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

Massive obstetric haemorrhage is a major cause of maternal death and morbidity; abruptio placentae, placenta praevia and postpartum haemorrhage being the main causes. A delay in the correction of hypovolaemia, a delay in the diagnosis and treatment of defective coagulation and a delay in the surgical control of bleeding are the avoidable factors in most maternal deaths caused by haemorrhage. The degree of hypotension is the first guide to the level of blood loss, except in abruptio placentae. A protocol incorporating the guidelines is shown. The rapid correction of hypovolaemia with crystalloids and red cells is the first priority, followed by blood component therapy as indicated by the haematocrit, coagulation tests, platelet count and clinical features. Serial monitoring of the response to treatment is essential. Oxytocin and prostaglandin will correct uterine atony, and appropriate surgical intervention is required for traumatic bleeding. Ligation of the uterine arteries, ovarian arteries and internal iliac arteries will usually control uterine bleeding, arterial embolization also being effective. Hysterectomy should be considered as well. Catastrophic bleeding may also arise in complications such as rupture of the liver and acute fatty liver of pregnancy. These rare complications are best managed by a multidisciplinary team involving the obstetrician, anaesthetist, haematologist, hepatologist and renal physician. The rupture of aneurysms in the splenic artery and in other branches of the aorta can result in massive haemorrhage during pregnancy and following delivery.
Baillieres Best Pract Res Clin Obstet Gynaecol 2000 Feb
PMID:Massive obstetric haemorrhage. 1078 57

Labour induction is undertaken when the advantages for the mother and/or the baby are considered to outweigh the disadvantages. When the uterine cervix is unfavourable, oxytocin, with or without amniotomy, is frequently ineffective. Vaginal prostaglandin E(2) is most commonly used if it is affordable. Evidence regarding many alternative methods is discussed in this chapter. Of particular interest are misoprostol and extra-amniotic saline infusion.Misoprostol, an orally active prostaglandin E(1) analogue, has been used widely by the vaginal and oral routes for labour induction at or near term. Several recent trials have confirmed that it is highly effective. Overall Caesarean section rates appear to be reduced, despite a relative increase in Caesarean sections for fetal heart rate abnormalities. Concern remains regarding increased rates of uterine hyperstimulation and meconium-stained amniotic fluid, although data on perinatal outcome have been reassuring. Postpartum haemorrhage may be increased following labour induction with misoprostol, and isolated reports of uterine rupture, with or without previous Caesarean section, have appeared. Using small dosages appears to reduce adverse outcomes. Very large trials are needed to evaluate rare adverse outcomes.Extra-amniotic saline infusion is an effective method which appears to reduce the risk of uterine hyperstimulation that occurs with the use of exogenous uterotonics.
Best Pract Res Clin Obstet Gynaecol 2003 Oct
PMID:Induction of labour with an unfavourable cervix. 1297 14

Premature rupture of membranes (PROM) occurs in 8% of term deliveries. In this situation labour induction with prostaglandins, compared with expectant management, results in a reduced risk of chorioamnionitis, neonatal antibiotic therapy, neonatal intensive care (NICU) admission, and increased maternal satisfaction. The use of prostaglandin is associated with an increased rate of diarrhoea and use of analgesia/anaesthesia. Compared with oxytocin, prostaglandin induction results in a lower rate of epidural use and internal fetal heart rate monitoring but a greater risk of chorioamnionitis, nausea, vomiting, more vaginal examinations, neonatal antibiotic therapy, NICU admission and neonatal infection. Women should be informed of the risks and benefits of each method of induction.Misoprostol is gaining increasing interest as an alternative induction agent. It appears to be an effective method of labour induction with term PROM. Further research is needed to identify the preferred dosage, route and interval of administration, and to assess uncommon maternal and neonatal outcomes. There has been limited research on the use of prostaglandins, including misoprostol, for induction of labour with a favourable cervix and intact membranes. Compared with intravenous oxytocin (with and without amniotomy), labour induction using vaginal prostaglandins in women with a favourable cervix (with and without PROM) results in a higher rate of vaginal delivery within 24 hours and increased maternal satisfaction. In women with a favourable cervix, artificial rupture of membranes followed by oral misoprostol has similar time to vaginal delivery compared with artificial rupture of membranes followed by oxytocin. Further research with prostaglandins, including misoprostol, is needed to evaluate other maternal and neonatal outcomes in women being induced with a favourable cervix. No form of prostaglandin induction in women with PROM or favourable cervix has proven clearly superior to oxytocin infusion.
Best Pract Res Clin Obstet Gynaecol 2003 Oct
PMID:Induction of labour with a favourable cervix and/or pre-labour rupture of membranes. 1297 15

Myometrial contractility is integral to the delivery of the placenta and the arrest of potential subsequent haemorrhage. The details of this physiological process are patchy but it is clear that there is an important hormonal contribution. Oxytocin, with or without ergometrine, has thus been widely used with a recognized beneficial treatment effect. This practice, however, was never universal. The injectable nature of these agents restricted their wider use, even in societies with average medical services. The availability of the prostaglandin analogue misoprostol has renewed interest in the third stage of labour, has taken its pharmacological management to new frontiers, and has expanded the therapeutic options for the management of postpartum haemorrhage.
Best Pract Res Clin Obstet Gynaecol 2003 Oct
PMID:Prostaglandins in the prevention and management of postpartum haemorrhage. 1297 16

