oxytocin and Diarrhea

Postpartum hemorrhage (PPH) increases the risk of maternal death worldwide. Heat-stable carbetocin, a long-acting oxytocin analog, is a newer uterotonic agent. Clinicians do not fully understand its side-effects, particularly the unanticipated side-effects. The aim of this study is to investigate the side-effects of carbetocin to PPH. The Cochrane Library, Web of Science, PubMed, Elsevier ScienceDirect, Embase, and ClinicalTrials.gov were searched from the inception to September 2020. Randomized controlled trials (RCTs) that considered pregnant women who received carbetocin before delivery and provided at least one adverse event were included. Statistical analysis included random or fixed-effect meta-analyses using relative risk. Stratified analyses and sensitivity analyses were also performed. Begger's and Egger's test and funnel plots were used to assess the publication bias. Seventeen RCTs involving 32,702 women were included, and all these studies ranked as medium- to high-quality. Twenty-four side-effects were reported. The use of carbetocin had a lower risk of vomiting in intravenously (0.53, 0.30 to 0.93) and cesarean birth (0.51, 0.32 to 0.81) women, and had a slightly higher risk of diarrhea (8.00, 1.02 to 62.79) compared with oxytocin intervention. No significant difference was found among other side-effects. Evidence from our systematic review and meta-analysis of 17 RCTs suggested that the risk of vomiting decreased with carbetocin use in the prevention of PPH after delivery.

Topics: Administration, Intravenous; Cesarean Section; Diarrhea; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Randomized Controlled Trials as Topic; Vomiting

To compare the physical and emotional effects of two medical protocols for induced abortion during the second trimester.. The present study was part of a prospective randomized controlled trial comparing mifepristone followed by oxytocin or misoprostol that was conducted at the Hadassah Hebrew University Medical Center, Jerusalem, Israel, from January 10, 2009, to February 22, 2012. Inclusion criteria were pregnancy (14-24weeks), epidural analgesia, and medical induction of abortion (either elective or following missed abortion). A structured questionnaire was used to assess the participants' physical symptoms and emotional responses. The primary outcome for the present analysis was the degree of physical symptoms reported.. Overall, 68 women in the oxytocin group and 67 in the misoprostol group received epidural analgesia and completed the questionnaire. As assessed using a five-point Likert scale, women in the misoprostol group were more likely than those in the oxytocin group to experience diarrhea (1.34±0.84 vs 1.10±0.55; P=0.05) and shivers (3.03±1.75 vs 1.75±1.21; P<0.001). No other between-group differences were detected for the physical or emotional variables evaluated.. Differences in physical symptoms experienced by the two treatment groups did not influence the participants' subsequent emotional response. ClinicalTrials.gov: NCT00784797.

Topics: Abortifacient Agents; Abortion, Induced; Administration, Intravaginal; Administration, Intravenous; Administration, Oral; Adult; Diarrhea; Emotions; Female; Humans; Israel; Mifepristone; Misoprostol; Oxytocin; Pregnancy; Pregnancy Trimester, Second; Prospective Studies; Psychiatric Status Rating Scales; Shivering

To compare the efficacy of oral misoprostol with that of oxytocin for active management of the third stage of labor (AMTSL).. A double-blind randomized control trial was undertaken at a center in Ilorin, Nigeria, between January and June 2013. Every other eligible patient (in the first stage of labor at term, to have a spontaneous vaginal delivery, and no/low risk of postpartum hemorrhage [PPH]) were randomly assigned with computer-generated random numbers to receive oral misoprostol (600μg) plus placebo injection or oral placebo plus oxytocin injection (1mL of 10IU) in the third stage of labor. The primary outcome was amount of blood loss during delivery.. Mean postpartum blood loss was 325.85±164.72mL in the 100 patients given misoprostol and 303.95±163.33mL in the 100 patients given oxytocin (P=0.391). PPH (≥500mL blood loss) was recorded in 15 (15.0%) patients given misoprostol and 14 (14.0%) given oxytocin (P=0.841). Shivering, pyrexia, and diarrhea were all significantly more common in the misoprostol group (P<0.01 for all).. The efficacy of oral misoprostol was similar to that of intramuscular oxytocin. Adverse effects associated with misoprostol were transient and self-limiting. Thus, oral misoprostol is efficacious and a good alternative to oxytocin for AMTSL. Pan African Clinical Trials Registry:PACTR201407000825227.

