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Please use this identifier to cite or link to this item: http://hdl.handle.net/2262/59130

Title: Oxytocin bolus versus oxytocin bolus and infusion for control of blood loss at elective caesarean section: double blind, placebo controlled, randomised trial.
Author: MURPHY, DEIRDRE
Sponsor: Health Research Board
Author's Homepage: http://people.tcd.ie/murphyd4
Keywords: Obstetrics
Gynecology
caesarean section
Issue Date: 2011
Citation: Sheehan SR, Montgomery AA, Carey M, McAuliffe FM, Eogan M, Gleeson R, Geary M, Murphy DJ, Oxytocin bolus versus oxytocin bolus and infusion for control of blood loss at elective caesarean section: double blind, placebo controlled, randomised trial., BMJ (Clinical research ed.), 343, 2011, d4661
Series/Report no.: BMJ (Clinical research ed.)
343
Abstract: OBJECTIVES: To determine the effects of adding an oxytocin infusion to bolus oxytocin on blood loss at elective caesarean section. DESIGN: Double blind, placebo controlled, randomised trial, conducted from February 2008 to June 2010. SETTING: Five maternity hospitals in the Republic of Ireland. PARTICIPANTS: 2069 women booked for elective caesarean section at term with a singleton pregnancy. We excluded women with placenta praevia, thrombocytopenia, coagulopathies, previous major obstetric haemorrhage (>1000 mL), or known fibroids; women receiving anticoagulant treatment; those who did not understand English; and those who were younger than 18 years. INTERVENTION: Intervention group: intravenous slow 5 IU oxytocin bolus over 1 minute and additional 40 IU oxytocin infusion in 500 mL of 0.9% saline solution over 4 hours (bolus and infusion). Placebo group: 5 IU oxytocin bolus over 1 minute and 500 mL of 0.9% saline solution over 4 hours (placebo infusion) (bolus only). Main outcomes Major obstetric haemorrhage (blood loss >1000 mL) and need for an additional uterotonic agent. RESULTS: We found no difference in the occurrence of major obstetric haemorrhage between the groups (bolus and infusion 15.7% (158/1007) v bolus only 16.0% (159/994), adjusted odds ratio 0.98, 95% confidence intervals 0.77 to 1.25, P=0.86). The need for an additional uterotonic agent in the bolus and infusion group was lower than that in the bolus only group (12.2% (126/1033) v 18.4% (189/1025), 0.61, 0.48 to 0.78, P<0.001). Women were less likely to have a major obstetric haemorrhage in the bolus and infusion group than in the bolus only group if the obstetrician was junior rather than senior (0.57, 0.35 to 0.92, P=0.02). CONCLUSION: The addition of an oxytocin infusion after caesarean delivery reduces the need for additional uterotonic agents but does not affect the overall occurrence of major obstetric haemorrhage. Trial Registration Current Controlled Trials ISRCTN17813715.
Description: PUBLISHED
URI: http://hdl.handle.net/2262/59130
Related links: http://dx.di.org/10.1136/bmj.d4661
Appears in Collections:Obstetrics & Gynaecology (Scholarly Publications)

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