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Impact of an Oxytocin Protocol on Secondary Uterotonic Use in Women Undergoing Elective Cesarean Delivery
Abstract Number: F3H-413
Abstract Type: Original Research
Background: Postpartum hemorrhage (PPH) complicates 2.9% of all deliveries and is associated with 19.1% of all in-hospital deaths after delivery. Prophylactic oxytocin immediately after delivery is recommended to prevent uterine atony. Potentially serious dose-dependent side effects from oxytocin have been described including hypotension, arrhythmias, and even cardiovascular collapse. In spite of this, the dose and rate of oxytocin administration varies widely across institutions. The utilization of a standardized oxytocin protocol has been shown to achieve adequate uterine tone with lower oxytocin doses compared to “free flow” oxytocin administration(1). In this study, we hypothesize the use of a standardized oxytocin protocol based on the “Rule of Threes”(2) will decrease secondary uterotonic use compared to an unmeasured oxytocin infusion.
Methods: In this single-center retrospective cohort study, we compared the effectiveness of a Rule of Threes oxytocin protocol (POST) to our previous oxytocin administration practice (PRE) in women undergoing elective cesarean delivery (CD). The PRE group underwent CD between 1/1/2010 through 12/31/2013, and received oxytocin (1 unit/100 cc) in a freely running infusion of one liter Lactated Ringer’s. The POST group underwent CD between 1/1/2015 and 8/31/2017, and received between 1 and 3 separate 3 unit micro-boluses of oxytocin over 30 seconds 3 minutes apart followed by an oxytocin infusion per the Rule of Threes algorithm. Data regarding patient demographics, indication for CD, number of oxytocin micro-boluses, secondary uterotonic use, estimated blood loss, and transfusion requirements were collected. The primary outcome was secondary uterotonic use. Secondary outcomes included time to secondary uterotonic administration and estimated blood loss.
Results: There were 437 women in the PRE group and 415 women in the POST. There were no differences in patient demographics except higher pre-delivery magnesium use in the POST group (4% vs. 9%, P=0.01). There was no difference in frequency of secondary uterotonic use or time to secondary uterotonic administration. Estimated blood loss was significantly lower in the POST group.
Conclusion: In spite of increased magnesium use, the use of a standardized oxytocin algorithm did not decrease secondary uterotonic medications but did decrease the estimated blood loss.
1. Lee A et al. Int J Obstet Anesth 2014;23:18-22.
2. Kovacheva V et al. Anesthesiology 2015; 123:92-100.