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Kominiarek MA, Lyleroehr M, Torres J. A qualitative exploration of the challenges providers experience during peripartum management of patients with a body mass index ≥ 50 kg/m2 and recommendations for improvement. PLoS One 2024; 19:e0303497. [PMID: 38753599 PMCID: PMC11098326 DOI: 10.1371/journal.pone.0303497] [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: 11/14/2023] [Accepted: 04/26/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The objective of this research was to conduct a qualitative study among a diverse group of providers to identify their clinical needs, barriers, and adverse safety events in the peripartum care of people with a body mass index (BMI) ≥ 50 kg/m2. METHODS Obstetricians, anesthesiologists, certified nurse midwives, nurse practitioners, and nurses were invited to participate in focus group discussions if they were employed at the hospital for >6 months. Key concepts in the focus group guide included: (1) Discussion of challenging situations, (2) Current peripartum management approaches, (3) Patient and family knowledge and counseling, (4) Design and implementation of a guideline (e.g., checklist or toolkit) for peripartum care. The audiotaped focus groups were transcribed verbatim, uploaded to a qualitative analysis software program, and analyzed using inductive and constant comparative approaches. Emerging themes were summarized along with representative quotes. RESULTS Five focus groups of 27 providers were completed in 2023. The themes included staffing (level of experience, nursing-patient ratios, safety concerns), equipment (limitations of transfer mats, need for larger sizes, location for blood pressure cuff, patient embarrassment), titrating oxytocin (lack of guidelines, range of uses), monitoring fetal heart rate and contractions, patient positioning, and communication (lack of patient feedback, need for bias training, need for interdisciplinary relationships). Providers gave examples of items to include in a "BMI cart" and suggestions for a guideline including designated rooms for patients with a BMI ≥ 50 kg/m2, defining nursing ratios and oxytocin titration plans, postpartum incentive spirometer, and touch points with providers (nursing, physicians) at every shift change. CONCLUSIONS Providers discussed a range of challenges and described how current approaches to care may negatively affect the peripartum experience and pose threats to safety for patients with a BMI ≥ 50 kg/m2 and their providers. We gathered information on improving equipment and communication among providers.
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Affiliation(s)
- Michelle A. Kominiarek
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Madison Lyleroehr
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Jissell Torres
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
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Dubey P, Fang Y, Tukei KL, Kuila S, Liu X, Sahota A, Frolova AI, Reinl EL, Malik M, England SK, Imoukhuede PI. Understanding the effects of oxytocin receptor variants on OXT-OXT receptor binding: A mathematical model. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.02.28.582600. [PMID: 38559157 PMCID: PMC10979843 DOI: 10.1101/2024.02.28.582600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Approximately half of U.S. women giving birth annually receive Pitocin, the synthetic form of oxytocin (OXT), yet its effective dose can vary significantly. This variability presents safety concerns due to unpredictable responses, which may lead to adverse outcomes for both mother and baby. To address the need for improved dosing, we developed a data-driven mathematical model to predict OXT receptor (OXTR) binding. Our study focuses on five prevalent OXTR variants (V45L, P108A, L206V, V281M, and E339K) and their impact on OXT-OXTR binding dynamics in two distinct cell types: human embryonic kidney cells (HEK293T), commonly used in experimental systems, and human myometrial smooth muscle cells, containing endogenous OXTR. We parameterized the model with cell-specific OXTR surface localization measurements. To strengthen the robustness of our study, we conducted a comprehensive meta-analysis of OXT- OXTR binding, enabling parameterization of our model with cell-specific OXT-OXTR binding kinetics (myometrial OXT-OXTR K d = 1.6 nM, kon = 6.8 × 10 5 M -1 min -1 , and koff = 0.0011 min -1 ). Our meta-analysis revealed significant homogeneity in OXT-OXTR affinity across experiments and species with a K d = 0.52 - 9.32 nM and mean K d = 1.48 ± 0.36 nM. Our model achieves several valuable insights into designing dosage strategies. First, we predicted that the OXTR complex reaches maximum occupancy at 10 nM OXT in myometrial cells and at 1 µM in HEK293T cells. This information is pivotal for guiding experimental design and data interpretation when working with these distinct cell types, emphasizing the need to consider effects for specific cell types when choosing OXTR-transfected cell lines. Second, our model recapitulated the significant effects of genetic variants for both experimental and physiologically relevant systems, with V281M and E339K substantially compromising OXT-OXTR binding capacity. These findings suggest the need for personalized oxytocin dosing based on individual genetic profiles to enhance therapeutic efficacy and reduce risks, especially in the context of labor and delivery. Third, we demonstrated the potential for rescuing the attenuated cell response observed in V281M and E339K variants by increasing the OXT dosage at specific, early time points. Cellular responses to OXT, including Ca 2+ release, manifest within minutes. Our model indicates that providing V281M- and E339K-expressing cells with doubled OXT dose during the initial minute of binding can elevate OXT-OXTR complex formation to levels comparable to wild-type OXTR. In summary, our study provides a computational framework for precision oxytocin dosing strategies, paving the way for personalized medicine.