Topics: Administration, Oral; Adult; Blood Volume; Diarrhea; Double-Blind Method; Female; Fever; Hospitals; Humans; Injections, Intramuscular; Labor Stage, Third; Misoprostol; Nigeria; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Shivering; Young Adult

To compare the impact of a dinoprostone vaginal insert and intravenous oxytocin in reducing blood loss of women undergoing vaginal or cesarean delivery.. This study was conducted among term singleton pregnancies delivered vaginally or by elective cesarean section. In the vaginally delivered cases, active management of the third stage of labor was conducted. During cesarean delivery, 20 IU of intravenous oxytocin was administered. Women, who either delivered via the vaginal or abdominal route, were then randomly allocated to receive 10 mg vaginal dinoprostone insert for 12 hours (group I, n: 100) or intravenous oxytocin (group II, n: 100), respectively.. Mean blood loss and need for additional uterotonics and postpartum hemoglobin and hematocrit levels at 24 and 36 hours after delivery did not differ between the two groups. Women allocated to the dinoprostone vaginal insert arm experienced more nausea and vomiting.. Dinoprostone vaginal insert was as effective as intravenous oxytocin in the prevention of postpartum blood loss.

Topics: Administration, Intravaginal; Adult; Delayed-Action Preparations; Delivery, Obstetric; Diarrhea; Dinoprostone; Female; Fever; Humans; Infusions, Intravenous; Nausea; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Prospective Studies; Shivering; Vomiting

This study was undertaken to determine a method of amino infusion that would 1) produce abortion within 12 hours; 2) be relatively free from risks of coagulapathy and electrolyte imbalance; 3) not result in delivery of liveborns; and 4) incur minimal gastrointestinal side effects from prostaglandin. Patients were randomly assigned to 1 of 3 groups unless history and examination revealed a contraindication to the use of prostaglandin. Three infusions were used: prostaglandin alone, urea alone, and a combination of urea and prostaglandin. All patients had pre-infusion laminaria inserted and all received oxytocin following infusion. There was a significant difference in instillation to abortion time when comparing the three groups and a marked reduction in gastrointestinal side effects using a lower dosage of prostaglandin. The synergistic effect of urea and prostaglandin F2alpha, previously demonstrated was further enhanced by the use of oxytocin and laminaria. This produced a mean instillation to abortion time significantly shorter than previous studies have shown and, indeed, offers a means of second trimester abortion suitable for use in ambulatory surgery facilities, precluding the high cost of inpatient care.. The purpose of this study was to determine a method of amnioinfusion which would 1) keep the instillation to abortion time (IAT) within 12 hours; 2) eliminate, as far as possible, the risk of coagulaopathy and electrolyte imbalance; 3) avoid delivery of liveborn fetuses; 4) reduce gastrointestinal side effects from prostaglandin. 89 midtrimester abortion applicants, divided into 3 groups, had laminaria inserted the afternoon prior to admission. 3 types of infusion were given: 40 mg PGF2 alpha, urea, and a combination of urea solution and 20 mg PGF2 alpha. Upon completion of the infusion the laminaria was removed. 1 hour later oxytocin was administered to all patients; the purpose of the delay was to allow time for prostaglandin impact. 21.4% of cases given urea, 47.8 of those given PGF2 alpha, and 77% of those given urea and PGF2 alpha had aborted 12 hours after infusion. 63.7% of those receiving the combination had aborted 9 hours after infusion. Gastrointestinal side effects were observed in 35% of cases given the higher prostaglandin dosage, compared to only 10% of cases given the lower dosage. The findings indicate that the synergistic effect of urea and prostaglandin was enhanced by the concurrent use of laminaria and oxytocin; the urea dosage was only half of that used in previous studies of synergism, the prostaglandin dosage half of that of prostaglandin only infusions. It seems clear that the initial prostaglandin impact is reinforced by simultaneous administration of urea. Future tests will determine whether the rate of progesterone withdrawal is increased by the synergistic activity of urea and PGF2 alpha in combination.

