Intravenous oxytocin dosing regimens for postpartum hemorrha
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This study states that bolus plus infusion regimens may lead to minor reductions in mean blood loss for postpartum hemorrhage (PPH) prevention at cesarean section.

The objective was to synthesize available evidence on intravenous (IV) oxytocin dosing regimens for the prevention of postpartum hemorrhage (PPH) at cesarean section (CS).

Researchers searched Medline/OVID, Embase, Global Index Medicus, CINAHL, CENTRAL, ClinicalTrials.gov, and ICTRP for eligible studies published until Feb 2020. Thirty-five studies (7,333 women) met our inclusion criteria, including 30 randomized trials and five non-randomized studies. There were limited data from trials for most outcomes, and results were not conclusive.

--Compared to bolus plus infusion regimens, bolus-only regimens probably result in slightly higher mean blood loss.

--Amongst bolus plus infusion regimens, initial bolus doses < 5 IU may reduce nausea as compared to 5-9 IU.

--Total oxytocin doses 5-9 IU versus 10-19 IU may increase the use of additional uterotonics. Effects on other outcomes were generally inconclusive.

In particular, there is limited data comparing IV oxytocin regimens for PPH prevention at CS. Bolus plus infusion regimens may lead to minor reductions in mean blood loss, and initial bolus doses of < 5 IU may minimize nausea. Bolus-only regimens of 10 IU versus 5 IU may decrease the use of additional uterotonics, however further comparative trials are required to understand effects on other key outcomes, particularly hypotension.

Source: https://doi.org/10.1016/j.ajog.2021.04.258
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