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Hermesch AC, Kernberg AS, Layoun VR, Caughey AB. Oxytocin: physiology, pharmacology, and clinical application for labor management. Am J Obstet Gynecol 2024; 230:S729-S739. [PMID: 37460365 DOI: 10.1016/j.ajog.2023.06.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 06/11/2023] [Accepted: 06/19/2023] [Indexed: 03/12/2024]
Abstract
Oxytocin is a peptide hormone that plays a key role in regulating the female reproductive system, including during labor and lactation. It is produced primarily in the hypothalamus and secreted by the posterior pituitary gland. Oxytocin can also be administered as a medication to initiate or augment uterine contractions. To study the effectiveness and safety of oxytocin, previous studies have randomized patients to low- and high-dose oxytocin infusion protocols either alone or as part of an active management of labor strategy along with other interventions. These randomized trials demonstrated that active management of labor and high-dose oxytocin regimens can shorten the length of labor and reduce the incidence of clinical chorioamnionitis. The safety of high-dose oxytocin regimens is also supported by no associated differences in fetal heart rate abnormalities, postpartum hemorrhage, low Apgar scores, neonatal intensive care unit admissions, and umbilical artery acidemia. Most studies reported no differences in the cesarean delivery rates with active management of labor or high-dose oxytocin regimens, thereby further validating its safety. Oxytocin does not have a predictable dose response, thus the pharmacologic effects and the amplitude and frequency of uterine contractions are used as physiological parameters for oxytocin infusion titration to achieve adequate contractions at appropriate intervals. Used in error, oxytocin can cause patient harm, highlighting the importance of precise administration using infusion pumps, institutional safety checklists, and trained nursing staff to closely monitor uterine activity and fetal heart rate changes. In this review, we summarize the physiology, pharmacology, infusion regimens, and associated risks of oxytocin.
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Affiliation(s)
- Amy C Hermesch
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR.
| | - Annessa S Kernberg
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
| | - Vanessa R Layoun
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
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Fang Y, Reinl EL, Liu A, Prochaska TD, Malik M, Frolova AI, England SK, Imoukhuede PI. Quantification of surface-localized and total oxytocin receptor in myometrial smooth muscle cells. Heliyon 2024; 10:e25761. [PMID: 38384573 PMCID: PMC10878913 DOI: 10.1016/j.heliyon.2024.e25761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/23/2024] Open
Abstract
Oxytocin acts through the oxytocin receptor (OXTR) to modulate uterine contractility. We previously identified OXTR genetic variants and showed that, in HEK293T cells, two of the OXTR protein variants localized to the cell surface less than wild-type OXTR. Here, we sought to measure OXTR in the more native human myometrial smooth muscle cell (HMSMC) line on both the cell-surface and across the whole cell, and used CRISPR editing to add an HA tag to the endogenous OXTR gene for anti-HA measurement. Quantitative flow cytometry revealed that these cells possessed 55,000 ± 3200 total OXTRs and 4900 ± 390 cell-surface OXTRs per cell. To identify any differential wild-type versus variant localization, we transiently transfected HMSMCs to exogenously express wild-type or variant OXTR with HA and green fluorescent protein tags. Total protein expression of wild-type OXTR and all tested variants were similar. However, the two variants with lower surface localization in HEK293T cells also presented lower surface localization in HMSMCs. Overall, we confirm the differential surface localization of variant OXTR in a more native cell type, and further demonstrate that the quantitative flow cytometry technique is adaptable to whole-cell measurements.
