oxytocin and Heart-Diseases

In women with heart disease (HD), the third stage of labour is managed with a reduced dose of oxytocin because it can have significant adverse cardiovascular effects. However, women with HD have high rates of postpartum haemorrhage (PPH); consequently, we designed a prospective study to investigate whether higher doses of oxytocin can be given safely and would reduce rates of PPH.. We performed a single centre, prospective, cohort study comparing the standard 'low-dose' oxytocin infusion (10 U of oxytocin in 500 mL of normal saline given intravenously at 36 mL/hour for 4 hours (12 mU/min), n=29) to the low-dose infusion and an additional 2 U of oxytocin given over 10 min immediately after birth (n=30). Maternal blood pressure was measured every minute for 10 min, continuous ECG (Holter) monitoring was performed and any symptoms (chest pain, dyspnoea) were recorded. Total blood loss and serum troponins were measured at 12 hours.. There were no cardiac symptoms, arrhythmias, change in the ST segment or increase in serum troponins. The fall in blood pressure and increase in heart rate were greater with the additional oxytocin, but neither were statistically or clinically significant. The blood loss was significantly less in women receiving additional oxytocin (505 vs 849 mL) and the proportion of women having a PPH was lower.. The use of an additional 2 U of oxytocin for the management of third stage in women with HD had no cardiac consequences and was associated with a significantly lower blood loss. Further larger studies on a larger population of women with HD are needed.

Topics: Adult; Female; Follow-Up Studies; Heart Diseases; Humans; Labor Stage, Third; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications, Cardiovascular; Prospective Studies; Risk Factors; Time Factors

Obstructive sleep apnea is a prevalent and poorly treated cardiovascular disease that leads to hypertension and autonomic imbalance. Recent studies that restore cardiac parasympathetic tone using selective activation of hypothalamic oxytocin neurons have shown beneficial cardiovascular outcomes in animal models of cardiovascular disease. This study aimed to determine if chemogenetic activation of hypothalamic oxytocin neurons in animals with existing obstructive sleep apnea-induced hypertension would reverse or blunt the progression of autonomic and cardiovascular dysfunction.. Two groups of rats were exposed to chronic intermittent hypoxia (CIH), a model of obstructive sleep apnea, for 4 weeks to induce hypertension. During an additional 4 weeks of exposure to CIH, 1 group was treated with selective activation of hypothalamic oxytocin neurons while the other group was untreated.. Hypertensive animals exposed to CIH and treated with daily hypothalamic oxytocin neuron activation had lower blood pressure, faster heart rate recovery times after exercise, and improved indices of cardiac function compared with untreated hypertensive animals. Microarray analysis suggested that, compared with treated animals, untreated animals had gene expression profiles associated with cellular stress response activation, hypoxia-inducible factor stabilization, and myocardial extracellular matrix remodeling and fibrosis.. In animals already presenting with CIH-induced hypertension, chronic activation of hypothalamic oxytocin neurons blunted the progression of hypertension and conferred cardioprotection after an additional 4 weeks of CIH exposure. These results have significant clinical translation for the treatment of cardiovascular disease in patients with obstructive sleep apnea.

Topics: Animals; Cardiovascular Diseases; Disease Models, Animal; Heart Diseases; Hypertension; Hypoxia; Neurons; Oxytocin; Rats; Rats, Sprague-Dawley; Sleep Apnea, Obstructive

Women with cardiac disease are thought to be at increased risk of post-partum haemorrhage. We sought to assess the estimated blood loss (EBL) in our cohort of women with and without cardiac disease (CD) in a quaternary hospital in the UK. Our population consisted of both congenital and acquired CD; and low risk women who delivered in our unit between 01/01/2012-30/09/2016.. Data were collected using computerised hospital records. CD was classified according to the modified WHO classification (mWHO). The primary outcome measure was estimated blood loss (mL).. A total of 5413 women with a singleton fetus in the cephalic presentation delivered during the study period (159 women with CD and 5254 controls). In the CD group, active management of the third stage of labour was consistent with that used in low risk women in 98% (152/155) of cases. Multivariable analyses demonstrated no significant difference in EBL between women with CD vs controls. The adjusted average blood losses were 247.2 ml, 241.8 ml and 295.9 ml in the control group, mWHO 1-2 and 3-4, respectively (p = 0.165).. Women with CD have comparable EBL to low risk women when management of the active third stage of labour is the same.

Topics: Adult; Case-Control Studies; Cesarean Section; Cohort Studies; Delivery, Obstetric; Female; Heart Diseases; Humans; Labor Stage, Third; Multivariate Analysis; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications, Cardiovascular; Retrospective Studies; United Kingdom; Young Adult

Topics: Adult; Female; Heart Diseases; Humans; Labor, Obstetric; Medication Therapy Management; Obstetric Labor Complications; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications, Cardiovascular; Retrospective Studies; United Kingdom

Debate continues over the dose and methods of administration of oxytocin for the prevention of haemorrhage during caesarean section. We surveyed 206 lead obstetric anaesthetists in the UK to determine standard practice in their unit as well as any differences in practice for high-risk cases. There were 150 responses (72.9% response rate). A total of 149 units use oxytocin. The majority use an initial 5-IU dose, whilst a small proportion (8; 5.3%) administer a dose < 5 IU for elective caesarean section. The administration of a 10-IU dose has ceased altogether. There is a broad range of administration methods, particularly with infusions. Forty (26.8%) respondents give a different oxytocin regimen following caesarean section in patients with severe pre-eclampsia, 72 (48.3%) in those with cardiac disease of New York Heart Association class 1-2, and 100 (66.7%) with class 3-4. In conclusion, there is a trend towards the use of lower doses of oxytocin in caesarean section, but there are still wide variations in detail. We suggest that there is a need for a national protocol to standardise oxytocin administration.

