International consensus statement on the use of uterotonic agents during caesarean section

Abstract

Summary It is routine to give a uterotonic drug following delivery of the neonate during caesarean section. However, there is much heterogeneity in the relevant research, which has largely been performed in low‐risk elective cases or women with uncomplicated labour. This is reflected in considerable variation in clinical practice. There are significant differences between dose requirements during elective and intrapartum caesarean section. Standard recommended doses are higher than required, with the potential for acute cardiovascular adverse effects. We recommend a small initial bolus dose of oxytocin, followed by a titrated infusion. The recommended doses of oxytocin may have to be increased in women with risk factors for uterine atony. Carbetocin at equipotent doses to oxytocin has similar actions, while avoiding the requirement for a continuous infusion after the initial dose and reducing the need for additional uterotonics. As with oxytocin, carbetocin dose requirements are higher for intrapartum caesarean sections. A second‐line agent should be considered early if oxytocin/carbetocin fails to produce good uterine tone. Women with cardiac disease may be very sensitive to the adverse effects of oxytocin and other uterotonics, and their management needs to be individualised.

Carbetocin at elective caesarean section: a sequential allocation trial to determine the minimum effective dose in obese women

“…Wide variability exists in the recommended doses of uterotonics, as well as those that are used in clinical practice [4]. Currently uterotonics are not given on a where obesity was not found to be a strong risk factor for postpartum haemorrhage.…”

“…For every maternal death, a larger number suffer serious morbidity, including multi-organ failure and peripartum hysterectomy [2]. There is strong evidence, and widespread recommendation, for the routine administration of uterotonics to prevent postpartum haemorrhage at caesarean section [2][3][4].…”

“…For every maternal death, a larger number suffer serious morbidity, including multi‐organ failure and peripartum hysterectomy . There is strong evidence, and widespread recommendation, for the routine administration of uterotonics to prevent postpartum haemorrhage at caesarean section . Despite the availability of uterotonic drugs, there has been a rising incidence of atonic postpartum haemorrhage in developed countries that has been attributed to various factors including: advanced maternal age; multiple pregnancy; induction and/or augmentation of labour; obesity; and the rising incidence of caesarean section .…”

A Nonpeptide Oxytocin Receptor Agonist for a Durable Relief of Inflammatory Pain

“…In clinics, OT is used since many years in patients by the intravenous route for the initiation of labor and the final expulsion of the fetus 13 . It is also administered to women as a nasal spray to stimulate milk ejection.…”

Pushing the Envelope in Obstetric Care: A Case Report of Cesarean Delivery in a Parturient with a BMI >100 kg m−2

“…ere is considerable variation in clinical practice with regard to the optimal dose and rate for use in cesarean sections [35]. e common practice is the continuous infusion of oxytocin at doses greater than 20 to 40 IU [35,36].…”