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Affiliation(s)
- Yingye Fang
- Department of Bioengineering, University of Washington, Seattle, WA, 98109, USA
| | - Erin L. Reinl
- Department of Obstetrics and Gynecology, Center for Reproductive Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, 63110, USA
| | - Audrey Liu
- Department of Obstetrics and Gynecology, Center for Reproductive Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, 63110, USA
| | - Trinidi D. Prochaska
- Department of Obstetrics and Gynecology, Center for Reproductive Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, 63110, USA
| | - Manasi Malik
- Department of Obstetrics and Gynecology, Center for Reproductive Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, 63110, USA
| | - Antonina I. Frolova
- Department of Obstetrics and Gynecology, Center for Reproductive Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, 63110, USA
| | - Sarah K. England
- Department of Obstetrics and Gynecology, Center for Reproductive Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, 63110, USA
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Maximum Dose Rate of Intrapartum Oxytocin Infusion and Associated Obstetric and Perinatal Outcomes. Obstet Gynecol 2023; 141:379-386. [PMID: 36649339 DOI: 10.1097/aog.0000000000005058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/03/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Despite lack of evidence for a safety threshold for oxytocin dose rate, many hospital protocols specify a maximum rate. We investigated whether exceeding 20 milliunits/min of oxytocin was associated with adverse outcomes. METHODS This is a secondary analysis of a double-blind, single-center, randomized controlled trial of nulliparous patients with singleton gestations at 36 weeks of gestation or later who presented in spontaneous labor randomized 1:1 to either a high-dose oxytocin titration regimen (initial-incremental rate of 6 milliunits/min) or standard-dose titration regimen (initial-incremental rate of 2 milliunits/min) for labor augmentation. A maximum oxytocin dose rate limit was not specified in the study protocol. For this secondary analysis, outcomes of participants who received oxytocin and exceeded a dose rate of 20 milliunits/min at any point in labor were compared with those whose rate remained at 20 milliunits/min or less. In addition, the cumulative proportions of labor and birth outcomes were calculated for each maximum dose rate of oxytocin reached among this study cohort. RESULTS Of the 1,003 participants in the parent trial, 955 (95.2%) received oxytocin, as planned, and were included, with 190 (19.9%) exceeding a maximum dose rate of 20 milliunits/min. Those who exceeded 20 milliunits/min were older and were more likely to have rupture of membranes as their trial entry indication, have hypertensive disorders of pregnancy, receive intrapartum magnesium sulfate infusion, and receive oxytocin for longer. Those whose maximum rates exceeded 20 milliunits/min underwent cesarean delivery more frequently, but the majority (74%) still delivered vaginally. In multivariable analyses, there were no significant associations between maximum oxytocin dose rates greater than 20 milliunits/min and cesarean delivery (adjusted odds ratio [aOR] 1.57, 95% CI 1.00-2.46), peripartum infection (aOR 0.69, 95% CI 0.41-1.19), postpartum hemorrhage (aOR 1.37, 95% CI 0.70-2.71), or neonatal intensive care unit (NICU) admission (aOR 1.72, 95% CI 0.89-3.31). Although 85% of spontaneous vaginal deliveries occurred at maximum oxytocin dose rates of 20 milliunits/min or less, vaginal deliveries continued to occur at higher maximum dose rates. The cumulative proportions of NICU admissions and composite severe neonatal morbidity and mortality cases increased with increasing oxytocin dose rates even with maximum oxytocin dose rates at 20 milliunits/min or less. CONCLUSION In multivariable analyses, there are no significant differences in maternal or perinatal adverse outcomes based on exceeding 20 milliunits/min of oxytocin. These data suggest that oxytocin dosing should be individualized to each patient and not be based on arbitrary thresholds. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov , NCT02487797.
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Olerich KLW, Souter VL, Fay EE, Katz R, Hwang JK. Cesarean delivery rates and indications in pregnancies complicated by diabetes. J Matern Fetal Neonatal Med 2022; 35:10375-10383. [PMID: 36202395 DOI: 10.1080/14767058.2022.2128653] [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: 01/20/2023]
Abstract
OBJECTIVE Rates of pregestational (PGDM) and gestational diabetes (GDM), and their associated pregnancy complications, are rising. Pregnancies complicated by diabetes have increased cesarean delivery (CD) rates; however, there are limited data regarding the current rates of, and contributing factors to, these deliveries. The Robson Ten Group Classification System (TGCS) is a clinically relevant, standardized framework that can be used to evaluate and analyze cesarean rates. The objective of this study was to evaluate rates of, and indications for, intrapartum, unplanned CD among pregnancies complicated by diabetes, compared to normoglycemic (NG) pregnancies, in a large United States birth cohort. METHODS This retrospective cohort study used chart-abstracted data on births between 24 and 42 weeks' gestation at 17 hospitals that contributed to the Obstetrical Care Outcome Assessment Program database between 01/2016 and 03/2019. The CD rate for NG pregnancies, and pregnancies complicated by gestational and PGDM was calculated and compared using the Robson TGCS. The indications for intrapartum CD in patients with term, singleton, vertex gestations without a prior cesarean were then analyzed. Univariate and multivariate logistic regression models were used to compare the cesarean rate and indications for CD, between the diabetic groups and the NG group. Results were adjusted for maternal age, BMI, neonatal birth weight, and insurance status, as well as clustering by hospital. RESULTS A total of 86,381 pregnant people were included in the study cohort. Of these 76,272 (88.3%) were NG, 8591 (9.9%) had GDM, and 1518 (1.8%) had PGDM. Compared to NG patients, overall cesarean rates were higher in patients with GDM (40.3% vs. 29.7%; aOR 1.25, 95%CI 1.18-1.31) and PGDM (60.0% vs. 29.7%; aOR 2.53, 95%CI 2.04-3.13). This finding remained true when the cohort was restricted to term, singleton, vertex laboring patients without a prior cesarean; compared to NG patients, the cesarean rate was higher in patients with GDM (17.4% vs. 12.2%, aOR 1.37, 95%CI 1.29-1.45) and PGDM (26.0% vs. 12.2%, aOR 2.55, 95%CI 2.00-3.25). The cesarean rate for fetal indications was similar in the GDM (5.7%) and NG (4.4%) groups, while those patients with PGDM had a significantly higher rate (10.4%; aOR 2.01, 95%CI 1.43-2.83). Similarly, the rate of cesarean for labor dystocia in patients with PGDM was significantly higher than in NG patients (16.9% vs. 7.0%, and aOR 2.28, 95%CI 1.66-3.13) while patients with GDM had an intermediate rate (10.6% vs. 7.0%, aOR 1.49, 95%CI 1.40-1.57). CONCLUSIONS The CD rate is significantly higher in pregnancies complicated by diabetes, particularly pregestational, compared to NG pregnancies. Despite controlling for maternal factors and birth weight, pregnancies complicated by diabetes are more likely to undergo an unplanned intrapartum cesarean secondary to labor dystocia than their NG counterparts, but only pregnancies complicated by PGDM have an increased risk of cesarean for fetal indications. More research is needed to understand whether this higher cesarean rate is due to factors intrinsic to diabetes in laboring patients or is due to a difference in the way clinicians manage diabetics in labor.
