Effectiveness of intramyometrial oxytocin versus intravenous oxytocin bolus administration during elective caesarean section – a randomized control trial

A D Dissanayake,U Y Samaratunge,I Piyadigama,K Gunawardena

doi:10.4038/sljog.v43i2.7979

A D Dissanayake, U Y Samaratunge + Show 2 more

Open Access

https://doi.org/10.4038/sljog.v43i2.7979

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Abstract

Introduction: Intravenous oxytocin (IVO) is recommended during elective caesarean section to prevent postpartum haemorrhage. However, compared to IVO intramyometrial oxytocin (IMO), may result in better contractility with minimal haemodynamic side effects. Limited number of studies are available on IMO use at elective Caesarean section (CS). Objective: To evaluate the effectiveness of prophylactic IMO against IVO, in term singleton mothers at elective CS. Methods: Sixty five term singleton mothers undergoing elective CS at the Teaching Hospital, Kandy from 1st February 2015 to April 2015 were randomized to IMO and IVO. Prior to umbilical cord clamping, either IMO 5 IU divided half to each cornu or routine IVO 5 IU was administered. Blood loss was assessed using gravimetric methods and allowable blood loss calculation. Surgeon assessed uterine tone at 2,5,10 and 15 minutes following injection and gave a score of 1 to 5. Hameodynamic parameters, side effects, haemoglobin and haematocrit were recorded. Results: Thirty three were in IMO group while 32 were in IVO group. There was no significant difference between IVO and IMO groups in relation to mean blood loss, (303.83, SD 103.77ml vs 267.65 SD 93.53 ml, p=0.43), uterine contractions at 2 and 5 minutes and side effects. Calculated allowable blood loss in IMO group was significantly less than IVO group (p=0.04) and contraction scores at 10 and 15minutes were significantly higher in IMO group. There was no difference in haemodynamic parameters in each group. Conclusion: IMO oxytocin was not more effective than IVO during elective CS.

Highlights

Intravenous oxytocin (IVO) is recommended during elective caesarean section to prevent postpartum haemorrhage
Our results do not show any difference between IVO and intramyometrial oxytocin (IMO) in terms of blood loss assessed through gravimetric methods, side effect profile and haemodynamic parameters
The findings from this study indicate that such localized effects are not apparent in the doses of oxytocin studied

Summary

Introduction

Intravenous oxytocin (IVO) is recommended during elective caesarean section to prevent postpartum haemorrhage. There was no significant difference between IVO and IMO groups in relation to mean blood loss, (303.83, SD 103.77ml vs 267.65 SD 93.53 ml, p=0.43), uterine contractions at 2 and 5 minutes and side effects. Uterine atony is considered as the commonest cause of PPH, which is preventable by active management in the third stage, which includes the use of an uterotonic as oxytocin, controlled cord traction and early cord clamping. It results in less blood loss compared to expectant mangement[2] and is capable of reducing PPH by nearly 60% 3. Studies have shown that intramyometrial carboprost may not be more effective than intramyometrial oxytocin[5]

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