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https://www.readbyqxmd.com/read/28526450/the-association-of-single-nucleotide-polymorphisms-in-the-oxytocin-receptor-and-g-protein-coupled-receptor-kinase-6-grk6-genes-with-oxytocin-dosing-requirements-and-labor-outcomes
#1
Chad A Grotegut, Emily Ngan, Melanie E Garrett, Marie Lynn Miranda, Allison E Ashley-Koch, Geeta K Swamy
BACKGROUND: Oxytocin is a potent uterotonic agent that is widely used for induction and augmentation of labor. Oxytocin has a narrow therapeutic index and the optimal dosing for any individual woman varies widely. OBJECTIVE: The objective of this study was to determine if genetic variation in the oxytocin receptor (OXTR) or in the gene encoding G protein-coupled receptor kinase 6 (GRK6), which regulates desensitization of the OXTR, could explain variation in oxytocin dosing and labor outcomes among women being induced near term...
May 16, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28526143/uterotonic-medications-oxytocin-methylergonovine-carboprost-misoprostol
#2
REVIEW
Cristianna Vallera, Lynn O Choi, Catherine M Cha, Richard W Hong
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...
June 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28499381/experience-in-the-use-of-non-pneumatic-anti-shock-garment-nasg-in-the-management-of-postpartum-haemorrhage-with-hypovolemic-shock-in-the-fundaci%C3%A3-n-valle-del-lili-cali-colombia
#3
María Fernanda Escobar, Carlos Eduardo Füchtner, Javier Andrés Carvajal, Albaro José Nieto, Adriana Messa, Sara Sofía Escobar, Angélica María Monroy, Angélica María Forero, José David Casallas, Marcela Granados, Suellen Miller
BACKGROUND: The aim of this case series is to describe the experience of using the non-pneumatic anti-shock garment (NASG) in the management of severe Postpartum hemorrhage (PPH) and shock, and the value of implementing this concept in high-complexity obstetric hospitals. METHODS: Descriptive case series of 77 women that received NASG in the management of PPH with severe hypovolemic shock from June 2014 to December 2015. Vital signs, shock index (SI), the lactic acid value and the base deficit were compared before and after NASG application...
May 12, 2017: Reproductive Health
https://www.readbyqxmd.com/read/28498927/efficacy-and-safety-of-carbetocin-given-as-an-intravenous-bolus-compared-with-short-infusion-for-caesarean-section-double-blind-double-dummy-randomized-controlled-non-inferiority-trial
#4
S Dell-Kuster, I Hoesli, O Lapaire, E Seeberger, L A Steiner, H C Bucher, T Girard
Background: Carbetocin is a synthetic oxytocin-analogue, which should be administered as bolus according to manufacturer's recommendations. A higher speed of oxytocin administration leads to increased cardiovascular side-effects. It is unclear whether carbetocin administration as short infusion has the same efficacy on uterine tone compared with bolus administration and whether haemodynamic parameters differ. Methods: In this randomized, double-blind, non-inferiority trial, women undergoing planned or unplanned Caesarean section (CS) under regional anaesthesia received a bolus and a short infusion, only one of which contained carbetocin 100 mcg (double dummy)...
May 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28479286/pdbu-induced-pkc-activation-triggers-sustained-contracture-in-human-myometrium-in-vitro
#5
Laurence Massenavette, Wilène Paul, Stéphanie Corriveau, Jean-Charles Pasquier, Éric Rousseau
BACKGROUND: Although physiological transition from rhythmic contractions to uterine retraction postpartum remains a poorly understood process, it has been shown that the latter is essential in the prevention of hemorrhage and its negative consequences. OBJECTIVE: This study aimed to investigate the transition from oscillatory contractions to tonic contracture in human myometrium after delivery; a mechanism purported to facilitate postpartum hemostasis. Protein Kinase C (PKC) plays a key regulatory role in human uterine contractions since it can prevent dephosphorylation of regulatory proteins and sensitize the contractile machinery to low Ca2+...
May 4, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28400465/hypercholesterolemia-impairs-oxytocin-induced-uterine-contractility-in-late-pregnant-mouse
#6
Amol R Padol, Susanth V Sukumaran, Abdul Sadam, Manickam Kesavan, Kandasamy Arunvikram, Ankita D Verma, Vivek Srivastava, Manjit Panigrahi, Thakur Uttam Singh, Avinash G Telang, Santosh K Mishra, Subhashree Parida
High cholesterol is known to negatively affect uterine contractility in ex vivo conditions. The aim of the present study was to reveal the effect of in vivo hypercholesterolemia on spontaneous and oxytocin-induced uterine contractility in late pregnant mouse uterus. Female Swiss albino mice were fed with high cholesterol (HC) diet (0.5% sodium cholate, 1.25% cholesterol and 15% fat) for 6 weeks and then throughout the gestation period after mating. On day 19 of gestation, serum cholesterol level was increased more than 3-fold while triglycerides level was reduced in HC diet-fed animals as compared to control animals fed with a standard diet...
