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Query: UNIPROT:P01178 (oxytocin)
 15,767 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The use of intraamniotic instillation of hypertonic saline with/without oxytocin in midtrimester abortion can sometimes lead to a fatal complication in the form of intravascular coagulopathy. Intraamniotic urea is used for the same purpose and has a similar mode of action. It decreases the circulating progesterone level and increases prostaglandin release. It can also cause fetal death. One of its major advantages is the lack of significant complications with inadvertent intravenous infusion of urea. 70 cases of midtrimester pregnancies were terminated by injection of 200 ml of urea (40%) intraamniotically between the period 8/77 to 8/78. The patients ranged in age from 20 to 35 years. No relationship was found between the induction-abortion interval and gestation period. Success rate was 88.7%; there were 8 failures. Average induction-abortion interval was 30.7 hours, with maximum abortions occurring between 24-48 hours. There were no major complications. Urea is also used intravenously in sickle cell crisis and neurosurgical procedures.
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PMID:Use of intra-amniotic urea as a second trimester abortifacient. 52 68

Among 4,069 healthy gravidas undergoing saline abortion, patients administered intravenous oxytocin had a significantly shorter instillation-to-abortion time (median, 25.5 hours) than did patients not administered oxytocin (median 33.3 hours). The instillation-to-abortion time was independent of the rate of oxytocin administration, which ranged from 1 to 4 U. per hour (17 to 67 mU. per minute), but was associated with the time at which oxytocin infusion was begun. When oxytocin infusion was started within eight hours after instillation, a shortened time from instillation to abortion was observed. Although oxytocin augmentation may result in a lower proportion of patients being exposed to the risk of infection associated with prolonged intervals from instillation to abortion, this potential advantage appears counterbalanced by an increased incidence of clinical consumptive coagulopathy associated with instillation-to-abortion intervals of less than 24 hours.
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PMID:Oxytocin administration, instillation-to-abortion time, and morbidity associated with saline instillation. 111 83

There are several medical methods of inducing 2nd trimester abortion, each with merits and drawbacks, difficult to compare, especially when supplemental techniques are used. Drugs used are hypertonic saline, urea, natural and synthetic prostaglandins (PGs), mannitol, formalin, ethacridine lactate (Rivanol) and others for intraamniotic route; saline, PGs, Rivanol, utus paste and other extraamniotically; and the above methods combined with oral antiprogestins, iv oxytocics, in or intravaginal PGs, or mechanical cervical dilators. Few double-blind studies exist comparing drugs. About 50,000 mid-trimester abortions are done in the US yearly, about 10% of all terminations, but these cause 2/3 of all complications and half of the deaths. Saline can be used after 15 weeks, can cause hypernatremia or coagulopathy, and takes up to 72 hours unless augmented with ocytocin and/or laminaria. Urea may have less risk of coagulopathy. Rivanol is considered safer than both in some countries, e.g., Scandinavia, Eastern Europe, Israel, India and Japan. It can be instilled transcervically. Various intrauterine PGs have been compared in several doses and routes by WHO Task Force research groups and others. Extraamniotic PGs require a lower dose, cause fewer cervical lacerations, and can be used when membranes are ruptured, in molar pregnancy, at Weeks 13-15, and in cases of fibroids. This route is somewhat less effective than intraamniotic PGs, and may require multiple doses. Intraamniotic PGs act slower but are more effective, after only 1 dose. Laminaria speed up the process, but adding oxytocin increases risk of injury. PGs may be safer than saline, especially if intramuscular route is used, because there is no danger of coagulation, cardiovascular, renal or hypernatremic complications or inadvertent injection. It is possible that some of the higher complications attributed to PGs are related to selection of patients with more severe medical conditions. PGs are more expensive, and require medication for side effects.
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PMID:Intrauterine administration of drugs for termination of pregnancy in the second trimester. 222 3

