Intravenous oxytocin bolus and infusion versus infusion alone on the blood loss during caesarean section

Abstract

Background: PPH is one of the leading causes of maternal mortality in the world. In India >30% maternal mortality is because of PPH.Methods: 250 females posted for LSCS were randomised into 2 groups. Group A: 5U oxytocin bolus + 40U oxytocin infusion @125 ml/hour in 500 ml saline. Group B: 5 ml Saline bolus + 40 U oxytocin infusionPrimary outcome was to measure blood loss (objective and subjective). Secondary outcomes were time for uterine hardening, additional uterotonic agents, hemodynamic changes, side effects and need for blood transfusion within 24 hours of LSCS.Results: Blood loss was significantly less in Group A in objective as well as subjective assessment (p<0.001). Requirement for additional oxytocin bolus was significantly higher in Group B as compared Group A (p=0.025). Postoperative hematocrit of Group A was higher than that of Group B (p<0.001). Transfusion requirement was significantly higher (p=0.04) in Group B (9.6% versus 3.2%). There was no significant difference in hemodynamics between the groups in the intraoperative period (p>0.05). However, during the postoperative period increase in heart rate was noted in Group B (p<0.05). Vomiting was the only major side effect observed, which was higher in Group A (5.6% versus 3.2%).Conclusions: Combination of 5U oxytocin bolus followed by an infusion of 40 U oxytocin given over 4 hours routinely in ASA grade I and ASA grade II parturient significantly decreases the operative blood loss during LSCS without causing any hemodynamic variability. This regimen provides better uterine contractility, lesser need for additional utero-tonic agents and lesser requirement of blood transfusion.

<p>A Randomized Control Trial of 3 IU IV Oxytocin Bolus with 7 IU Oxytocin Infusion versus 10 IU Oxytocin Infusion During Cesarean Section for Prevention of Postpartum Hemorrhage</p>

“…4 Various studies have used higher doses of Oxytocin infusion of 40 IU. 21 This would lead to excessive use of Oxytocin which may be unnecessary and would lead to extra cost. Our study used 10 IU in all that would make it more cost-effective, with less adverse effects, without causing an increase in postpartum hemorrhage.…”

Randomised Control Trial of 3 IU Intravenous Oxytocin Bolus With 7 IU Oxytocin Infusion Versus 10 IU Intramuscular Oxytocin in the Third Stage of Labour in the Prevention of Postpartum Hemorrhage

“…The IV bolus dose of oxytocin is quicker in action in comparison to the IM route. The applied dose of IV bolus oxytocin in cesarean section (C-section) has been variable, including 10, 5, 3, 2, and 1 IU of IV oxytocin bolus (4)(5)(6)(7)(8).…”