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Podcast family in this episode, which I think is going to be pretty darn brief. It really is kind of a mini episode because I just wanted to put this together. I thought it was too good not to, because just recently I was asked to opine on some series of events that happened intrapartum, not at our institution, not with somebody I'm personally connected to. I just asked to give my opinion on a series of events. We're not gonna give any names, any locations, but I thought there was enough there for medical education that we should put a mini episode together to answer this one little brief question. Once again, I was asked to opine. That's a good word. Opine on the use of oxytocin. So synthetic oxytocin, pitocin, intrapartum, and the risk of placental abruption just by the use of intrapartum synthetic oxytocin, otherwise known as oxytocin now. And I've got no skin in the game. I don't know the people who are involved with this. I just asked once again for my opinion. And I said very easily, well, my opinion is one thing, but what you're really asking for is what does the data show? Which is what I'm going to do because there's a lot of weird stuff out there, especially on quote unquote, anecdotal experience, which is what somebody had contributed to the conversation. Well, in my experience. Well, brother, let's just stop right there. Your opinion don't mean your experiences don't mean anything because experiences are personal, experiences may not be reproducible, and experiences definitely don't make for evidence based medicine. So I was asked to give a rebuttal to this statement which said, in my experience, I have seen that intravenous synthetic oxytocin, in other words, pitocin, leads to an increase of placental abruption intrapartum. And I was like, whoa, whoa, whoa, whoa, whoa, hold on. In your experience, where's the data? Well, there's no data given. I mean, it's very clear. The answer is in my experience, this is what I have seen once Again, experiences are great. Not minimizing his or her experience, but we are not looking for somebody's individual experience. That's fine to flavor the meat, but the meat itself is what is reproducible based on the evidence. The, a burden of proof on whether something does or does not do something that, that you're accusing it of. Now, uncontrolled pitocin use does have some issues. We're going to cover that, of course, but. But is placental abruption one of them? We do have lots of evidence here that is going to answer this question for us. But, but it's very easy. When I, when I was approached, hey, would you mind, we just, you know, give us your, your opinion opinion on this. And so it's very easy. I'm like, look, you want my opinion or do you want the facts? Because what I'm going to give you isn't my opinion, it's the fact one answers. I think I'm entitled. You want answers? The truth. I'm going to give you the truth, not just my opinion because again, thankful for people's opinions. That's great. But you know what they say about people's opinions. It's really about what is reproducible. So we're going to answer this. Does intrapartum pitocin increase the risk of abruption? That's it. Does intrapartum pitocin increase the risk of abruption? And I'm not minimizing that. Once again, before we leave the intro, which we're about to do, I'm not minimizing that. Oxytocin used incorrectly or without some kind of control can lead to some problems. But is abruption one of them? The answer may surprise you. I think I've set it up enough. Now that we've done all that, let's get out of the intro. Will be right back. This is Dr. Chapa's OB GYN. No spin. Podcast it.
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And it also bred this ridiculous notion we've always had my opinion is worth as much as your opinion. But now we've got my opinion is worth as much as your fact, which is nonsense. So there is a skit. It's actually coming from a pretty funny guy, but it's not funny at all. He's actually trying to make a great point here by Ricky Gervais. Ricky Gervais has this little thing on social media and the demise of facts. And I love that little quote that he had. I mean, for being a comedian, boy, he nailed it. Which is we're now in the time when, you know, my opinion is just as good as somebody's fact. No, it's not. It's just your opinion, which is fine and everyone's opinion should be valued and respected, but it doesn't make it a fact. It's just insanity. So anyway, I just found that so fitting by Ricky Gervais, not a sponsor. So that's what we're talking about here because again, somebody apparently gave their opinion and stated that and that was the downfall of the argument. Outside of the fact that it wasn't based on the data, which was. Well, in my experience, in my opinion, intravenous oxytocin, otherwise known as pitocin, increases the risk of potential abruption over spontaneous labor and offered no data. And they even try to get him there. Well, where does that come from? Well, I've got X years of experience, which therefore makes me correct. What? Insanity. Insanity. So to be very clear, I'm not on anybody's quote unquote side. I just have to. At some point you're like bruh, bruh. No, the facts are this and stop giving misinformation or mislead the information, disinformation, whatever you want to call it, about something that sometimes we have to use appropriately, you know, synthetic oxytocin. Pitocin is the most commonly used medical intervention in labor and delivery. So by the way, as a little aside, have you ever asked most common ish something and know what they're asking for? What is the most common surgery in obstetrics? Of course that's a C section. What's the most common intervention? You know, something that's done non medical, just intervention, that's electronic fetal monitoring. What's the most Common medication in obstetrics, hands down, that's Pitocin. So just little tidbits on when you're asked that you have to be clarified what exactly you talked about. Most common, what most common surgery, most common intervention, most common medication. Because pitocin is the most common medication, medical intervention across the world in obstetrics, whether that's intrapartum or postpartum for control of postpartum hemorrhage. But this was the issue. And I just, Man, I flipped my lid. I'm like, oh, my goodness, you cannot say that because your opinion, which we respect, but in all due respect, means nothing. The use of Pitocin or oxytocin during labor does not be very clear, does not increase the risk of placental abruption or when done correctly. Now that's the key word. When done correctly. And people get into this, well, is that