Use of additional oxytocin to reduce blood loss at elective caesarean section: A randomised control trial

Güngördük, Kemal; Aşıcıoğlu, Osman; Celikkol, Ozgu; Olgaç, Yusuf; Ark, Cemal

doi:10.1111/j.1479-828x.2009.01106.x

Cited by 43 publications

(38 citation statements)

References 13 publications

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“…13 Additional oxytocic needed among the groups in this study is consistent with the result reported in other similar studies that women in the bolus and infusion group were less likely to require an additional uterotonic agent than those in the bolus only group. [13][14][15] In this study, post caesarean section Hb% significantly decreased within the groups after 24 hours; however, there was no significant difference in Hb% between the groups. In other study, it was shown that the difference of preoperative and postoperative Hb% of misoprostol and oxytocin groups was not remarkable which is consistent with this study.…”

Section: Discussionmentioning

confidence: 71%

“…3 Güngördük et al showed a reduction of major obstetric haemorrhage in oxytocin bolus and 30 IU oxytocin infusion than oxytocin bolus only. 15 Conde-Agudelo et al showed that misoprostol combined with oxytocin appears to be more effective than oxytocin alone in reducing intraoperative and postoperative hemorrhage during cesarean section; however, there was no significant differences in intraoperative and postoperative hemorrhage when misoprostol was compared to oxytocin. 17 Side effects occurred in 7 (23.3%) patients of group 1, 18 (60.0%) in group 2, and 6 (20.0%) in group 3.…”

Section: Discussionmentioning

confidence: 99%

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Randomized controlled trial of three oxytocic regimens to prevent primary postpartum haemorrhage at caesarean section

2017

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The objective of this present study was to compare the efficacy of three oxytocic regimens to prevent primary postpartum haemorrhage (PPH) at caesarean section. A randomized controlled trial including 90 patients who underwent caesarean section were selected according to inclusion and exclusion criteria assigned randomly into three groups (30 patients in each group) was conducted. Group 1 and group 2 were exposure groups and group 3 was control group. All patients were given 10 units intravenous (IV) bolus oxytocin immediately after delivery of baby. Group 1 was given additional 20 units oxytocin in each 1000 ml fluid for 24 hours. Group 2 received additional 1000 microgram misoprostol per rectal. Group 3 did not receive any additional oxytocic drug. Background characteristics of all the three groups were similar. It was observed that 501-1000 ml blood loss was found among 25 (83.3%) cases in group 1, 27 (90.0%) in group 2 and 27 (90.0%) in group 3. The mean (SD) amount of blood loss was found 733 (190) ml in group 1792 (187) ml in group 2 and 818 (14) ml in group 3. Occurrence of PPH and blood transfusion needed among 1 (3.3%) in group 1, 2 (6.7%) in group 2 and 3 (10.0%) in group 3. Side effects occurred in 7 (23.3%) patients of group 1, 18 (60.0%) in group 2, and 6 (20.0%) in group 3. Shivering was found among 4 (13.3%) in group 1, 10 (33.3%) in group 2 and 3 (10%) in group 3. Vomiting was found among 2 (6.7%) in group 1, 4 (13.3%) in group 2, and 2 (6.7%) in group 3. Pyrexia was 1 (3.3%) in group 1, 4 (13.3%) in group 2 and 1 (3.3%) in group 3. Side effects were more in the group where misoprostol was used. Except side effects there was no statistical difference of occurrence of different events among the three groups. Only bolus IV oxytocin appears to be as effective as oxytocin infusion in addition to bolus IV oxytocin or per rectal misoprostol in addition to bolus IV oxytocin to prevent primary PPH at caesarean section. But occurrence of transient side effects such as shivering, pyrexia and vomiting were noted more frequently with the use of misoprostol.Mediscope Vol. 4, No. 2: Jul 2017, Page 5-11

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Randomized controlled trial of three oxytocic regimens to prevent primary postpartum haemorrhage at caesarean section

2017

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“…18,20 Women in the higher dose group had significantly lower mean estimated blood loss and lower frequencies of blood loss greater than 500ml or greater than 1000 ml, need for uterotonic treatment or blood transfusion. 18,20 In another small study of cesareans, higher dose of oxytocin was associated with a higher uterine tone and a non-significant reduction in need for additional uterotonic. 19 Finally, in the previous trial at our institution 80 units as compared with 10 units of prophylactic oxytocin reduced the need for any uterotonic treatment as well as the need for treatment with second line agents among women who underwent cesarean delivery after labor.…”

Section: Discussionmentioning

confidence: 95%

“…11,18–20 Typically, these studies have associated higher doses of prophylactic oxytocin with beneficial impact on outcomes such as estimated blood loss, decline in hematocrit or need for additional uterotonics among women who underwent cesarean delivery. 11,18–20 In two studies, women undergoing scheduled cesarean received a 5 unit IV bolus versus 35 units (5 unit bolus+30 units over 4 hours) of prophylactic oxytocin. 18,20 Women in the higher dose group had significantly lower mean estimated blood loss and lower frequencies of blood loss greater than 500ml or greater than 1000 ml, need for uterotonic treatment or blood transfusion.…”

