oxytocin and Uterine-Neoplasms

Leiomyomas are benign mesenchymal tumors that consist of smooth muscle cells and varying amounts of fibrous stroma. Uterine leiomyomas are the most common, affecting 20% to 30% of reproductive-age women, but vaginal leiomyomas are rare. Treatments gradually diversify with increased awareness of vaginal leiomyoma, but transvaginal fibroid resection remains the commonly used scheme.. Herein, we present the case of a 50-year-old asymptomatic woman who had a mass in the left anterior wall of the vagina discovered by gynecological examination and ultrasound. We used oxytocin diluent injection during surgery to create a water pad in the tissue space and then performed a transvaginal myomectomy. There was little or negligible intraoperative bleeding and no peripheral tissue injury, early or late postoperative complications, incision dehiscence, and no surgical site infection.. Transvaginal ultrasonography is the preferred examination for vaginal leiomyomas, and transvaginal myomectomy is the classic treatment method. The formation of a water pad with oxytocin dilution can effectively reduce intraoperative bleeding and shorten surgery time.

Topics: Female; Humans; Leiomyoma; Middle Aged; Oxytocin; Uterine Myomectomy; Uterine Neoplasms; Vaginal Neoplasms; Water

To synthesize evidence on the most effective pharmacological interventions for bleeding reduction during open and minimally invasive myomectomy.. Systematic review and network meta-analysis of randomized controlled trials (RCTs).. Not applicable.. Trials assessing efficacy of pharmacological interventions during different types of myomectomy.. Misoprostol, oxytocin, vasopressin, tranexamic acid (TXA), epinephrine, or ascorbic acid.. Intraoperative blood loss and need for blood transfusion.. The present review included 26 randomized control trials (RCTs) (N = 1627). For minimally invasive procedures (9 RCTs; 474 patients), network meta-analysis showed that oxytocin (mean difference [MD] -175.5 mL, 95% confidence interval [CI] -30.1.07, -49.93), ornipressin (MD -149.6 mL, 95% CI - 178.22, -120.98), misoprostol, bupivacaine plus epinephrine, and vasopressin were effective in reducing myomectomy blood loss, but the evidence is of low quality. Ranking score of treatments included in subgroup analysis of minimally invasive myomectomy showed that oxytocin ranked first in reducing blood loss, followed by ornipressin. For open myomectomy (17 RCTs; 1,153 patients), network meta-analysis showed that vasopressin plus misoprostol (MD -652.97 mL, 95% CI - 1113.69, -174.26), oxytocin, TXA, and misoprostol were effective; however, the evidence is of low quality. Vasopressin plus misoprostol ranked first in reducing blood loss during open myomectomy (P = .97).. There is low-quality evidence to support uterotonics, especially oxytocin, and peripheral vasoconstrictors as effective options in reducing blood loss and need for blood transfusion during minimally invasive myomectomy. Oxytocin is the most effective intervention in minimally invasive myomectomy. For open myomectomy, a combination of uterotonics and peripheral vasoconstrictors is needed to effectively reduce blood loss.

Topics: Blood Loss, Surgical; Female; Humans; Leiomyoma; Minimally Invasive Surgical Procedures; Network Meta-Analysis; Oxytocin; Perioperative Care; Randomized Controlled Trials as Topic; Uterine Myomectomy; Uterine Neoplasms

Open myomectomy is the most adopted surgical strategy in the conservative treatment of uterine fibroids. According to several studies, the likelihood that a woman could develop uterine myomas is estimated around 75% by the age of 50. Open myomectomy is nonetheless a complicated surgery in terms of blood loss and need for transfusion. Many strategies have been published with the aim of limiting intra and post-operative bleeding complications. The scope of this review is to describe in detail the different techniques reported in literature focusing on their validity and safety.

Topics: Antifibrinolytic Agents; Blood Loss, Surgical; Female; Gonadotropin-Releasing Hormone; Hemostasis, Surgical; Hemostatics; Humans; Leiomyoma; Ligation; Operative Blood Salvage; Oxytocics; Oxytocin; Tourniquets; Tranexamic Acid; Uterine Artery; Uterine Artery Embolization; Uterine Neoplasms; Vasopressins

To assess the effectiveness and safety of interventions to reduce blood loss during myomectomy.. Electronic searches of the Cochrane Library, MEDLINE, and EMBASE, between 1966 and 2006 for randomized controlled trials (RCTs).. We found significant reductions in blood loss with vaginal misoprostol (weighted mean difference [WMD] -149.00 mL, 95% confidence interval [CI] -229.24 to -68.76); intramyometrial vasopressin and analogues (WMD -298.72 mL, 95% CI -593.10 to -4.34); intramyometrial bupivacaine plus epinephrine (WMD -68.60 mL, 95% CI -93.69 to -43.51); and pericervical tourniquet (WMD -1870.00 mL, 95% CI -2547.16 to -1192.84). There was no evidence of effect in blood loss with myoma enucleation by morcellation and oxytocin.. There is limited evidence from a few RCTs that some interventions may reduce bleeding during myomectomy. There is need for adequately powered RCTs to shed more light on the effectiveness, safety, and cost of different interventions to reduce blood loss during myomectomy.

Topics: Blood Loss, Surgical; Bupivacaine; Combined Modality Therapy; Female; Gynecologic Surgical Procedures; Humans; Leiomyomatosis; Misoprostol; Oxytocin; Randomized Controlled Trials as Topic; Tourniquets; Uterine Neoplasms; Vasopressins

Topics: Abortion, Threatened; Biological Assay; Biomarkers; Depression, Postpartum; Diagnostic Techniques, Endocrine; Female; Humans; Hydatidiform Mole; Inappropriate ADH Syndrome; Labor, Obstetric; Oxytocin; Pregnancy; Radioimmunoassay; Specimen Handling; Uterine Neoplasms

Gestational trophoblastic disease cases encountered in 88 pregnant women during a period between January 1985 and June 1992 were retrospectively studied. During the same period we had 6800 deliveries. The incidence of gestational trophoblastic diseases was 12.9 per 1000 deliveries. Of these cases 72 (81.8%) were diagnosed as hydatidiform mole and 16 (18.2%) were diagnosed as choriocarcinoma in histopathological investigations. The preferred method of treatment for cases of hydatidiform mole was termination with suction curettage and oxytocin perfusion. Trophoblastic diseases were common in women with five or more pregnancies from rural areas and our incidence was higher when compared with similar studies. Moreover, our patients had low socio-economic and poor educational status. All these factors seem to be etiologic reasons, besides multiparity.

