manage hypotension. The patient remained hemodynamically stable with no evidence of acute volume overload.
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Affiliation(s)
- S Beaudry
- Department of Anesthesiology, New York-Presbyterian/Weill Cornell Medical College, New York, NY, USA.
| | - J Pick
- Department of Anesthesiology, New York-Presbyterian/Weill Cornell Medical College, New York, NY, USA
| | - P M Heerdt
- Department of Anesthesiology, New York-Presbyterian/Weill Cornell Medical College, New York, NY, USA
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Kjaer BN, Krøigaard M, Garvey LH. Oxytocin use during Caesarean sections in Denmark - are we getting the dose right? Acta Anaesthesiol Scand 2016; 60:18-25. [PMID: 26338081 DOI: 10.1111/aas.12603] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 06/14/2015] [Accepted: 06/21/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND In Denmark, an iv bolus of 10 IU oxytocin was traditionally given after delivery to prevent atony during caesarean sections. Randomized controlled trials have shown that lower iv bolus doses have same efficacy with fewer side effects and many countries now recommend a 5 IU maximum dose. The aims of this study were to investigate whether patients referred for allergy testing after oxytocin exposure had dose-related side effects to oxytocin rather than true allergic reactions and to investigate whether updated international recommendations on lower bolus doses had been implemented in practice. METHODS Medical notes of patients tested with oxytocin as part of investigations in the Danish Anaesthesia Allergy Centre from May 2004 to January 2014 were reviewed retrospectively. A telephone survey of on-duty obstetricians at all Danish obstetric departments was performed and most recent online recommendations from the Danish societies of obstetrics and anaesthesia about the use of oxytocin were identified. RESULTS In total 30 women were tested with oxytocin as part of investigations. None were allergic to oxytocin but 19 had symptoms consistent with dose-related side effects on iv provocation. The telephone survey revealed that iv doses of 10 IU oxytocin were still used and recommendations on the websites were not updated. CONCLUSION Too high oxytocin doses are still used in Denmark leading to dose-related side effects mimicking allergic reactions. Coordination between obstetricians and anaesthesiologists on producing common updated guidelines on the administration of oxytocin and dissemination of this information to obstetric and anaesthetic departments in Denmark is needed.
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Affiliation(s)
- B. N. Kjaer
- Department of Anaesthesia; Aalborg University Hospital; Aalborg Denmark
| | - M. Krøigaard
- Danish Anaesthesia Allergy Centre; Allergy Clinic; Gentofte Hospital; Hellerup Denmark
| | - L. H. Garvey
- Danish Anaesthesia Allergy Centre; Allergy Clinic; Gentofte Hospital; Hellerup Denmark
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Sumikura H, Niwa H, Sato M, Nakamoto T, Asai T, Hagihira S. Rethinking general anesthesia for cesarean section. J Anesth 2015; 30:268-73. [DOI: 10.1007/s00540-015-2099-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 10/30/2015] [Indexed: 12/19/2022]
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Ducloy-Bouthors AS, Vallet B, Susen S, Wong CA, Butwick A, Lockhart E. In response. Anesth Analg 2015; 120:956-7. [PMID: 25790218 DOI: 10.1213/ane.0000000000000621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Anne-Sophie Ducloy-Bouthors
- Pole d'Anesthésie-Réanimation, Academic Hospital Lille, Lille, France, Pole d'Hématologie Transfusion, Academic Hospital Lille, Université Lille Nord de France, Lille, France Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois Department of Anesthesia, Stanford University School of Medicine, Stanford, California Transfusion Service, University of New Mexico, Albuquerque, New Mexico
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RETIRED: Guidelines for Oxytocin Administration after Birth: AWHONN Practice Brief Number 2. J Obstet Gynecol Neonatal Nurs 2015; 44:161-163. [DOI: 10.1111/1552-6909.12528] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Effects of oxytocin on high intensity focused ultrasound (HIFU) ablation of adenomysis: A prospective study. Eur J Radiol 2014; 83:1607-11. [DOI: 10.1016/j.ejrad.2014.05.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 02/13/2014] [Accepted: 05/05/2014] [Indexed: 10/25/2022]
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[Oxytocin for the prophylaxis of uterine atony after cesarean delivery. Should we reconsider our protocols?]. ACTA ACUST UNITED AC 2014; 61:359-61. [PMID: 24924341 DOI: 10.1016/j.redar.2014.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 05/06/2014] [Accepted: 05/06/2014] [Indexed: 11/23/2022]
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Morillas-Ramírez F, Ortiz-Gómez JR, Palacio-Abizanda FJ, Fornet-Ruiz I, Pérez-Lucas R, Bermejo-Albares L. [An update of the obstetrics hemorrhage treatment protocol]. ACTA ACUST UNITED AC 2014; 61:196-204. [PMID: 24560060 DOI: 10.1016/j.redar.2013.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 11/17/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022]
Abstract
Obstetric hemorrhage is still a major cause of maternal and fetal morbimortality in developed countries. This is an underestimated problem, which usually appears unpredictably. A high proportion of the morbidity of obstetric hemorrhage is considered to be preventable if adequately managed. The major international clinical guidelines recommend producing consensus management protocols, adapted to local characteristics and keep them updated in the light of experience and new scientific publications. We present a protocol updated, according to the latest recommendations, and our own experience, in order to be used as a basis for those anesthesiologists who wish to use and adapt it locally to their daily work. This last aspect is very important to be effective, and is a task to be performed at each center, according to the availability of resources, personnel and architectural features.
