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Am J Perinatol 2013; 30(07): 523-528
DOI: 10.1055/s-0032-1329184
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Dose and Duration of Oxytocin to Prevent Postpartum Hemorrhage: A Review

Michelle K. Roach
1   Center for Women's Reproductive Health and Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, University Hospital, University of Alabama at Birmingham, Birmingham, Alabama
,
Adi Abramovici
1   Center for Women's Reproductive Health and Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, University Hospital, University of Alabama at Birmingham, Birmingham, Alabama
,
Alan T.N. Tita
1   Center for Women's Reproductive Health and Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, University Hospital, University of Alabama at Birmingham, Birmingham, Alabama
› Author Affiliations
Further Information

Publication History

03 April 2012

05 July 2012

Publication Date:
03 December 2012 (online)

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Abstract

Objective Oxytocin, the most commonly used uterotonic agent in the United States to prevent postpartum hemorrhage, has no established standard dose. The aim of this review is to present data on oxytocin dosing for the prevention of postpartum hemorrhage.

Study Design We conducted a PubMed search for clinical trials that utilized oxytocin for hemorrhage prophylaxis following either vaginal or cesarean delivery. We further narrowed the results to studies that compared alternative dosing and duration of oxytocin administration.

Results Seven of 46 eligible reports were selected for detailed review. We compared the dose and duration of oxytocin used, study population, and outcomes (estimated blood loss, need for additional uterotonics, and change in hematocrit after delivery). Dose of oxytocin used ranged from 5 to 100 IU and duration of administration ranged from 5 to 30 seconds (intravenous bolus) to 8 hours diluted in crystalloid.

Conclusion Overall, higher infusion doses (up to 80 IU/500 mL) and bolus doses of oxytocin appear to be more effective than lower doses or protracted administration of a fixed dose at reducing outcome measures of postpartum hemorrhage, particularly among cesarean deliveries.

Keywords

oxytocin - dose - postpartum - hemorrhage
 

  • References

  • 1 Ronsmans C, Graham WJ. Lancet Maternal Survival Series steering group. Maternal mortality: who, when, where, and why. Lancet 2006; 368: 1189-1200
    CrossrefPubMedSearch in Google Scholar
  • 2 Combs CA, Murphy EL, Laros Jr RK. Factors associated with hemorrhage in cesarean deliveries. Obstet Gynecol 1991; 77: 77-82
    PubMedSearch in Google Scholar
  • 3 Practice Bulletin ACOG. 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: 1039-1047
    CrossrefPubMedSearch in Google Scholar
  • 4 Prendiville W, Elbourne D, Chalmers I. The effects of routine oxytocic administration in the management of the third stage of labour: an overview of the evidence from controlled trials. Br J Obstet Gynaecol 1988; 95: 3-16
    CrossrefPubMedSearch in Google Scholar
  • 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: 386-390
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 7 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: 294-299
    CrossrefPubMedSearch in Google Scholar
  • 8 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: 36-39
    CrossrefPubMedSearch in Google Scholar
  • 9 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: 1460-1466
    CrossrefPubMedSearch in Google Scholar
  • 10 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
    CrossrefPubMedSearch in Google Scholar
  • 11 George RB, McKeen D, Chaplin AC, McLeod L. Up-down determination of the ED(90) of oxytocin infusions for the prevention of postpartum uterine atony in parturients undergoing Cesarean delivery. Can J Anaesth 2010; 57: 578-582
    CrossrefPubMedSearch in Google Scholar
  • 12 Sarna MC, Soni AK, Gomez M, Oriol NE. Intravenous oxytocin in patients undergoing elective cesarean section. Anesth Analg 1997; 84: 753-756
    CrossrefPubMedSearch in Google Scholar
  • 13 Balki M, Ronayne M, Davies S , et al. Minimum oxytocin dose requirement after cesarean delivery for labor arrest. Obstet Gynecol 2006; 107: 45-50
    CrossrefPubMedSearch in Google Scholar
  • 14 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: 30-33
    CrossrefPubMedSearch in Google Scholar
  • 15 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
    Search in Google Scholar
  • 16 Moran C, Ni Bhuinneain M, Geary M, Cunningham S, McKenna P, Gardiner J. Myocardial ischaemia in normal patients undergoing elective Caesarean section: a peripartum assessment. Anaesthesia 2001; 56: 1051-1058
    CrossrefPubMedSearch in Google Scholar
  • 17 Chilvers JP, Cooper G, Wilson M. Myocardial ischaemia complicating an elective Caesarean section. Anaesthesia 2003; 58: 822-823
    PubMedSearch in Google Scholar
  • 18 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: 297-300
    CrossrefPubMedSearch in Google Scholar
  • 19 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
    CrossrefPubMedSearch in Google Scholar