Medical termination of abnormal pregnancy requires specific techniques since some conditions make therapy more effective, e.g., missed abortion intrauterine death and molar pregnancy, and others less so, e.g. anencephalic pregnancy. In all cases it is best to terminate the pregnancy as soon as possible to reduce anguish and risks of complications such as consumptive coagulopathy. Oxytocin is not consistently effective, but intraamniotic rivanol has oxytocic properties, and prostaglandins (PGs) are effective by several routes. Surgical methods are more popular in Japan and the US. A diagnostic flow chart is included and described. For missed abortion and fetal death vacuum aspiration or dilatation and evacuation are appropriate for early pregnancy, or PGs are used for later pregnancy, unless there are medical contraindications. Anencephalic pregnancy, usually diagnoses in 2nd or 3rd trimester, is resistant to medical therapy and must often be terminated by cesarean section. Molar pregnancy can be managed with vacuum aspiration at any length of gestation, but must be completed by curettage. Intraamniotic PGs are not advised for mole or fetal death. PG analogs can be administered intramuscularly, or vaginally in gel form. Other types of abnormal pregnancy that can be managed with PGs are spina bifida, hydrocephalus, hydrops fetalis, Dandy-Walker syndrome and Down's syndrome. Tubal pregnancy can be evacuated with intratubally administered PGs under laparoscopic control, thereby preserving tubal integrity.
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PMID:Medical management of abnormal pregnancy. 222 5

The customary use of Hemabate sterile solution for postpartum hemorrhage was studied at 12 cooperating obstetrics units for a 12-month period. Outcomes of interest were the characteristics of patients chosen by the attending physicians to receive the drug, conditions of drug use, and patient status after drug use. Cessation of bleeding was considered a successful outcome and in 208 of 237 cases (87.8%) the hemorrhage was controlled directly after the administration of Hemabate sterile solution. An additional 17 successful outcomes were achieved with further administration of oxytocics for an overall success rate of 94.9%. Twelve cases of postpartum hemorrhage were considered pharmacologic treatment failures, requiring surgical intervention. Among the patients in whom pharmacologic treatment failed were factors that may have played a significant role in the cause of the hemorrhage including peripheral coagulopathy, retained products of conception, lacerations, chorioamnionitis, oxytocin-induced or augmented labor, increased fetal weight, magnesium-treated preeclampsia, and cesarean delivery. However, no combination of factors could be consistently associated with pharmacologic treatment failure.
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PMID:Controlling refractory atonic postpartum hemorrhage with Hemabate sterile solution. 240 76

This review of prostaglandins (PGs) covers the following: PGs in obstetrics and gynecology (induction of labor, cervical priming, termination of pregnancies complicated by fetal death, use in 1st and 2nd trimester abortions, and potential contraceptive use); and PGs in other areas of medicine. The original work on the use of PGs in the induction of labor indicated that of the naturally occurring PGs only PGE2 and PGF2alpha are clinically important in reproduction. Ensuing clinical trials confirmed this observation but lead to the conclusion that intravenous PGs for routine labor induction provided no real benefit over intravenous oxytocin, and, in contrast to oxytocin, were associated with frequent gastrointestinal side effects and a pyrexia which could lead to confusion. A recent modification using a cross linked polymer pessary has been designed in an effort to provide a constant sustained release of the incorporated PGE2 for absorption by the vaginal surface. Further studies to assess this innovation are necessary. There was renewed interest in PGs in the mid 1970s when it was observed that they possibly enhanced the outcome of induced labor in patients with an unfavorable cervix. Recent research has established PGE2 as possibly the most efficient cervical priming agent available at this time. A cervical effect may be the reason why PGs are successful in evacuating pregnancies complicated by fetal death. The vaginal route has gained preference as a simple, nontraumatic means of stimulating uterine activity without increasing the chances of intrauterine infection. It seems unlikely that PGs will ever supersede routine aspiration termination of 1st trimester pregnancy. Longterm studies have not been reported yet to indicate that occult cervical damage will be avoided with preoperative PG treatment. Considerable research has been conducted into the safety of PGs for late abortion. Initial concerns of possible coagulopathy, encephalopathy and cardiopulmonary system disturbances have now been largely dismissed; the drugs have been confirmed as safe. The possibility of PGs becoming fertility controlling agents was initially explored in the early 1970s. Although abortion has been successfully induced in 80-90% of treated cases, in many reported series the observed side effects, particularly severe uterine effects, have thus far made the method untenable for routine management. Other uses of PGs include the treatment of spasmodic dysmenorrhea and dysfunctional uterine bleeding and the treatment of gastric ulcers.
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PMID:Prostaglandins. Has the initial promise been realised? 682 14

