A Randomized Control Trial of 3 IU IV Oxytocin Bolus with 7 IU Oxytocin Infusion versus 10 IU Oxytocin Infusion During Cesarean Section for Prevention of Postpartum Hemorrhage

Effect of administration routes of oxytocin on hemoglobin in neonates with delayed umbilical cord clamping: a multi-centre randomized controlled clinical trial

PURPOSE

To evaluate the effect of intravenous infusion versus intramyometrial injection of oxytocin on hemoglobin levels in neonates with delayed umbilical cord clamping during cesarean section.

METHODS

The multi-centre randomized controlled trial was performed at three hospitals from February to June 2023. Women with term singleton gestations scheduled for cesarean delivery were allocated to receive an intravenous infusion of 10 units of oxytocin or a myometrial injection of 10 units of oxytocin during the surgery. The primary outcome was neonatal hemoglobin at 48 to 96 h after birth. Secondary outcomes were side-effects of oxytocin, postpartum haemorrhage, phototherapy for jaundice, feeding at 1 month, maternal and neonatal morbidity and re-admissions.

RESULTS

A total of 360 women were randomized (180 women in each group). The mean neonatal hemoglobin did not show a significant difference between the intravenous infusion group (194.3 ± 21.7 g/L) and the intramyometrial groups (195.2 ± 24.3 g/L) (p = 0.715). Secondary neonatal outcomes, involving phototherapy for jaundice, feeding at 1 month and neonatal intensive care unit admission were similar between the two groups. The maternal outcomes did not differ significantly between the two groups, except for a 200 mL higher intraoperative infusion volume observed in the intravenous group compared to the intramyometrial group.

CONCLUSION

Among women undergoing elective cesarean delivery of term singleton pregnancies, there was no significant difference in neonatal hemoglobin at 48 to 96 h after birth between infants with delayed cord clamping, whether the oxytocin was administrated by intravenous infusion or intramyometrial injection.

TRIAL REGISTRATION

Chinese Clinical trial registry: ChiCTR2300067953 (1 February 2023).

Intravenous oxytocin regimens in patients undergoing cesarean delivery: a systematic review and network meta-analysis of cluster-based groups

Information on evaluations of different oxytocin regimens used to prevent post-partum hemorrhage during cesarean delivery is scarce, and there is a lack of statistically pooled results for comparative doses. In this review, we aimed to analyze the effectiveness of different oxytocin regimens used and rank them accordingly. We performed a meta-analysis of randomized controlled trials (RCTs) reporting the incidence of additional uterotonic (AUT) use or amount of blood loss during cesarean delivery, where different oxytocin regimens were compared. Cluster analysis was used to define different clusters of oxytocin therapy based on the identified variable regimens. During the frequentist network meta-analysis, all clusters were compared to bolus clusters of dose range 3-5 IU. Data from 33 RCTs (6741 patients) to 26 RCTs (5422 patients) were assessed for AUT use and blood loss, respectively. Pairwise meta-analysis revealed a significant reduction in the use of AUTs or blood loss was recorded for bolus-infusion combination regimens. The network meta-analysis found that combined bolus-infusion regimens of (i) 3-5 IU and 0.25-1 IU/min or (ii) 3-5 IU and < 0.25 IU/min had statistically significant results for lowest consumption of AUTs (Ranks 1 and 2, respectively); whereas with the latter's use, the lowest blood loss (Rank 2) was observed. In contrast, the dose range, > 5 IU regimen was associated with higher side effects (lowest rank). During cesarean delivery, a significant reduction in the use of AUTs or blood loss (Rank 2) was recorded for bolus-infusion combination regimens. High doses did not have enough evidence to draw meaningful conclusions.

Cohort Study Summary of the Effects of Carboprost Tromethamine Combined with Oxytocin on Infant Outcome, Postpartum Hemorrhage and Uterine Involution of Parturients Undergoing Cesarean Section

Background

Carboprost tromethamine injection has a high safety factor in clinical application and has a good effect on uterine smooth muscle and vasoconstriction. Carboprost aminobutyriol combined with oxytocin may be beneficial to infant outcome and uterine involution after cesarean section.

Objective

To investigate the effects of carboprost tromethamine combined with oxytocin on infant outcome, postpartum hemorrhage, and uterine involution in parturients undergoing cesarean section.

Methods

A total of 120 parturients undergone cesarean section in our hospital from February 2019 to April 2021 were selected as the object of study. The parturients were randomly divided into control group (n = 60) and research group (n = 60). The control group was treated with oxytocin, and the research group was treated with carboprost aminobutyriol combined with oxytocin. The amount of maternal bleeding, uterine floor decline index, the end of lochia, poor rate of uterine involution, infant outcome, and the incidence of adverse drug reactions were compared between the two groups.

Results

The amount of bleeding in the research group was significantly lower than that in the control group (P < 0.05). The position of the last uterine floor and the index of uterine floor downward movement in the research group were significantly higher than those in the control group (P < 0.05). The disappearance time of bloody lochia and serous lochia in the research group was significantly shorter than that in the control group (P < 0.05). The end time of lochia in the research group was higher than that in the control group, and the rate of uterine involution in the research group was lower than that in the control group (P < 0.05). The neonatal weight and Apgar score in the research group were higher than those in the control group, and the hospitalization rate of neonatal ICU in the research group was significantly lower than that in the control group. The incidence of adverse reactions in the research group was significantly lower than that in the control group (P < 0.05).

Conclusion

Carboprost aminobutyriol combined with carbestatin can effectively prevent the occurrence of bleeding after cesarean section, improve uterine involution, and improve neonatal birth quality, which is worth popularizing.