Topics: Abortion, Induced; Amnion; Diarrhea; Drug Synergism; Female; Humans; Infusions, Parenteral; Nausea; Oxytocin; Pregnancy; Pregnancy Trimester, Second; Prostaglandins F; Seaweed; Time Factors; Urea; Vomiting

Topics: Age Factors; Body Weight; Bradycardia; Cesarean Section; Clinical Trials as Topic; Delivery, Obstetric; Diarrhea; Female; Fetal Diseases; Humans; Infant, Newborn; Labor, Induced; Muscle Tonus; Nausea; Oxytocin; Parity; Phlebitis; Pregnancy; Prostaglandins; Vomiting

Topics: Apgar Score; Body Weight; Bradycardia; Cervix Uteri; Cesarean Section; Clinical Trials as Topic; Diarrhea; Evaluation Studies as Topic; Female; Fetal Heart; Humans; Infant, Newborn; Labor, Induced; Nausea; Obstetric Labor Complications; Oxytocin; Parity; Pregnancy; Prostaglandins; Vomiting

One hundred women seeking interruption of pregnancy between 7-20 weeks were given prostaglandin E2 as a 20 mg vaginal suppository every four hours. Abortion was achieved within an arbitrary time limit of 36 hours in 97 patients and was complete in 76. Mean abortion intervals according to gestational length and parity ranged between 7.67 and 14.93 hours. Augmentive intravenous oxytocin, usually for placental expulsion, was given to 31 patients. Side-effects such as vomiting, diarrhea, and drug fever were encountered in the majority of patients but no sepsis was noted and no patient was transfused. The results are discussed with particular reference to other prostaglandin and hypertonic saline regimens for pregnancy interruption.. A series of 100 consecutive patients seeking pregnancy termination in pregnancy weeks 7-20 were treated with a schedule of 20-mg vaginal suppositories containing prostaglandin E2 (PGE2); the schedule was being tested for its efficacy, specifically reduction of total dose and related side effects. 94 of the 100 patients were aborted within an arbitrary time span of 36 hours. Total drug dose ranged from 40-160 mg. 31 patients received augmentative intravenous oxytocin. Induction-abortion interval varied from 6-32.5 hours. Of the 97 successes, 76 were classified as complete abortions. No significant differences were noted in midtrimester groups based on increasing parity, although parous patients in gestation week 13-15 seemed to have the best results, based on average interval time. No sepsis or need for transfusion was encountered. Side effects were emesis (n-75), diarrhea (n=17), and drug fever (n=66); less frequent side effects included headache, breast tenderness, and vasomotor symptoms (n=13, 1, and 1, respectively). The midtrimester patient results compared favorably with results of studies using saline for abortifacient. The number of first trimester patients was too small to yield any conclusion.

Topics: Abortion, Induced; Diarrhea; Female; Fever; Gestational Age; Humans; Oxytocin; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Prostaglandins; Vagina; Vomiting

Twenty-six women received intramuscular or intra-amniotic 15 (S) 15-methyl prostaglandin F2 alpha to induce midtrimester abortion. The median initial injection-abortion interval was 10 hours and 25 minutes. The advantages of intramuscular analogue are somnolence and reduced discomfort during labor. Disadvantages include severe gastrointestinal toxicity in the majority of patients and symptoms of acute respiratory distress in two patients.

Topics: Abortion, Induced; Diarrhea; Female; Humans; Injections, Intramuscular; Oxytocin; Pregnancy; Pregnancy Trimester, Second; Prostaglandins; Respiratory Insufficiency; Time Factors; Vomiting

