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Prophylactic Dose of Oxytocin for Uterine Atony During Caesarean Delivery: a Systematic Review

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Prophylactic Dose of Oxytocin for Uterine Atony During Caesarean Delivery: a Systematic Review International Journal of Environmental Research and Public Health Systematic Review Prophylactic Dose of Oxytocin for Uterine Atony during Caesarean Delivery: A Systematic Review Vilda Baliuliene 1,*, Migle Vitartaite 2 and Kestutis Rimaitis 1 1 Department of Anaesthesiology, Lithuanian University of Health Sciences, Eiveniu str. 2, LT-50009 Kaunas, Lithuania; [email protected] 2 Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus str. 9, LT-44307 Kaunas, Lithuania; [email protected] * Correspondence: [email protected]; Tel.: +370-67-267569 Abstract: Objective—to overview, compare and generalize results of randomized clinical trials an- alyzing different oxytocin doses to prevent postpartum hemorrhage, initiate and maintain uterine contraction after Caesarean delivery. Methods—‘PubMed’, ‘EMBASE’, ‘CENTRAL’, and ‘CINAHL’ electronic databases were searched for clinical trials analyzing the effectiveness of different dose of oxytocin given intravenously during surgery for uterine contraction and to reduce postpartum hemorrhage. A systematic review of relevant literature sources was performed. Results—our search revealed 813 literature sources. A total of 15 randomized clinical trials, comparing different doses of oxytocin bolus and infusion used after caesarean delivery have met the selection criteria. Conclusion—oxytocin bolus 0.5–3 UI is considered an effective prophylactic dose. Recommended effective prophylactic oxytocin infusion dose is 7.72 IU/h, but it is unanswered whether we really need a prophylactic infusion of oxytocin if we choose effective bolus dose size and rate. Adverse hemodynamic effects were observed when a 5 UI oxytocin bolus was used. However, topics such Citation: Baliuliene, V.; Vitartaite, M.; as bolus dose size, infusion dose size and requirement as well as bolus injection rate, still remain Rimaitis, K. Prophylactic Dose of unanswered. The doses that are recommended in the guidelines of peripartum hemorrhage prophy- Oxytocin for Uterine Atony during laxis are not confirmed by randomized controlled double-blind trials and more research should cover Caesarean Delivery: A Systematic this topic. Review. Int. J. Environ. Res. Public Health 2021, 18, 5029. https:// Keywords: oxytocin; uterine contraction; caesarean delivery; hemorrhage doi.org/10.3390/ijerph18095029 Academic Editor: Andrea Tinelli 1. Introduction Received: 8 April 2021 Early postpartum hemorrhage can occur if oxytocin is not used or if the dose of its Accepted: 6 May 2021 Published: 10 May 2021 bolus or infusion is too small. The American College of Obstetricians and Gynecologist defines early (primary) postpartum hemorrhage as at 1000 mL or more of total blood Publisher’s Note: MDPI stays neutral loss or loss of blood accompanied by signs and symptoms of hypovolemia within 24 h with regard to jurisdictional claims in following the delivery, including intrapartum loss [1]. The Royal College of Obstetricians published maps and institutional affil- and Gynecologists divides it into minor (500–1000 mL) and major (1000 mL and more) iations. categories. They also define late (secondary) postpartum hemorrhage as abnormal or excessive bleeding later than 24 h post-birth but no later than 12 weeks [2]. Parturient hemorrhage has been the main cause of maternal morbidity and mortality for many years all over the world. Postpartum hemorrhage is one of the most common complications after caesarean delivery, which is an important surgical intervention performed in obstetric Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. practice. This has to be considered because caesarean delivery rates in the developing This article is an open access article world countries keep getting higher [3,4]. Minimizing the amount of blood lost during distributed under the terms and caesarean delivery has a great benefit to decrease postoperative morbidity and to decrease conditions of the Creative Commons the risks associated with blood transfusions. The routine use of oxytocin correlates with a Attribution (CC BY) license (https:// significant reduction in the occurrence of postpartum hemorrhage (PPH) [5–7]. creativecommons.org/licenses/by/ Finding an optimal dose of oxytocin in patients undergoing caesarean delivery is a 4.0/). problem of great importance because it is mandatory to achieve an adequate balance be- Int. J. Environ. Res. Public Health 2021, 18, 5029. https://doi.org/10.3390/ijerph18095029 https://www.mdpi.com/journal/ijerph Int. J. Environ. Res. Public Health 2021, 18, x 2 of 13 Finding an optimal dose of oxytocin in patients