Topics: Adolescent; Adult; Choriocarcinoma; Female; Humans; Hydatidiform Mole; Middle Aged; Oxytocin; Parity; Pregnancy; Rural Population; Schools, Medical; Trophoblastic Neoplasms; Turkey; Uterine Neoplasms; Vacuum Curettage

Uterine leiomyoma is one of the most common benign tumors in females. High-intensity focused ultrasound (HIFU) has been widely used in the therapy of uterine leiomyomas. However, HIFU method has a prolonged duration of operation and poor patient tolerance, which need improvement. This study sought to explore the efficacy and safety of add-on use of oxytocin in uterine leiomyomas patients who received HIFU and ultrasound-guided percutaneous anhydrous ethanol injection.. This is a randomized controlled trial. A total of 60 patients with uterine leiomyomas were included and randomly divided into study group and control group. The patients in the control group were treated with HIFU and ultrasound-guided percutaneous anhydrous ethanol injection, while the study group received oxytocin injection in addition to the treatment measures of the control group. The efficacy and safety of the treatments were assessed by using the volume ablation rate of the tumor and the Society of Interventional Radiology (SIR) Practice Guidelines, respectively.. Finally, all of the 60 patients (30 in the study group and 30 in the control group) completed the treatments. There were no statistically significant differences between the 2 groups in terms of leiomyoma volume ablation rate (94.48%±2.07% vs. 94.91%±2.53%, P=0.36), crumb gray time (150.70±57.51 vs. 165.77±77.13 s, P=0.37), total treatment energy (556,835.0±202,583 vs. 512,610.0±158,004 J, P=0.19), and total treatment time (116.70±28.61 vs. 107.40±23.22 mins, P=0.14). The pain score of the oxytocin group was significantly greater than that in the control group (4.53±1.55 vs. 3.60±1.19, P=0.008). At 3 months and 1-year post-therapy, no statistically significant differences were observed in the residual necrotic leiomyoma volume between the 2 groups.. The add-on use of oxytocin in uterine leiomyomas patients undergoing HIFU and ultrasound-guided intratumoral ethanol injection could not improve treatment effect.. Chinese Clinical Trial Registry identifier: ChiCTR2200058584.

Topics: Ethanol; Female; High-Intensity Focused Ultrasound Ablation; Humans; Leiomyoma; Magnetic Resonance Imaging; Oxytocin; Treatment Outcome; Ultrasonography, Interventional; Uterine Neoplasms

To evaluate the efficacy of carbetocin versus placebo in decreasing intraoperative blood loss and the need for blood transfusion during abdominal myomectomy.. Randomized, double-blind, placebo-controlled trial.. Tertiary university hospital from September 2019 to February 2020.. A total of 138 women with symptomatic leiomyoma who were candidates for abdominal myomectomy (n = 69 in each group).. We randomized the study participants in a 1:1 ratio to carbetocin and placebo groups. Intravenous 100 μg carbetocin or placebo was administered slowly after induction of anesthesia.. Intraoperative blood loss, need for blood transfusion, postoperative hemoglobin, operative time, length of hospitalization, and drug side-effects.. The baseline characteristics were similar among all groups. Carbetocin had significantly lower intraoperative blood loss compared with placebo (mean difference 184 mL). Hemoglobin level 24 hours after surgery was significantly lower in the placebo group than in the carbetocin group (9.1 ± 0.8 vs. 10.3 ± 0.6 g/dL). Eight women in the carbetocin group needed blood transfusion compared with 17 in placebo group. Operative time, length of hospitalization, and side-effects were similar in both groups.. A single preoperative intravenous dose of 100 μg carbetocin is a simple, practical, and effective method of decreasing intraoperative blood loss and the need for blood transfusion during abdominal myomectomy, with tolerable, few, nonsignificant side-effects.. NCT04083625.

Topics: Adult; Blood Loss, Surgical; Delayed-Action Preparations; Double-Blind Method; Female; Humans; Leiomyoma; Middle Aged; Oxytocics; Oxytocin; Prospective Studies; Treatment Outcome; Uterine Myomectomy; Uterine Neoplasms

To assess oxytocin infusion efficacy in terms of mean blood loss in patients undergoing abdominal myomectomy.. The single-blind randomised control trial was conducted at the Obstetrics and Gynaecology Department of Military Hospital, Rawalpindi, Pakistan, July 15, 2017, to January 15, 2018, and comprised women with intramural fibroids of American Society of Anaesthesia class I and II who were candidates for elective abdominal myomectomy. The women were randomised into study and control groups. In the study group, an infusion of 30 units of oxytocin in 1000ml normal saline was given at the rate of 15 units/hour during surgery. In the control group, pure normal saline was given. The main outcome measure was intra-operative blood loss. Data was analysed using SPSS 21.. Of the 60 women, there were 30(50%) in the study group with a mean age of 37.10±4.35 years, and 30(50%) in the control group with a mean age of 36.67±3.70 (p>0.05). Mean intra-operative blood loss in the study group was 409.67±181.29ml which was significantly lower than the control group 875.33±284.71 (p<0.05). The mean surgery time also showed statistically significant difference between the two groups (p<0.05). In the study group, 3(10%) patients required blood transfusion, while blood was transfused to 11(36.6%) patients in the control group (p=0.046).. Oxytocin, when given as an infusion, was found to be effective in reducing blood loss during abdominal myomectomy.