The current study was formulated to investigate the abortifacient activity of prostaglandin 15-methyl F2alpha (15-methyl PGF2alpha) administered intramuscularly to 80 healthy women with gestations between 8 and 22 weeks. Goals were the establishment of an effective dosage schedule and assessment of the incidence and severity of side effects. All 80 gravidas were aborted, with a mean time to abortion of 15.70 hours (SD, 6.52). Gastrointestinal side effects occurred in 89% of the patients; temperature elevations greater than or equal to 100.6 degrees F were noted in 14 cases. No other significant complications were encountered. Transabdominal intra-amniotic pressure monitoring indicated the need to administer the drug at 2-hour intervals. The 15-methyl PGF2alpha patients were matched for parity and gestational length with 80 gravidas aborted with PGE2 20-mg vaginal suppositories. The difference in interval to abortion in the two groups was not statistically significant. While gastrointestinal side effects were more common with 15-methyl PGF2alpha, the frequency of drug-induced temperature elevations was reduced.. It has been reported that intra-amniotic administration of 15-methyl PGF2a (prostaglandin F2alpha) for abortion results in a high level of uterine contractility, a high rate of success, and a low incidence of side effects. This study assesses the abortifacient activity of 15-methyl PGF2alpha administered intramuscularly in 80 healthy women aged 14 to 40 with gestational ages between 8 and 22 weeks. 56 patients were nulliparious. Transabdominal intra-amniotic pressure monitoring was used to measure uterine contractility and to establish an effective dose schedule. 350 to 520 mcg of 15-methyl PGF2a were administered intramuscularly at 2-hour intervals until the onset of abortion. Intravenous oxytocin was infused in 6 cases to facilitate passage of retained placental tissue. Medications were given to reduce diarrhea, vomiting, and pain. All patients aborted. Total drug dose ranged from 900 to 8400 mcg; mean dose was 3254.32 mcg. Duration of treatment ranged from 4 to 34 hours. Induction-abortion time ranged from 5.5 to 35 hours, with mean interval of 15.70 hours. 89% of the patients experienced gastrointestinal side effects. 14 patients had temperature elevation more than or equal to 100.6 degrees F. There were no significant complications. The 15-methyl PGF2a patients were matched with 80 gravidas who had abortion using PGE2 20 mg vaginal suppositories. There were no statistical differences in interval to abortion between the 2 groups.

Topics: Abortion, Induced; Adolescent; Adult; Diarrhea; Female; Humans; Injections, Intramuscular; Oxytocin; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Prostaglandins E; Prostaglandins F; Suppositories; Vacuum Curettage; Vomiting

Topics: Administration, Oral; Adolescent; Adult; Diarrhea; Female; Humans; Hypertension; Infusions, Parenteral; Injections, Intravenous; Labor, Induced; Meperidine; Nausea; Oxytocin; Pregnancy; Prostaglandins; Time Factors; Vomiting

PGE2 (prostaglandin E2), 20 mgm vaginal suppositories were administered to 2 groups of women seeking termination of pregnancy. 1 group had the suppository inserted inside a contraceptive diaphragm. Statistical comparisons were carried out for instillation to abortion time, side effects, and intrauterine pressure parameters. The usage of the diaphragm significantly reduced side effects, and resulted in an instillation to abortion time of 12.8 + or - 2.3 hours with no failures. The quantitative analysis of the uterine pressure recordings revealed activity significantly different than that seen with intraamniotic or extraovular PGF2alpha. The development of uterine activity simulates that of normal labor in that elevation of resting pressure does not occur and maximum active pressure evolves slowly.

Topics: Abortion, Induced; Adult; Contraceptive Devices; Diarrhea; Female; Fever; Humans; Muscle Contraction; Nausea; Oxytocin; Parity; Placenta; Pregnancy; Pressure; Progesterone; Prostaglandins; Stimulation, Chemical; Suppositories; Time Factors; Uterus; Vomiting

The efficacy of intramuscular administration of 15 methyl (15S) prostaglandin F2alpha (PGF2a) in midtrimester pregnancy termination was evaluated in 16 healthy patients (mean age, 23.3; mean parity, 1.4; mean number of menstrual weeks, 16.1) by measuring dose response; oxytocin conversion; abortion time; side effects; intrauterine dynamics and progesterone withdrawal. Labor was monitored using extraovular balloon placed transvaginally; transcervically; and connected to a Physiograph machine. Patients not aborting within 48 hours after the first dose were considered failures. Blood samples were collected at 0, 3, and 6 hours and at abortion time for plasma progesterone measurement. Average dose given was 789 +or- 60 micrograms. Only 9 of 10 patients aborted within the prescribed 48 hours: 7 were complete abortions, and 2 were incomplete and required suction curettage. Mean induction to abortion time was 20.2 +or- 2.7 hours. Nausea, vomiting and diarrhea were the main side effects. The findings suggest that 15 methyl PGF2a in the dosages and routes prescribed is not as efficient as PGF2a. It is also suggested that prostaglandin affects the myometrium at 2 levels: 1) a membrane effect, and 2) a more fundamental intracellular regulatory effect which is necessary to initiate labor.

