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Association between recovery time (oxytocin discontinuation to delivery) and blood loss during cesarean deliveries following oxytocin augmented labor - A retrospective cohort study
Abstract Number: F-12
Abstract Type: Original Research
Introduction: Induction and augmentation of labor with oxytocin (OT) is currently a common obstetric practice. However, prolonged OT exposure during labor has been shown to be associated with uterine atony and postpartum hemorrhage (PPH)  due to OT receptor desensitization. In theory, discontinuation of OT following labor augmentation may facilitate a time-dependent recovery of OT receptor function  that can restore myometrial contractility, and thus decrease blood loss at cesarean delivery (CD). The purpose of this study was to examine the association between the time interval from discontinuation of OT to delivery (recovery time) and blood loss at CD for labor arrest.
Methods: This retrospective chart review included women who underwent CD for labor arrest following OT augmented labor from July 2013 to July 2015. Data on patient demographics, labor/delivery characteristics, amount and duration of OT exposure, recovery time and PPH risk factors were collected. Recovery time and PPH risk factors were included in a multiple linear regression model with estimated blood loss (EBL) as the primary outcome. EBL was calculated based on the hematocrit variation method.
Results: Data from 490 women were analyzed. The mean (SD) EBL was 1341 (577) mL. Duration and amount of OT infusion during labor were 619 (355) min and 6447 (6868) mU, respectively, while recovery time was 99 (65) min (range=0-367 min). There was an inverse correlation between recovery time and EBL that was significant after controlling for PPH risk factors (p=0.01). Every 10 min increase in recovery time was associated with a decrease in EBL on average by 10.3 mL. The EBL for recovery time < 1h was significantly higher than for ≥ 1h [1438 (586) ml vs. 1298 (569) mL; p=0.01]. Recovery time was not associated with the need for additional uterotonics or surgical interventions to control bleeding. There was a significant correlation between the total amount and duration of OT with the need for additional uterotonics (p<0.01) and surgical interventions (p≤0.01), but not with EBL.
Discussion: Our results suggest that OT should be stopped as soon as labor arrest is declared, and a longer interval between OT cessation and CD can help reduce blood loss. This could be due to OT receptor resensitization during the recovery time that possibly helps to restore myometrial responsiveness to prophylactic OT at CD.
References: 1) AJOG 2011;204:56.e1-6; 2) Am J Physiol Endocrinol Metab 2009;296:E532-42