Topics: Adult; Blood Loss, Surgical; Female; Humans; Leiomyoma; Oxytocin; Pakistan; Pregnancy; Single-Blind Method; Uterine Myomectomy; Uterine Neoplasms

To evaluate the effectiveness of oxytocin infusion to reduce intraoperative bleeding during abdominal myomectomies.. This randomized, parallel group, blinded study was conducted between October 2017 and May 2018. Patients undergoing abdominal myomectomies were randomized 1:1 either to the oxytocin group or to the control group (saline). In the oxytocin group, 10 IU oxytocin in 500 ml of saline at a rate of 120 ml/h was given during the course of the operation. The primary outcome of this study was to measure intraoperative blood loss between the study groups. Correlation and multiple regression analysis were performed to illustrate factors associated with intraoperative blood loss during the myomectomy.. The mean intraoperative blood loss during the surgery was 489.20 ± 239.72 ml in the oxytocin group and was 641.40 ± 288.21 ml in the control group. The hemoglobin decline was more evident in the control group than in the oxytocin group. Positive correlations were also observed between the intraoperative blood loss and number of fibroids removed during the surgery, largest fibroid removed and weight of fibroids removed. The use of oxytocin infusion during the myomectomy resulted in a reduction of bleeding in the regression model.. Intravenous oxytocin infusion is a safe and practical method to reduce intraoperative blood loss during the abdominal myomectomy.

Topics: Abdomen; Adult; Blood Loss, Surgical; Double-Blind Method; Female; Humans; Infusions, Parenteral; Leiomyoma; Oxytocics; Oxytocin; Treatment Outcome; Turkey; Uterine Myomectomy; Uterine Neoplasms

The aim of the study was to evaluate the clinical efficacy of magnetic resonance-guided High-Intensity Focused Ultrasound (HIFU) in patients with symptomatic uterine fibroids (myomata) after application of oxytocin.. 156 women with symptomatic uterine fibroids were treated using MR-guided HIFU procedure. 51 patients had additional IV administration of 40 IU of oxytocin in 5% Glucose or 0,9% NaCl solution during therapy. Before and after the procedure we performed MR and measured initial perfused volume, final perfused volume, nonperfused volume (NPV), and treated volume ratio (TVR). The follow-up was up to 15 months to assess efficacy of treatment and relief of symptoms.. Nonperfused volume was statistically significantly larger in oxytocin group than in control group (p=0.0019). The remaining parameters did not show significant difference between both groups.. Oxytocin administration seems to improve efficiency of HIFU therapy although further research is required to assess its value. This study' clinical registration number is DRKS00014794.

Topics: Female; High-Intensity Focused Ultrasound Ablation; Humans; Leiomyoma; Magnetic Resonance Imaging; Myoma; Oxytocics; Oxytocin; Treatment Outcome; Uterine Neoplasms

To assess the effectiveness and safety of oxytocin to reduce blood loss during abdominal myomectomy.. Double-blind randomised controlled trial.. Obstetrics and Gynecologic University Medical Centre.. Eighty healthy women candidates for abdominal myomectomy.. Women were randomly assigned to two groups. In the study group (n = 40) oxytocin 30 IU in 500 ml normal saline; and in the placebo group (n = 40) pure normal saline was administered during myomectomy. The main outcome measures were peri-operative blood loss and rates of blood transfusion.. Estimated intra-operative blood loss.. Estimated intra-operative blood loss in the study group (189.5 ± 16.72 ml) was significantly lower than the placebo group (692.25 ± 89.93 ml) (95% CI 672.54-711.96; P < 0.0001).The need for blood transfusion was significantly lower in the study group. Blood transfusions were required for three (7.5%) women in the study group and 10 (25%) women in the placebo group (95% CI 15.5-34.5; P < 0.001).. Intra-operative oxytocin infusion appears to be safe and effective in decreasing blood loss during abdominal myomectomy.. Intra-operative oxytocin is effective in decreasing blood loss during abdominal myomectomy.

Topics: Abdomen; Adult; Blood Loss, Surgical; Blood Transfusion; Double-Blind Method; Female; Humans; Infusions, Parenteral; Leiomyoma; Oxytocics; Oxytocin; Treatment Outcome; Uterine Myomectomy; Uterine Neoplasms

The pseudocapsule surrounding fibroids consists of compressed myometrium containing nerves and blood vessels that continue into adjacent myometrium. Oxytocin (OXT) is thought to affect wound healing after myomectomy. We determined the presence of OXT and protein gene product 9.5 (PGP9.5) immunoreactive nerve fibers in pseudocapsule compared to adjacent myometrium. Samples (N=106) of pseudocapsule and adjacent myometrium were collected from 57 women with uterine fibroids undergoing myomectomy, and stained with anti-OXT and PGP 9.5 antibodies to demonstrate the presence of nerve fibers. Nerve fibers in the pseudocapsule stained positively with OXT (89/106, 84.0%) and PGP 9.5 (94/106, 88.7%). The densities of nerve fibers staining with PGP 9.5 and OXT in the pseudocapsule were highest in the isthmus (23.68±22.45/mm2 and 43.35±40.74/mm2, respectively). There were no significant differences in the density of nerve fibers, stained with either OXT or PGP 9.5, between the pseudocapsule, and adjacent normal myometrium regardless of the fibroid location in the uterus (P>0.05). These results suggest that the pseudocapsule should avoid to be damaged during the myomectomy procedure.

Topics: Adult; Female; Humans; Leiomyoma; Myometrium; Nerve Fibers; Oxytocin; Uterine Myomectomy; Uterine Neoplasms

The myoma pseudocapsule (MP) is a fibro-vascular network rich of neurotransmitters, as a neurovascular bundle, surrounding fibroid and separating myoma from myometrium. We investigated the distribution of the opioid neuropeptides, as enkephalin (ENK) and oxytocin (OXT), in the nerve fibers within MP and their possible influence in human reproduction in 57 women. An histological and immunofluorescent staining of OXT and ENK was performed on nerve fibers of MP samples from the fundus, corpus and isthmian-cervical regions, with a successive morphometric quantification of OXT and ENK. None of the nerve fibers in the uterine fundus and corpus MPs contained ENK and the nerve fibers in the isthmian-cervical region demonstrated an ENK value of up to 94 ± 0.7 CU. A comparatively lower number of OXT-positive nerve fibers were found in the fundal MP (6.3 ± 0.8 CU). OXT-positive nerve fibers with OXT were marginally increased in corporal MP (15.0 ± 1.4 CU) and were substantially higher in the isthmian-cervical region MP (72.1 ± 5.1 CU) (p < 0.01). The distribution of OXY neurofibers showed a slight into the uterine corpus, while are highly present into the cervico-isthmic area, with influence on reproductive system and sexual disorders manifesting after surgical procedures on the cervix.