Topics: Abortion, Induced; Action Potentials; Diarrhea; Endometritis; Female; Humans; Injections, Intramuscular; Muscle Contraction; Nausea; Oxytocin; Pregnancy; Pregnancy Trimester, Second; Pressure; Progesterone; Prostaglandins; Stimulation, Chemical; Uterus; Vomiting

Topics: Abortion, Induced; Adolescent; Adult; Amnion; Diarrhea; Female; Fever; Gestational Age; Humans; Hypotension; Injections; Methods; Oxytocin; Pregnancy; Prostaglandins; Time Factors; Vomiting

160 women with uteri at 10-20 weeks gestation were treated with either PG(prostaglandin)F2alpha or saline solution followed by oxytocin to effect an abortion. 80 women were in each treatment group. The distribution of the patients according to age, parity, and gestation duration is tabulated. PGF2alpha was administered extraovularly in a concentration of .1 mg/ml with .7 mg being injected in the operating theater and nurses administering the rest based on response to previous injections. Administration continued for up to 30 hours. Saline was given in a volume in ml dependent on the duration of pregnancy multiplied by a factor of 10. Subcutaneous injections of oxytocin were given on subsequent days to speed the abortion. 85% of the PG patients successfully aborted without surgical dilatation of the cervix. The average dosage of PG required was 7.5 mg in 11 instillations. Side effects and complications in the PG group were minimal. 1 instillation of saline followed by 2 days of oxytocin were required to effect a 79% abortion rate in the saline group. Although the number of patients requiring surgical dilatation was the same for both groups, the procedure was much less time-consuming for the PG group. The complication rate was 26% for the saline group as compared to 14% for the PG group. The PG group required a shorter hospital stay.

Topics: Abortion, Induced; Adolescent; Adult; Amnion; Blood Pressure; Bronchial Spasm; Depression, Chemical; Diarrhea; Female; Humans; Injections; Muscle Contraction; Nausea; Oxytocin; Pregnancy; Prostaglandins; Pulse; Sodium Chloride; Time Factors; Uterine Hemorrhage; Uterine Rupture; Uterus

Topics: Administration, Oral; Adult; Delivery, Obstetric; Diarrhea; Dose-Response Relationship, Drug; Female; Fetal Heart; Heart Rate; Humans; Labor, Induced; Obstetric Labor Complications; Oxytocin; Parity; Pregnancy; Prostaglandins; Uterus; Vomiting

132 physically health patients (aged 12-41 years; 12-21 weeks gestation) were given intraamniotic PGF2alpha (prostaglandin F2alpha) for induction of midtrimester abortion. Analgesic agents and antiemetics were administered intramuscularly as needed. The patients were grouped as follows: 1) Group A (n=48), those who were given an initial dose of 25 mg PGF2a, then as needed; 2) Group B (n=43), initial dose of 30 mg, 25 mg at hour 6-8, and 25 mg at hour 24; 3) Group C (n=17), initial dose of 40 mg, subsequent 40 mg if unaborted at hour 24; and 4) Group D (n=24), initial dose of 40 mg, 10-25 mg at hour 6-8, additional 20 mg if unaborted at hour 24. A 94.7% incidence of abortion was achieved. In Group A, 29 had complete abortion, 16 incomplete, and 3 failures. Group B had 32 complete abortions, 8 incomplete, and 3 failures. Group C had 9 complete, 7 incomplete, and 1 failure. Corresponding figures for Group D were 19, 5 and 0 respectively. Average time to abortion ranged from 13 hours 22 minutes to 25 hours 33 minutes. The primary side effects of PGF2a were gastrointestinal (vomiting, diarrhea). 70% of patients vomited and 13.6% became febrile. Serious complications included sepsis, systemic reaction to prostaglandin, and cervical laceration. Advantages of intraamniotic PGF2a include ease of administration; generally short injection-abortion time; and its ability to induce myometrial contractions regardless of gestational size. However, the safety, convenience, and acceptability of PGF2 are yet to be established. The following guidelines are suggested for minimizing complications: 1) a test dose of 2.5 mg should be administered slowly over at least 1 minute, 2) fever should not be attributed to drug reaction but considered as suggestive evidence of developing infection, 3) patients unaborted at hour 24 should be considered as high risk with respect to potential failure to abort, development of infection, or cervical laceration, and 4) cervical inspection should be performed, especially in the nulliparous patient with a later gestation and a long labor.

