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Maternal plasma levels of oxytocin during physiological childbirth - a systematic review with implications for uterine contractions and central actions of oxytocin.

Forskningsöversiktsartikel
Författare Kerstin Uvnäs-Moberg
Anette Ekström-Bergström
Marie Berg
Sarah Buckley
Zada Pajalic
Eleni Hadjigeorgiou
Alicja Kotłowska
Luise Lengler
Bogumila Kielbratowska
Fatima Leon-Larios
Claudia Meier Magistretti
Soo Downe
Bengt Lindström
Anna Dencker
Publicerad i BMC pregnancy and childbirth
Volym 19
Nummer/häfte 1
Sidor 285
ISSN 1471-2393
Publiceringsår 2019
Publicerad vid Centrum för personcentrerad vård vid Göteborgs universitet (GPCC)
Institutionen för vårdvetenskap och hälsa
Sidor 285
Språk en
Länkar dx.doi.org/10.1186/s12884-019-2365-...
www.ncbi.nlm.nih.gov/entrez/query.f...
Ämneskategorier Annan hälsovetenskap, Annan medicinsk grundvetenskap

Sammanfattning

Oxytocin is a key hormone in childbirth, and synthetic oxytocin is widely administered to induce or speed labour. Due to lack of synthetized knowledge, we conducted a systematic review of maternal plasma levels of oxytocin during physiological childbirth, and in response to infusions of synthetic oxytocin, if reported in the included studies.An a priori protocol was designed and a systematic search was conducted in PubMed, CINAHL, and PsycINFO in October 2015. Search hits were screened on title and abstract after duplicates were removed (n = 4039), 69 articles were examined in full-text and 20 papers met inclusion criteria. As the articles differed in design and methodology used for analysis of oxytocin levels, a narrative synthesis was created and the material was categorised according to effects.Basal levels of oxytocin increased 3-4-fold during pregnancy. Pulses of oxytocin occurred with increasing frequency, duration, and amplitude, from late pregnancy through labour, reaching a maximum of 3 pulses/10 min towards the end of labour. There was a maximal 3- to 4-fold rise in oxytocin at birth. Oxytocin pulses also occurred in the third stage of labour associated with placental expulsion. Oxytocin peaks during labour did not correlate in time with individual uterine contractions, suggesting additional mechanisms in the control of contractions. Oxytocin levels were also raised in the cerebrospinal fluid during labour, indicating that oxytocin is released into the brain, as well as into the circulation. Oxytocin released into the brain induces beneficial adaptive effects during birth and postpartum. Oxytocin levels following infusion of synthetic oxytocin up to 10 mU/min were similar to oxytocin levels in physiological labour. Oxytocin levels doubled in response to doubling of the rate of infusion of synthetic oxytocin.Plasma oxytocin levels increase gradually during pregnancy, and during the first and second stages of labour, with increasing size and frequency of pulses of oxytocin. A large pulse of oxytocin occurs with birth. Oxytocin in the circulation stimulates uterine contractions and oxytocin released within the brain influences maternal physiology and behaviour during birth. Oxytocin given as an infusion does not cross into the mother's brain because of the blood brain barrier and does not influence brain function in the same way as oxytocin during normal labour does.

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Denna text är utskriven från följande webbsida:
http://www.gu.se/forskning/publikation/?publicationId=283669
Utskriftsdatum: 2019-11-12