The effect of morbid obesity or advanced maternal age on oxytocin-induced myometrial contractions: an in vitro study

Luca, A.; Carvalho, José Carlos Almeida; Ramachandran, N.; Balki, Mrinalini

doi:10.1007/s12630-020-01615-6

Cited by 13 publications

(8 citation statements)

References 45 publications

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“…Obesity itself appears to reduce myometrial contractility and confer a blunted response to oxytocin [18]. Recent in‐vitro research from our own group indicates that myometrial strips obtained from women with a BMI ≥ 40 kg.m ‐2 undergoing elective caesarean delivery contract with less force and lower frequency than those of women of a normal weight [19]. The biological processes underpinning these findings are uncertain, and many mechanisms have been proposed [18,35–37].…”

Section: Discussionmentioning

confidence: 99%

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Oxytocin at elective caesarean delivery: a dose‐finding study in women with obesity

et al. 2020

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Prophylactic oxytocin administration at the third stage of labour reduces blood loss and the need for additional uterotonic drugs. Obesity is known to be associated with an increased risk of uterine atony and postpartum haemorrhage. It is unknown whether women with obesity require higher doses of oxytocin in order to achieve adequate uterine tone after delivery. The purpose of this study was to establish the bolus dose of oxytocin required to initiate effective uterine contraction in 90% of women with obesity (the ED 90 ) at elective caesarean delivery. We conducted a double-blind dose-finding study using the biased coin up-down design method. Term pregnant women with a BMI ≥ 40 kg.m À2 undergoing elective caesarean delivery under regional anaesthesia were included. Those with conditions predisposing to postpartum haemorrhage were not included. Oxytocin was administered as an intravenous bolus over 1 minute upon delivery of the fetus. With the first woman receiving 0.5 IU, oxytocin doses were administered according to a sequential allocation scheme. The primary outcome measure was satisfactory uterine tone, as assessed by the operating obstetrician 2 minutes after administration of the oxytocin bolus. Secondary outcomes included the need for rescue uterotonic drugs, adverse effects and estimated blood loss. We studied 30 women with a mean (SD) BMI of 52.3 (7.6) kg.m -2 . The ED 90 for oxytocin was 0.75 IU (95%CI 0.5-0.93 IU) by isotonic regression and 0.78 IU (95%CI 0.68-0.88 IU) by the Dixon and Mood method. Our results suggest that women with a BMI ≥ 40 kg.m -2 require approximately twice as much oxytocin as those with a BMI < 40 kg.m -2 , in whom an ED 90 of 0.35 IU (95%CI 0.15-0.52 IU) has previously been demonstrated.

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Section: Discussionmentioning

confidence: 99%

“…Maternal obesity may increase the risks of PPH and uterine atony [14][15][16][17][18], and may be associated with an increased risk of death in women with PPH [2]. The reasons behind these observations remain unclear, although impaired myometrial contraction in response to oxytocin may play a role [19].…”

Section: Introductionmentioning

confidence: 99%

Oxytocin at elective caesarean delivery: a dose‐finding study in women with obesity

et al. 2020

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“…Recent clinical and translational studies have suggested a decrease in uterine contractility among obese and morbidly obese women. [24][25][26] Uterine contractility plays an important role in postdelivery uterine involution; impaired contractility can contribute to PPH. Should contractility be impaired among obese women, there would be implications for management.…”

