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Background: It has been reported globally that many females died of severe bleeding following their delivery with postpartum hemorrhage being a common cause of maternal death. It is mainly caused by uterine atony. To manage this, the third stage of labor needs to be managed actively. Generally, oxytocin is used for uterus contraction following delivery. However, it has a shorter life, more side effects, and less contraction time, hence, recently Carbetocin has been used with lesser side effects and prolonged acting time. Aim: The present study aimed to assess the safety and efficacy of oxytocin to Carbetocin in managing the third stage of labor at an Indian healthcare center. Methods: The study assessed 100 subjects based on the inclusion and exclusion criteria of the study. In all the subjects, per abdomen examination was done along with the general examination. An ultrasound examination was also done. The data gathered were analyzed statistically. Results: Baseline demographics and data were not comparable in the two study groups. In the majority of the subjects from both groups, mild anemia was seen. No side effects were noted in the Carbetocin group. In the oxytocin group, abdominal pain and nausea were seen. Mean blood loss was higher in the oxytocin group compared to Carbetocin group. Conclusions: The present study concludes that carbetocin has higher efficacy compared to oxytocin as it maintains the tone of the uterus adequately and prevents blood loss and postpartum hemorrhage in females undergoing vaginal delivery. Hence, carbetocin is considered a good alternative to oxytocin in the active management of third-stage labor. [ABSTRACT FROM AUTHOR]

Abstract Background Prior studies have shown that, when administered as an intravenous bolus to prevent uterine atony, prophylactic phenylephrine infusion increased the dose requirement of oxytocin and second-line uterotonics. For the prevention of uterine atony, oxytocin should be delivered by continuous infusion. Here, we aimed to determine the ED50 and ED90 parameters (the effective doses for 50 and 90% patients without uterine atony) of oxytocin for co-infusion with prophylactic phenylephrine during cesarean delivery. Methods In this prospective randomized double-blinded dose-finding study, one hundred patients were divided into four groups to receive 2.5, 5.0, 7.5, or 10 IU/h oxytocin infusion, after the umbilical cord was clamped during the study period. The uterine tone was evaluated and defined as either adequate or inadequate. Probit regression analysis was applied to calculate the ED50 and ED90 of oxytocin infusion. Uterine tone, the percentage of patients who needed additional oxytocin bolus, second-line uterotonics, side effects, estimated blood loss, and neonatal outcomes were monitored. Results The estimated ED50 and ED90 values of the oxytocin infusion doses for the prevention of uterine atony were 1.9 IU/h (95% CI -4.6-3.8) IU/h and 9.3 IU/h (95% CI 7.3–16.2) IU/h, respectively. Across groups, there was a significant linear trend between the infusion dose and the percentage of patients who required additional oxytocin (p-value = 0.002). No differences were observed in the incidence of side effects and neonatal outcomes. Conclusion Under the conditions of this study, the ED90 of oxytocin infusion for the prevention of uterine atony was 9.3 IU/h, which is higher than the current recommendation. This finding is helpful for clinical practice, because of the routine use of phenylephrine in cesarean delivery. Further studies are needed to determine the appropriate initial bolus of oxytocin after neonatal delivery. Trial registration The study was registered on the Chinese Clinical Trial Register (register no. ChiCTR2200059556 ).

Background: Prior studies have shown that, when administered as an intravenous bolus to prevent uterine atony, prophylactic phenylephrine infusion increased the dose requirement of oxytocin and second-line uterotonics. For the prevention of uterine atony, oxytocin should be delivered by continuous infusion. Here, we aimed to determine the ED50 and ED90 parameters (the effective doses for 50 and 90% patients without uterine atony) of oxytocin for co-infusion with prophylactic phenylephrine during cesarean delivery. Methods: In this prospective randomized double-blinded dose-finding study, one hundred patients were divided into four groups to receive 2.5, 5.0, 7.5, or 10 IU/h oxytocin infusion, after the umbilical cord was clamped during the study period. The uterine tone was evaluated and defined as either adequate or inadequate. Probit regression analysis was applied to calculate the ED50 and ED90 of oxytocin infusion. Uterine tone, the percentage of patients who needed additional oxytocin bolus, second-line uterotonics, side effects, estimated blood loss, and neonatal outcomes were monitored. Results: The estimated ED50 and ED90 values of the oxytocin infusion doses for the prevention of uterine atony were 1.9 IU/h (95% CI -4.6-3.8) IU/h and 9.3 IU/h (95% CI 7.3–16.2) IU/h, respectively. Across groups, there was a significant linear trend between the infusion dose and the percentage of patients who required additional oxytocin (p-value = 0.002). No differences were observed in the incidence of side effects and neonatal outcomes. Conclusion: Under the conditions of this study, the ED90 of oxytocin infusion for the prevention of uterine atony was 9.3 IU/h, which is higher than the current recommendation. This finding is helpful for clinical practice, because of the routine use of phenylephrine in cesarean delivery. Further studies are needed to determine the appropriate initial bolus of oxytocin after neonatal delivery. Trial registration: The study was registered on the Chinese Clinical Trial Register (register no. ChiCTR2200059556). [ABSTRACT FROM AUTHOR]

