Impact of Neuraxial Labor Analgesia on Oxytocin Augmentation and Postpartum Hemorrhage---A Report from No Pain Labor N' Delivery in China

Abstract Number: BP 6
Abstract Type: Original Research

Yun Xia MD, PhD1 ; Mingpin Hu MD2; Lingqun Hu MD3; Francis S Stellaccio MD4; Tianna J Xia BA (Bachelor of Arts)5; Roger R Dzwonczyk MS, PE6
The Ohio State University Wexner Medical Center1 ; Second Affiliated Hospital of Wenzhou Medical College2; Northwestern University Feinberg School of Medicine 3; Stony Brook University School of Medicine, State University of New York at Stony Brook Health Science Center4; Case Western Reserve University5; The Ohio State University Wexner Medical Center6

Introduction: There is a concern in the Chinese obstetric community that neuraxial labor analgesia (NA) may be associated with postpartum hemorrhage (PPH) due to desensitization of oxytocin receptors caused by a possible increase in oxytocin augmentation during labor. No Pain Labor N’ Delivery (NPLD) was launched at the 2nd Affiliated Hospital of Wenzhou Medical College in 2010. The NA rate increased from 0% to 57%, the vaginal delivery rate increased and cesarean delivery (CD) rate decreased by 3.5%, and there was no change in the intrapartum CD rate. The aim of this impact study was to evaluate the impact of NA on oxytocin augmentation and PPH in a single Chinese academic center.
Methods: Data were collected from medical record review and from several hospital databases (01/2009-06/2011). The study period was divided into two phases, baseline (01/2009-06/2009, NA = 0%) and post (06/2010-06/2011, anesthesia service 24/7, NA >50%). NA was used only in the first stage of labor in low-risk laboring parturients; oxytocin augmentation or postpartum oxytocin was administered based on clinical judgment. Prophylactic intrauterine oxytocin 20 IU was administrated to CD patients. The packed red blood cell (PRBC) transfusion protocol was based on current ASA guidelines. Comparisons were made between the baseline and the post phases; outcomes included rate of oxytocin augmentation, postpartum oxytocin, PPH, transfusion, and hysterectomy. Chi-Square or Student’s t-test was used to determine statistical difference with alpha = 0.01.
Results: Among 15,415 deliveries, in the vaginal delivery patients of the post phase, the oxytocin augmentation rate increased by 17.6%, and the rates of postpartum oxytocin and PRBC administration decreased by 17.8%, and 1.5% respectively. The median oxytocin augmentation dose was 2.5 IU. No difference was found in the rate of PPH and average EBL of PPH patients for either vaginal delivery or CD, the average postpartum oxytocin dose and rate of PRBC administrated CD patients, nor overall PRBC transfused and hysterectomy rate.
Conclusions: Our data suggests that the increase in low dose intrapartum oxytocin augmentation observed after a marked increase in the rate of NA in the 1st stage of labor had no negative impact on PPH.

SOAP 2013