Prophylactic use of oxytocin at caesarean section: where are the guidelines?

Modern Views on Oxytocics in Obstetrics Practice

“…[20] Recently there is a Paradigm Shift -from Bolus to Infusion The reported death of mothers relating to IV administration of bolus 10 units oxytocin [17] has changed the subsequent clinical practice in the UK towards using lower doses such as 5 IU bolus. [5] However, rapid IV bolus of 5 units can also lead to hypotension and tachycardia. [18] As significant haemodynamic changes have been found even after a 2 IU bolus, an even smaller initial bolus administered slowly or an oxytocin infusion alone might be a safer option.…”

“…[18] As significant haemodynamic changes have been found even after a 2 IU bolus, an even smaller initial bolus administered slowly or an oxytocin infusion alone might be a safer option. [11,23,24] In a recent editorial, Laxton C and Weale N [5] mentioned that reducing the dose of the oxytocin bolus may not be the effective step in reducing adverse effects as low boluses between 0.5 to 3 IU have been shown to produce hypotension in 20-30% of patients. Rather, reducing the speed of drug delivery may be the safest, especially so in those at high risk owing to cardiac disease or hypovolaemia.…”

“…Rather, reducing the speed of drug delivery may be the safest, especially so in those at high risk owing to cardiac disease or hypovolaemia. [5] A recent case series [25] reviewed the anaesthetic management of 59 highrisk pregnant mothers with cardiac disease undergoing CD where the authors used 'ultra-low doses' (0.05-0.5 IU) of oxytocin, repeated as necessary at the time of delivery in order to avoid extreme haemodynamic disturbance and excess IV fluid administration accompanying oxytocin infusions. However, it seems to be a difficult task to balance between the lowest doses of oxytocin ensuring haemodynamic stability in cardiac patients against the risk of bleeding owing to uterine atony.…”

“…In the UK, an infusion over 4 hours is most commonly used. [5,30] Maintenance oxytocin infusion can be continued for up to 8 hours following delivery. [31] However, the optimum duration of infusion is yet to be determined.…”

A Clinical Study on Prophylactic Iv Oxytocin Infusion at the Time of Incision in Caesarean Section and Its Outcome in a Tertiary Care Hospital

“…2018;7(13):1577-1579, DOI: 10.14260/jemds/2018/356 BACKGROUND Postpartum haemorrhage (PPH) accounts for a quarter of maternal deaths worldwide 1 and its incidence in developed world is increasing. [2][3][4] According to the recent Confidential Enquiries into Maternal and Child Health (CEMACH) Report, obstetric haemorrhage occurs in around 3.7 per 1000 births with uterine atony being the commonest cause. Worldwide, PPH continues to contribute to significant maternal morbidity and mortality mainly due to 'too little being done too late.'…”