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Affiliation(s)
- Kelsey L W Olerich
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Washington, Seattle, WA, USA
| | | | - Emily E Fay
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Washington, Seattle, WA, USA
| | - Ronit Katz
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Joseph K Hwang
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Washington, Seattle, WA, USA
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7
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Malik M, Fang Y, Wakle-Prabagaran M, Roh M, Prifti K, Frolova AI, Imoukhuede PI, England SK. Pharmacological chaperones for the oxytocin receptor increase oxytocin responsiveness in myometrial cells. J Biol Chem 2022; 298:101646. [PMID: 35093385 PMCID: PMC8881472 DOI: 10.1016/j.jbc.2022.101646] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 01/22/2022] [Accepted: 01/24/2022] [Indexed: 11/29/2022] Open
Abstract
Oxytocin is a potent uterotonic agent administered to nearly all patients during childbirth in the United States. Inadequate oxytocin response can necessitate Cesarean delivery or lead to uterine atony and postpartum hemorrhage. Thus, it may be clinically useful to identify patients at risk for poor oxytocin response and develop strategies to sensitize the uterus to oxytocin. Previously, we showed that the V281M variant in the oxytocin receptor (OXTR) gene impairs OXTR trafficking to the cell surface, leading to a decreased oxytocin response in cells. Here, we sought to identify pharmacological chaperones that increased oxytocin response in cells expressing WT or V281M OXTR. We screened nine small-molecule agonists and antagonists of the oxytocin/vasopressin receptor family and identified two, SR49059 and L371,257, that restored both OXTR trafficking and oxytocin response in HEK293T cells transfected with V281M OXTR. In hTERT-immortalized human myometrial cells, which endogenously express WT OXTR, treatment with SR49059 and L371,257 increased the amount of OXTR on the cell surface by two- to fourfold. Furthermore, SR49059 and L371,257 increased the endogenous oxytocin response in hTERT-immortalized human myometrial cells by 35% and induced robust oxytocin responses in primary myometrial cells obtained from patients at the time of Cesarean section. If future studies demonstrate that these pharmacological chaperones or related compounds function similarly in vivo, we propose that they could potentially be used to enhance clinical response to oxytocin.
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Affiliation(s)
- Manasi Malik
- Department of Obstetrics and Gynecology, Center for Reproductive Health Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Yingye Fang
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Monali Wakle-Prabagaran
- Department of Obstetrics and Gynecology, Center for Reproductive Health Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Michelle Roh
- Department of Obstetrics and Gynecology, Center for Reproductive Health Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kevin Prifti
- Department of Obstetrics and Gynecology, Center for Reproductive Health Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Antonina I Frolova
- Department of Obstetrics and Gynecology, Center for Reproductive Health Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Princess I Imoukhuede
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Sarah K England
- Department of Obstetrics and Gynecology, Center for Reproductive Health Sciences, Washington University in St. Louis, St. Louis, Missouri, USA.
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Baranowska B, Kajdy A, Kiersnowska I, Sys D, Tataj-Puzyna U, Daly D, Rabijewski M, Bączek G, Węgrzynowska M. Oxytocin administration for induction and augmentation of labour in polish maternity units - an observational study. BMC Pregnancy Childbirth 2021; 21:764. [PMID: 34763657 PMCID: PMC8582102 DOI: 10.1186/s12884-021-04190-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/12/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND There is not enough data regarding practices and protocols on the dose of oxytocin administrated to women during labour. Empirical evidence indicates that compliance with the guidelines improves the quality of healthcare and reduces adverse effects. The study aimed to evaluate practices of oxytocin provision for labour induction and augmentation in two maternity units in Poland. METHODS The article presents a prospective observational study. Data from 545 (n = 545) labours was collected in two maternity units. First, the total dose (the total amount of oxytocin provided from the beginning in the labour ward until delivery including the III and IV stage of labour) and cumulative dose of oxytocin (the amount of oxytocin given until the birth of the neonate) administered to women during labour was calculated. Then, the relationship between the cumulative dose of oxytocin and short term perinatal outcomes (mode of delivery, use of epidural anaesthesia, Apgar scores, birth weight and postpartum blood loss) was analysed. Finally, the compliance of oxytocin supply during labour with national guidelines in the following five criteria: medium, start dose, escalation rate, interval, the continuation of infusion after established labour was examined. RESULTS The average cumulative dose of oxytocin administrated to women before birth was 4402 mU following labour induction and 2366 mU following labour augmentation. The actual administration of oxytocin deviated both from the unit and national guidelines in 93.6% of all observed labours (mainly because of continuation of infusion after established labour). We found no statistically significant correlation between the cumulative dose of oxytocin administered and mode of delivery, immediate postpartum blood loss or Apgar scores. There was no observed effect of cumulative dose oxytocin on short-term perinatal outcomes. The two units participating in the study had similar protocols and did not differ significantly in terms of total oxytocin dose, rates of induction and augmentation - the only observed difference was the mode of delivery. CONCLUSIONS The study showed no effect of the mean cumulative oxytocin dose on short-term perinatal outcomes and high rate of non-compliance of the practice of oxytocin administration for labour induction and augmentation with the national recommendations. Cooperation between different professional groups of maternity care providers should be considered in building national guidelines for maternity care.. Further studies investigating possible long-term effects of the meant cumulative dose of oxytocin and the reasons for non-compliance of practice with guidelines should be carried out.
