Comparison of Varying Bolus Doses of Oxytocin in Patients Undergoing Caesarean Spinal Delivery

Authors

  • Muhammad Salman Maqbool
  • Huda Shafqat
  • Ayesha

DOI:

https://doi.org/10.51985/JBUMDC2020018

Keywords:

Caesarean section, Maternal hemodynamics, Oxytocin, Phenylephrine, Uterine atony.

Abstract

caesarean delivery avoiding side effects.
Study design and setting: A study was conducted at Rawal General and Dental Hospital, from 10th Oct, 2018 to 27th
May, 2019.
Methodology: Patients undergoing elective cesarean spinal delivery were randomly divided by computer generated
numbers(n=155) into 5 groups A, B, C, D and E receiving 0.5, 1, 3, 5 and 10 units of injection oxytocin as bolus respectively
after delivery of baby. Uterine contraction was assessed by gynecologist by manual palpation of uterus on a linear scale.
Value of 8 was considered adequate and 8 inadequate uterine tone respectively. Heart rate, non-invasive blood pressure
and oxygen saturation were noted before and after oxytocin bolus. All patients received oxytocin infusion. The primary
outcome measure was the assessment of uterine tone at 2 minute of oxytocin bolus. The secondary outcome variables
included shortness of breath, chest discomfort, top-up bolus administered, hemodynamic variables, epigastric discomfort
and oxytocin related effects (tachycardia, epigastric discomfort and hypotension).
Results: The use of 5 units oxytocin (group-D) showed most optimal uterine contractions, 61.3% in comparison to commonly
used 10 units bolus dose (group-E) 48.4% with minimal side effects like, less tachycardia(12.9% versus 72.9%) and
hypotension (12.9% versus 32.3%), no top-up bolus dose was required in 54.8% cases and no complain of epigastric
discomfort was observed.
Conclusion: Low doses of oxytocin are effective in terms of uterine contraction with minimal side effects.

References

REFERENCES:

Murphy DJ, Carey M , Montgomery AA , Sheehan SR . Study Protocol. ECSSIT - Elective Caesarean Section Syntocinon Infusion Trial. A multi-Centre Randomised Controlled Trial of Oxytocin (Syntocinon) 5 IU bolus and Placebo Infusion Versus Oxytocin 5 IU bolus and 40 IU Infusion for the Control of Blood Loss at Elective Caesarean Section. BMC Pregnancy Childbirth. 2009;9:36.

Kothari D, Bhalavi S, Gautam A, Choudhary B, Dahiya S, Pathak V. Effects of three doses of oxytocin (3, 5 ,10 I U) on haemodynamic parameters, uterine tone and blood loss in elective caesarean section under spinal anaesthesia. A prospective randomised double-blind study. J. Evolution Med. Dent. Sci. 2018:17(35);3913-3917.

Prendiville W, Elbourne D, Chalmers I. The effects of routine oxytocic administration in the management of the third stage

of labour: an overview of the evidence from controlled trials. Br J Obstet Gynaecol 1988;95(1):3-16. 4. Carvalho Jose CA, Balki M, Kingdom J, Windrim R. Oxytocin Requirements at Elective Cesarean Delivery: A Dose-Finding Study. Obstet & Gynecol 2004;104:1005-10.

Svanstrom MC, Biber B, Hanes M, Johansson G, Naslund U, Balfors EM. Signs of Myocardial Ischaemia After Injection of Oxytocin: A Randomized Double-Blind Comparison of Oxytocin and Methylergometrine During Caesarean Section. Br J Anaesth 2008;100(5):683-9.

Pinder AJ, Dresner M, Calow C, Shorten GD, O’Riordan J, Johnson R. Haemodynamic changes caused by oxytocin during caesarean section under spinal anaesthesia. Int J Obstet Anesth 2002; 11:156– 9.

Edwards BR, LaRochelle Jr FT. Antidiuretic Effect of Endogenous Oxytocin in Dehydrated Brattleboro Homozygous

Rats. Am J Physiol 1984; 247:453-65.

Wedisinghe L, Macleod M, Murphy DJ. Use of Oxytocin to Prevent Haemorrhage at Caesarean Section- A Survey of

Practice in the United Kingdom. Eur J Obstet Gynecol Reprod Biol 2008; 137:27-30.

Cunningham FG, MacDonald PC, Gant NF. Cesarean section and cesarean hysterectomy. In: Cunningham FG, MacDonald

PC, Gant NF, eds. Williams obstetrics. Norwalk: Appleton & Lange, 1989;441-59.

Kovacheva VP, Soens MA, Tsen LC. A Randomized, Doubleblinded Trial of a "Rule of Threes" Algorithm Versus

Continuous Infusion of Oxytocin During Elective Cesarean Delivery. Anesthesiology 2015; 123 (1):92-100.

Thomas TA, Cooper GM. Maternal Deaths from Anaesthesia. An Extract from Why Mothers Die 1997-1999, the Confidential

Enquiries Into Maternal Deaths in the United Kingdom. Br J Anaesth. 2002; 89: 499-508.