Factor XI (F XI) deficiency is an autosomal recessive coagulopathy found in Holstein cattle. Affected animals have a 50% greater prevalence of repeat breeding. Therefore, several parameters describing ovarian function were studied. Daily blood sampling revealed that progesterone concentrations were slower to decline from a peak at day 16 (p < 0.01) to values less than 3 nmol/L in F XI-deficient cows (5.14 +/- 0.69 days (mean +/- SD) versus 4.05 +/- 0.63 days in control animals), resulting in an oestrous cycle length of 24.7 +/- 2.1 days compared to 22.9 +/- 3.0 days, respectively. This was not due to an alteration in the availability of prostaglandin F2 alpha (PGF2 alpha) or oxytocin (OT) involved in luteolysis. No significant differences (p > 0.05) were seen between normal (n = 7) and F XI-deficient (n = 7) cows in the peak values or the area under the curve for the pulse in 13,14-dihydro-15-keto PGF2 alpha in response to OT challenge or in the parameters describing the pulse of ovarian OT secretion after PGF2 alpha injection (n = 7 for each) between days 12 and 14. Ovulatory follicular development was assessed by ultrasound monitoring and plasma 17 beta-oestradiol values at 8-h intervals after a luteolytic injection of cloprostenol (n = 6 for each). Follicular diameter was smaller (p < 0.05) and accompanied by lower peak oestradiol values near the time of ovulation in F XI-deficient cows. The results suggest that the oestrous cycle in F XI-deficient cows is characterized by a slower process of luteolysis that may be associated with smaller follicular development.
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PMID:Preliminary findings of altered follicular activity in Holstein cows with coagulation factor XI deficiency. 861 84

Most cases of postpartum haemorrhage are caused by uterine atony, maternal soft-tissue trauma, retained placenta or its parts, and obstetric coagulopathy. The factors most significantly associated with haemorrhage include advanced maternal age, prolonged labour, pre-eclampsia, obesity of mother, multiple pregnancy, a birth weight of more than 4000g, and previous postpartum haemorrhage. It seems that multiparity itself is only a weakly associated factor. The prophylactic use of oxytocic drugs (oxytocin or its combination with ergometrine at the third stage of labour is always recommended for decreasing the bleeding. Prostaglandins should be used as a second line treatment if uterine atony cannot be abolished by uterine massage and oxytocin infusion. In the surgical management, the role of hypogastric artery ligation is decreasing. The stepwise uterine devascularization may be a reasonable method in the most severe uncontrollable postpartum bleeding. The uterine tamponade with gauze or specific tubes may also be a useful alternative in some cases. Selective arterial embolization is a promising new method that seems to have success in controlling the heavy postpartum bleeding unresponsive to more usual measures. However, the value of this method should be evaluated in bigger series.
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PMID:Postpartum haemorrhage. 862 78

A 20-year old female seeking legal abortion was pregnant with gestation in the 16th week as confirmed by ultrasound. Low hemoglobin count of 8.7 g/dl showed iron deficiency which was corrected by transfusion of 2 units of packed cells. Extraamniotic termination of pregnancy was commenced, and 5 mg of prostaglandin E2 (PGE2) in 50 ml of .9% saline was administered. Abortion started 9 hours later; the placenta was removed by curettage, however, severe hemorrhaging and shock ensued. Uterine perforation was ruled out by examination. Hartmann's solution and oxytocin 40 u/l were administered iv. A clotting defect with prolonged prothrombin time, thromboplastin time, and thrombin time was implicated in the excessive bleeding. 3 units of whole blood, 4 units of fresh frozen plasma, and 6 units of platelets were used to treat the coagulopathy. The patient recovered quickly, and clotting tests became normal after 2 days. Follow-up of 1 and 6 weeks showed normal hemoglobin values. PGE2 is routinely used in middle trimester abortions, however, a twentyfold increase in maternal mortality had been reported. Clotting screens are recommended for patients undergoing abortions because of coagulopathy associated with major hemorrhage.
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PMID:Coagulation defect after middle trimester abortion using prostaglandin E2 by the extra-amniotic route. 1234 67

Primary atonic post-partum hemorrhage during lower segment cesarean section, which was not controlled by ecbolics--oxytocin, methylergometrine, 15-methyl-prostaglandinF2alpha--was managed by applying a B-Lynch Brace Suture. The test of potential efficacy was the control of hemorrhage by bimanual uterine compression. Six primigravida patients at their term gestation, who underwent emergency cesarean section, all except one under spinal anesthesia, received this type of suture. Interestingly, in every case hemorrhage was controlled successfully with the compression suture. None of them received blood or blood products transfusions or developed disseminated intravascular coagulopathy. Postoperative recovery was good and all patients are in follow-up to assess their future reproductive activity. B-Lynch Brace Suturing is an invaluable procedure for the control of atonic primary post-partum hemorrhage following cesarean delivery.
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PMID:B-Lynch Brace Suturing in primary post-partum hemorrhage during cesarean section. 1464 2


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