Efficacy of an Alternative Oxytocin Dosing Regimen for Postpartum Hemorrhage Prevention at Cesarean Delivery [13P]

Abstract

INTRODUCTION: In 2013, the University of New Mexico Hospital transitioned from a 20IU oxytocin infusion to a “rule of threes” algorithm (3 IU of oxytocin titrated to uterine tone) for prevention of postpartum hemorrhage (PPH) at time of cesarean delivery. This study seeks to identify whether PPH rates have been affected by this change in oxytocin dosing. METHODS: This is a retrospective cohort study comparing PPH rates before and after an institutional shift in oxytocin administration at the time of cesarean delivery. IRB exemption was obtained for this study. Medical records were reviewed for scheduled and unscheduled cesarean section patients before and after the protocol change. 225 patients in each group were randomly selected for the analysis. Our primary outcome was the rate of PPH, determined by estimated blood loss reported by the surgeon. Secondary outcomes included administration of additional uterotonic agents, transfusion, hysterectomy, vasopressor administration, and mortality. RESULTS: There were no significant differences in age, gravidity, parity, prior number of cesarean sections, gestational age, BMI, fetal weight, or induction of labor. Women who received the 20IU oxytocin infusion had a significantly lower rate of PPH (22.2%) compared to “rule of threes” dosing (32.4%, Fishers test P=.0198). CONCLUSION: Our data show an increased rate of PPH with a rule of threes oxytocin dosing at the time of cesarean section compared with infusion dosing of oxytocin. These data indicate that rule of threes dosing may not be applicable to a wider patient population.

Image Analysis Application of Motherwort Total Alkaloid Injection in the Treatment of Postabortion Hemorrhage

“…Ultrasound image examination: scanning the pelvic cavity from multiple angles focus on observing the shape and size of the uterus, whether there are abnormal echoes in the myometrium and uterine cavity, and whether there are other abnormalities in the double appendage area and the pelvic cavity. When an abnormal echo is found in the uterine cavity or muscle layer, record its location and scope in detail and use color and spectral Doppler to detect its blood flow; when the arterial blood flow spectrum is collected, with its resistance index (RI), pulse index (PI), and peak systolic velocity (PSV), when sampling multiple times, the final data are the maximum value of PSV [ 4 ]. Domestic perinatal medicine, clinical pharmacy, evidence-based medicine, and experts from various clinical related disciplines jointly drafted and formulated the “Consensus on the Application of Motherwort Injection in the Prevention and Treatment of Postpartum Hemorrhage,” for reference to physicians and pharmacists in clinical works to further standardize the clinical application of Leonurus injection, in order to achieve more ideal results and benefit more patients [ 5 ].…”