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confidence: 99%

The Impact of Obesity on the Management and Outcomes of Postpartum Hemorrhage

2020

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Objective The study aimed to evaluate the impact of obesity on the management and outcomes of postpartum hemorrhage. Study Design We conducted a retrospective cohort study of women who delivered at a tertiary care center between February 1, 2013 and January 31, 2014 and experienced a postpartum hemorrhage. Charts were reviewed for clinical and sociodemographic data, and women were excluded if the medical record was incomplete. Hemorrhage-related severe morbidity indicators included blood transfusion, shock, renal failure, transfusion-related lung injury, cardiac arrest, and use of interventional radiology procedures. Obese (body mass index [BMI] ≥ 30 kg/m2) and nonobese women were compared. Data were analyzed using Chi-square, Student's t-test, Mann–Whitney U test, and linear regression where appropriate. The p-value <0.05 was significant. Results Of 9,890 deliveries, 2.6% (n = 262) were complicated by hemorrhage. Obese women were more likely to deliver by cesarean section (55.5 vs. 39.8%, p = 0.016), undergo a cesarean after labor (31.1 vs. 12.2%, p = 0.001), and have a higher quantitative blood loss (1,313 vs. 1,056 mL, p = 0.003). Both groups were equally likely to receive carboprost, methylergonovine, and misoprostol, but obese women were more likely to receive any uterotonic agent (95.7 vs. 88.9%, p = 0.007) and be moved to the operating room (32.3 vs. 20.4, p = 0.04). There was no difference in the use of intrauterine pressure balloon tamponade, interventional radiology, or decision to proceed with hysterectomy. The two groups were similar in time to stabilization. There was no difference in the need for blood transfusion. Obese women required more units of blood transfused (2.2 ± 2 vs. 2 ± 5 units, p = 0.023), were more likely to have any hemorrhage-related severe morbidity (34.1 vs. 25%, p = 0.016), and more than one hemorrhage related morbidity (17.1 vs. 7.9, p = 0.02). After controlling for confounding variables, quantitative blood loss, and not BMI was predictive of the need for transfusion. Conclusion Despite similar management, obese women were more likely to have severe morbidity and need more units of blood transfused. Key Points

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“…In addition, to achieve vaginal delivery, obese women require more concentration, higher doses, and longer duration of exposure of uterotonics medication, using similar protocol and guidelines on labor induction for all women with different BMI to end up with higher failure rate among obese women [ 44 , 45 ]. The current study has been shown that uterine contractility impairment is higher among morbid obesity women; uterine contractility dysfunction might lead to failed induction [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

Predicting factors of failed induction of labor in three hospitals of Southwest Ethiopia: a cross-sectional study

Genetu

Shewangizaw

Lambyo³

2021

BMC Pregnancy Childbirth

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Introduction Failed induction of labor affects maternal and neonatal outcomes as well as the cost of healthcare, especially in low-resource setting regions in which the prevalence of failed induction is higher despite the incidence of labor induction is low. This study aimed to assess the prevalence of failed induction of labor in southwest Ethiopia. Method A hospital-based cross-sectional study was conducted among 441 induced women from March 1 to August 30, 2018. A systematic random sampling technique was used to select study participants. Data were collected using a pretested and structured questionnaire. Bivariable and multivariable logistic regression models were done and fitted to identify predictors of failed induction. An adjusted odds ratio with 95% confidence interval (CI) was calculated to determine the level of significance. Result Premature rupture of membrane was the most common cause of labor induction and the commonly used method of labor induction were oxytocin infusion. Cesarean section was done for 28.1% of induced women. Failed induction of labor was found to be 21%. Primiparous [AOR = 2.35 (1.35–4.09)], analgesia/anesthesia [AOR = 4.37 (1.31–14.59)], poor Bishop Score [AOR = 2.37 (1.16–4.84)], Birth weight ≥ 4 k grams [AOR = 2.12 (1.05–4.28)] and body mass index [AOR = 5.71 (3.26–10.01)] were found to be significantly associated with failed induction of labor. Conclusion The prevalence of failed induction of labour was found to be high. Preparation of the cervix before induction in primi-parity women is suggested to improve the success of induction. To achieve the normal weight of women and newborns, proper nutritional interventions should be given for women of reproductive age. It is better to use analgesia/anesthesia for labor induction when it becomes mandatory and there are no other optional methods of no- pharmacologic pain management.

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The effect of morbid obesity or advanced maternal age on oxytocin-induced myometrial contractions: an in vitro study

Cited by 13 publications

References 45 publications

Oxytocin at elective caesarean delivery: a dose‐finding study in women with obesity

Oxytocin at elective caesarean delivery: a dose‐finding study in women with obesity

The Impact of Obesity on the Management and Outcomes of Postpartum Hemorrhage

Predicting factors of failed induction of labor in three hospitals of Southwest Ethiopia: a cross-sectional study

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