The MFMU Cesarean Registry: Uterine atony after primary cesarean delivery

Rouse, Dwight J.; Leindecker, Sharon; Landon, Mark B.; Bloom, Steven L.; Varner, Michael W.; Moawad, Atef H.; Spong, Catherine Y.; Caritis, Steve N.; Harper, Margaret; Wapner, Ronald J.; Sorokin, Yoram; Miodovnik, Menachem; OʼSullivan, Mary J.; Sibai, Bahaeddine M; Langer, Oded

doi:10.1016/j.ajog.2005.07.077

Cited by 61 publications

(41 citation statements)

References 5 publications

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“…18 Within clinical obstetric care, there are several factors predisposing patients to uterine atony that have an association with oxidative stress, including prolonged labor, hypertensive diseases of pregnancy, chorioamnionitis, multiple gestation, and retained placenta. [34][35][36] Whether inhibition of XO could result in meaningful clinical improvements in uterine tone, particularly in the setting of multiple risk factors for uterine atony, is unknown, but may represent an interesting area for further animal and clinical investigation.…”

Section: Discussionmentioning

confidence: 97%

Serum uric acid as a novel marker for uterine atony and post-spinal vasopressor use during cesarean delivery

Kovacheva¹,

Soens²,

Tsen³

2013

International Journal of Obstetric Anesthesia

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Section: Discussionmentioning

confidence: 97%

Serum uric acid as a novel marker for uterine atony and post-spinal vasopressor use during cesarean delivery

Kovacheva¹,

Soens²,

Tsen³

2013

International Journal of Obstetric Anesthesia

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“…We found that certain factors that may impair uterine contractility and affect systemic hemostasis were also risk factors for severe PPH. These factors included chorioamnionitis, preeclampsia and magnesium sulfate – factors that have been reported to increase both the risk of uterine atony and the need for transfusion at the time of cesarean delivery [8,9]. We did not have sufficient cases to distinguish the effects of preeclampsia from magnesium sulfate, but in a study of uterine atony after primary cesarean delivery, magnesium sulfate was independently associated with uterine atony [8].…”

Section: Discussionmentioning

confidence: 99%

“…Severe PPH is less common, but is a significant contributor to maternal morbidity and the deaths of an estimated 75,000–100,000 women worldwide each year [3,4]. Multiple studies have evaluated the underlying risk factors and causes for PPH [5,6,7,8,9]. Factors which have been associated with severe PPH include placental abruption, placenta previa, multiple gestation, retained placenta (including placenta accreta), cervical or vaginal lacerations, episiotomy, fetal macrosomia, maternal obesity, induction of labor, prolonged or rapid delivery, high parity, history of uterine atony in a prior pregnancy, chorioamnionitis, uterine inversion, and uterine rupture [10].…”

Section: Introductionmentioning

confidence: 99%

Body Mass Index and Severe Postpartum Hemorrhage

Paglia

Grotegut

Johnson

et al. 2011

Gynecol Obstet Invest

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Background/Aims: The purpose of this study was to determine the relationship between maternal characteristics and severe postpartum hemorrhage (PPH). Methods: Medical records of women who delivered at Duke University Hospital between 2001 and 2004 with an ICD-9 code for PPH were reviewed. Women with PPH who received blood component therapy (severe PPH) were selected as cases and compared with controls matched for age, parity and mode of delivery. Results: Among 12,476 deliveries, there were 109 women with severe PPH. Hispanic women had an almost fourfold increase in the odds of severe PPH [OR 3.9 (1.8, 8.7)] that persisted when controlling for other significant predictors of PPH. Women with PPH were almost two times more likely [OR 1.8 (1.1, 3.1)] to have a BMI <30 when controlling for Hispanic ethnicity, oxytocin exposure, labor induction, treatment with magnesium and chorioamnionitis. Conclusion: Systemic factors as well as obstetrical factors modify the risk of severe PPH. Hispanic women and women with a BMI <30 are more likely to have severe PPH. When mode of delivery is controlled for, BMI ≧30 is associated with a reduced risk of severe PPH.

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“…4 Desensitization of the OXTR paradoxically leads to decreases in uterine contractions that can present clinically as dysfunctional labor patterns, which increase the risk for cesarean delivery, or as uterine atony following delivery, increasing the risk for postpartum hemorrhage. 2, 5–8 …”

Section: Introductionmentioning

confidence: 99%

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

Grotegut

Ngan

Garrett

et al. 2017

American Journal of Obstetrics and Gynecology

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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. Study Design Pregnant women with a singleton gestation residing in Durham County, NC were prospectively enrolled as part of the Healthy Pregnancy, Healthy Baby cohort study. Those women undergoing an induction of labor at 36 weeks or greater were genotyped for 18 haplotype tagging (ht) single nucleotide polymorphisms (SNPs) in OXTR and 7 htSNPs in GRK6 using TaqMan assays. Linear regression was used to examine the relationship between maternal genotype and maximal oxytocin infusion rate, total oxytocin dose received, and duration of labor. Logistic regression was used to test for association of maternal genotype with mode of delivery. For each outcome, backward selection techniques were utilized to control for important confounding variables and additive genetic models were employed. Race/ethnicity was included in all models due to differences in allele frequencies across populations and Bonferroni correction for multiple testing was used. Results DNA was available from 482 women undergoing induction of labor at 36 weeks or greater. 18 SNPs within OXTR and 7 SNPs within GRK6 were examined. Five SNPs in OXTR showed nominal significance with maximal infusion rate of oxytocin and two SNPs in OXTR were associated with total oxytocin dose received. One SNP in OXTR and two SNPs in GRK6 were associated with duration of labor, one of which met the multiple testing threshold (p=0.0014, rs2731664 [GRK6], mean duration of labor 17.7 hours vs. 20.2 hours vs. 23.5 hours for AA, AC and CC genotypes, respectively). Three SNPs, two in OXTR and one in GRK6, showed nominal significance with mode of delivery. Conclusions Genetic variation in OXTR and GRK6 is associated with the amount of oxytocin required, as well as the duration of labor and risk for cesarean delivery among women undergoing induction of labor near term. With further research, pharmacogenomic approaches may potentially be utilized to develop personalized treatment to improve safety and efficacy outcomes among women undergoing induction of labor.

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The MFMU Cesarean Registry: Uterine atony after primary cesarean delivery

Cited by 61 publications

References 5 publications

Serum uric acid as a novel marker for uterine atony and post-spinal vasopressor use during cesarean delivery

Serum uric acid as a novel marker for uterine atony and post-spinal vasopressor use during cesarean delivery

Body Mass Index and Severe Postpartum Hemorrhage

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

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