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Title: Maternal plasma levels of oxytocin during physiological childbirth - A systematic review with implications for uterine contractions and central actions of oxytocin
Authors: Uvnäs-Moberg, Kerstin 
Ekström, Anette 
Berg, Marie Louise Lekås 
Buckley, Sarah 
Pajalić, Zada 
Hadjigeorgiou, Eleni 
Kotłowska, Alicja 
Lengler, Lengler 
Kiełbratowska, Bogumiła 
León Larios, Fátima 
Magistretti, Claudia Meier 
Downe, Soo 
Lindström, Bengt 
Dencker, Anna 
Major Field of Science: Medical and Health Sciences
Field Category: Basic Medicine
Keywords: Birth;Central effects;Infusion of synthetic oxytocin;Neurobiology;Oxytocin;Physiological labour;Plasma levels;Pregnancy;Uterine contractions
Issue Date: 9-Aug-2019
Source: BMC Pregnancy and Childbirth, 2019, vol. 19, no. 1
Volume: 19
Issue: 1
Journal: BMC Pregnancy and Childbirth 
Abstract: Background: 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. Methods: 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. Results: 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. Conclusions: 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. © 2019 The Author(s).
ISSN: 14712393
DOI: 10.1186/s12884-019-2365-9
Rights: © The Author(s)
Type: Article
Affiliation : Cyprus University of Technology 
Swedish University of Agricultural Sciences 
University of Skövde 
University West Trollhättan 
University of Agriculture 
University of Gothenburg 
University of Queensland 
Oslo and Akershus University College of Applied Sciences 
Medical University of Gdansk 
Hannover Medical School 
University of Seville 
Lucerne University of Applied Sciences and Arts 
University of Central Lancashire 
Norwegian University of Science and Technology 
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