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Affiliation(s)
- Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Anna Kajdy
- Department of Reproductive Health, Centre of Postgraduate Medical Education, 90 Żelazna St., 01-004, Warsaw, Poland.
| | - Iwona Kiersnowska
- Department of Obstetrics and Perinatology, Medical University of Warsaw, Warsaw, Poland
| | - Dorota Sys
- Department of Reproductive Health, Centre of Postgraduate Medical Education, 90 Żelazna St., 01-004, Warsaw, Poland
| | - Urszula Tataj-Puzyna
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Déirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Michał Rabijewski
- Department of Reproductive Health, Centre of Postgraduate Medical Education, 90 Żelazna St., 01-004, Warsaw, Poland
| | - Grażyna Bączek
- Department of Gynecologic and Obstetrical Didactics, Medical University of Warsaw, Warsaw, Poland
| | - Maria Węgrzynowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
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Naturally Occurring Genetic Variants in the Oxytocin Receptor Alter Receptor Signaling Profiles. ACS Pharmacol Transl Sci 2021; 4:1543-1555. [PMID: 34661073 PMCID: PMC8506602 DOI: 10.1021/acsptsci.1c00095] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Indexed: 01/04/2023]
Abstract
![]()
The hormone oxytocin
is commonly administered during childbirth
to initiate and strengthen uterine contractions and prevent postpartum
hemorrhage. However, patients have wide variation in the oxytocin
dose required for a clinical response. To begin to uncover the mechanisms
underlying this variability, we screened the 11 most prevalent missense
genetic variants in the oxytocin receptor (OXTR)
gene. We found that five variants, V45L, P108A, L206V, V281M, and
E339K, significantly altered oxytocin-induced Ca2+ signaling
or β-arrestin recruitment and proceeded to assess the effects
of these variants on OXTR trafficking to the cell membrane, desensitization,
and internalization. The variants P108A and L206V increased OXTR localization
to the cell membrane, whereas V281M and E339K caused OXTR to be retained
inside the cell. We examined how the variants altered the balance
between OXTR activation and desensitization, which is critical for
appropriate oxytocin dosing. The E339K variant impaired OXTR activation,
internalization, and desensitization to roughly equal extents. In
contrast, V281M decreased OXTR activation but had no effect on internalization
and desensitization. V45L and P108A did not alter OXTR activation
but did impair β-arrestin recruitment, internalization, and
desensitization. Molecular dynamics simulations predicted that V45L
and P108A prevent extension of the first intracellular loop of OXTR,
thus inhibiting β-arrestin binding. Overall, our data suggest
mechanisms by which OXTR genetic variants could alter
clinical response to oxytocin.
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Mitidieri E, Vanacore D, Turnaturi C, Sorrentino R, d’Emmanuele di Villa Bianca R. Uterine Dysfunction in Diabetic Mice: The Role of Hydrogen Sulfide. Antioxidants (Basel) 2020; 9:antiox9100917. [PMID: 32993056 PMCID: PMC7599872 DOI: 10.3390/antiox9100917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 12/19/2022] Open
Abstract
It is well-known that the physiological uterine peristalsis, related to several phases of reproductive functions, plays a pivotal role in fertility and female reproductive health. Here, we have addressed the role of hydrogen sulfide (H2S) signaling in changes of uterine contractions driven by diabetes in non-obese diabetic (NOD) mice, a murine model of type-1 diabetes mellitus. The isolated uterus of NOD mice showed a significant reduction in spontaneous motility coupled to a generalized hypo-contractility to uterotonic agents. The levels of cyclic nucleotides, cAMP and cGMP, notoriously involved in the regulation of uterus homeostasis, were significantly elevated in NOD mouse uteri. This increase was well-correlated with the higher levels of H2S, a non-specific endogenous inhibitor of phosphodiesterases. The exposure of isolated uterus to L-cysteine (L-Cys), but not to sodium hydrogen sulfide, the exogenous source of H2S, showed a weak tocolytic effect in the uterus of NOD mice. Western blot analysis revealed a reorganization of the enzymatic expression with an upregulation of 3-mercaptopyruvate-sulfurtransferase (3-MST) coupled to a reduction in both cystathionine-β-synthase (CBS) and cystathionine-γ-lyase (CSE) expression. In conclusion, the increased levels of cyclic nucleotides dysregulate the uterus peristalsis and contractility in diabetic mice through an increase in basal H2S synthesis suggesting a role of 3-MST.
