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Oxytocin infusion does not prevent major hemorrhage during cesarean delivery

Clinical Question:
Does oxytocin infusion at elective cesarean delivery reduce the rate of major obstetrical hemorrhage?

Bottom Line:
Intravenous infusion of oxytocin of 40 IU over 4 hours after elective cesarean delivery does not reduce the incidence of major obstetrical hemorrhage (defined as more than 1000 mL blood loss). (LOE = 1b)

Reference:
Sheehan SR, Montgomery AA, Carey M, et al, for the ECSSIT Study Group. Oxytocin bolus versus oxytocin bolus and infusion for control of blood loss at elective cesarean section: double blind, placebo controlled, randomized trial. BMJ 2011;343:d4661.  [PMID:21807773]

Study Design:
Randomized controlled trial (double-blinded)

Funding:
Government

Allocation:
Concealed

Setting:
Inpatient (any location)

Synopsis:
The purpose of this randomized controlled trial was to determine whether oxytocin infusion with elective cesarean delivery prevents major obstetrical hemorrhage (estimated at more than 1000 mL). Healthy women (N = 2058) were included with singleton gestation of more than 36 weeks. Oxytocin bolus of 5 IU was administered to both study groups just prior to controlled cord traction for placental delivery. This was followed by an infusion of 500 mL of intravenous 0.9% saline solution over 4 hours with or without (double blinded) 40 IU of oxytocin. Blood loss was estimated primarily on the basis of the change in packed red cell volume and secondarily from measurement in operative suction volume and sponge weight. There were no differences between groups in the risk of major hemorrhage, blood transfusion, hypotension, or length of stay. There was less unplanned use of additional uterotonic drugs in the oxytocin infusion group.

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