Background: Postpartum hemorrhage remains a challenge in obstetric practice in developing climes and contributes immensely to the horrendous figures of maternal mortality worldwide. Aim: The aim was to compare the effect of intravenous (IV) carbetocin on uterine tone under different anesthetic techniques for elective cesarean section. Methods: Four hundred and seventy-eight consecutive women scheduled for elective cesarean section were recruited into two groups by convenience. While 445 parturients received subarachnoid block (SAB), 33 had general anesthesia (GA). At delivery, IV carbetocin was administered. The uterine tone was assessed manually and blood loss from intraoperative period to the 24th h was determined. Other variables such as hemodynamic profiles and Apgar scores were determined and recorded. Results: The bio-characteristics between the two groups were essentially the same in terms of age, weight, height, body mass index, preoperative hemoglobin, and gestational age. While the response to the administered carbetocin was slower in the GA group, there was no need for additional dose. The mean estimated intraoperative blood loss under SAB was 250.44 ± 50.59 ml and that under GA was 470.89 ± 35.70 ml, P = 0.000000. The ephedrine consumption was 6.25 ± 2.05 mg in the SAB group while it was 11.25 ± 2.49 mg, P = 0.000000. There was no further maternal blood loss observed after the intraoperative period until the end of 24-h period. The hemodynamic profiles were significantly different in terms of mean systolic blood pressure, mean diastolic blood pressure, and mean arterial blood pressure, P = 0.006, P = 0.002, and P = 0.003, respectively. However, the difference in the mean heart rate was not statistically significant, P = 0.304. While the Apgar scores between groups were not statistically significant, the mean umbilical pH was 7.34 ± 0.09 in the SAB group, it was 7.35 ± 0.02 in the GA group, P = 0.071. Conclusion: Intraoperative maternal blood loss was more among the parturients who received GA than subarachnoid blood. This could probably be due to the effect of the halogenated vapor used for the GA on the uterine tone. There was no further blood loss after the intraoperative period. The hemodynamic profile was better under SAB as evidenced by the total ephedrine consumption. [ABSTRACT FROM AUTHOR]

Background: Oxytocin (OT) is routinely administered during caesarean delivery to prevent and treat postpartum haemorrhage (PPH). The common adverse effects of intravenous OT are tachycardia, hypotension, chest pain, Electrocardiogram (ECG) changes, nausea and vomiting. We aimed to compare the uterine contractility, haemodynamic changes, need for other uterotonics and adverse effects by comparing the intravenous bolus dose versus infusion dose of OT while retaining its benefits. Methods: Sixty patients undergoing elective caesarean delivery under spinal anaesthesia were randomised to receive OT 3 IU as a bolus (repeat 3 IU at an interval of 3 min) in group B (Bolus) or as an infusion 1 IU per minute in group I (infusion). The uterine tone was assessed by a blinded obstetrician as either adequate or inadequate. The intraoperative heart rate, blood pressure, blood loss and any other adverse events were recorded. Results: The adequacy of uterine tone was more sustained and the requirement of other uterotonics was less in group I. The heart rate increased to 20–25 beats/min at 3–5 min in group B and 8–10 beats/min at 2–4 mins and reached the baseline at 8–9 min in group B as well as in group I. Also, a significant fall in the mean blood pressure was observed at 3–5 min in group B. The ECG changes (ST-T changes) were more common in group B compared to group I. There was no significant difference in the estimated blood loss between the two groups. Conclusion: The infusion dose of OT provides more haemodynamic stability, better uterine tone and fewer adverse effects compared to the bolus dose.