Topics: Adult; Cervix Uteri; Enkephalins; Female; Humans; Hysterectomy; Immunohistochemistry; Leiomyomatosis; Menorrhagia; Neoplasm Proteins; Neovascularization, Pathologic; Nerve Fibers; Oxytocin; Pelvic Pain; Uterine Neoplasms; Uterus

To explore the safe and effective method of hemostasis in laparoscopic hysteromyomectomy (LM).. Two hundred and eighty women with symptomatic uterine intramural fibroids undergoing LM were assigned to 4 groups, Group A undergoing fibroid pedicle ligation, Group B injected with 12 IU diluted vasopressin around the myoma, Group C injected with 20 IU oxytocin combined with pedicle ligation, and Group D injected with vasopressin combined with pedicle ligation. The operation time, amount of blood loss, operative complications, bowel deflation, post-operative hemoglobin dropping, and length of hospital stay were compared.. The amounts of blood loss of Groups A and C were (171 +/- 146) ml and (184 +/- 140) ml, both significantly higher than those of Groups B and D [(115 +/- 70) ml and (106 +/- 73) ml, both P < 0.01]. The length of hospital stay of Group D was (2.9 +/- 0.5) d, significantly shorter than those of Groups A, B, and C [(3.1 +/- 0.7) d, (3.6 +/- 0.8) d, and (3.3 +/- 0.7) d, all P < 0.05]. The bowel deflation time of Group D was (20 +/- 6) h, significantly shorter than those of the Groups A, B, and C [(26 +/-) h, (25 +/- 7) h, and (25 +/- 8) h respectively, all P < 0.05]. The post-operative hemoglobin dropping of group D was (1.1 +/- 0.9) g/L, significantly less than those of Groups A, B, and C [(1.5 +/- 1.0), (1.4 +/- 0.8), and (1.2 +/- 0.7) g/L respectively, all P < 0.05].. Vasopressin (12 IU) injection around the myoma is a simple, effective, and safe homeostatic procedure during LM. Pedicle ligation can reduce advanced post-operative bleeding post-operation.

Topics: Adult; Combined Modality Therapy; Female; Gynecologic Surgical Procedures; Hemostatic Techniques; Hemostatics; Humans; Laparoscopy; Leiomyoma; Myoma; Oxytocics; Oxytocin; Postoperative Hemorrhage; Treatment Outcome; Uterine Neoplasms; Vasopressins

To investigate the effectiveness of uterotonics misoprostol and oxytocin on reducing blood loss during laparoscopy-assisted vaginal hysterectomy (LAVH).. Randomised, double-blind placebo-controlled trial.. University hospital.. One hundred and seventy-three women underwent LAVH for symptomatic uterine myomas and were randomly allocated to uterotonics (n = 91) or placebo (n = 82).. Women underwent LAVH for symptomatic uterine myomas and were randomly assigned to receive either rectal misoprostol (400 microg) and intravenous oxytocin (10 IU/hour) or placebo during LAVH. Parameters related to surgical outcome were compared.. The main outcome measure was intra-operative blood loss.. Patient characteristics and indications for LAVH were similar in both groups. Mean [SD] for all continuous data estimated weight of blood loss (198.1 [123.2] vs 396 [337.6] g; P < 0.0001), mean operation time (106.2 [39.4] vs 116.6 [34.6] minutes; P = 0.02), mean change in haemoglobin (1.5 [1.0] vs 1.9 [1.2] g/dL; P = 0.02) and haematocrit levels (4.8 [2.9]% vs 5.8 [3.6]%; P = 0.04) and mean hospitalisation period (3.3 [0.8] vs 3.9 [1.1] days; P < 0.0001), which were significantly less in the group given rectal misoprostol and intravenous oxytocin than in the placebo group, respectively. There was no significant difference in complications and side effects between the two groups (P > 0.05).. Combined rectal misoprostol and intravenous oxytocin is a feasible and effective method of reducing blood loss and operation time in LAVH.

Topics: Administration, Rectal; Adult; Blood Loss, Surgical; Drug Therapy, Combination; Female; Humans; Hysterectomy, Vaginal; Infusions, Intravenous; Laparoscopy; Leiomyoma; Length of Stay; Middle Aged; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Treatment Outcome; Uterine Neoplasms

To evaluate the influence of oxytocin on peroperative blood loss during myomectomy.. From October 1998 to May 2002, 94 patients requiring surgical myomectomy by laparotomy or by the vaginal approach were enrolled in a randomized double blind study. Patients were randomized to two groups. In the first group (47 patients) oxytocin was administered during myomectomy and in the second group (47 patients) a placebo was used. The main outcome measures were peroperative blood loss and rates of blood transfusion and autotransfusion.. Peroperative blood loss was no different between the oxytocin group and the placebo group (508 +/- 558 ml versus 451 +/- 336 ml; P=0.55). Rates of autotransfusion and blood transfusion were also similar in both groups.. Administration of oxytocin during myomectomy did not reduce peroperative blood loss in our study. The benefits of using oxytocin to prevent hemorrhage during myomectomy seem to be limited.

Topics: Adult; Blood Loss, Surgical; Blood Transfusion; Double-Blind Method; Female; Hemoglobins; Humans; Leiomyoma; Middle Aged; Oxytocin; Placebos; Uterine Neoplasms

STUDY OBJECTIVE. To evaluate the role of oxytocin in decreasing operative blood loss in laparoscopic-assisted vaginal hysterectomy (LAVH) for the large uterus (weight > or = 500 g).. Prospective clinical study (Canadian Task Force classification II-2).. Tertiary care university hospital.. Eighty-eight women scheduled for a hysterectomy for large benign uterine tumors.. Two ampules of oxytocin (10 u/mL/amp) were added to 1000 mL of saline solution running at the rate of 40 mU/min during the course of LAVH.. Blood loss and blood transfusion rate were significantly greater in the group without oxytocin infusion (group B) than in the group with oxytocin infusion (group A), with 485.7 +/- 321.6 mL versus 364.1 +/- 173.2 mL (p <.05) and 26.7% versus 6. 1% (p <.05), respectively. There was no significant difference in average age, body weight, and number of vaginal deliveries and cesarean sections between the two groups. There also was no significant difference in mean uterine weight, postoperative stay, and complications between the two groups.. Oxytocin infusion can cause uterine contractions that decrease uterine perfusion. It is a safe and inexpensive method to help decrease operative blood loss during LAVH for the large uterus.