Routine care in normal labour may range from supportive care at home to intensive monitoring and multiple interventions in hospital. Good evidence of effectiveness is necessary to justify interventions in the normal process of labour. Inadequate evidence is available to support perineal shaving, routine enemas, starvation in labour and excluding the choice for home births. Evidence supports continuity of care led by midwives, companionship in labour, restricting the use of episiotomy, and active management of the third stage of labour, including routine use of 10 units of oxytocin. Both benefits and risks are associated with routine amniotomy, continuous electronic fetal heart rate monitoring, epidural analgesia, and oxytocin-ergometrine to prevent postpartum haemorrhage. More evidence is needed regarding the emotional consequences of labour interventions, home births, vaginal cleansing, opioid use, the partograph, second-stage labour techniques, misoprostol for primary prevention of postpartum haemorrhage, and strategies to promote evidence-based care in labour.
Best Pract Res Clin Obstet Gynaecol 2005 Feb
PMID:Evidence-based intrapartum care. 1574 69

The primary function of the uterus during gestation is to harbour the growing conceptus in a largely quiescent environment. Upon maturation of the fetus to a point sufficient for extrauterine survival, the uterus must remodel itself sufficiently to generate forceful contractions during labour. During preterm delivery, the process of remodelling of the myometrium occurs early due to a number of different causes, although the underlying basis for myometrial contraction remains the same. This review summarises the anatomical, physiological and molecular basis for contraction. We describe the fibre structure of the human uterus and how this relates to the spread of electrical excitation during a contraction. The process of excitation within a single myometrial cell is described, as well as how this relates to contraction. We then focus on how excitation-contraction coupling is modulated by intercellular communication, pharmacomechanical-coupling and hormonal milieu. Lastly, we consider the actions of the commonly accepted uterine agonists oxytocin, prostaglandin F(2alpha), and prostaglandin E(2), and the tocolytic ritodrine.
Best Pract Res Clin Obstet Gynaecol 2007 Oct
PMID:Preterm labour. Myometrial function in prematurity. 1744 38

This review article summarizes the structure, signalling pathways, and tissue distribution of the vasopressin receptors, V1 vascular, V2 renal, V3 pituitary, and oxytocin receptors, as well as the P2 class of purinoceptors. The physiological effects of vasopressin on its receptors are described. The future direction with regard to the role of the V1a receptor in circulatory shock states is discussed; further studies with V1a receptor agonists are warranted to further develop treatment strategies to reduce mortality in life threatening diseases like septic shock.
Best Pract Res Clin Anaesthesiol 2008 Jun
PMID:Physiology of the vasopressin receptors. 1868 72

Postpartum haemorrhage (PPH) causes preventable maternal deaths, mainly in low-income countries. Misoprostol has powerful uterotonic effects and, because it is well absorbed orally and sublingually, has the potential to be used more widely than would be possible with injectable uterotonics alone. Misoprostol is clearly less effective than oxytocin. Placebo-controlled studies have had variable results, although two recent trials in low-income communities have shown promising results. The main recognized side effects have been dose-related pyrexia and shivering, including occasional hyperpyrexia. In the randomized trials reported to date, there has been a trend to more deaths with misoprostol than with the control groups. The dose that has been most commonly used in clinical trials for preventing PPH is 600 microg orally. Meta-analysis of direct and adjusted indirect comparisons between 600 and 400 microg showed very similar effectiveness. To date, there is very limited evidence for the effectiveness of misoprostol, the lowest effective dose and the magnitude of adverse effects, both direct and indirect. The need for further research is a matter of great urgency.
Best Pract Res Clin Obstet Gynaecol 2008 Dec
PMID:Misoprostol for the prevention and treatment of postpartum haemorrhage. 1878 63

The incidence and importance of retained placenta (RP) varies greatly around the world. In less developed countries, it affects about 0.1% of deliveries but has up to 10% case fatality rate. In more developed countries, it is more common (about 3% of vaginal deliveries) but very rarely associated with mortality. There are three main types of retained placenta following the vagina delivery: placenta adherens (when there is failed contraction of the myometrium behind the placenta), trapped placenta (a detached placenta trapped behind a closed cervix) and partial accreta (when there is a small area of accreta preventing detachment). All can be treated by manual removal of placenta, which should be carried out at 30-60 minutes postpartum. Medical management is also an option for placenta adherens and trapped placenta. The need for manual removal can be reduced by 20% by the use of intraumbilical oxytocin (30 i.u. in 30 mL saline). A trapped placenta may respond to glyceryl trinitrate (500 mcg sublingually) or gentle, persistent, controlled cord traction.
Best Pract Res Clin Obstet Gynaecol 2008 Dec
PMID:The retained placenta. 1879 76

A statistically significant association with uterine rupture during a trial of labour after caesarean delivery was found in at least two studies for the following variables: inter-delivery interval (higher risk with short interval), birth weight (higher risk if 4000 g or over), induction of labour (higher risk), oxytocin dose (higher risk with higher doses), and previous vaginal delivery (lower risk). However, no clinically useful risk estimation model that includes clinical variables has been published. A thin lower uterine segment at 35-40 weeks, as measured by ultrasound in women with a caesarean hysterotomy scar, increases the risk of uterine rupture or dehiscence. No cut-off for lower uterine segment thickness, however, can be suggested because of study heterogeneity, and because prospective validation is lacking. Large caesarean hysterotomy scar defects in non-pregnant women seen at ultrasound examination increase the risk of uterine rupture or dehiscence in subsequent pregnancy, but the strength of the association is unknown. To sum up, we currently lack a method that can provide a reliable estimate of the risk of uterine rupture or dehiscence during a trial of labour in women with caesarean hysterotomy scar(s).
Best Pract Res Clin Obstet Gynaecol 2013 Apr
PMID:Prediction of scar integrity and vaginal birth after caesarean delivery. 2310 7


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