Background: Oxytocin (OT) is routinely administered during caesarean delivery to prevent and treat postpartum haemorrhage (PPH). The common adverse effects of intravenous OT are tachycardia, hypotension, chest pain, Electrocardiogram (ECG) changes, nausea and vomiting. We aimed to compare the uterine contractility, haemodynamic changes, need for other uterotonics and adverse effects by comparing the intravenous bolus dose versus infusion dose of OT while retaining its benefits. Methods: Sixty patients undergoing elective caesarean delivery under spinal anaesthesia were randomised to receive OT 3 IU as a bolus (repeat 3 IU at an interval of 3 min) in group B (Bolus) or as an infusion 1 IU per minute in group I (infusion). The uterine tone was assessed by a blinded obstetrician as either adequate or inadequate. The intraoperative heart rate, blood pressure, blood loss and any other adverse events were recorded. Results: The adequacy of uterine tone was more sustained and the requirement of other uterotonics was less in group I. The heart rate increased to 20–25 beats/min at 3–5 min in group B and 8–10 beats/min at 2–4 mins and reached the baseline at 8–9 min in group B as well as in group I. Also, a significant fall in the mean blood pressure was observed at 3–5 min in group B. The ECG changes (ST-T changes) were more common in group B compared to group I. There was no significant difference in the estimated blood loss between the two groups. Conclusion: The infusion dose of OT provides more haemodynamic stability, better uterine tone and fewer adverse effects compared to the bolus dose. [ABSTRACT FROM AUTHOR]

Purpose: Studies involving mouse models and human uterine smooth muscle cells have shown that phenylephrine inhibits uterine contractions in non-pregnant mice and human in vitro cell via cyclic adenosine monophosphate (cAMP) signaling. However, there has been no limited exploration to date of the effect of phenylephrine on uterine contractions in clinical practice. This study aimed to compare the dose requirement of oxytocin with or without the infusion of prophylactic phenylephrine to prevent post spinal hypotension during cesarean delivery under combined spinal and epidural anesthesia. Methods: This was a double-blinded, single-center, randomized, control study. One hundred and sixty pregnant patients provided informed consent and were randomly allocated to the phenylephrine (phenylephrine infusion) and control (saline infusion) groups. Patients randomized to the phenylephrine group received an intravenous prophylactic phenylephrine infusion at a fixed rate of 0.5 μg/kg/min. The control group received a saline placebo at the same rate and used the same apparatus for delivery. After neonatal delivery and clamping of the umbilical cord, patients received a standard institutional oxytocin protocol. The primary outcome measure was the total dose of oxytocin administered during CD. Secondary outcomes including the proportion (%) of patients requiring a secondary uterotonic agent and estimated blood loss (EBL) in the first 24 h after surgery. Results: The median oxytocin dose administered was significantly higher in the phenylephrine group than in the control group [6.9 ± 2.5 international standardized units (IU) vs. 5.4 ± 2.4 IU, p = 0.0004]. The number of patients that required a secondary uterotonic agent was significantly higher in the phenylephrine group than in the control group (24.2% vs. 9.1%; p = 0.034). The EBL in the first 24-h postoperatively was similar between the two groups (467 ± 47 ml vs. 392 ± 38 ml; p = 0.22). Conclusions: Prophylactic infusion of phenylephrine used to prevent post-spinal hypotension during CD was associated with a higher dose of oxytocin. This has important clinical implications, as the suboptimal use of oxytocin is associated with an increased risk of postpartum hemorrhage and increased maternal morbidity and mortality. Further studies are now needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Purpose: Studies involving mouse models and human uterine smooth muscle cells have shown that phenylephrine inhibits uterine contractions in non-pregnant mice and human in vitro cell via cyclic adenosine monophosphate (cAMP) signaling. However, there has been no limited exploration to date of the effect of phenylephrine on uterine contractions in clinical practice. This study aimed to compare the dose requirement of oxytocin with or without the infusion of prophylactic phenylephrine to prevent post spinal hypotension during cesarean delivery under combined spinal and epidural anesthesia.Methods: This was a double-blinded, single-center, randomized, control study. One hundred and sixty pregnant patients provided informed consent and were randomly allocated to the phenylephrine (phenylephrine infusion) and control (saline infusion) groups. Patients randomized to the phenylephrine group received an intravenous prophylactic phenylephrine infusion at a fixed rate of 0.5 μg/kg/min. The control group received a saline placebo at the same rate and used the same apparatus for delivery. After neonatal delivery and clamping of the umbilical cord, patients received a standard institutional oxytocin protocol. The primary outcome measure was the total dose of oxytocin administered during CD. Secondary outcomes including the proportion (%) of patients requiring a secondary uterotonic agent and estimated blood loss (EBL) in the first 24 h after surgery.Results: The median oxytocin dose administered was significantly higher in the phenylephrine group than in the control group [6.9 ± 2.5 international standardized units (IU) vs. 5.4 ± 2.4 IU, p = 0.0004]. The number of patients that required a secondary uterotonic agent was significantly higher in the phenylephrine group than in the control group (24.2% vs. 9.1%; p = 0.034). The EBL in the first 24-h postoperatively was similar between the two groups (467 ± 47 ml vs. 392 ± 38 ml; p = 0.22).Conclusions: Prophylactic infusion of phenylephrine used to prevent post-spinal hypotension during CD was associated with a higher dose of oxytocin. This has important clinical implications, as the suboptimal use of oxytocin is associated with an increased risk of postpartum hemorrhage and increased maternal morbidity and mortality. Further studies are now needed to confirm these findings.