Section: Discussionmentioning

confidence: 99%

“…11,18–20 In two studies, women undergoing scheduled cesarean received a 5 unit IV bolus versus 35 units (5 unit bolus+30 units over 4 hours) of prophylactic oxytocin. 18,20 Women in the higher dose group had significantly lower mean estimated blood loss and lower frequencies of blood loss greater than 500ml or greater than 1000 ml, need for uterotonic treatment or blood transfusion. 18,20 In another small study of cesareans, higher dose of oxytocin was associated with a higher uterine tone and a non-significant reduction in need for additional uterotonic.…”

Section: Discussionmentioning

confidence: 99%

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Higher-Dose Oxytocin and Hemorrhage After Vaginal Delivery

Tita

Szychowski

Rouse

et al. 2012

Obstetrics & Gynecology

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Objective Higher-dose oxytocin is more effective than lower-dose regimens to prevent postpartum hemorrhage following cesarean delivery. We compared two higher-dose regimens (80U and 40U) to our routine regimen (10U) among women who delivered vaginally. Methods In a double-masked randomized trial, oxytocin (80U, 40U or 10U) in 500ml was given over 1 hour after placental delivery. The primary outcome was a composite: any treatment of uterine atony or hemorrhage. Prespecified secondary outcomes included outcomes in the primary composite and a decline of 6% or greater in hematocrit. A sample size of 600 per group (N=1800) was required to compare each of the 80U and 40U to the 10U group. At planned interim review (n=1201), enrollment in the 40U group was stopped for futility and enrollment continued in the other groups. Results Of 2,869 women, 1,798 were randomized: 658 to 80U, 481 to 40U and 659 to 10U. Most characteristics were similar across groups. The risk of the primary outcome in the 80U group (6%; RR 0.93, 95% CI: 0.62–1.40) or the 40U group (6%; 0.94, 0.61–1.47) was not different compared with the 10U group (7%). Treatment with additional oxytocin after the first hour was less frequent with 80U compared with 10U (RR 0.41; 0.19–0.88) as was a 6% or greater decline in hematocrit (0.83; 0.69–0.99); both outcomes declined with increasing oxytocin dose. Outcomes were similar between the 40U and 10U groups. Conclusion Compared with 10 units, 80 or 40 units of prophylactic oxytocin did not reduce overall postpartum hemorrhage treatment when given in 500ml over 1 hour for vaginal delivery. Eighty units decreased the need for additional oxytocin and the risk of a 6% or greater decline in hematocrit.

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Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis

Gallos

Williams

Price

et al. 2018

Cochrane Database of Systematic Reviews

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Ergometrine plus oxytocin combination, carbetocin, and misoprostol plus oxytocin combination were more effective for preventing PPH ≥ 500 mL than the current standard oxytocin. Ergometrine plus oxytocin combination was more effective for preventing PPH ≥ 1000 mL than oxytocin. Misoprostol plus oxytocin combination evidence is less consistent and may relate to different routes and doses of misoprostol used in the studies. Carbetocin had the most favourable side-effect profile amongst the top three options; however, most carbetocin trials were small and at high risk of bias.Amongst the 11 ongoing studies listed in this review there are two key studies that will inform a future update of this review. The first is a WHO-led multi-centre study comparing the effectiveness of a room temperature stable carbetocin versus oxytocin (administered intramuscularly) for preventing PPH in women having a vaginal birth. The trial includes around 30,000 women from 10 countries. The other is a UK-based trial recruiting more than 6000 women to a three-arm trial comparing carbetocin, oxytocin and ergometrine plus oxytocin combination. Both trials are expected to report in 2018.Consultation with our consumer group demonstrated the need for more research into PPH outcomes identified as priorities for women and their families, such as women's views regarding the drugs used, clinical signs of excessive blood loss, neonatal unit admissions and breastfeeding at discharge. To date, trials have rarely investigated these outcomes. Consumers also considered the side-effects of uterotonic drugs to be important but these were often not reported. A forthcoming set of core outcomes relating to PPH will identify outcomes to prioritise in trial reporting and will inform futures updates of this review. We urge all trialists to consider measuring these outcomes for each drug in all future randomised trials. Lastly, future evidence synthesis research could compare the effects of different dosages and routes of administration for the most effective drugs.

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Use of additional oxytocin to reduce blood loss at elective caesarean section: A randomised control trial

Abstract: An additional oxytocin infusion after 5 IU oxytocin bolus infusion at elective C/S may reduce blood loss and required blood transfusion.

Cited by 43 publications

References 13 publications

Randomized controlled trial of three oxytocic regimens to prevent primary postpartum haemorrhage at caesarean section

Randomized controlled trial of three oxytocic regimens to prevent primary postpartum haemorrhage at caesarean section

Higher-Dose Oxytocin and Hemorrhage After Vaginal Delivery

Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis

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