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Active Management of Third Stage of Labour May Increase Total Oxytocin Administered, Without Adverse Outcomes: Presented at ASA

By Lexa W. Lee

NEW ORLEANS -- October 22, 2009 -- The active management of the third stage of labour in vaginal delivery (VD) may increase the total oxytocin administered without adverse outcomes, according to a new study presented here at the 2009 Annual Meeting of the American Society of Anesthesologists (ASA). In the case of caesarean delivery (CD), limiting the maximum rate of oxytocin infusions after delivery can reduce oxytocin usage without increasing vasopressor usage, reported Amy I. Lee, MD, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, on October 19.

Studies have shown that active management, such as earlier initiation of oxytocin, during the third stage of labour can reduce bleeding complications without increasing adverse incomes. This study evaluated the effect of an oxytocin infusion protocol in the third stage of labour on hypotension and the administration of uterotonics. Study patients had no uniform management of this stage of labour or the maximum infusion rate of oxytocin before the protocol was implemented.

Researchers analysed data collected from 2,648 patients who received neuraxial analgesia in the time surrounding initiation of the oxytocin infusion protocol. Parameters included the amount of oxytocin infused after delivery, administration of supplemental uterotonics (eg, methylergonovine, prostaglandin 15-methyl F2 alpha, or misoprostol), occurrence of hypotension requiring vasopressor administration, and estimated blood loss.

Data were stratified by mode of delivery (VD or CD). Patients treated before protocol implementation were compared with those treated post implementation. The Mann-Whitney U test and a chi-square statistic were used for analysis. Significance was set at P < .05.

In the VD group, the total amount of oxytocin administered increased from 10 IU before protocol change to 21 IU after (P < .001), with no difference in estimated blood loss or uterotonic use. In the CD group, the total oxytocin administered decreased from 20% before the change to 12% after the change (P < .001), with no difference in estimated blood loss or uterotonic use, and by limiting the maximum infusion rate, vasopressor use may not have to be increased when oxytocin is decreased.

The researchers concluded that active management of VD patients in the third stage of labour may increase the total oxytocin administered but without adverse effects. Limiting the maximum rate of oxytocin infusion after CD may enable a decrease in oxytocin use without increasing vasopressor use. The potential increase in estimated blood loss with protocol implementation after CD is not likely to be clinically significant. The trend toward greater uterotonic use after protocol implementation may reflect use of uterotonics by the obstetrician during the initial protocol implementation but merits further investigation.

[Presentation title: Retrospective Evaluation of the Impact of Implementation of an Oxytocin Administration Protocol on Uterotonic Use and Maternal Hypotension. Abstract A819]

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