Purpose: Oxytocin is the preferred choice for prophylaxis and treatment of postpartum hemorrhage. Intravenous infusion has been a widely accepted route for Oxytocin administration. However, intravenous bolus route is not a readily preferred route due to apprehensions regarding hypotension that it may cause. This trial compares low dose 3 IU intravenous (IV) bolus Oxytocin along with 7 IU Oxytocin in intravenous infusion to 10IU Oxytocin intravenous infusion during cesarean section. Patients and Methods: A total of 250 term pregnant women were randomized to either 3 IU intravenous bolus with 7 IU intravenous infusion of Oxytocin or 10IU of intravenous Oxytocin infusion. The difference in pre- and post-operative hemoglobin levels, tone of the uterus, hemodynamic changes, adverse effects of the drug, need for additional uterotonics and need for blood transfusions were assessed. Results: There was 6.7% less blood loss in the 3 IU IV bolus Oxytocin with 7 IU Oxytocin infusion group in comparison to the Oxytocin infusion group. The tone of the uterus was firmer in IV bolus Oxytocin with Oxytocin infusion group at 5 minutes (p< 0.001) than the Oxytocin infusion group. There was no significant difference in the hemodynamic changes, adverse effects or need for blood transfusions. Conclusion: Intravenous bolus of 3 IU Oxytocin along with 7 IU infusion of Oxytocin is as safe and more effective than intravenous infusion of 10 IU of Oxytocin during cesarean section in the prevention of postpartum hemorrhage. [ABSTRACT FROM AUTHOR]

Introduction: Uterine Atony is the most common cause of postpartum bleeding and uterus contraction is associated with pain. Acupressure stimulates physiological functions of channels and in certain disease by management of symptoms and increasing the flow of energy causes balance in the inner function of the body. This study was performed with aim to assess the effect of acupressure on uterine tone and pain after delivery Methods: This randomized double-blind clinical trial was performed in 2015 on 114 mothers with NVD in Omolbanin hospital. The subjects were randomly allocated into three groups of main acupressure, sham (placebo point), and control. In the main acupressure group, after newborn delivery and before placenta expulsion, 2 minutes pressure was applied on points CV6 and 4, and in sham acupressure group, less pressure was applied on 2 placebo points. There was no intervention in control group. The Research Assistant measured uterine tone using VAS immediately after placenta expulsion and during afterpain, at 1 and 2 hours after birth. Data were analyzed by SPSS software (version 16) and Kruskal-Wallis, Variance analysis, and Chi-square tests. P0.05). Mean score of pain severity at 1 and 2 hours post-delivery in the main acupressure group was 8.9±17.5 and 4.6±11.9, respectively, and in sham acupressure group was 2.5±15.9 and 5.3±13.9, respectively, and in control group was 9.8±19.2 and 7.6±17.4. Despite that it was less in the main group than in the control group, Kruskal-Wallis Test showed no significant difference in the three groups (P>0.05). Conclusion: Acupressure on main points has no effect on the uterine tone and pain at 1 and 2 hours post-delivery, but performing further studies are necessary to determine its effect on the tone and pain during the period under consideration.