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Affiliation(s)
| | - J R Ortiz-Gómez
- Servicio de Anestesiología, Hospital Virgen del Camino, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | | | - I Fornet-Ruiz
- Servicio de Anestesiología, Hospital Puerta de Hierro, Majadahonda, Madrid, España
| | - R Pérez-Lucas
- Servicio de Ginecología, Hospital Gregorio Marañón, Madrid, España
| | - L Bermejo-Albares
- Servicio de Anestesiología, Hospital Gregorio Marañón, Madrid, España
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Khan M, Balki M, Ahmed I, Farine D, Seaward G, Carvalho JCA. Carbetocin at elective Cesarean delivery: a sequential allocation trial to determine the minimum effective dose. Can J Anaesth 2013; 61:242-8. [DOI: 10.1007/s12630-013-0082-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 11/05/2013] [Indexed: 11/25/2022] Open
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Medical prevention and treatment of postpartum hemorrhage: a comparison of different guidelines. Arch Gynecol Obstet 2013; 289:555-67. [DOI: 10.1007/s00404-013-3016-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 08/26/2013] [Indexed: 10/26/2022]
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Conde-Agudelo A, Nieto A, Rosas-Bermudez A, Romero R. Misoprostol to reduce intraoperative and postoperative hemorrhage during cesarean delivery: a systematic review and metaanalysis. Am J Obstet Gynecol 2013; 209:40.e1-40.e17. [PMID: 23507545 PMCID: PMC3731410 DOI: 10.1016/j.ajog.2013.03.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 02/26/2013] [Accepted: 03/13/2013] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of prophylactic misoprostol use at cesarean delivery for reducing intraoperative and postoperative hemorrhage. STUDY DESIGN Systematic review and metaanalysis of randomized controlled trials. RESULTS Seventeen studies (3174 women) were included of which 7 evaluated misoprostol vs oxytocin and 8 evaluated misoprostol plus oxytocin vs oxytocin alone. Overall, there were no significant differences in intraoperative and postoperative hemorrhage between sublingual or oral misoprostol and oxytocin. Rectal misoprostol, compared with oxytocin, was associated with a significant reduction in intraoperative and postoperative hemorrhage. The combined use of sublingual misoprostol and oxytocin, compared with the use of oxytocin alone, was associated with a significant reduction in the mean decrease in hematocrit (mean difference, -2.1%; 95% confidence interval, -3.4 to -0.8) and use of additional uterotonic agents (relative risk, 0.33; 95% confidence interval, 0.18-0.62). Compared with oxytocin alone, buccal misoprostol plus oxytocin reduced the use of additional uterotonic agents; rectal misoprostol plus oxytocin decreased intraoperative and postoperative blood loss, mean fall in hematocrit, and use of additional uterotonic agents; and intrauterine misoprostol plus oxytocin reduced the mean fall in hemoglobin and hematocrit. Women receiving misoprostol, alone or combined with oxytocin, had a higher risk of shivering and pyrexia. CONCLUSION Misoprostol combined with oxytocin appears to be more effective than oxytocin alone in reducing intraoperative and postoperative hemorrhage during cesarean section. There were no significant differences in intraoperative and postoperative hemorrhage when misoprostol was compared to oxytocin. However, these findings were based on a few trials with methodological limitations.
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Affiliation(s)
- Agustín Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, and Detroit, MI
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DaGraca J, Malladi V, Nunes K, Scavone B. Outcomes after institution of a new oxytocin infusion protocol during the third stage of labor and immediate postpartum period. Int J Obstet Anesth 2013; 22:194-9. [DOI: 10.1016/j.ijoa.2013.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 02/01/2013] [Accepted: 03/10/2013] [Indexed: 12/29/2022]
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