Higher-Dose Oxytocin to Prevent Obstetric Hemorrhage at Vaginal Delivery—Does Duration of Infusion Matter?

Abstract

Objective Postpartum higher-dose oxytocin (80 U) compared with lower dose (10 U) given in 500 mL over 1 hour does not decrease postpartum hemorrhage (PPH) requiring treatment, but reduces the risk of hematocrit decline ≥ 6% among women delivering vaginally. Our objective was to evaluate whether the duration of administration of oxytocin influences outcomes.

Study Design We compared a cohort receiving a postpartum oxytocin infusion of 80 U/500 mL over 1 hour to a concurrent cohort of women receiving 80 U/500 mL over 8 hours. The primary outcome was any treatment of PPH (uterotonics, blood transfusion, tamponade, and surgery). Secondary outcomes included pre- to postdelivery median hematocrit change and hematocrit decline ≥ 6%.

Results There were 653 and 676 women identified in the 1- and 8-hour cohorts, respectively. There was no difference in PPH requiring any treatment between the 1- and 8-hour cohorts (6 vs. 6%, p = 0.70). There were no differences in individual treatment components including blood transfusion (p = 0.75). Median hematocrit decline (p = 0.02) was lower in the 8-hour cohort, but there was no difference in frequency of hematocrit decline ≥ 6% (p = 0.15). Results were unchanged by multivariable adjustments.

Conclusions Postpartum higher-dose oxytocin administered over 1 hour compared with 8 hours was not associated with an increased treatment of PPH or frequency of hematocrit decline ≥ 6%.

Keywords

oxytocin - infusion duration - postpartum hemorrhage - vaginal delivery

Note

This study was presented at the 61st Annual Clinical Meeting of the American Congress of Obstetricians and Gynecologists in New Orleans, LA, May 4 to 8, 2013.

• References

• 1 Berg CJ, Chang J, Callaghan WM, Whitehead SJ. Pregnancy-related mortality in the United States, 1991-1997. Obstet Gynecol 2003; 101 (2) 289-296
• 2 Ronsmans C, Graham WJ ; Lancet Maternal Survival Series steering group Maternal mortality: who, when, where, and why. Lancet 2006; 368 (9542) 1189-1200
• 3 American College of Obstetricians and Gynecologists. ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists Number 76, October 2006: postpartum hemorrhage. Obstet Gynecol 2006; 108 (4) 1039-1047
• 4 Combs CA, Murphy EL, Laros Jr RK. Factors associated with hemorrhage in cesarean deliveries. Obstet Gynecol 1991; 77 (1) 77-82
• 5 Munn MB, Owen J, Vincent R, Wakefield M, Chestnut DH, Hauth JC. Comparison of two oxytocin regimens to prevent uterine atony at cesarean delivery: a randomized controlled trial. Obstet Gynecol 2001; 98 (3) 386-390
• 6 Tita AT, Szychowski JM, Rouse DJ , et al. Higher-dose oxytocin and hemorrhage after vaginal delivery: a randomized controlled trial. Obstet Gynecol 2012; 119 (2) , Pt 1): 293-300
• 7 Roach MK, Abramovici A, Tita AT. Dose and duration of oxytocin to prevent postpartum hemorrhage: a review. Am J Perinatol 2013; 30 (7) 523-528
• 8 World Health Organization. WHO Recommendations for the Prevention and Treatment of Postpartum Hemorrhage. Geneva: World Health Organization; 2012
• 9 Güngördük K, Asicioglu O, Celikkol O, Olgac Y, Ark C. Use of additional oxytocin to reduce blood loss at elective caesarean section: a randomised control trial. Aust N Z J Obstet Gynaecol 2010; 50 (1) 36-39
• 10 King KJ, Douglas MJ, Unger W, Wong A, King RA. Five unit bolus oxytocin at cesarean delivery in women at risk of atony: a randomized, double-blind, controlled trial. Anesth Analg 2010; 111 (6) 1460-1466
• 11 Sarna MC, Soni AK, Gomez M, Oriol NE. Intravenous oxytocin in patients undergoing elective cesarean section. Anesth Analg 1997; 84 (4) 753-756
• 12 Murphy DJ, MacGregor H, Munishankar B, McLeod G. A randomised controlled trial of oxytocin 5IU and placebo infusion versus oxytocin 5IU and 30IU infusion for the control of blood loss at elective caesarean section—pilot study. ISRCTN 40302163. Eur J Obstet Gynecol Reprod Biol 2009; 142 (1) 30-33
• 13 Davies GA, Tessier JL, Woodman MC, Lipson A, Hahn PM. Maternal hemodynamics after oxytocin bolus compared with infusion in the third stage of labor: a randomized controlled trial. Obstet Gynecol 2005; 105 (2) 294-299
• 14 Cotter A, Ness A, Tolosa J. Prophylactic Oxytocin for the Third Stage of Labour. The Cochrane Library. Vol 3. Chichester, UK: John Wiley & Sons, Ltd; 2005
• 15 Carvalho JC, Balki M, Kingdom J, Windrim R. Oxytocin requirements at elective cesarean delivery: a dose-finding study. Obstet Gynecol 2004; 104 (5, Pt 1) 1005-1010
• 16 Balki M, Ronayne M, Davies S , et al. Minimum oxytocin dose requirement after cesarean delivery for labor arrest. Obstet Gynecol 2006; 107 (1) 45-50
• 17 Elbourne DR, Prendiville WJ, Carroli G, Wood J, McDonald S. Prophylactic use of oxytocin in the third stage of labour. Cochrane Database Syst Rev 2001; (4) CD001808
• 18 McDonald S, Abbott JM, Higgins SP. Prophylactic ergometrine-oxytocin versus oxytocin for the third stage of labour. Cochrane Database Syst Rev 2004; (1) CD000201
• 19 Liabsuetrakul T, Choobun T, Peeyananjarassri K, Islam QM. Prophylactic use of ergot alkaloids in the third stage of labour. Cochrane Database Syst Rev 2007; (2) CD005456
• 20 Soltani H, Hutchon DR, Poulose TA. Timing of prophylactic uterotonics for the third stage of labour after vaginal birth. Cochrane Database Syst Rev 2010; (8) CD006173
• 21 Winkler CL, Gray SE, Hauth JC, Owen J, Tucker JM. Mid-second-trimester labor induction: concentrated oxytocin compared with prostaglandin E2 vaginal suppositories. Obstet Gynecol 1991; 77 (2) 297-300
• 22 Owen J, Hauth JC, Winkler CL, Gray SE. Midtrimester pregnancy termination: a randomized trial of prostaglandin E2 versus concentrated oxytocin. Am J Obstet Gynecol 1992; 167 (4, Pt 1) 1112-1116