Spontaneous vaginal birth following induction with intravenous oxytocin: Three oxytocic regimes to minimise blood loss post birth |
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| Affiliation: | 1. School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Perth, Western Australia 6102, Australia;2. Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Perth, Western Australia, 6008, Australia;3. Division of Obstetrics and Gynaecology, The University of Western Australia, Nedlands, Perth, Western Australia 6009, Australia;4. Labour and Birth Suite, King Edward Memorial Hospital, Subiaco, Perth, Western Australia, 6008, Australia;5. Pharmacy Department, King Edward Memorial Hospital, Subiaco, Perth, Western Australia, 6008, Australia;6. Department of Obstetrics and Gynaecology, King Edward Memorial Hospital, Subiaco, Perth, Western Australia 6008, Australia;1. School of Nursing, York University, Canada;2. School of Nursing and Midwifery, Monash University, Australia;3. Department of Obstetrics, Affiliated Hospital of Xuzhou Medical University, PR China;4. Department of Obstetrics, Sir Run Run Hospital of Nanjing Medical University, PR China;5. Department of Nursing, Sir Run Run Hospital of Nanjing Medical University, PR China;1. School of Nursing and Midwifery, La Trobe University, Melbourne, Australia;2. Department of Rural Health, The University of South Australia, Adelaide, Australia;1. Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia;2. Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia |
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| Abstract: | BackgroundNo evidence was identified in relation to the downward titration/cessation of intravenous oxytocin post spontaneous vaginal birth, in the absence of postpartum haemorrhage (PPH); suggesting clinicians’ management is based on personal preference in the absence of evidence.AimTo determine the proportion of induced women with a spontaneous vaginal birth and PPH, when intravenous oxytocin was utilised intrapartum and ceased 15, 30 or 60 minutes post birth.MethodsThis three armed pilot randomised controlled trial, was undertaken on the Birth Suite of an Australian tertiary obstetric hospital. Incidence of PPH was assessed using univariable and adjusted logistic regression, which compared the effect of titrating intravenous oxytocin post birth on the likelihood of PPH, relative to the 15 minute titration group.FindingsPostpartum haemorrhage occurred in 26% (30 of 115), 20% (23 of 116), and 22% (30 of 134) of women randomised to a 15, 30 and 60 minute titration time post birth, with no statistically significant differences between groups.ConclusionThere was no difference in the incidence of PPH between the three groups. Therefore, we question the benefit of delaying cessation of intravenous oxytocin for 60 minutes post birth. Further investigation in this cohort is recommended, to compare the incidence of PPH when intravenous oxytocin is ceased either immediately, or 30 minutes post birth. This research is warranted, as an evidence-based framework is lacking, to guide midwives globally in relation to their management of intravenous oxytocin post an induced spontaneous vaginal birth, in the absence of PPH. |
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| Keywords: | Postpartum haemorrhage Blood loss Intravenous oxytocin Induced labour Randomised controlled trial |
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