May 2017: Reproduction: the Official Journal of the Society for the Study of Fertility
https://www.readbyqxmd.com/read/28390325/effects-of-early-versus-delayed-umbilical-cord-clamping-during-antepartum-lower-segment-caesarean-section-on-placental-delivery-and-postoperative-haemorrhage-a-randomised-controlled-trial
#7
M Withanathantrige, I M Goonewardene
Introduction: Although recommended, delayed cord clamping (DCC) is not frequently practised during lower segment caesarean section (LSCS). Objectives: To assess the effects of DCC during antepartum LSCS on placental delivery and postoperative hemorrhage Methods: A randomised controlled trial was carried out on 156 women undergoing antepartum LSCS between 37-39 weeks gestation at the Academic Obstetric Unit, Teaching Hospital Mahamodara, Galle from 21st January to 30th April 2013...
March 31, 2017: Ceylon Medical Journal
https://www.readbyqxmd.com/read/28320332/assessing-emergency-obstetric-and-newborn-care-can-performance-indicators-capture-health-system-weaknesses
#8
Andrea Solnes Miltenburg, Richard Forget Kiritta, Thabea Benedicto Bishanga, Jos van Roosmalen, Jelle Stekelenburg
BACKGROUND: Regular monitoring and assessment of performance indicators for emergency obstetric and newborn care can help to identify priorities to improve health services for women and newborns. The aim of this study was to perform a district wide assessment of emergency obstetric and newborn care performance and identify ways for improvement. METHODS: Facility assessment of 13 dispensaries, four health centers and one district hospital in a rural district in Tanzania was performed in two data collection periods in 2014...
March 20, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28295136/impact-of-uterine-balloon-tamponade-on-the-use-of-invasive-procedures-in-severe-postpartum-hemorrhage
#9
Emilie Gauchotte, Manuela De La Torre, Estelle Perdriolle-Galet, Catherine Lamy, Guillaume Gauchotte, Olivier Morel
INTRODUCTION: The aim of this study was to assess the impact of tamponade, when uterotonic agents fail, on the need for surgery or interventional radiology. MATERIAL AND METHODS: All women who received sulprostone for postpartum hemorrhage were retrospectively compared over two periods: December 2008 to December 2010 without use of tamponade (period 1) and June 2011 to June 2013 with use of tamponade (period 2), in the case of sulprostone failure (STROBE compliant retrospective cohort study)...
March 12, 2017: Acta Obstetricia et Gynecologica Scandinavica
https://www.readbyqxmd.com/read/28291126/strategies-to-reduce-blood-product-utilization-in-obstetric-practice
#10
Holger Neb, Kai Zacharowski, Patrick Meybohm
PURPOSE OF REVIEW: Patient blood management (PBM) aims to improve patient outcome and safety by reducing the number of unnecessary RBC transfusions and vitalizing patient-specific anemia reserves. Although PBM is increasingly recognized as best clinical practice in elective surgery, implementation of PBM is restrained in the setting of obstetrics. This review summarizes recent findings to reduce blood product utilization in obstetric practice. RECENT FINDINGS: PBM-related evidence-based benefits should be urgently adopted in the field of obstetric medicine...
June 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28245191/serum-fibrinogen-levels-could-be-an-index-of-successful-use-of-balloon-tamponade-in-postpartum-hemorrhage
#11
Ayaka Nakashima, Kazuhide Ogita, Masaya Chita, Takeshi Yokoi
OBJECTIVE: The object of our study was to determine whether serum fibrinogen levels could be used to predict the success rates of balloon tamponade and decrease the use of invasive methods. METHODS: This retrospective study, conducted at Rinku General Medical Center, was aimed to identify factors associated with high success rates in balloon tamponade. Forty-six patients with postpartum hemorrhage (PPH), non-responsive to uterotonics and treated with balloon tamponade between April 2008 and March 2015, were included...
February 28, 2017: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/28228338/extra-and-intracellular-calcium-signaling-pathway-s-differentially-regulate-histamine-induced-myometrial-contractions-during-early-and-mid-pregnancy-stages-in-buffaloes-bubalus-bubalis
#12
Abhishek Sharma, Udayraj P Nakade, Soumen Choudhury, Rajkumar Singh Yadav, Satish Kumar Garg
This study examines the differential role of calcium signaling pathway(s) in histamine-induced uterotonic action during early and mid-pregnancy stages in buffaloes. Compared to mid pregnancy, tonic contraction, amplitude and mean-integral tension were significantly increased by histamine to produce myometrial contraction during early pregnancy with small effects on phasic contraction and frequency. Although uterotonic action of histamine during both stages of pregnancy is sensitive to nifedipine (a L-type Ca(2+) channels blocker) and NNC55-0396 (T-type Ca(2+) channels blocker), the role of extracellular calcium seems to be more significant during mid-pregnancy as in this stage histamine produced only 9...
April 2017: Animal Reproduction Science
https://www.readbyqxmd.com/read/28212181/effect-of-a-high-rate-versus-a-low-rate-oxytocin-infusion-for-maintaining-uterine-contractility-during-elective-cesarean-delivery-a-prospective-randomized-clinical-trial
#13
Adrienne Duffield, Christine McKenzie, Brendan Carvalho, Bharathi Ramachandran, Victoria Yin, Yasser Y El-Sayed, Edward T Riley, Alexander J Butwick
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...
