The Intraoperative Median Effective Dose of Oxytocin for Preventing Uterine Atony in Parturients with a Prior History of Caesarean Delivery

Wei, Chang Na; Drzymalski, Dan; Cao, Yun; Ping, Ze Peng; Wu, Hui; Chen, Xinzhong

doi:10.1007/s40261-021-01090-x

Cited by 2 publications

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“…Clinical research has also shown that elderly parturients required more oxytocin for preventing uterine atony (Bobrowski and Bottoms, 1995;Wei et al, 2020). Our previous study estimated the ED50 of oxytocin was greater in the parturients with a history of prior caesarean delivery than in the parturients without a history of prior caesarean delivery (Wei et al, 2021). Therefore, uterine scarring and advanced maternal age may be responsible for the increased requirements of oxytocin in elderly parturients with a prior history of CD.…”

Section: Figurementioning

confidence: 91%

The optimal oxytocin infusion rate for preventing uterine atony during cesarean delivery in elderly parturients with prior history of cesarean delivery

Wang

Dong

et al. 2023

Front. Pharmacol.

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Background: An estimate of 90% effective dose (ED90) of oxytocin infusion has already been proved effective in non-laboring parturients. However, the requirements of oxytocin for elderly parturients with prior history of cesarean delivery (CD) may be higher. The aim of this study was to find the optimum oxytocin infusion rate for preventing uterine atony during CD in elderly parturients with prior history of CD.Method: We performed a randomized, double-blinded study in 120 healthy elderly parturients with prior history of CD scheduled for elective CD under combined spinal–epidural (CSE) anesthesia. Participants were treated with oxytocin infusion randomly at the rates of 0, 4, 8, 12, 16, or 20 IU h−1 after the delivery of infants. Following oxytocin administration, a blinded obstetrician evaluated the uterine tone (UT), verbally describing it using numerical scales (0–10: 0, no UT; 10, optimal UT) as either adequate or inadequate at the time intervals of 3, 6, and 9 min. Maternal adverse effects, requirements for additional uterotonic agents, delivery–placenta delivery time (PD), and estimated blood loss (EBL) were recorded.Results: The 50% effective dose (ED50) and 90% effective dose (ED90) of oxytocin infusion were 14.6 IU h−1 (95% confidence interval 12.0–18.4 IU h−1) and 27.7 IU h−1 (95% confidence interval 22.5–39.4 IU h−1), respectively. As the rate of infusion was increased in parturients, the rescue oxytocin dose and delivery-PD time were decreased. Parturients who received 0 IU h−1 oxytocin at 3, 6, and 9 min obtained lower UT scores than those who received 16 and 20 IU h−1 oxytocin (p < 0.05, respectively). No significant differences were observed among groups in EBL and maternal adverse effects.Conclusion: The infusion rate of oxytocin at 14.57 and 27.74 IU h−1 produces adequate UT in 50% and 90% of elderly parturients with prior history of CD, respectively. An oxytocin infusion rate of 27.7 IU h−1 is suggested to be the optimal dose for preventing uterine atony during CD in elderly parturients with prior history of cesarean delivery.Clinical Trial Registration: [https://www.chictr.org.cn/bin/project/edit?pid=62489], Identifier: [ChiCTR2000038891].

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Section: Figurementioning

confidence: 91%

The optimal oxytocin infusion rate for preventing uterine atony during cesarean delivery in elderly parturients with prior history of cesarean delivery

Wang

Dong

et al. 2023

Front. Pharmacol.

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“…Of note, all studies found an oxytocin bolus dose requirement well under 5 units (and generally under 1 unit). A randomized controlled trial of oxytocin bolus dosing at the time of cesarean delivery showed that patients with a history of prior cesarean birth required a higher oxytocin dose (0.95 units [95% confidence interval (CI) 0.82–1.08] vs. 0.55 units [95% CI 0.38–0.73], P < 0.001) [15]. Similarly, when patients with preeclampsia receiving magnesium sulfate were compared to nonhypertensive patients (not on magnesium) at the time of cesarean, patients on magnesium required significantly higher oxytocin doses and suffered significantly more side effects and hypotension as a result [16].…”

Section: Treatmentmentioning

confidence: 99%

Uterine atony

Miller

Ansari

2022

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewPostpartum hemorrhage (PPH) is the leading preventable cause of maternal morbidity and mortality worldwide. Uterine atony is identified as the underlying etiology in up to 80% of PPH. This serves as a contemporary review of the epidemiology, risk factors, pathophysiology, and treatment of uterine atony.Recent findingsRates of postpartum hemorrhage continue to rise worldwide with the largest fraction attributed to uterine atony. A simple 0–10 numerical rating score for uterine tone was recently validated for use during cesarean delivery and may allow for more standardized assessment in clinical and research settings. The optimal prophylactic dose of oxytocin differs depending on the patient population, but less than 5 units and as low as a fraction of one unit is needed for PPH prevention, with an increased requirements within that range for cesarean birth, those on magnesium, and advanced maternal age. Carbetocin is an appropriate alternative to oxytocin. Misoprostol shows limited to no efficacy for uterine atony in recent studies. Several uncontrolled case studies demonstrate novel mechanical and surgical interventions for treating uterine atony.SummaryThere is a critical, unmet need for contemporary, controlled studies to address the increasing threat of atonic PPH.

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The Intraoperative Median Effective Dose of Oxytocin for Preventing Uterine Atony in Parturients with a Prior History of Caesarean Delivery

Cited by 2 publications

References 32 publications

The optimal oxytocin infusion rate for preventing uterine atony during cesarean delivery in elderly parturients with prior history of cesarean delivery

The optimal oxytocin infusion rate for preventing uterine atony during cesarean delivery in elderly parturients with prior history of cesarean delivery

Uterine atony

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