References

Aalkjaer C, Peng HL. pH and smooth muscle. Acta Physiologica Scandinavica. 1997; 161:(4)557-66

Aguilar HN, Mitchell BF. Physiological pathways and molecular mechanisms regulating uterine contractility. Human Reproduction Update. 2010; 16:(6)725-744

Archer JR. Points from letters: synthetic oxytocin. 1969; 3

Association of Ontario Midwives. Life After Postpartum Haemorrhage: Recovering from the Unexpected. 2017. https://www.ontariomidwives.ca/sites/default/files/CPG%20client%20resources/Life-after-PPH-English.pdf (accessed 16 September 2021)

Barley SL, Ripman HA. Induction of labour with synthetic oxytocin. British Medical Journal. 1970; 4:(5726)55-56

Beazley JM, Bamovic I, Feld MS. Maintenance of labour. British Medical Journal. 1975; 2:(5965)248-250

Berde B. Some observations on the circulatory effects of oxytocin, vasopressin and similar polypeptides. In: Pinkerton JHM (ed). London: Pergammon Press Ltd; 1965

Bhogal K. Focus on cardiotocography: Intrapartum monitoring of uterine contractions. British Journal of Midwifery. 2017; 25:(8)491-497

Bobrow CS, Soothill PW. Causes and consequences of fetal acidosis. Archives of Disease in Childhood - Fetal and Neonatal Edition. 1999; 80:F246-F249

Brinsden PRS, Clark AD. Postpartum Haemorrhage after induced and spontaneous labour. British Medical Journal. 1978; 2:(6141)855-856

Brinsden PR, Clark AD. Postpartum haemorrhage and induction of labour. BMJ. 1979; 1

British National Formulary. Oxytocin. 2021. https://bnf.nice.org.uk/drug/oxytocin.html (accessed 17 September 2021)

Brown DB. Syntometrine. BMJ. 1962; 2

Brown DB. Oxytocic drugs in labour. BMJ. 1968; 1

Budden A, Chen LJY, Henry A. High-dose versus low-dose oxytocin infusion regimens for induction of labour at term. Cochrane Database of Systematic Reviews. 2014;

Butterworth JF, Mackey DC, Wasnick JD. Fluid management and blood component therapy, 6th edition. In: Butterworth JF, Mackey DC, Wasnick JD (eds). Ohio: McGraw-Hill Education; 2018

Chukudebelu WO, Marshall AT, Chalmers JA. Use of “Syntometrine” in the third stage of labour. BMJ. 1963; 1:1390-1391

Coltart TH, Nash TG. Pitocin buccal in late pregnancy. BMJ. 1974; 3

Dupont C, Carayol M, Le Ray C Oxytocin administration during spontaneous labour: guidelines for clinical practice. Gynécologie, obstétrique, fertilité & sénologie Fédération nationale des collèges de gynécologie médicale. 2017; 45:(1)56-61

Physical and psychological aspects of pain in obstetrics. 2012. https://www.intechopen.com/chapters/40395 (accessed 28 September 2021)

Embrey MP, Barber DTC, Scudamore JH. Use of “syntometrine” in prevention of post-partum haemorrhage. BMJ. 1963; 1

Feeney JG. Water intoxication and oxytocin. BMJ. 1982; 285:(6337)

Fitzpatrick RJ, Walmsley CF. The release of oxytocin during parturition. In: Pinkerton JHM (ed). London: Pergamon Press Ltd; 1965

Ford JB, Roberts CL, Simpson JM Increased postpartum hemorrhage rates in Australia. International Journal of Gynecology & Obstetrics. 2007; 98:(3)237-43

Griffiths SK, Campbell JP. Placental structure, function and drug transfer. British Journal of Anaesthesia: Continuing Education in Anaesthesia Critical Care & Pain. 2015; 15:(2)84-89

Hofmeyr G, Abdel-Aleem H, Abdel-Aleem MA. Uterine massage for preventing postpartum haemorrhage. Cochrane Database of Systematic Reviews. 2013;

Hytten FE, Paintin DB. Increase in plasma volume during normal pregnancy. International Journal of Obstetrics and Gynaecology. 1963; 70:(3)402-407

JHP Pharmaceuticals. Pitocin Archived. 2009. https://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=10055 (accessed 11 September 2021)