March 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28209484/successful-provision-of-inter-hospital-extracorporeal-cardiopulmonary-resuscitation-for-acute-post-partum-pulmonary-embolism
#14
C McDonald, J Laurie, S Janssens, C Zazulak, P Kotze, K Shekar
Mortality during pregnancy in a well-resourced setting is rare, but acute pulmonary embolism is one of the leading causes. We present the successful use of extracorporeal cardiopulmonary resuscitation (eCPR) in a 22-year old woman who experienced cardiopulmonary collapse following urgent caesarean section in the setting of a sub-massive pulmonary embolus. Resources and personnel to perform eCPR were not available at the maternity hospital and were recruited from an adjacent pediatric hospital. Initial care used low blood flow extracorporeal membrane oxygenation (ECMO) with pediatric ECMO circuitry, which was optimized when the team from a nearby adult cardiac hospital arrived...
May 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28208943/role-of-prophylactic-tranexamic-acid-in-reducing-blood-loss-during-elective-caesarean-section-a-randomized-controlled-study
#15
Sj Dhivya Lakshmi, Reena Abraham
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...
December 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28207596/a-role-for-adrenergic-receptors-in-the-uterotonic-effects-of-ergometrine-in-isolated-human-term-nonlaboring-myometrium
#16
Rebecca A Fanning, Florike Sheehan, Claire Leyden, Niamh Duffy, Luis F Iglesias-Martinez, Michael F Carey, Deirdre P Campion, John J O'Connor
BACKGROUND: Ergometrine is a uterotonic agent that is recommended in the prevention and management of postpartum hemorrhage. Despite its long-standing use, the mechanism by which it acts in humans has never been elucidated fully. The objective of this study was to investigate the role of adrenoreceptors in ergometrine's mechanism of action in human myometrium. The study examined the hypothesis that α-adrenoreceptor antagonism would result in the reversal of the uterotonic effects of ergometrine...
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28196269/shock-index-and-vital-sign-reference-ranges-during-the-immediate-postpartum-period
#17
Dyese Taylor, Adiel Fleischer, Natalie Meirowitz, Lisa Rosen
OBJECTIVE: To determine reference ranges for patient vital signs during the immediate postpartum period. METHODS: A retrospective chart review collected data on the variables of interest for all women with 0-24-hour postpartum data available at two hospitals in the USA, between July 1, 2012, and January 31, 2015. Patients were excluded if they had received antihypertensives, uterotonics, or blood products. Regression lines, with 95% prediction intervals, were constructed for shock index, systolic blood pressure, heart rate, pulse pressure, and rate over pressure evaluation (ROPE) values...
May 2017: International Journal of Gynaecology and Obstetrics
https://www.readbyqxmd.com/read/28176919/management-of-obstetric-postpartum-hemorrhage-a-national-service-evaluation-of-current-practice-in-the-uk
#18
Bassel H Al Wattar, Jennifer A Tamblyn, William Parry-Smith, Mathew Prior, Helen Van Der Nelson
BACKGROUND: Postpartum hemorrhage (PPH) continues to be one of the major causes of maternal mortality and morbidity in obstetrics. Variations in practice often lead to adverse maternity outcomes following PPH. Our objective was to assess the current practice in managing PPH in the UK. METHODS: We performed a national multicenter prospective service evaluation study over one calendar month and compared the current performance to national standards for managing PPH...
2017: Risk Management and Healthcare Policy
https://www.readbyqxmd.com/read/28140723/placenta-previa-and-maternal-hemorrhagic-morbidity
#19
Karen J Gibbins, Brett D Einerson, Michael W Varner, Robert M Silver
OBJECTIVE: Placenta previa is associated with maternal hemorrhage, but most literature focuses on morbidity in the setting of placenta accreta. We aim to characterize maternal morbidity associated with previa and to define risk factors for hemorrhage. METHODS: This is a secondary cohort analysis of the NICHD Maternal-Fetal Medicine Units Network Cesarean Section Registry. This analysis included all women undergoing primary Cesarean delivery without placenta accreta...
February 21, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28110281/incidence-risk-factors-and-risk-prediction-of-hospital-acquired-suspected-adverse-drug-reactions-a-prospective-cohort-of-ugandan-inpatients
#20
Ronald Kiguba, Charles Karamagi, Sheila M Bird
OBJECTIVES: To determine the incidence and risk factors of hospital-acquired suspected adverse drug reactions (ADRs) among Ugandan inpatients. We also constructed risk scores to predict and qualitatively assess for peculiarities between low-risk and high-risk ADR patients. METHODS: Prospective cohort of consented adults admitted on medical and gynaecological wards of the 1790-bed Mulago National Referral Hospital. Hospital-acquired suspected ADRs were dichotomised as possible (possible/probable/definite) or not and probable (probable/definite) or not, using the Naranjo scale...
January 20, 2017: BMJ Open
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