Topics: Adult; Blood Loss, Surgical; Female; Humans; Hysterectomy, Vaginal; Laparoscopy; Leiomyoma; Middle Aged; Organ Size; Oxytocics; Oxytocin; Prospective Studies; Uterine Neoplasms; Uterus

In this study, C118P, a novel vascular disrupting agent (VDA), was evaluated for its ability in improving the ablative effect of high-intensity focused ultrasound (HIFU) on uterine fibroids by reducing blood perfusion.. Eighteen female rabbits were infused with isotonic sodium chloride solution (ISCS), C118P or oxytocin for 30 min, and an HIFU ablation of the leg muscles was performed within the last 2 min. Blood pressure, heart rate and laser speckle flow imaging (LSFI) of the auricular blood vessels were recorded during perfusion. Ears with vessels, uterus and muscle ablation sites were collected and sliced for hematoxylin-eosin (HE) staining to compare vascular size, as well as nicotinamide adenine dinucleotide-tetrazolium reductase (NADH-TR) staining to observe necrosis after ablation.. Analyses revealed that the perfusion of C118P or oxytocin steadily reduced blood perfusion in the ears to approximately half by the end of the perfusion, constricted the blood vessels of the ears and uterus, and improved HIFU ablation in the muscle tissues. C118P increased blood pressure and decreased heart rate. The degree of contraction of the auricular and uterine blood vessels was positively correlated.. This study confirmed that C118P could reduce blood perfusion in various tissues and had a better synergistic effect with HIFU ablation of muscle (the same tissue type as fibroids) than did oxytocin. C118P could therefore possibly replace oxytocin in facilitating HIFU ablation of uterine fibroids; however, electrocardiographic monitoring is required.

Topics: Animals; Feasibility Studies; Female; High-Intensity Focused Ultrasound Ablation; Humans; Leiomyoma; Magnetic Resonance Imaging; Oxytocin; Rabbits; Treatment Outcome; Uterine Neoplasms

Uterine fibroids (UFs) are very common benign tumors of the female reproductive tract. According to recent reports, magnetic resonance-guided high-intensity ultrasound (MR-HIFU) appears to be a well-tolerated and efficient treatment option for UFs. However, MR-HIFU still presents several limitations. The treatment is rarely associated with achieving complete non-perfused volume (NPV). Not all patients are qualified for a final procedure, and selected women obtain very good results in such treatment. The primary objective of this experimental study was to assess the effect of transvaginal misoprostol and intravenous oxytocin preparation on UF volume change, sonication time and NPV after MR-HIFU procedure in women of reproductive age with symptomatic UFs. Secondary outcomes included the effect on the peri-procedural effectiveness of misoprostol and oxytocin. This study enrolled 247 women with symptomatic UFs; based on gynecologic examinations and magnetic resonance imaging (MRI) scans, 128 women qualified for MR-HIFU without pharmacologic treatment, 57 women qualified for the misoprostol/diclofenac group and 62 women qualified for the oxytocin group. Pharmacologic pre-treatment improved NPV compared with non-pharmacologic treatment (average NPV: controls 61.9% ± 25.8%; oxytocin 76.8% ± 20.7%; misoprostol/diclofenac 85.2% ± 15.1%; average sonication time: controls 120 min ± 56.4%; oxytocin 111 min ± 45.4%; misoprostol/diclofenac 80 min ± 47.7%). Statistical analysis did not reveal significant intergroup differences in UF volume changes after 6 mo (controls: n = 40, 37.4% ± 27.5%; oxytocin n = 25, 45.8% ± 31%; misoprostol/diclofenac n = 19, 33.4% ± 23.2%). The misoprostol/diclofenac group, which achieved the highest NPV immediately after the MR-HIFU procedure, was characterized by the lowest UF volume change percentages 6 mo later. The administration of vasoconstrictor drugs (oxytocin and misoprostol/diclofenac) to support MR-HIFU in UF treatment is a new issue that may improve the total effectiveness of this method. Randomized controlled trials are necessary to estimate the real effect of vasoconstrictors on MR-HIFU.

Topics: Adult; Cohort Studies; Combined Modality Therapy; Diclofenac; Drug Combinations; Female; High-Intensity Focused Ultrasound Ablation; Humans; Leiomyoma; Magnetic Resonance Imaging, Interventional; Misoprostol; Oxytocin; Preoperative Period; Prospective Studies; Surgery, Computer-Assisted; Uterine Neoplasms; Young Adult

Uterine fibroids are the most common benign neoplasms in women. The administration of intravenous oxytocin is known to increase the efficacy of a non-invasive thermal ablation method (MR-HIFU) for treating fibroids. However, it is not known whether this phenomenon is caused by the effect of the oxytocin on the myometrium or the fibroid itself. The objective of this study was to evaluate the influence of oxytocin on the blood flow of fibroids, myometrium and skeletal muscle using a quantitative perfusion MRI technique.. 17 premenopausal women with fibroids considered to be treated with MR-HIFU and 11 women with no fibroids were enrolled in the study. An extended MRI protocol of the pelvis was acquired for each subject. Later another MRI scan was performed with continuous intravenous infusion of oxytocin. The effect of oxytocin was analyzed from quantitative perfusion imaging. The study was registered in clinicaltrials.gov NCT03937401.. Oxytocin is effective in decreasing the blood flow in fibroids while having minor or no effect on the blood flow of normal myometrium. Routine use of oxytocin in HIFU therapy may make the therapy suitable to a larger group of women in a safe manner.

