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Created on : 23 Jan 2011
Modified on : 12 Jan 2012

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Bibliographical entry (without author) :

Oxytocin exposure during labor among women with postpartum hemorrhage secondary to uterine atony. American Journal of Obstetrics & Gynecology, Volume 204, Issue 1 , Pages 56.e1-56.e6, January 2011

Author(s) :

Chad A. Grotegut, Michael J. Paglia, Lauren N.C. Johnson, Betty Thames, Andra H. James

Year of publication :

2011

URL(s) :

http://www.ajog.org/article/PIIS0002937810010264/a…
https://doi.org/10.1016/j.ajog.2010.08.023

Résumé (français)  :

Abstract (English)  :

Objective

We sought to determine if women with severe postpartum hemorrhage (PPH) secondary to uterine atony received greater amounts of oxytocin during labor compared to women without PPH.

Study Design

Subjects with severe PPH secondary to uterine atony, who received a blood transfusion, were compared to matched controls. Total oxytocin exposure was calculated as the area under the concentration curve (mU/min*min). Variables were compared using paired t test, ki-2, and logistic regression.

Results

Women with severe PPH had a mean oxytocin area under the curve of 10,054 mU compared to 3762 mU in controls (P < .001). After controlling for race, body mass index, admission hematocrit, induction status, magnesium therapy, and chorioamnionitis using logistic regression, oxytocin area under the curve continued to predict severe PPH.

Conclusion

Women with severe PPH secondary to uterine atony were exposed to significantly more oxytocin during labor compared to matched controls.

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We propose that prolonged oxytocin treatment leads to OXTR desensitization that interferes with oxytocin-induced uterine contractility, leading to uterine atony and PPH. We have demonstrated that oxytocin exposure is a significant independent risk factor for severe PPH secondary to uterine atony. This finding supports the molecular mechanisms involved in OXTR desensitization in the setting of prolonged oxytocin desensitization leading to decreases in oxytocin-mediated function. Protocols that decrease the amount of oxytocin that patients receive may decrease the incidence of PPH secondary to uterine atony.

Sumário (português)  :

Nous montrons qu’une administration prolongée d’ocytocine entraîne une
désensibilisation du récepteur d’ocytocine (OXTR) qui interfère avec la capacité de
l’utérus à se contracter sois l’effet de l’ocytocine, ce qui conduit à une atonie
utérine et à l’hémorragie post-partum (PPH). Nous avons prouvé que l’exposition à
l’ocytocine était un facteur de risque important pour une hémorragie post-partum
causée par l’atonie utérine. Cette découverte confirme les mécanismes moléculaires
qui sous-tendent la désensibilisation de l’OXTR dans le contexte d’une
désensibilisation prolongée à l’ocytocine qui entraîne des diminutions du
fonctionnement gouverné par l’ocytocine. Les protocoles visant à diminuer la dose
d’ocytocine administrée aux patientes peuvent décroître l’incidence de l’hémorragie
post-partum causée par l’atonie utérine.

Resumen (español)  :

Full text (private) :

Comments :

Voir discussion sur le wiki : http://cianewiki.naissance.asso.fr/Articles/2424

Argument (français) :

L’exposition à l’ocytocine est un facteur de risque important d’une hémorragie post-
partum causée par l’atonie utérine.

Argument (English):

Oxytocin exposure is a significant independent risk factor for severe PPH secondary
to uterine atony

Argumento (português):

Argumento (español):

Keywords :

➡ postpartum hemorrhage ; oxytocin

Author of this record :

Bernard Bel — 23 Jan 2011