Ngan Kee WD. Prevention of Maternal Hypotension After Regional Anaesthesia for Caesarean Section. Curr Opin

Anaesthesiol 2010; 23 (3): 304 - 9.

Mohta M, Kumar V, Agarwal R, Chilkoti Geetanjali T, Duggal S. Efficacy of Phenylephrine in Preventing Hemodynamic

Responses of Oxytocin during Elective Cesarean Section: A Randomized, Double-Blind, Controlled Trial. Ann Natl Acad

Med Sci (India) 2019; 55(1):48-53.

Orbach-Zinger S, Einav S, Yona A, Eidelman LA, Fein S, Davis A, Loscovich A. A survey of physicians’ attitudes

toward uterotonic administration in parturients undergoing cesarean section. The Journal of Maternal-Fetal & Neonatal

Medicine 2018: 31(23); 3183-3190.15. Abbas A, Akram H, Farooq B. Comparison of hemodynamic

changes caused by 2 units versus 5 units of oxytocin during elective caesarean section under spinal anaesthesia. Esculapio

J Services Inst Med Sci Oct-Dec 2013;9(4):168-70.

Morgan GE, Mikhail MS. Clinical Anesthesiology. 5th Edition. Mc Graw Hill Education 2013; 18: 297.

Dyer RA, Farina Z, Joubert IA, Du Toit P, Meyer M, Torr G,Wells K, James MF. Crystalloid preload versus rapid

crystalloid administration after induction of spinal anaesthesia (coload) for elective caesarean section. Anaesth Intensive

Care 2004; 32:351–7.

Breen TW, Shapiro T, Glass B, Foster-Payne D, Oriol NE. Epidural anesthesia for labor in an ambulatory patient. Anesth

Analg 1993;77: 919-24.

Apgar V, Holaday DA, James LS, Weisbrot IM, Berrien C. Evaluation of the newborn infant; second report. J Am Med

Assoc. 1958; 168:1985-8.

Maqbool MS. Evaluation of Heart Rate Variability and Baroreflex Sensitivity in Cesarean Spinal Delivery. Med

Forum 2018;29(3):78-82.

Anya SU, Onyekwulu FA, Onuora EC. Comparison of visual estimation of intra-operative blood loss with haemoglobin

estimation in patients undergoing caesarean section. Niger Postgrad Med J 2019; 26:25-30.

Ashraf Aly H, Ramadani HM. Assessment of blood loss during cesarean section under general anesthesia and epidural

analgesia using different methods. Alexandria J Anaesth Intensive Care 2006; 9:25-34.

Sartain JB, Barry JJ, Howat PW, McCormack DI, Bryant M. Intravenous Oxytocin Bolus of 2 Units Is Superior to 5 Units

During Elective Caesarean Section. Br J Anesth 2008; 101:822-6.

Sheehan SR, Wedisinghe L, Macleod M, Murphy DJ, Implementation of Guidelines on Oxytocin Use at Caesarean

Section: A Survey of Practice in Great Britian and Ireland.

Eur J Obstet Gynecol Reprod Biol 2010; 148:121-4. 25. Stoelting RK. Pharmacology and Physiology in Anesthetic

Practice, 3rd ed. Lippincott Williams & Wilkins, USA 1999. https://doi.org/10.1097/00000542-200610000-00052

Butwick AJ, Coleman L, Cohen SE, Riley ET, Carvalho B. Minimum Effective Bolus Dose of Oxytocin During Elective

Caesarean Delivery. Br J Anaesth 2010; 104:338-43.

Qian XW, Drzymalski DM, Ly CC, Guo FH, Wang LY, Chen XY. The ED 50 and ED95 of Oxytocin Infusion Rate for

Maintaining Uterine Tone During Elective Caesarean Delivery: A Dose-Finding Study. BMC Pregnancy Childbirth 2020; 20:6.

Beiranvand S, Karimi A, Vahabi S, Amin-Bidokhti A . Comparison of the Mean Minimum Dose of Bolus Oxytocin

for Proper Uterine Contraction During Cesarean Section. Curr

Clin Pharmacol 2019; 14:208-213. 29. Shashikiran, Kaur H, Bala R, Gupta N. A study to determine

minimum effective dose of oxytocin infusion during caesarean delivery in parturients at high risk of uterine atony. J Obstet

Anaesth Crit Care 2017; 7:75-80.

Keikhaie KR, Behzadmehr R, Salarzaeis M. Comparison of Two Doses of Oxytocin Regimes to Prevent Post-Caesarean

Bleeding Due to Uterine Atony in Pregnant Women Referring to Amir-al Momenin Hospital of Zabol in 2016. Ann Med

Health Sci Res. 2017; 7:405-407.

Downloads

Published

2021-03-18

How to Cite

Maqbool, M. S. ., Shafqat, H. ., & Ayesha. (2021). Comparison of Varying Bolus Doses of Oxytocin in Patients Undergoing Caesarean Spinal Delivery. Journal of Bahria University Medical and Dental College, 10(4), 261–265. https://doi.org/10.51985/JBUMDC2020018

Issue

Section

Original Articles

Most read articles by the same author(s)