title: Outcomes after institution of a new oxytocin infusion protocol during the third stage of labor and immediate postpartum period.
abstract: BACKGROUND
  Due to safety concerns when oxytocin is administered in an uncontrolled fashion, and recent dose-response data that indicate oxytocin's effectiveness at doses lower than those traditionally used, we instituted a new protocol for the infusion of oxytocin during the third stage of labor and in the immediate postpartum period. We undertook this study to confirm that this change in practice did not have untoward effects on postpartum hemorrhage rates.
  
  
  METHODS
  In this retrospective review, patients who delivered in the six months before (PRE group) and patients who delivered in the six months after (POST group) the new protocol had been introduced were identified through an institutional database and their medical records were reviewed. The primary outcome variable was the postpartum hemorrhage rate. Secondary outcomes included maternal and fetal co-morbidities, protocol compliance, administration of other uterotonic agents, use of Bakri balloons and B-Lynch sutures, rate of uterine artery embolization and peripartum hysterectomy, need for red blood cell transfusion, and drop in hemoglobin after delivery. Categorical data were analyzed using Chi-squared or Fisher's Exact test, as appropriate. Continuous data were analyzed using a Mann-Whitney U test. A P value <0.05 was required to reject the null hypothesis.
  
  
  RESULTS
  A total of 1572 medical records were reviewed. Postpartum hemorrhage occurred in 9.0% of PRE patients and 7.1% of POST patients, and was not different between groups (P=0.17). Carboprost use was lower in the POST group, but no other differences were noted.
  
  
  CONCLUSIONS
  Adoption of a protocol to infuse oxytocin in a controlled manner at a lower dose than that historically used was not associated with an increased incidence of postpartum hemorrhage.
authors.affiliation: Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL, USA.
authors.forename: J
authors.initials: J
authors.lastname: Dagraca
authors.forename: V
authors.initials: V
authors.lastname: Malladi
authors.forename: K
authors.initials: K
authors.lastname: Nunes
authors.forename: B
authors.initials: B
authors.lastname: Scavone
mesh_terms: D000328:Adult; D002585:Cesarean Section; D036861:Delivery, Obstetric; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D007749:Labor Stage, Third / Q000502:physiology*; D007743:Labor, Obstetric; D010120:Oxytocics / Q000008:administration & dosage*; D010121:Oxytocin / Q000008:administration & dosage*; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000517:prevention & control; D049590:Postpartum Period / Q000502:physiology*; D011247:Pregnancy; D011785:Quality Assurance, Health Care; D018401:Sample Size; D016896:Treatment Outcome
chemical_list: D010120:Oxytocics; D010121:Oxytocin