Topics: Abortion, Therapeutic; Adolescent; Adult; Amniocentesis; Amnion; Child; Diarrhea; Endometritis; Female; Fever; Humans; Infections; Injections, Intravenous; Oxytocin; Parity; Pregnancy; Prostaglandins; Time Factors; Vomiting

Topics: Administration, Oral; Adult; Diarrhea; Female; Fetus; Gestational Age; Heart Rate; Humans; Injections, Intravenous; Labor, Induced; Oxytocin; Pregnancy; Prostaglandins; Time Factors; Uterus; Vomiting

This study determines the efficacy of extraamniotic administration of prostaglandins E2 and F2alpha (PGE2 and PGF2alpha) in abortion induction. The method consists of introducing a Foley catheter (14 gauge) through the cervix with the aid of a speculum so that the inflated balloon lies just within the internal os. The balloon volume varies from 30 ml at 12 weeks to 40 ml at 16 weeks gestation and over. Following an initial test dose, a fully effective dose of 200 mcg PGE2 or 750 mcg PGF2alpha is instilled for diffusion into the extraovular space; this dose is repeated at 2 hourly intervals. An automatic pump may also be used to administer the PG. The pattern of uterine contractility with this method is similar to that seen with intravenous therapy. Of 163 consecutive cases analyzed, 144 (88%) achieved abortions within 36 hours, 72% aborted within 24 hours and 94% within 48 hours. Mean abortion time was 22.2 hours. No significant difference was seen in the success rate or abortion time between 21 patients in their 1st trimester of pregnancy and 142 patients in the 2nd trimester. In primigravidas, abortion (within 36 hours) was successful in 87% of the cases; mean abortion time was 24.0 hours. Multigravidas had higher success rate (90%) and shorter mean abortion time (20.4 hours). Comparison of results obtained separately with PGF2alpha and PGE2 shows the superiority of PGE2. Of 93 patients receiving PGF2alpha, 85% aborted within 36 hours (mean abortion time, 24.9 hours). Of 70 PGE2-treated patients, 93% aborted within 36 hours (p=.01) (mean abortion time, 19.4 hours). When parity was considered, PGE2 came out superior again over PGF2alpha. In primigravidas, only 84% of PGF2alpha-treated patients had abortion within 36 hours compared to 90% for PGE2-treated patients. In multigravidas, the success rates at 36 hours were 86% for PGF2alpha and 95% for PGE2. Side effects were minimal. In another trial, intravenous oxytocin was used in addition to extraamniotic PG, resulting in a very substantial decrease in mean abortion time. This method is a simple, effective abortion technique which can be carried out in most cases on a 24-hour basis.

Topics: Abortion, Induced; Administration, Topical; Diarrhea; Dose-Response Relationship, Drug; Drug Synergism; Female; Fever; Humans; Oxytocin; Pregnancy; Prostaglandins; Prostaglandins E; Prostaglandins F; Time Factors; Uterus; Vomiting

Topics: Abortion, Induced; Adolescent; Adult; Amnion; Amniotic Fluid; Diarrhea; Dose-Response Relationship, Drug; Drug Evaluation; Female; Humans; Injections; Oxytocin; Pregnancy; Prostaglandins F; Time Factors; Vomiting

Topics: Animals; Arteries; Diarrhea; Electrocardiography; Female; Fetal Death; Heart Rate; Humans; Intestine, Small; Muscle Tonus; Oxytocin; Pregnancy; Prostaglandins F; Rats; Time Factors; Uterine Contraction; Uterus

Topics: Abortion, Therapeutic; Adolescent; Adult; Amniotic Fluid; Curettage; Diarrhea; Evaluation Studies as Topic; Female; Gestational Age; Humans; Oxytocin; Pregnancy; Prostaglandins; Vomiting