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Affiliation(s)
- Emma Mitidieri
- Department of Pharmacy, School of Medicine, University of Naples, Federico II, Via D. Montesano, 49, 80131 Naples, Italy; (E.M.); (D.V.); (C.T.); (R.d.d.V.B.)
| | - Domenico Vanacore
- Department of Pharmacy, School of Medicine, University of Naples, Federico II, Via D. Montesano, 49, 80131 Naples, Italy; (E.M.); (D.V.); (C.T.); (R.d.d.V.B.)
| | - Carlotta Turnaturi
- Department of Pharmacy, School of Medicine, University of Naples, Federico II, Via D. Montesano, 49, 80131 Naples, Italy; (E.M.); (D.V.); (C.T.); (R.d.d.V.B.)
| | - Raffaella Sorrentino
- Department of Molecular Medicine and Medical Biotechnologies, School of Medicine, University of Naples, Federico II, Via Pansini, 5, 80131 Naples, Italy
- Interdepartmental Centre for Sexual Medicine, University of Naples, Federico II, Via Pansini 5, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-081-678437
| | - Roberta d’Emmanuele di Villa Bianca
- Department of Pharmacy, School of Medicine, University of Naples, Federico II, Via D. Montesano, 49, 80131 Naples, Italy; (E.M.); (D.V.); (C.T.); (R.d.d.V.B.)
- Interdepartmental Centre for Sexual Medicine, University of Naples, Federico II, Via Pansini 5, 80131 Naples, Italy
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11
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The Regulation of Uterine Function During Parturition: an Update and Recent Advances. Reprod Sci 2020; 27:3-28. [DOI: 10.1007/s43032-019-00001-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/19/2019] [Indexed: 12/13/2022]
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12
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Zhang L, Troendle J, Branch DW, Hoffman M, Yu J, Zhou L, Duan T, Zhang J. The expected labor progression after labor augmentation with oxytocin: A retrospective cohort study. PLoS One 2018; 13:e0205735. [PMID: 30379856 PMCID: PMC6209192 DOI: 10.1371/journal.pone.0205735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 10/01/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To describe labor progression patterns with oxytocin for augmentation in women who achieve vaginal delivery; and to determine how long one should wait with effective uterine contraction before labor arrest can be diagnosed. DESIGN Population-based retrospective cohort study. POPULATION The final sample involved 8,988 women with singleton gestation, term live birth, vertex presentation, no previous cesarean section, vaginal delivery, and neonatal Apgar score at 5 minutes at 7 or higher, and complete information on oxytocin augmentation in 2005-2007. METHODS Linear interpolation was used from the vaginal exam records for each woman to estimate the cervical dilation when oxytocin was started and the highest dose was first reached by parity. We used survival methods to estimate quartiles of the traverse time distributions of cervical dilation. MAIN OUTCOME MEASURES Duration of labor under oxytocin augmentation. RESULTS When oxytocin was just started, it took a long time to observe cervical dilation. The 50th(95th) centiles of the time interval from 4 to 5 cm, 5 to 6 cm, and 6 to 10 cm dilation were 2.9(8.8) hr, 1.7(5.8) hr, and 2.1(6.0) hr in nulliparas; and 3.1(10.1) hr, 1.9(8.0) hr, and 1.7(6.2) hr in multiparas. After effective uterine contractions were achieved under oxytocin, labor progressed much faster. The corresponding values were 0.7(2.4)hr, 0.5(1.5)hr, and 0.5(1.5)hr in nulliparas; and 0.6(1.9)hr, 0.4(1.1)hr, and 0.4(0.9)hr in multiparas. Low- and high-dose oxytocin regimens had similar effects on labor. CONCLUSION When oxytocin is just started for labor augmentation in early first stage, it may take up to 10 hours for the cervix to dilate by 1 cm. Once effective uterine contractions are achieved and the cervix is dilated more than 5 cm, cervical dilation to the next centimeter occurs within 2 hrs in both nulliparas and multiparas in 95% of the cases. High- and low-dose oxytocin had a similar impact on labor progression in augmented labor.