Topics: Female; High-Intensity Focused Ultrasound Ablation; Humans; Leiomyoma; Magnetic Resonance Imaging; Myometrium; Oxytocin; Treatment Outcome; Uterine Neoplasms

The use of a modified energy transmission protocol and oxytocin augmentation is being proposed as a high-intensity-focused ultrasound (HIFU) treatment for uterine fibroids, to aim for an effective and well-tolerable treatment to be given as an out-patient procedure without anesthesia or sedation. The objective of this study was to evaluate the safety and treatment effectiveness of this new protocol. The treatment outcomes of 9 consecutive patients (study group) were compared with those of 51 patients (control group) who had been randomized (1:1) to receive HIFU (n = 24) or uterine artery embolization ([UAE] n = 27). There was no major adverse event. At 3 mo, the median proportion of fibroid volume compared with the baseline was 51.1% in the study group, significantly smaller than that in the control groups (HIFU 76.6%, UAE 66.2%). At 6 mo, all patients in the study group became symptom free (9/9, 100%), a result significantly better than that of both control groups. The proportion of patients with good quality of life was significantly higher in the study group (5/7, 71.4%) compared with the control groups (HIFU 3/24, 12.5%; UAE 7/27, 25.9%). Within 24 mo, none of the patients in the study HIFU group required re-intervention, a result significantly better than that in the control HIFU group (15/24, 62.5%). The treatment could result in a very promising long-term imaging and clinical outcome that may be better than those of UAE; however, a randomized control trial of larger scale is required for further evaluation of this treatment.

Topics: Adult; Female; High-Intensity Focused Ultrasound Ablation; Humans; Leiomyoma; Middle Aged; Oxytocics; Oxytocin; Prospective Studies; Treatment Outcome; Uterine Artery Embolization; Uterine Neoplasms; Uterus

To explore the effect of oxytocin on uterine fibroids treated by ultrasound ablation.. Eighty-two single points in 29 uterine fibroids from 26 patients were sonicated with magnetic resonance imaging guided by high intensity focused ultrasound before and after using oxytocin. The required total energy, sonication time required to reach 60°C and the acoustic energy for increasing 1°C of temperature at the single point before and after using oxytocin were compared.. Before intravenous infusion of oxytocin, the average total sonication energy required to reach 60°C was (5320 ± 910) J and it took (21 ± 20) seconds for sonicating a single point, the energy required for increasing 1°C was (255 ± 302) J. In contrast, after intravenous infusion of oxytocin, the average total sonication energy required to reach 60°C was (2890 ± 325) J, and it took (12 ± 7) seconds for sonicating a single point, the energy required for increasing 1°C was (126 ± 94) J. Those three index all reached statistical difference (P = 0.002, P = 0.001, P = 0.002, respectively).. It seemed that Oxytocin could significantly decrease the energy required for ablating uterine fibroids, shorten treatment time and improve the treatment efficiency.

Topics: Adult; Contrast Media; Female; Fentanyl; High-Intensity Focused Ultrasound Ablation; Humans; Injections, Intravenous; Leiomyoma; Magnetic Resonance Imaging; Midazolam; Oxytocin; Retrospective Studies; Treatment Outcome; Ultrasonography; Uterine Neoplasms; Uterus

We report the case of a pregnancy of 16 weeks with anemia and a presumptive diagnosis of partial mole. In secondary care this diagnosis was ruled out through ultrasonography and diffuse cysts were found in the myometrium. Spectral Doppler ultrasound showed no flow, but it could be observed with power angiography. Cesarean section was performed at 38 weeks and hysterectomy 24 hours after because of intra-abdominal hemorrhage. Power angiography, spectral Doppler and serum human chorionic gonadotropin are the most useful diagnostic tools in the differential diagnosis of diffuse cavernous hemangioma of the uterus. Postpartum hemorrhage is a likely complication.

Topics: Blood Transfusion; Cesarean Section; Combined Modality Therapy; Diagnosis, Differential; Female; Hemangioma, Cavernous; Hemoperitoneum; Humans; Hydatidiform Mole; Hysterectomy; Infant, Newborn; Male; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications, Neoplastic; Ultrasonography; Uterine Neoplasms; Young Adult

To assess the expression of the oxytocin receptor (OTR) and the role of oxytocin (OT) in the proliferation of myometrial and leiomyoma cells.. Prospective laboratory study.. Research laboratory at the Italian National Research Council.. Twenty-two women who underwent therapeutic myomectomy for fibroids.. Primary cultures of leiomyoma and myometrium cells were established from eutopic and ectopic myometrial tissues. An immortalized myometrial cell line (h-TERTmyo) and a leiomyosarcoma cell line (SK-UT-1) were also characterized.. Expression of OTR and desmin mRNA was determined by quantitative real-time polymerase chain reaction. Cell growth was determined by 3-[4,5-dimethylthiazol-2-yl]5-(3-carboxymethoxyphenyl)2-(4-sulfophenyl)-2H tetrazolium assay. Apoptosis was determined by annexin V cell staining and flow cytometry analysis.. Oxytocin stimulated proliferation of primary myometrial and leiomyoma cells but inhibited the proliferation of h-TERTmyo and SK-UT-1, indicating a change in phenotype during immortalization. A progressive and rapid decrease in desmin and OTR mRNA was observed in primary cultures, indicating that myometrial cells dedifferentiate very rapidly in culture. The relative expression of OTR mRNA varied widely in both myometrial and leiomyoma smooth muscle cells, but there was no significant difference.. These results indicate that OT stimulates the proliferation of both myometrial and leiomyoma cells, demonstrating that the OT/OTR system plays an important role in regulating uterine cell growth and providing a rationale for evaluating the use of OTR antagonists in managing uterine myomas.

Topics: Adult; Apoptosis; Cell Differentiation; Cell Line, Tumor; Cell Proliferation; Cells, Cultured; Desmin; Female; Humans; Leiomyoma; Leiomyosarcoma; Myometrium; Oxytocics; Oxytocin; Prospective Studies; Receptors, Oxytocin; Uterine Neoplasms

Interaction of sex hormone-binding globulin (SHBG) and oxytocin (OT) is among the factors that control smooth muscle proliferation and tumor growth through the oxytocin receptor (OTR). Also, a close functional interaction of OTR and caveolin-1 has been shown to modulate cell growth and proliferation.. We studied surgical samples from 23 leiomyoma patients (aged 33-66 years) with immunocytochemistry. Specimens from five patients (34-76 years), who had hysterectomy for other reasons, served as controls. Tissue samples were cut into serial 1-microm thick sections for co-localization of SHBG, OTR, proliferation marker p21 and caveolin-1.. SHBG was found in smooth muscle cells in all samples. OTR staining occurred in most of these cells in myomas, while controls contained only scattered cells positive for OTR. There were no apparent differences in immunostaining for p21, while immunoreactivity for caveolin-1 was observed in most cells in myomas and in only few cells in controls. Caveolin-1 was mostly co-localized with SHBG and OTR in myoma samples whereas controls showed this co-localization only occasionally.. Our observations indicate an interaction of SHBG and OTR, associated with caveolin-1, which may account in part for known non-genomic actions of ovarian steroids. Growth of leiomyomas may be linked to these mechanisms.