Background: Oxytocin is routinely administered during cesarean delivery for uterine contraction. Adverse effects are known to occur after intravenous oxytocin administration, notably tachycardia, hypotension, and electrokardiogram (EKG) changes, which can be deleterious in high-risk patients. Aims and Objectives: To compare the hemodynamic changes and uterotonic effect of equivalent dose of oxytocin administered as an intravenous bolus versus intravenous infusion. Study Design: Randomized, double-blind, active controlled trial. Materials and Methods: Eighty parturients undergoing elective cesarean delivery, under spinal anesthesia, were randomly allocated to receive 3 IU of oxytocin either as a bolus intravenous injection over 15 seconds (group B, n = 40) or as an intravenous infusion over 5 minutes (group I, n = 40). Uterine tone was assessed as adequate or inadequate by an obstetrician. Intraoperative heart rate, non-invasive blood pressure, and EKG changes were recorded. These data were compared between the groups. Any other adverse events like chest pain, nausea, vomiting, and flushing were noted. Results: There was significant rise in heart rate and significant decrease in mean arterial pressure in bolus group compared to infusion group. Three patients in bolus group had EKG changes in the form of ST-T depression and 5 patients complained of chest pain. No such complications were found in infusion group. Conclusion: Bolus oxytocin (at a dose of 3 IU over 15 seconds) and infusion of oxytocin (at a dose of 3 IU over 5 minutes) have comparable uterotonic effect. However, the bolus regime shows significantly more adverse cardiovascular events.

Background: The two most commonly used uterotonic drugs in caesarean section are oxytocin and carbetocin, a synthetic oxytocin analogue. Carbetocin has a longer half-life when compared to oxytocin, resulting in a reduced use of additional uterotonics. Oxytocin is known to cause fewer cardiovascular side effects when administered as a short-infusion compared to as an intravenous bolus. Based on these findings, we aim at comparing carbetocin 100 mcg given as a slow intravenous bolus with carbetocin 100 mcg applied as a short-infusion in 100 ml 0.9 % sodium chloride in women undergoing a planned or unplanned caesarean delivery. We hypothesise uterine contraction not to be inferior to a bolus application (primary efficacy endpoint) and greater haemodynamic stability to be achieved after a short-infusion than after a bolus administration, as measured by heart rate and mean arterial blood pressure (primary safety endpoint).Methods/design: This is a prospective, double-blind, randomised controlled, investigator-initiated, non-inferiority trial taking place at the University Hospital Basel, Switzerland. Uterine tone is quantified by manual palpation by the obstetrician using a linear analogue scale from 0 to 100 at 2, 3, 5 and 10 minutes after cord clamping. We will evaluate whether the lower limit of the confidence interval for the difference of the maximal uterine tone within the first 5 minutes after cord clamping between both groups does not include the pre-specified non-inferiority limit of -10. Both haemodynamic secondary endpoints will be analysed using a linear regression model, adjusting for the baseline value and the dosage of vasoactive drug given between cord clamping and 1 minute thereafter, in order to investigate superiority of a short-infusion as compared to a bolus application. We will follow the extension of CONSORT guidelines for reporting the results of non-inferiority trials.Discussion: Haemodynamic stability and adequate uterine tone are important outcomes in caesarean sections. The results of this trial may be used to optimise these factors and thereby increase patient safety due to a reduction in cardiovascular side effects.Trial Registration: Clinicaltrials.gov NCT02221531 on 19 August 2014 and www.kofam.ch SNCTP000001197 on 15 November 2014. [ABSTRACT FROM AUTHOR]

Background: Oxytocin is routinely administered during cesarean delivery for uterine contraction. Adverse effects are known to occur after intravenous oxytocin administration, notably tachycardia, hypotension, and electrokardiogram (EKG) changes, which can be deleterious in high-risk patients. Aims and Objectives: To compare the hemodynamic changes and uterotonic effect of equivalent dose of oxytocin administered as an intravenous bolus versus intravenous infusion. Study Design: Randomized, double-blind, active controlled trial. Materials and Methods: Eighty parturients undergoing elective cesarean delivery, under spinal anesthesia, were randomly allocated to receive 3 IU of oxytocin either as a bolus intravenous injection over 15 seconds (group B, n = 40) or as an intravenous infusion over 5 minutes (group I, n = 40). Uterine tone was assessed as adequate or inadequate by an obstetrician. Intraoperative heart rate, non-invasive blood pressure, and EKG changes were recorded. These data were compared between the groups. Any other adverse events like chest pain, nausea, vomiting, and flushing were noted. Results: There was significant rise in heart rate and significant decrease in mean arterial pressure in bolus group compared to infusion group. Three patients in bolus group had EKG changes in the form of ST-T depression and 5 patients complained of chest pain. No such complications were found in infusion group. Conclusion: Bolus oxytocin (at a dose of 3 IU over 15 seconds) and infusion of oxytocin (at a dose of 3 IU over 5 minutes) have comparable uterotonic effect. However, the bolus regime shows significantly more adverse cardiovascular events. [ABSTRACT FROM AUTHOR]