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Oxytocin exposure during labor among women with postpartum hemorrhage secondary to uterine atony

Published:November 08, 2010DOI:https://doi.org/10.1016/j.ajog.2010.08.023

      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, χ2, 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.

      Key words

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      References

        • Berg C.J.
        • Chang J.
        • Callaghan W.M.
        • Whitehead S.J.
        Pregnancy-related mortality in the United States, 1991-1997.
        Obstet Gynecol. 2003; 101: 289-296
        • Chang J.
        • Elam-Evans L.D.
        • Berg C.J.
        • et al.
        Pregnancy-related mortality surveillance–United States, 1991–1999.
        MMWR Surveill Summ. 2003; 52: 1-8
        • Callaghan W.M.
        • Kuklina E.V.
        • Berg C.J.
        Trends in postpartum hemorrhage: United States, 1994-2006.
        Am J Obstet Gynecol. 2010; 202: 353.e1-353.e6
        • Combs C.A.
        • Murphy E.L.
        • Laros Jr, R.K.
        Factors associated with postpartum hemorrhage with vaginal birth.
        Obstet Gynecol. 1991; 77: 69-76
        • Combs C.A.
        • Murphy E.L.
        • Laros Jr, R.K.
        Factors associated with hemorrhage in cesarean deliveries.
        Obstet Gynecol. 1991; 77: 77-82
        • Petersen L.A.
        • Lindner D.S.
        • Kleiber C.M.
        • Zimmerman M.B.
        • Hinton A.T.
        • Yankowitz J.
        Factors that predict low hematocrit levels in the postpartum patient after vaginal delivery.
        Am J Obstet Gynecol. 2002; 186: 737-744
        • Clark S.L.
        • Yeh S.Y.
        • Phelan J.P.
        • Bruce S.
        • Paul R.H.
        Emergency hysterectomy for obstetric hemorrhage.
        Obstet Gynecol. 1984; 64: 376-380
        • Rouse D.J.
        • Leindecker S.
        • Landon M.
        • et al.
        The MFMU cesarean registry: uterine atony after primary cesarean delivery.
        Am J Obstet Gynecol. 2005; 193: 1056-1060
        • Zingg H.H.
        • Laporte S.A.
        The oxytocin receptor.
        Trends Endocrinol Metab. 2003; 14: 222-227
        • Grotegut C.A.
        • Murtha A.P.
        • Rockman H.A.
        Beta-arrestin mediates oxytocin receptor desensitization and MAPK signaling following oxytocin stimulation.
        Reprod Sci. 2009; 16: 104A
        • Oakley R.H.
        • Laporte S.A.
        • Holt J.A.
        • Barak L.S.
        • Caron M.G.
        Molecular determinants underlying the formation of stable intracellular G protein-coupled receptor-beta-arrestin complexes after receptor endocytosis*.
        J Biol Chem. 2001; 276: 19452-19460
        • Balki M.
        • Cristian A.L.
        • Kingdom J.
        • Carvalho J.C.
        Oxytocin pretreatment of pregnant rat myometrium reduces the efficacy of oxytocin but not of ergonovine maleate or prostaglandin F 2 alpha.
        Reprod Sci. 2010; 17: 269-277
        • Amico J.A.
        • Seitchik J.
        • Robinson A.G.
        Studies of oxytocin in plasma of women during hypocontractile labor.
        J Clin Endocrinol Metab. 1984; 58: 274-279
        • Seitchik J.
        • Amico J.
        • Robinson A.G.
        • Castillo M.
        Oxytocin augmentation of dysfunctional labor, IV: oxytocin pharmacokinetics.
        Am J Obstet Gynecol. 1984; 150: 225-228
        • Daniel-Spiegel E.
        • Weiner Z.
        • Ben-Shlomo I.
        • Shalev E.
        For how long should oxytocin be continued during induction of labor?.
        BJOG. 2004; 111: 331-334
        • Clark S.
        • Belfort M.
        • Saade G.
        • et al.
        Implementation of a conservative checklist-based protocol for oxytocin administration: maternal and newborn outcomes.
        Am J Obstet Gynecol. 2007; 197: 480.e1-480.e5
        • Knight M.
        • Callaghan W.M.
        • Berg C.
        • et al.
        Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the international postpartum hemorrhage collaborative group.
        BMC Pregnancy Childbirth. 2009; 9: 55