Outcomes after Institution of a New Oxytocin Infusion Protocol during the Third Stage of Labor and Immediate Postpartum Period
Abstract Number: F-8
Abstract Type: Original Research
Introduction: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality; uterine atony is the most common cause of severe PPH(1). Therefore oxytocin is commonly administered after delivery of the fetus but its untoward effects can be severe and few recommendations exist regarding appropriate dosing (2).
In this IRB approved project, we designed an oxytocin dosing protocol for the third stage of labor and immediate postpartum period based on current literature. We then undertook a chart review to ensure compliance with the new protocol, and to monitor PPH rates before and after its institution.
The protocol calls for an initial dose of 18 IU/hr x 1 hr followed by 3.6 IU/hr. For PPH, 36 IU/hr is used, and for continued PPH additional uterotonics drugs (UTD) are administered. Data were gathered from an institutional database during time periods 6 months prior to (8/1/10 - 1/31/11) and 6 months after (3/1/11 - 8/31/11) protocol implementation. Charts were audited for 1 week near the end of the 2nd 6-month period to determine compliance. Note was made of the total number of deliveries, mode of delivery, PPH rates (VD with EBL > 500 mL or CS with EBL > 1000 mL), number of patients transfused, number of B-lynch sutures and Bakri balloons used, and the number of patients who received alternative UTD, uterine artery ligation or peripartum hysterectomy.
Results: Prior to protocol implementation there were 799 deliveries (548 VD, 251 CS); after implementation, there were 772 deliveries (572 VD, 200 CS). Chart audit demonstrated 100% compliance with the new protocol. No differences in PPH rates were detected between the two time periods (table). There was no difference in rates of transfusion, use of B Lynch suture or Bakri balloon, administration of alternative UTD, uterine artery ligation or peripartum hysterectomy.
Clinical Implications: Rapid infusion of large doses of oxytocin is associated with risks of serious adverse effects (2). Adoption of a new protocol to infuse oxytocin in a more controlled manner than had been practiced previously was not only feasible, as demonstrated by a 100% compliance rate, but also improves maternal safety without increasing the risk of postpartum bleeding.
1. Berg: Obstet Gynecol 1996;88:161-7.
2. Thomas: BJA 2007;98:116–9.