Topics: Adult; Aged; Case-Control Studies; Caveolin 1; Cyclin-Dependent Kinase Inhibitor p21; Female; Humans; Immunohistochemistry; Leiomyomatosis; Middle Aged; Myometrium; Oxytocin; Receptors, Oxytocin; Sex Hormone-Binding Globulin; Uterine Neoplasms

We used an animal model to study uterine leiomyoma in the context of pregnancy-associated changes in gene expression and to determine how they might modulate tumor growth. Spontaneous tumors and normal myometrium were collected from Eker rats and compared with myometrial samples from pregnant animals. A leiomyoma-derived cell line was also used to assess pregnancy-related changes in gene expression and to determine the impact of signaling by the oxytocin receptor. Eker rat leiomyomas expressed several pregnancy-related genes, including connexin 43, oxytocin receptor (OTR), and cyclooxygenase (COX)-1; however, the tumors did not express COX-2, which is expressed in the parturient myometrium. The leiomyoma-derived cell lines also expressed OTR, which responds to estrogen, binds to oxytocin, and exhibits a calcium flux when stimulated with oxytocin. The OTR signaling mediated by oxytocin inhibited estrogen-stimulated growth of leiomyoma cells. Leiomyoma cells expressed many genes of the parturient myometrium, including OTRs, but were deficient in COX-2 expression. Signaling via the OTR appears to inhibit estrogen-induced cell proliferation, suggesting that signaling by this receptor might help mediate the protective effect of pregnancy on this disease.

Topics: Animals; Blotting, Western; Cell Division; Connexin 43; Cyclooxygenase 1; Cyclooxygenase 2; Dinoprostone; Estradiol; Female; Gene Expression; Immunohistochemistry; Isoenzymes; Leiomyoma; Membrane Proteins; Myometrium; Oxytocin; Polymerase Chain Reaction; Pregnancy; Prostaglandin-Endoperoxide Synthases; Rats; Receptors, Oxytocin; RNA, Messenger; Signal Transduction; Tumor Cells, Cultured; Uterine Neoplasms

Topics: Blood Loss, Surgical; Cesarean Section; Female; Humans; Infusions, Intravenous; Leiomyoma; Myometrium; Oxytocin; Pregnancy; Pregnancy Complications, Neoplastic; Uterine Neoplasms

The aim of this study was to assess whether there was a change in the mode of evacuation of GTD over two time periods and to assess whether mode of evacuation influenced the subsequent need for chemotherapy.. A retrospective case note study of 4257 cases between 1986 and 1996, at a screening and treatment center managing GTD, was performed.. Between the time periods 1986-1989 and 1990-1996 there was significant change in the mode of evacuation to suction curettage. The mode of evacuation was significant in determining the need for chemotherapy. The highest rate of chemotherapy was associated with medical methods of evacuation.. Suction curettage is a safe method of uterine evacuation in GTD and its usage has increased with time. Medical methods of uterine evacuation are associated with higher rates of chemotherapy. This is probably due to a higher rate of incomplete evacuation. Medical methods of evacuation should not be used in cases of complete hydatiform mole.

Topics: Abortifacient Agents, Steroidal; Dilatation and Curettage; Female; Humans; Hydatidiform Mole; Mifepristone; Oxytocin; Pregnancy; Prostaglandins; Retrospective Studies; Uterine Neoplasms; Vacuum Curettage

Women with uterine fibromyomas may suffer from dysmenorrhea, menorrhagia or infertility, which all may be due to an effect of the fibroids on uterine activity. The effect of myomectomy on uterine contractility is unknown.. In women undergoing myomectomy because of dysmenorrhea, menorrhagia or infertility, intrauterine pressure was recorded before and three months after the operation on corresponding days of the menstrual cycle. Records were obtained during spontaneous uterine activity as well as after oxytocin and vasopressin challenge by intravenous bolus injections of 10 pmol/kg body weight. The area under the recording curve (AUC), maximal amplitude of uterine contractions and deformation index of uterine pressure recordings were measured.. In six women, in whom recordings could be obtained before and after operation on corresponding days of late follicular phase of the menstrual cycle, the AUC and maximal amplitude of contractions increased after myomectomy. The effect of oxytocin injection also varied, whereas no difference was seen in effect of vasopressin.. It is suggested that women with uterine fibromyomas may have disturbed uterine spontaneous contractions and responsiveness, which may be regulated by myomectomy.

Topics: Adult; Female; Humans; Hysterectomy; Infertility, Female; Leiomyoma; Oxytocin; Uterine Contraction; Uterine Neoplasms; Uterus; Vasopressins

A retrospective study was undertaken to assess whether stimulation of uterine contractility prior to surgical evacuation of a molar pregnancy will lead to an increased frequency of persistent trophoblastic disease. Forty-seven patients treated with chemotherapy for persistent trophoblastic disease after a hydatidiform mole between 1971 and 1988 were evaluated. The use of medical methods in this study group was compared to a control group of 219 patients with hydatidiform mole not requiring further treatment. A medical method, mainly treatment with prostaglandins, was used in 61.7% in the study group compared to 35.2% in the control group. This difference was, however, due to different stage distribution in the groups. Persistent disease was significantly correlated to uterine size and medical methods were mainly used in patients where uterine size corresponded to 15 weeks gestation or more. In this subset of patients, a medical method was used in the same frequency in both groups. Thus, large uterine size seems to be an independent risk factor. We conclude that stimulation of uterine contractility, which in Sweden is frequently used before surgical evacuation of the uterus in patients with hydatidiform mole and large uteri, carries no additional risk.

