Benefits Of Prophylactic Oxytocin As Part Of Active Management Of The Third Stage Of Labor

3300 Words Oct 2nd, 2014 14 Pages
Abstract Introduction: Prophylactic administration of oxytocin as part of active management of the third stage of labor reduces the risk of postpartum hemorrhage. Prophylactic oxytocin is often administered as an infusion rather than a bolus. The aim of the current up-down sequential allocation dose-response study was to test the hypothesis that parturients who receive intrapartum exogenous oxytocin therapy, and subsequently undergo cesarean delivery for labor dystocia, will have a higher ED90 for oxytocin infusion in the third stage of labor compared with nonlaboring parturients. Methods: The study design was a single-blinded, dual-arm, dose-response study using a 9:1 biased-coin (1:9) sequential allocation method to estimate the ED90 of an infusion of prophylactic oxytocin in women undergoing cesarean delivery with neuraxial anesthesia. The experimental group included women scheduled for intrapartum cesarean delivery after prior exposure to exogenous oxytocin and the control group included women scheduled for elective cesarean delivery. The starting infusion rate was 18 IU/h with an incremental dose of 2 IU/h. The outcome was satisfactory uterine tone 4 minutes after delivery as judged by the obstetrician. Secondary outcomes included requirement for additional uterotonic agents and maternal side effects (e.g., nausea and vomiting, ST segment depression). Dose-response data for each group were evaluated by a log-logistic function and ED90 estimates derived from the…

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