title: Effect of a High-Rate Versus a Low-Rate Oxytocin Infusion for Maintaining Uterine Contractility During Elective Cesarean Delivery: A Prospective Randomized Clinical Trial.
abstract: Oxytocin is routinely used as prophylaxis against uterine atony. During elective cesarean delivery (CD), an oxytocin bolus is used to initiate adequate uterine tone, followed by an oxytocin infusion to maintain uterine contractility. However, it is unclear whether oxytocin maintenance infusion rate influences total estimated blood loss (EBL).
  
  
  
  We performed a prospective, randomized, double-blind trial in 51 women undergoing elective CD. Women were randomly assigned to receive an oxytocin maintenance infusion of 2.5 or 15 U/h. All women received an oxytocin 1 U bolus to initiate adequate uterine tone. The primary outcome was EBL. EBL values between groups were compared using a Mann-Whitney U test; P < .05 as statistically significant. The median EBL difference with 95% confidence intervals was also calculated. Secondary outcomes included adequacy of uterine tone, use of additional uterotonics, and oxytocin-related side effects, including hypotension.
  
  
  
  Of 51 women, 24 received a low-rate infusion and 27 received a high-rate infusion. Median (interquartile range) EBL values in the low-rate and high-rate groups were 634 (340-886) mL versus 512 (405-740) mL, respectively (P = .7). The median difference in EBL between groups was 22 mL; 95% confidence interval = -158 to 236 mL. The rate of postpartum hemorrhage did not differ between groups (low-rate group: 4/24 [16.7%] versus high-rate group: 4/26 [15.4%]). There were no between-group differences over time (first 20 minutes after commencing infusion) in the incidence of adequate uterine tone (P = .72) or hypotension (P = .32).
  
  
  
  Among women undergoing elective CD receiving an oxytocin maintenance infusion, EBL and uterine tone did not differ between women receiving 2.5 U/h oxytocin and those receiving 15 U/h oxytocin. Our findings suggest that efficacy can be obtained with a low oxytocin maintenance infusion rate; however, dose-finding studies are needed to determine the infusion rate that optimizes drug efficacy while minimizing side effects.
authors.affiliation: From the *Department of Anesthesiology, Perioperative, and Pain Medicine and †Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Duffield
authors.forename: Christine
authors.initials: C
authors.lastname: McKenzie
authors.forename: Brendan
authors.initials: B
authors.lastname: Carvalho
authors.forename: Bharathi
authors.initials: B
authors.lastname: Ramachandran
authors.forename: Victoria
authors.initials: V
authors.lastname: Yin
authors.forename: Yasser Y
authors.initials: YY
authors.lastname: El-Sayed
authors.forename: Edward T
authors.initials: ET
authors.lastname: Riley
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Butwick
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D010120:Oxytocics / Q000008:administration & dosage*; D010121:Oxytocin / Q000008:administration & dosage*; D011247:Pregnancy; D011446:Prospective Studies; D016896:Treatment Outcome; D014590:Uterine Contraction / Q000187:drug effects* / Q000502:physiology
chemical_list: D010120:Oxytocics; D010121:Oxytocin