The optimum oxytocin dosage schedule for caesarean sections depends on uterine tone, maternal hemodynamics, and safety. This study compares a continuous 20 IU infusion (Group B) versus a 3 IU bolus followed by a 10 IU per hour infusion during elective caesarean delivery to determine their efficacy and safety (Group A). Two groups of sixty elective caesarean patients were randomly assigned. Uterine tone, maternal hemodynamics, uterotonic drug need, and side effects were assessed. The two dosing schedules were statistically compared. Five minutes post-oxytocin administration, Group A had significantly higher uterine tone than Group B (p < 0.001). Although not statistically significant, Group B maternal hemodynamics showed lower systolic and diastolic blood pressure. The groups had similar adverse effects and uterotonic drug needs. Despite the fast uterine tone of the bolus + infusion regimen, maternal hemodynamics must be regulated. Both regimens were safe; however, a customised dose may be needed. Clinical settings and patient characteristics are critical. This study shows how quickly uterine tone may be achieved following elective caesarean surgery using a 3 IU bolus and 10 IU oxytocin each hour. Maternal hemodynamics and uterotonic efficacy should inform dosing recommendations, with an emphasis on customised techniques.
TopIntroduction
One of the primary causes of maternal morbidity and mortality globally, postpartum haemorrhage, must be optimally managed uterotonically due to the increasing frequency of caesarean procedures, or C-sections (American College of Obstetricians and Gynecologists, 2019). Achieving and maintaining an appropriate uterine tone is crucial for preventing excessive bleeding after elective caesarean sections, particularly when the uterus is not naturally contracted by labor's physiological processes (Baliuliene et al., 2021).
Among the most common surgical procedures performed worldwide, caesarean sections are performed for a variety of reasons, including medical issues and maternal preferences (Carvalho et al., 2004). When necessary, this surgical surgery can save lives, but it is not without risk. Postpartum haemorrhage is one major danger that can cause severe maternal morbidity and mortality if left unchecked (Plaat & Wray, 2008).
Uterotonic drugs, which increase uterine contractions and lower the likelihood of atony or the loss of uterine muscle tone, are the mainstay of postpartum haemorrhage therapy. Of all these agents, oxytocin is the most effective. An essential hormone for parturition and lactation, oxytocin is produced naturally by the posterior pituitary gland. Oxytocin stimulates uterine contractions by acting on myometrial cells when it is given externally (Phipps et al., 2005). It is a key component in reducing postpartum haemorrhage during caesarean delivery due to its extensive use and proven effectiveness (Simmons et al., 2012).
The administration of oxytocin during caesarean section is not without difficulties, despite its crucial significance. There is ongoing discussion and research over the ideal dosage, timing, and mode of administration. When oxytocin is not administered sparingly, it can have harmful cardiovascular consequences in mothers, such as hypotension and tachycardia, which can be detrimental to their health (Grindheim et al., 2012).
Clinicians must carefully weigh the appropriate uterotonic effects against the danger of hemodynamic instability when choosing an oxytocin dosage regimen, whether it takes the form of a bolus dose or continuous infusion. The lack of consensus in clinical recommendations further complicates the decision-making process, allowing medical professionals to rely on a mix of custom, firsthand knowledge, and the few pieces of evidence at their disposal when deciding whether to administer oxytocin during caesarean delivery.
In the past, oxytocin was frequently given as a bolus dosage right after delivery, usually in the range of 3 to 5 IU. This method can quickly intensify uterine contractions, but because of the sudden spike in oxytocin levels, it may also raise the risk of hemodynamic instability (Ruilope & Schmieder, 2008). On the other hand, a more consistent and regulated uterotonic effect can be achieved by continuous oxytocin infusion; however, this requires cautious titration and may result in overuse (Leduc & Senikas, 2009).
The Physiological Basis for the Use of Oxytocin
Understanding oxytocin's function in uterine contraction is essential to using it during caesarean procedures. During labour, the hormone is naturally secreted into the body and acts on particular myometrial receptors to start and sustain rhythmic contractions. These contractions accomplish two things: they push the foetus out of the birth canal during vaginal delivery, and they also lessen the possibility of heavy bleeding by constricting blood vessels in the uterine wall and encouraging hemostasis. To simulate these physiologic contractions and avoid uterine atony, oxytocin injection is necessary for situations of elective caesarean sections, where the natural labour process is missing.
Exogenous oxytocin usage, however, may provide a number of therapeutic difficulties. Although oxytocin is useful in inducing contractions in the uterus, it also affects smooth muscle cells outside of the uterus, most notably the vasculature. Unintended consequences, including the possibility of harmful cardiovascular effects, can result from this non-specificity (Yeoh et al., 2010). These side effects could show up as maternal tachycardia and hypotension, which could be detrimental to the patient's general health.