undergoing caesarean delivery is a Int. J. Environ. Res. Public Health 2021problem, 18, 5029 of great importance because it is mandatory to achieve an adequate balance2 be- of 14 tween effective uterine contraction to limit postpartum hemorrhage and oxytocin-induced adverse events. The aim of this review was to analyze the randomized controlled trials and to find thetween best effectiveand lowest uterine possible contraction prophylactic to limit postpartumdose of oxytocin hemorrhage during and caesarean oxytocin-induced delivery (CD).adverse events. The aim of this review was to analyze the randomized controlled trials and to find the 2.best Methods and lowest possible prophylactic dose of oxytocin during caesarean delivery (CD). 2. MethodsThe design of this systematic review of the literature is followed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guide- The design of this systematic review of the literature is followed by the Preferred Re- lines. Data were identified from searches of MEDLINE (PubMed), Excerpta Medica Data- porting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. base (EMBASE), Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Data were identified from searches of MEDLINE (PubMed), Excerpta Medica Database Index to Nursing and Allied Health Literature (CINAHL) databases and conducted up to (EMBASE), Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index the 15 November 2020. The combination of keywords included terms ‘oxytocin’ and ‘cae- to Nursing and Allied Health Literature (CINAHL) databases and conducted up to the sarean’15 November and ‘dose’ 2020. or The ‘hemorrhage combination’ in ofPubMed keywords Advanced included Search terms ‘oxytocin’Builder in and all fields ‘caesarean’ ac- cordanceand ‘dose’ with or the ‘hemorrhage’ PICO criteria: in PubMed ‘participants’ Advanced were Search limited Builder to pregnant in all fields women, accordance ‘inter- ventions’with the covered PICO criteria: were randomized ‘participants’ controlledwere limited clinical to pregnant trials on women, caesarean ‘interventions’ delivery, covered‘com- parator’were randomized—comparing controlled oxytocin clinical with placebo trials on or caesarean a different delivery, dose ‘comparator’—of oxytocin, ‘outcomes’comparing discoveredoxytocin withafter placeboa thorough or a analysis different of dose researches of oxytocin, and classified ‘outcomes’ into discovered categories afteraccording a thor- toough the trial analysis type ofand researches most common and classified findings. into Records categories were screened according by to the the title, trial abstract type and andmost full common text by two findings. independent Records investigators were screened (V. byB. and the title,M.V. abstract). Any disagreements and full textby were two resolvedindependent through investigators evaluation and (V.B. discussion and M.V.). or Anyby consulting disagreements a third were independent resolved investi- through gatorevaluation who made and the discussion final decision. or by consulting Inclusion criteria a third independentwere: (1) full investigatortext articles published who made inthe English; final decision. (2) not older Inclusion than criteria2004; (3) were: single, (1) double full text or articles triple- publishedblinded randomized in English; (2)trials not ofolder differe thannt oxytocin 2004; (3) single,intravenous double dosage or triple-blinded and/or placebo; randomized (4) caesarean trials of delivery; different (5) oxytocin aged overintravenous 18. However, dosage we and/orreview placebo;or meta-analy (4) caesareanze systematic delivery; review (5) articles, aged over commentaries, 18. However, abstractwe review-only or publications, meta-analyze guidelines, systematic case review reports, articles, trials commentaries, with oxytocin abstract-only and carbetocin publi-, othercations, than guidelines, oxytocin uterotonic case reports, agent, trials but with not oxytocinrandomized and carbetocin,trials, and dose other-ranging than oxytocin trials wereuterotonic excluded. agent, but not randomized trials, and dose-ranging trials were excluded. TheThe detailed detailed search search flowchart flowchart is is presented presented in in Figure Figure 1.1 . FigureFigure 1. 1.FlowFlow chart chart Int. J. Environ. Res. Public Health 2021, 18, 5029 3 of 14 3. Results 3.1. Study Selection Process The research yielded 813 results, extracted from one database. All duplicates were removed, 526 articles were checked manually for relevance by screening their titles and abstracts. A total 120 results met the inclusion criteria, but only 15 were included after a full-text review. Only full-text articles were selected because the information given in the abstract was not sufficient for the thorough analysis. The randomized trials, conducted
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