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Dosing of Oxytocin in Patients Undergoing Cesarean Delivery After a Period of Labor
Abstract Number: F-14
Abstract Type: Original Research
INTRODUCTION: Experts recommend postpartum oxytocin to prevent uterine atony and hemorrhage.1 Its published ED90 is 17(95% CI 9.0-25.8) IU/hr.2 Based on this ED90 we adopted a protocol that calls for 1) routine administration of oxytocin 18 IU/hr; 2) administration at 36 IU/hr for uterine atony; and 3) administration of other uterotonic agents for persistent atony.3 A more recent study determined an ED90 of 44.2 (95% CI 33.8-55.6) IU/hr in patients exposed to oxytocin prior to cesarean delivery (CD).4 To determine the clinical relevance of these data, we undertook this study to compare postpartum oxytocin/other uterotonic requirements in patients exposed to oxytocin prior to CD (OXY+) versus those not exposed (OXY-) in order to assess adequacy of our current protocol.
METHODS: In this IRB-approved study we reviewed medical records of patients who delivered via CD under neuraxial anesthesia during one year. Data collected included gravidity, parity, EGA, neonatal weight, intrapartum exposure to oxytocin/dose/duration, and relevant co-morbidities. Note was made of maximum postpartum oxytocin dose (18 vs 36 IU/hr) and use of other uterotonic drugs, uterostatic procedures, EBL, transfusion, and pre- and post-delivery Hgb. Nominal data were compared with the Chi-square or Fisher’s Exact test; continuous data with the Mann-Whitney U test.
RESULTS: OXY+ patients had higher EGA and neonatal weight and were more likely to be nulliparous and have chorioamnionitis and less likely to have multiple gestation than OXY- patients (table). Other comorbidities did not differ. OXY+ patients required high dose (36 IU/hr) postpartum oxytocin and other uterotonic agents more often than OXY- patients. EBL, hemorrhage rates and transfusion rates did not differ but OXY+ patients had a bigger drop in hemoglobin after delivery.
CONCLUSION: Differences in the ED90 of postpartum oxytocin appear to be clinically significant and we therefore plan to alter our current protocol so that women pre-exposed to oxytocin will receive higher oxytocin doses routinely.
1. ACOG Practice Bulletin No. 76. Obset Gynecol 2006;108:1039
2. George: Can J Anesth 2010;57:578
3. DeGraca: Int J Obste Anes 2013;22:194
4. Lavoie: Anesth Analg 2015;121:159