The effect of low dose oxytocin infusion on cerebral hemodynamics in preeclamptic women.

Griffioen, A.C. (Annemiek) (2013) The effect of low dose oxytocin infusion on cerebral hemodynamics in preeclamptic women. thesis, Medicine.

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Abstract

Introduction: Hypertensive disorders of pregnancy complicate about 5-10% of pregnancies. Cerebral complications, such as hemorrhage, edema and encephalopathy are the leading causes of death in those patients. Previous studies have shown alterations in the cerebral hemodynamics in those patients, when compared to healthy pregnant women. Labor is induced in 23,4% of pregnancies in the United States, with oxytocin being one of the most common used medications. Low dose oxytocin infusion does not seem to affect the cerebral hemodynamics in normal pregnant women, but the effect on women with hypertensive disorders is not known. Therefore, the aim of this study was to determine the acute effect of induction-dose oxytocin on the cerebral hemodynamics in the first 30 minutes after induction in pregnant hypertensive women. Secondary the effect of induction-dose oxytocin after two hours was evaluated. Methods: In this prospective observational study, Transcranial Doppler sonography (TCD) was used to measure the blood flow velocity in the proximal portion of the middle cerebral artery (MCA). Measurements were done at baseline and 30, 60, and 120 minutes after the start of oxytocin infusion. The peak systolic velocity (PSV), mean velocity (MV) and diastolic velocity (DV) were used to calculate the resistance index (RI), pulsatility index (PI) and cerebral perfusion pressure (CPP). The values of these different hemodynamic parameters were checked for normality. For the acute effect the paired t-test was used (the Wilcoxon Signed Rank Test for not normally distributed data), the longitudinal comparisons between the different time points were done with the One Way Repeated Measures ANOVA (on Ranks if the data were not normally distributed). Results: Thirteen patients with elevated blood pressures who were admitted for induction of labor were studied. The PSV, MV and DV were significantly elevated (P=0.020, P=0.030, and P=0.049 respectively) 30 minutes after initiation of oxytocin infusion. One and two hours after oxytocin initiation, those values were returned to the baseline. The patients with preeclampsia did not show any significant change in one of the measured parameters at one of the timepoints, when compared with patients with gestational hypertension. Maternal age showed a significant correlation with PSV at all four timepoints (p=0.034, p=0.004, p=0.038, p=0.011 respectively). None of the other demographic or clinical parameters showed significance. Conclusion: Oxytocin causes an acute change in cerebral hemodynamics in pregnant women with hypertensive disorders. These changes were reversible within one hour. These data suggest a safe use of oxytocin in the daily practice for induction of labor in women with elevated blood pressures.

Item Type:	Thesis (Thesis)
Supervisor name:	Berg, P.P. van den
Supervisor name:	Haeri, S. MD and Texas Children’s Hospital, Pavilion for Women and Houston, TX
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:39
Last Modified:	25 Jun 2020 10:39
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/121

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