low dose or high dose? Pit. The answer is whatever. It doesn't matter. That's why we don't have only one protocol. Whether it's the old Parkland high dose protocol, whether it's traditional low dose protocol, it doesn't matter. The fact is, is that labor in and of itself, whether spontaneous or augmented, induced by an agent, it really does not increase. I'm sorry, has a baseline risk of abruption, and it's not increased any further based on the use of Pitocin. It's just an inherent risk of labor, period. Now, if you're saying, well, where does that come from? Look, man, lots of data. There was one large retrospective review of close to 300,000 women. I don't want somebody to send me something ugly because I'm gonna give you the exact number. It was actually 260,000. Right. So 260k found that the use of utero tonics, including oxytocin, quote, is not associated with an increased risk of placental abruption after adjusting for confounders like maternal age, parity, hypertension, and other maternal risk factors, end quote. And that's very well published. Now, there's things that increase the risk of abruption. Hypertension, of course, rapid uterine decompression, intrapartums or poly that gets ruptured, that decompression can lead to abruption. The. There's idiopathic abruption, of course there is the facts of illegal substances like amphetamines or cocaine that can lead to placental eruption. We know that there's things that can do that. But is oxytocin one of them? Based on that data, the answer is no. Now, that data actually came out of archives in gynecology and Obstetrics back in 2014 about 10 years ago. And the title of that publication was do uterotonic drugs increase the risk of abrupto placenta and eclampsia? And the answer was no. So, and that's not the only one. Also in ACOG's first and second stage of labor management, while it does say, while ACOG does say, look uses of oxytocin, this was in clinical practice guidance, the CPG which we covered, number eight, it says that there is some potential complications of either low and high risk oxytocin that can include tachystole with fetal heart rate abnormalities. It can increase the risk for cesarean section because of those fetal heart rate abnormalities. It may increase the risk of uterine rupture. It may increase the risk of Bandel's band formation, especially with obstructed labor over a prolonged period of time. And we've covered Bandle's band B, A, N, D, L, E Bandle's band in the past, but it does not, it does not increase in and of itself the risk of placental abruption. Now, should the patient have a rupture, a uterine rupture, of course, that therefore can increase the risk of an abruption, but that's a secondary factor. The primary is the uterine rupture. So based on the current evidence that we have as of right now, although oxytocin administered synthetically through an IV in the form of Pitocin, while that can increase, and there's real issues here, guys, I mean you gotta be careful with it. Now I'm not minimizing that. I mean it can cause both hypotension and in some cases based on certain anesthetic agents, hypertension that's been reported. And fetal heart rate abnormalities, mainly due to tachysystole, which is more than five contractions over a 10 minute interval, averaged over 30 minutes. Those are real issues. And of course you can increase the risk of uterine rupture, not just in those patients who've had prior section, although the risk is again just slightly above spontaneous. But even in those who've had maybe adenomyosis. We've covered the uterine rupture in the non scarred uterus in the past. That's just part of the labor process. But this person, this, this very well respected author who said that yes, synthetic oxytocin can increase the risk of a potential abruption. No sir, that's not what the data show. So I want to Be very clear. I am not minimizing, once again, just for on the record, the risks of inadvertent or misused intravenous pitocin. But this is how things get out of hand because somebody on social media may have heard and or seen or experienced an abruption as a side effect of something else, like potentially uterine rupture or preeclampsia or whatever. And there were also. It just happened to be that they were on oxytocin and the two get married together. But as far as we know, the current published data and guidelines do not support an association between oxytocin administration during labor and an increased risk of placental abruption. Tachycystole, check. Fetal heart rate abnormalities, check. Especially if that first issue of tachycystole is there. Increased risk of C section, sure. Increased risk of postpartum hemorrhage, usually because of pitocin receptor saturation and uterine fatigue. Yes. But abruption in and of itself as a standalone complication is not. Let me say that again, is not supported in the data. And just very quickly, and then we're going to wrap this up. There is actually a publication even further back almost 24 years ago, guys, in the journal Maternal fetal medicine in 2001 that looked at this. The title is Oxytocin using Grand Moliparous Patients Safety and Complications. Because if there's any patient at risk for issue, intrapartum is a grand moltip, right? They're at risk already for abruption, potentially for uterine rupture, definitely for a postpartum hemorrhage, just because of the wear and tear, so to speak, of a uterus intrapartum. And According to this 2001 report, and again, it's nothing perfect. I mean it was a review of the cases, but they looked at over 11,000 grand multi pairs patients, grand multipairs patients, and no significant differences were found between the oxytocin and the control groups in the rates of placental abruption. That's the evidence that along with clinical Practice guidance number eight, along with that other large retrospective study of 260,000 patients say that oxytocin has to be respected. But does oxytocin increase the risk of abruption? Which was all I was asked to opine on. That's just that one factor. The answer, as far as we know as of October 2025 seems to be no. Podcast family. I told you this was quick. I just wanted. I found that interesting. I'm like, we're going to do this as a mini episode, in case you're asked about it. It may accompany some other adverse issue, but oxytocin alone equals abruption alone doesn't seem to be supported based on the evidence. That's not opinion. That is evidence based data. Now that we've done all that, podcast family, Michael, let's take it home. This has been Dr. Chapa Zobetyn, no Spin Podcast Podcast family. Thank you for your support. Thank you for listening. And as always, we'll see you on another episode of the no Spin podcast. Sam.