Kemp J. Clinical trial of “Syntometrine” in the third stage of labour. BMJ. 1963; 1

Kent Pharma Ltd. Oxytocin 10 IU/ml solution for injection. 2018. https://www.medicines.org.uk/emc/product/12690/smpc#gref (accessed 30 September 2021)

Knight M, Callahan WM, Berg C Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC Pregnancy & Childbirth. 2009; 9

Loscul C, Chantry AA, Caubit L Association between oxytocin augmentation intervals and the risk of postpartum haemorrhage. Journal de Gynécologie Obstétrique et Biologie de la Reproduction. 2015; 45:(7)708-15

Mansy A. Does labor augmentation with oxytocin increase the risk of postpartum hemorrhage? A randomized controlled trial. Clinics in Mother and Child Health. 2017; 14

Manuelsweb.com. Manuel's web allowable blood loss calculator. 2017. https://www.manuelsweb.com/blood_loss.htm (accessed 15 February 2021)

MacKenzie IZ, Castle B, Bellinger J. Transfer of prostaglandins to the fetus after prostaglandin E2 vaginal pessary administration. American Journal of Obstetrics and Gynaecology. 1989; 161:(4)920-923

Moodie JE, Moir DD. Ergometrine, Oxytocin, and Extradural Analgesia. British Journal of Anaesthesia. 1976; 48

Mylan Products Ltd. Syntocinon 5 IU. 2019. https://www.medicines.org.uk/emc/product/9736/smpc (accessed 1 September 2021)

National Collaborating Centre for Women's and Children's Health. Induction of Labour. 2008. https://www.nice.org.uk/guidance/cg70/evidence/cg70-induction-of-labour-full-guideline2 (accessed 7 May 2021)

Normington EAM. A Simplified method of syntocinon infusion following amniotomy. The Journal of Obstetrics and Gynaecology of the British Commonwealth. 1972; 79:(12)1108-1112

Nursing and Midwifery Council. The Code. Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates. 2018. https://www.nmc.org.uk/standards/code/ (accessed 28 September 2021)

NHS Digital. NHS Maternity Statistics England. 2016. https://digital.nhs.uk/data-and-information/publications/statistical/nhs-maternity-statistics/2016-17 (accessed 3 September 2021)

Oxytocinmeasures.com. Synthetic Oxytocin Graphics and Charts. 2021. https://img1.wsimg.com/blobby/go/cefe1145-35a3-404d-b032-bf7c9a96111f/downloads/Synthetic%20Oxytocin%20Graphics%20and%20Charts%20-__%20 (accessed 2 September 2021)

O'Driscoll K, Jackson RJA, Gallagher JT. Prevention of prolonged labour. BMJ. 1969; 2:477-480

Patterson JH. Third stage of labour. BMJ. 1964; 1

Pinkerton JHM. Buccal Oxytocin. British Medical Journal. 1964; 2:(5421)

Pinkerton JHM. Some observations on the circulatory effects of oxytocin, vasopressin and similar polypeptides. In: Pinkerton JHM (ed). London: Pergammon Press Ltd; 1965

Pehlivanoglu B, Bayrak S, Dogan M. A close look at the contraction and relaxation of the myometrium; the role of calcium. Journal Of The Turkish-German Gynecological Association. 2013; 14:(4)230-234

Royal College of Obstetrics and Gynaecologists. Induction of labour RCOG evidence-based clinical guidelines. 2001. http://www.perinatal.sld.cu/docs/guiasclinicas/inductionoflabour.pdf (accessed 15 February 2021)

Induction of labour, 2nd edition. London: RCOG; 2008

Royal College of Obstetrics and Gynaecologists. Heavy bleeding after birth (postpartum haemorrhage). 2016. https://www.rcog.org.uk/en/patients/patient-leaflets/heavy-bleeding-after-birth-postpartum-haemorrhage/ (accessed 16 September 2021)

Salameh AI, Ruffin VA, Boron WF. Effects of metabolic acidosis on intracellular pH responses in multiple cell types. The American Journal of Physiology Regulatory, Integrative and Comparative Physiology. 2014; 307:(12)R1413-1427

Stallworthy J. A Plea for the freer use of blood transfusion in obstetrics. BMJ. 1939; 1

Steer PJ, Little DJ, Lewis NL Uterine activity in induced labour. International Journal for Obstetrics and Gynaecology. 1975; 82:(6)433-441