Topics: Adolescent; Adult; Combined Modality Therapy; Female; Humans; Hydatidiform Mole; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Regression, Spontaneous; Neoplasm Staging; Oxytocin; Pregnancy; Prostaglandins; Retrospective Studies; Tocolysis; Uterine Neoplasms; Uterus

From July 1, 1969 to June 30, 1985, 381 patients received primary management for hydatidiform mole at Los Angeles County-University of Southern California Medical Center Women's Hospital. Three hundred fifty-eight of these women had complete records available for analysis. Of these, 277 women (77.4%) underwent suction curettage to remove the hydatidiform mole. Sharp curettage (41 patients, 11.5%), Pitocin (15, 4.2%), hysterectomy (12, 3.4%), prostaglandins (10, 2.8%), and hysterotomy (1, 0.3%) were used less frequently. Two patients (0.6%) had no therapy after spontaneous expulsion of a mole. Complications including infection, toxemia of pregnancy, anemia or hemorrhage, and postevacuation respiratory insufficiency were recorded in 242 patients (67.6%). This experience documents that hydatidiform mole is a high-risk pregnancy that requires prompt and intensive management. Suction curettage of the uterus is clearly the best means of management in most cases.

Topics: Abortion, Therapeutic; Curettage; Female; Humans; Hydatidiform Mole; Hysterectomy; Oxytocin; Pregnancy; Prostaglandins; Suction; Uterine Neoplasms

Topics: Cesarean Section; Female; Humans; Labor, Obstetric; Leiomyoma; Oxytocin; Pregnancy; Pregnancy Complications, Neoplastic; Uterine Neoplasms

Topics: Dilatation and Curettage; Dinoprostone; Female; Humans; Hydatidiform Mole; Hysterectomy; Labor, Induced; Oxytocin; Pregnancy; Prostaglandins E; Rh-Hr Blood-Group System; Uterine Neoplasms; Uterus

This study was designed to investigate the oxytocin (OT) specific binding receptors in 20,000 x g pellets of nonpregnant, first trimester and term human myometria. The receptor analysis was done using the lower uterine segment at term and the lower portion of the anterior uterine body in nonpregnant and first trimester subjects, and no difference was found in the myometrial receptor concentrations in the various uteri. The mean +/- S.D. values of the receptor dissociation constants were 3.33 +/- 0.50, 2.71 +/- 1.03 and 1.87 +/- 0.30 nM and the number of binding sites was 0.30 +/- 0.10, 0.50 +/- 0.10 and 1.50 +/- 0.50 pmol/mg protein at each stage studied, indicating that the gestational increase of uterine sensitivity to OT is due to the increase in myometrial OT binding sites as well as its binding affinity. Further, myometrial OT binding before and after the onset of labor was studied and a marked decrease in total myometrial OT binding was noticed; 35.6 +/- 13.0% before and 20.2 +/- 5.0% after. This decrease was thought to be due to the decrease in the number of binding sites from 1.50 +/- 0.50 to 0.74 +/- 0.21 pmol/mg protein after the onset of labor (p less than 0.01). No changes were found in the dissociation constants. Thus it seems that OT and its receptor coupling triggers labor or is involved in the early steps of labor.

Topics: Adult; Female; Humans; Leiomyoma; Myometrium; Oxytocin; Pregnancy; Pregnancy Complications, Neoplastic; Pregnancy Trimester, First; Receptors, Cell Surface; Receptors, Oxytocin; Uterine Neoplasms; Uterus

Topics: Adult; Estrogens; Female; Gonadotropins; Humans; Lactation; Leiomyoma; Oxytocin; Postpartum Period; Pregnancy; Pregnanediol; Prolactin; Uterine Neoplasms

Topics: Adult; Female; Histamine; Humans; Leiomyoma; Middle Aged; Oxytocin; Uterine Contraction; Uterine Neoplasms; Uterus

Topics: Adenocarcinoma; Animals; Carcinoma, Bronchogenic; Choriocarcinoma; Culture Media; Diuresis; Female; In Vitro Techniques; Liver; Liver Neoplasms; Lung Neoplasms; Neoplasm Metastasis; Oxytocin; Pancreatic Neoplasms; Pregnancy; Rats; Recurrence; Uterine Neoplasms; Vasopressins

Topics: Abortion, Induced; Adenocarcinoma; Blood Coagulation Disorders; Carcinoma in Situ; Carcinoma, Squamous Cell; Curettage; Dilatation; Embryo, Mammalian; Female; Fetus; Gestational Age; Humans; Hypernatremia; Hypertonic Solutions; Lymphatic Metastasis; Oxytocin; Pregnancy; Prognosis; Thromboplastin; United States; Uterine Cervical Neoplasms; Uterine Neoplasms; Vaginal Smears

Topics: Adult; Arteries; Blood Flow Velocity; Blood Pressure; Depression, Chemical; Electromagnetic Phenomena; Female; Humans; Leiomyoma; Methods; Methylergonovine; Middle Aged; Oxytocin; Regional Blood Flow; Rheology; Uterine Neoplasms; Uterus

Topics: Aminopeptidases; Female; Humans; Hypothalamo-Hypophyseal System; Leiomyoma; Oxytocin; Uterine Neoplasms; Water-Electrolyte Balance

Topics: Adult; Biopsy; Cesarean Section; Endometrium; Female; Humans; Hysterectomy; Meconium; Obstetric Labor Complications; Oxytocin; Pregnancy; Sarcoma; Uterine Neoplasms

Topics: Choriocarcinoma; Female; Humans; Hydatidiform Mole; Hysterectomy; Mortality; Oxytocin; Pregnancy; Trophoblastic Neoplasms; Uterine Neoplasms

Topics: Cervix Uteri; Choriocarcinoma; Chorionic Gonadotropin; Diagnosis; Female; Gonadotropins; Humans; Hydatidiform Mole; Hysterectomy; Methotrexate; Mortality; Oxytocin; Pregnancy; Surgical Procedures, Operative; Uterine Neoplasms

Topics: Abortion, Induced; Abortion, Missed; Abortion, Spontaneous; Abortion, Therapeutic; Drug Therapy; Female; Humans; Hydatidiform Mole; Oxytocin; Pregnancy; Uterine Neoplasms

Topics: Abortion, Induced; Abortion, Missed; Abortion, Spontaneous; Female; Humans; Hydatidiform Mole; Oxytocics; Oxytocin; Pregnancy; Uterine Neoplasms