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Affiliation(s)
- Lin Zhang
- Gynecology and Obstetrics Department, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- MOE-Shanghai Key Lab of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - James Troendle
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - D. Ware Branch
- Intermountain Healthcare and University of Utah Health Sciences, Salt Lake, Utah, United States of America
| | - Matthew Hoffman
- Christiana Care Health System, Newark, Delaware, United States of America
| | - Jun Yu
- Gynecology and Obstetrics Department, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lixia Zhou
- Gynecology and Obstetrics Department, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Duan
- Shanghai First Maternity and Infant Hospital, Shanghai, China
| | - Jun Zhang
- MOE-Shanghai Key Lab of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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13
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Wang QH, Zhang S, Qin LM, Zhang WJ, Liu FH, Xu JQ, Ma YF, Teng KD. Yimu San improves obstetric ability of pregnant mice by increasing serum oxytocin levels and connexin 43 expression in uterine smooth muscle. J Zhejiang Univ Sci B 2017; 18:986-993. [PMID: 29119736 DOI: 10.1631/jzus.b1600289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Prolonged farrowing remains one of the critical challenges in intensive pig farming. This study aims to explore the effects and mechanism of Yimu San (YMS), a Chinese veterinary medicine micro mist, on delivery ability with mouse models. Thirty-two pregnant mice were randomly divided into a control group and low-YMS, med-YMS, and high-YMS groups. The labor process time and stillbirth rate were recorded, the levels of serum oxytocin and prostaglandin E2 (PGE2) were measured with enzyme-linked immunosorbent assay (ELISA). Contractility measurements of the isolated uterus and the expression of connexin 43 (Cx43) in uterine smooth muscle were evaluated. The results showed that compared with the control group, the birth process time and stillbirth rate in the med-YMS and high-YMS groups were remarkably lower. The in vitro uterine contractions, levels of oxytocin, PGE2, and Cx43 in the med-YMS and high-YMS groups were significantly higher than those in the control group. The differences of the above measurements between the low-YMS group and the control group were not obvious. It can be speculated that YMS could significantly promote labor in pregnant mice by enhancing the levels of oxytocin, Cx43, and PGE2.
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Affiliation(s)
- Qi-Huan Wang
- College of Veterinary Medicine, China Agricultural University, Beijing 100193, China
| | - Shuang Zhang
- College of Veterinary Medicine, China Agricultural University, Beijing 100193, China
| | - Li-Meng Qin
- College of Veterinary Medicine, China Agricultural University, Beijing 100193, China
| | - Wen-Jun Zhang
- College of Veterinary Medicine, China Agricultural University, Beijing 100193, China
| | - Feng-Hua Liu
- College of Animal Science and Technology, Beijing University of Agriculture, Beijing 102206, China
| | - Jian-Qin Xu
- College of Veterinary Medicine, China Agricultural University, Beijing 100193, China
| | - Yun-Fei Ma
- College of Veterinary Medicine, China Agricultural University, Beijing 100193, China
| | - Ke-Dao Teng
- College of Veterinary Medicine, China Agricultural University, Beijing 100193, China
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Abstract
PURPOSE OF REVIEW Laboratory animal experiments have consistently shown that oxytocin causes early termination of food intake, thereby promoting a decrease in body weight in a long term. Recent studies have also assessed some of oxytocin's effects on appetite and energy balance in humans. The present study examines the findings of the key basic research and of the few clinical studies published thus far in the context of potential benefits and challenges stemming from the use of oxytocin in obese patients. RECENT FINDINGS Basic research indicates the involvement of oxytocin in satiety, processing, in reducing a drive to eat for pleasure and because of psychosocial factors. Although the results of clinical studies are very scarce, they suggest that oxytocin administered intranasally in humans decreases energy-induced and reward-induced eating, supports cognitive control of food choices, and improves glucose homeostasis, and its effectiveness may be BMI dependent. SUMMARY Despite the wealth of basic research showing broad anorexigenic effects of oxytocin, clinical studies on oxytocin's therapeutic potential in obesity, are still in their infancy. Future implementation of oxytocin-based pharmacological strategies in controlling energy balance will likely depend on our ability to integrate diverse behavioral and metabolic effects of oxytocin in obesity treatment regimens.