Svanstrom MC, Biber B, Hanes B Signs of myocardial ischaemia after injection of oxytocin: a randomized double-blind comparison of oxytocin and methyl-ergometrine during Caesarean section. British Journal of Anaesthesia. 2008; 100:(5)683-689

Theobald GW, Graham A, Campbell BJ The use of post-pituitary extract in physiological amounts in obstetrics. A preliminary report. British Medical Journal. 1948; 2:(4567)123-127

Theobald GW. Home on the second day: the Bradford experiment. British Medical Journal. 1959; 2:(5163)1364-1367

Theobald GW. Buccal Oxytocin. British Medical Journal. 1965; 1:(5428)190-192

Theobald GW. Induction of labour with buccal oxytocin. British Medical Journal. 1966a; 1:(5501)

Theobald GW. Buccal oxytocin. British Medical Journal. 1966b; 2:(5514)645-646

Thompson JF, Heal LJ, Roberts CL, Ellwood DA. Women's breastfeeding experiences following a significant primary postpartum haemorrhage: A multicentre cohort study. International Breastfeeding Journal. 2010; 5

Vrachnis N, Malamas FM, Stavros S The oxytocin-oxytocin receptor system and its antagonists as tocolytic agents. International Journal of Endocrinology. 2011; 2011

Walsh D. Pain and epidural use in normal childbirth. Evidence Based Midwifery. 2009; 7:(3)89-93

Weeks A, Neilson J. Rethinking our approach to postpartum haemorrhage and uterotonics. British Medical Journal. 2015; 351

Weeks A, Cunningham C, Taylor W A phase 2 clinical trial of the PPH Butterfly, a new device to ‘turn off the tap’ of Post-Partum Hemorrhage.: Authorea; 2021

World Health Organization. Managing complications in pregnancy and childbirth: a guide for midwives and doctors. 2017. http://www.who.int/maternal_child_adolescent/documents/managing-complications-pregnancy-childbirth/en/ (accessed 22 March 2021)

Postpartum haemorrhage and synthetic oxytocin dilutions in labour

02 October 2021

Professional

02 October 2021

Volume 29 · Issue 10

ISSN (print): 0969-4900

ISSN (online): 2052-4307

Abstract

This study investigated postpartum haemorrhage and historic oxytocin usage, because haemorrhage rates are rising. During the evolution of practice from intravenous bovine post-pituitary extract to synthetic oxytocin, experimental interventions had produced improved outcomes in certain cases and the postpartum haemorrhage rate was low. In this study, current synthetic oxytocin regimes from across the UK were compared with the 1977 (unchanged) licensed instructions for infusion. As a result of the pain-inducing properties of synthetic oxytocin, epidural analgesia prior to infusion is now standard for unlicensed regimes, adding complexity to intrapartum care and greater risks of complex births, as the fetus may be adversely affected by epidural drugs and acidosis. Unlicensed synthetic oxytocin dilutions and increments, the desensitising of oxytocin receptors, and unmeasured error factors in infusion pumps affect labour progress and outcomes. Today's rates of postpartum haemorrhage are associated with these changes to obstetric practice. Failure to inform women of intended unlicensed practices with synthetic oxytocin, or obtain consent for such, or offer licensed practice as standard constitutes neglect of the legal obligations outlined for doctors and midwives by professional Codes of Practice, intended to protect patients from predictable dangers.

The author, Monica Tolfari's experiences listening to women and their families in debrief and antenatal clinics between 2014 and 2018 have revealed that the impact of massive bleeds is enormous and lasts for years, causing fear not only for themselves but also for family and friends. This fully justifies historical efforts by obstetricians and midwives to prevent maternal morbidity and death from postpartum haemorrhage (Stallworthy, 1939; Brown, 1962; 1968; Chukudebelu et al, 1963; Embrey et al, 1963; Kemp, 1963; Patterson, 1964; O'Driscoll et al, 1969; Brinsden and Clark, 1979; Weeks et al, 2021).

In their early careers, both authors observed minute blood losses after spontaneous labours. Later returning to work on a labour ward, Monica was surprised to find major postpartum haemorrhage being normalised by some midwives and obstetricians.

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Synthetic oxytocin

Postpartum haemorrhage

Labour