Benefits Of Prophylactic Oxytocin As Part Of Active...

Abstract Introduction: Prophylactic administration of oxytocin as part of active management of the third stage of labor reduces the risk of postpartum hemorrhage. Prophylactic oxytocin is often administered as an infusion rather than a bolus. The aim of the current up-down sequential allocation dose-response study was to test the hypothesis that parturients who receive intrapartum exogenous oxytocin therapy, and subsequently undergo cesarean delivery for labor dystocia, will have a higher ED90 for oxytocin infusion in the third stage of labor compared with nonlaboring parturients. Methods: The study design was a single-blinded, dual-arm, dose-response study using a 9:1 biased-coin (1:9) sequential allocation method to estimate the ED90†¦show more content†¦Results: Thirty-eight and 32 subjects participated in the nonlaboring and laboring groups, respectively. The oxytocin ED90 was significantly greater for the laboring group (44.2 IU/h [95% CI 33.8 to 55.6]) compared with th e nonlaboring group (16.2 IU/h [95% CI 13.1 to 19.3]) (difference in dose 28 IU/h, [95% CI of difference 26 to 29, P 0.001]). Significantly more women in the laboring group (34%) than the nonlaboring group (8%) required supplemental uterotonic agents (P = 0.008). The overall incidence of side effects was greater in the laboring group (69%) than the nonlaboring group (34%) (P = 0.004). Conclusions: Women with prior exposure to exogenous oxytocin require a higher initial infusion rate of oxytocin to prevent uterine atony after cesarean delivery than women without prior exposure. Introduction Uterine atony is the most common cause of postpartum hemorrhage postpartum hemorrhage is the leading cause of maternal mortality worldwide.1 Active management of the third stage of labor, which includes the prophylactic administration of oxytocin, has been shown to decrease uterine atony and the risk of PPH.2 Several studies have sought to determine the dose-response of intravenous oxytocin administered for third stage prophylaxis. In patients undergoing scheduled cesarean delivery, the estimated effective dose in 90% of parturients (ED90) for satisfactory uterine tone of a bolus dose of oxytocin was 0.35 IU.3 In contrast,