Topics: Adult; Anesthesia, Obstetrical; Cesarean Section; Dose-Response Relationship, Drug; Female; Health Care Surveys; Heart Diseases; Humans; Infusions, Intravenous; Oxytocics; Oxytocin; Pre-Eclampsia; Pregnancy; Risk; United Kingdom

We conducted a prospective observational survey of pregnant women with cardiac disease. The aim was to analyse and present the mode of delivery, outcome, and haemodynamic changes during a caesarean section under regional anaesthesia in women with cardiac disease.. All pregnant women with a cardiovascular diagnosis, except hypertension, were included in the registry. Based on the cardiac diagnoses, and on the New York Heart Association classification, a multidisciplinary group made recommendations for each patient and decided on the mode of delivery. The data from continuous, invasive haemodynamic monitoring in intermediate- and high-risk patients under regional anaesthesia for a caesarean section were analysed and presented.. The hospital had approximately 9000 deliveries in the period from November 2003 to April 2008. A total of 113 pregnancies in 107 women were included. Thirty-two (28.3%) pregnancies were classified into the high-risk category. Of 103 deliveries, caesarean sections were performed in 59 (52.2%) cases, with regional anaesthesia in 51 patients (18 emergencies), general anaesthesia in eight patients (five emergencies), and a planned vaginal delivery in 44 patients. There was no mortality among the mothers or the babies during the hospital stay or 6 months postpartum. Pre-operative cardiovascular stability during the caesarean section was maintained by volume and phenylephrine infusion guided by invasive monitoring of haemodynamic variables.. Our study suggests that pregnant women with cardiac disease may safely deliver the baby by a caesarean section under regional anaesthesia. According to our findings, haemodynamic stability can be obtained by titrated regional anaesthesia, intravenous (i.v.) volume, phenylephrine infusion, and small repeated doses of i.v. oxytocin guided by invasive monitoring.

Topics: Adult; Anesthesia, Obstetrical; Anesthesia, Spinal; Blood Pressure; Cardiac Output; Cesarean Section; Delivery, Obstetric; Female; Heart Diseases; Humans; Monitoring, Intraoperative; Oxytocics; Oxytocin; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy, High-Risk; Prospective Studies; Treatment Outcome; Young Adult

We sought to determine risk factors for deep vein thrombosis and pulmonary embolism during pregnancy or post partum.. We performed a population-based case-control study. All Olmsted County, Minnesota, residents with a first lifetime deep vein thrombosis or pulmonary embolism during pregnancy or post partum from 1966 to 1990 were identified (N = 90). Where possible, a resident without deep vein thrombosis or pulmonary embolism was matched to each patient by date of the first live birth after the patient's child. The medical records of all remaining patients and all control subjects were reviewed for >25 baseline characteristics, which were tested as risk factors for deep vein thrombosis or pulmonary embolism.. In multivariate analysis smoking (odds ratio, 2.4) and prior superficial vein thrombosis (odds ratio, 9.4) were independent risk factors for deep vein thrombosis or pulmonary thrombosis during pregnancy or post partum.. Venous thromboembolism prophylaxis may be warranted for pregnant women with prior superficial vein thrombosis. Smoking cessation should be recommended, especially during pregnancy and the postpartum period.

Topics: Bed Rest; Body Mass Index; Case-Control Studies; Delivery, Obstetric; Eclampsia; Female; Heart Diseases; Humans; Hypertension; Obstetric Labor, Premature; Odds Ratio; Oxytocin; Parity; Pre-Eclampsia; Pregnancy; Pulmonary Embolism; Risk Factors; Smoking; Venous Thrombosis

Topics: Female; Fetal Heart; Heart Diseases; Humans; Labor, Induced; Maternal-Fetal Exchange; Oxytocin; Pregnancy; Prostaglandins F

Topics: Cardiac Output; Female; Heart Diseases; Humans; Labor, Obstetric; Mitral Valve Stenosis; Oxytocin; Pregnancy; Pregnancy Complications, Cardiovascular; Puerperal Disorders; Pulmonary Edema; Sodium Chloride

Topics: Anticoagulants; Blood Pressure; Body Temperature; Female; Heart Diseases; Humans; Labor Stage, First; Labor Stage, Second; Labor Stage, Third; Labor, Induced; Monitoring, Physiologic; Obstetric Labor Complications; Oxytocin; Pregnancy; Pregnancy Complications, Cardiovascular; Pulse; Respiration