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Affiliation(s)
- Pawel K Olszewski
- aDepartment of Food Science and Nutrition, University of Minnesota, St Paul, Minnesota, USA bDepartment of Biological Sciences, Faculty of Science and Engineering, University of Waikato, Hamilton, New Zealand
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15
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Reinl EL, Goodwin ZA, Raghuraman N, Lee GY, Jo EY, Gezahegn BM, Pillai MK, Cahill AG, de Guzman Strong C, England SK. Novel oxytocin receptor variants in laboring women requiring high doses of oxytocin. Am J Obstet Gynecol 2017; 217:214.e1-214.e8. [PMID: 28456503 DOI: 10.1016/j.ajog.2017.04.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/09/2017] [Accepted: 04/19/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although oxytocin commonly is used to augment or induce labor, it is difficult to predict its effectiveness because oxytocin dose requirements vary significantly among women. One possibility is that women requiring high or low doses of oxytocin have variations in the oxytocin receptor gene. OBJECTIVES To identify oxytocin receptor gene variants in laboring women with low and high oxytocin dosage requirements. STUDY DESIGN Term, nulliparous women requiring oxytocin doses of ≤4 mU/min (low-dose-requiring, n = 83) or ≥20 mU/min (high-dose-requiring, n = 104) for labor augmentation or induction provided consent to a postpartum blood draw as a source of genomic DNA. Targeted-amplicon sequencing (coverage >30×) with MiSeq (Illumina) was performed to discover variants in the coding exons of the oxytocin receptor gene. Baseline relevant clinical history, outcomes, demographics, and oxytocin receptor gene sequence variants and their allele frequencies were compared between low-dose-requiring and high-dose-requiring women. The Scale-Invariant Feature Transform algorithm was used to predict the effect of variants on oxytocin receptor function. The Fisher exact or χ2 tests were used for categorical variables, and Student t tests or Wilcoxon rank sum tests were used for continuous variables. A P value < .05 was considered statistically significant. RESULTS The high-dose-requiring women had greater rates of obesity and diabetes and were more likely to have undergone labor induction and required prostaglandins. High-dose-requiring women were more likely to undergo cesarean delivery for first-stage arrest and less likely to undergo cesarean delivery for nonreassuring fetal status. Targeted sequencing of the oxytocin receptor gene in the total cohort (n = 187) revealed 30 distinct coding variants: 17 nonsynonymous, 11 synonymous, and 2 small structural variants. One novel variant (A243T) was found in both the low- and high-dose-requiring groups. Three novel variants (Y106H, A240_A249del, and P197delfs*206) resulting in an amino acid substitution, loss of 9 amino acids, and a frameshift stop mutation, respectively, were identified only in low-dose-requiring women. Nine nonsynonymous variants were unique to the high-dose-requiring group. These included 3 known variants (R151C, G221S, and W228C) and 6 novel variants (M133V, R150L, H173R, A248V, G253R, and I266V). Of these, R150L, R151C, and H173R were predicted by Scale-Invariant Feature Transform algorithm to damage oxytocin receptor function. There was no statistically significant association between the numbers of synonymous and nonsynonymous substitutions in the patient groups. CONCLUSION Obesity, diabetes, and labor induction were associated with the requirement for high doses of oxytocin. We did not identify significant differences in the prevalence of oxytocin receptor variants between low-dose-requiring and high-dose-requiring women, but novel oxytocin receptor variants were enriched in the high-dose-requiring women. We also found 3 oxytocin receptor variants (2 novel, 1 known) that were predicted to damage oxytocin receptor function and would likely increase an individual's risk for requiring a high oxytocin dose. Further investigation of oxytocin receptor variants and their effects on protein function will inform precision medicine in pregnant women.
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Affiliation(s)
- Erin L Reinl
- Department of Obstetrics and Gynecology, Center for Reproductive Health Sciences, Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - Zane A Goodwin
- Division of Dermatology, Center for Pharmacogenomics, Center for the Study of Itch, Department of Medicine, Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - Nandini Raghuraman
- Department of Obstetrics and Gynecology, Center for Reproductive Health Sciences, Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - Grace Y Lee
- Department of Obstetrics and Gynecology, Center for Reproductive Health Sciences, Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - Erin Y Jo
- Department of Obstetrics and Gynecology, Center for Reproductive Health Sciences, Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - Beakal M Gezahegn
- Department of Obstetrics and Gynecology, Center for Reproductive Health Sciences, Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - Meghan K Pillai
- Department of Obstetrics and Gynecology, Center for Reproductive Health Sciences, Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - Alison G Cahill
- Department of Obstetrics and Gynecology, Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - Cristina de Guzman Strong
- Division of Dermatology, Center for Pharmacogenomics, Center for the Study of Itch, Department of Medicine, Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - Sarah K England
- Department of Obstetrics and Gynecology, Center for Reproductive Health Sciences, Washington University in St. Louis, School of Medicine, St. Louis, MO.
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Coulm B, Tessier V. Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 4: Oxytocin efficiency according to implementation in insufficient spontaneous labor. J Gynecol Obstet Hum Reprod 2017; 46:499-507. [PMID: 28526519 DOI: 10.1016/j.jogoh.2017.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- B Coulm
- Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité (CRESS), University Hospital Department "Risks in Pregnancy", université Paris Descartes, 53, avenue de l'Observatoire, 75014 Paris, France.
| | - V Tessier
- University Hospital Department "Risks in Pregnancy", AP-HP, HUPC-AP-HP, 53, avenue de l'Observatoire, 75014 Paris, France.
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Effect of magnesium sulfate on oxytocin-induced contractility in human myometrium: an in vitro study. Can J Anaesth 2017; 64:744-753. [DOI: 10.1007/s12630-017-0867-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 02/01/2017] [Accepted: 03/14/2017] [Indexed: 10/19/2022] Open
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18
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Coulm B, Tessier V. Recommandations pour l’administration d’oxytocine au cours du travail spontané. Chapitre 4 : efficacité de l’oxytocine au cours du travail spontané selon les modalités d’administration. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.sagf.2016.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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