Routine use of oxytocin at birth: just the right amount to prevent postpartum hemorrhage
Administering the appropriate amount of oxytocin maximizes its benefits and minimizes its side effects. Regrettably, too little, too much or none at all is often administered at birth.
In addition, a self-contained, single-use Uniject (BD, Franklin Lakes, New Jersey) injection device containing oxytocin has been developed specifically for use in resource-limited settings (FIGURE). The device can be used by minimally trained personnel and stored at room temperature for up to 2 months.
Single-use injection device
Uniject can be filled with oxytocin for use outside of a hospital setting. Photo courtesy of and © Becton, Dickinson and Company.
What’s your next step if oxytocin isn’t enough?
There is a high probability that administering oxytocin alone may not prevent postpartum hemorrhage in settings of:
- prolonged use of oxytocin for the purposes of labor induction
- a prolonged labor in which oxytocin has been used to augment labor
- chorioamnionitis.
Rather than continue to administer more and more oxytocin in these situations, consider administering a second agent, such as methlyergonovine (Methergine), misoprostol (Cytotec), or carboprost tromethamine (Hemabate, 0.25 mg IM).
Additionally, mechanical massage of the uterus can help to increase uterine tone and reduce bleeding. When postpartum hemorrhage fails to respond to the administration of multiple uterotonics, rapid institution of a postpartum bleeding protocol is warranted.10,11
Review your medication order sets for oxytocin administration
It is likely that your hospital has a well-established order set for the administration of oxytocin at birth. Reviewing your hospital’s protocols for administering oxytocin to prevent postpartum hemorrhage can help to ensure that all patients receive a uterotonic at a dose and duration that maximizes the benefits and reduces side effects and theoretical risks. Anesthesiologists play an important role in the administration of a uterotonic during cesarean delivery, and they should be involved in the review of the medication order entry sets for prevention of postpartum hemorrhage.
Prevention of postpartum hemorrhage is a top priority for all obstetric providers. Routine administration of an optimal dose of oxytocin, or another uterotonic, should be a standard clinical process in all birthing units throughout the world.
- Act fast when confronted by a coagulopathy postpartum
Robert L. Barbieri, MD (Editorial, March 2012) - Update on Obstetrics
John T. Repke, MD, and Jaimey M. Pauli, MD (January 2012) - Have you made best use of the Bakri balloon in PPH?
Robert L. Barbieri, MD (Editorial, July 2011) - 10 practical, evidence-based recommendations for the management of severe postpartum hemorrhage
Baha M. Sibai (June 2011) - Postpartum hemorrhage: 11 critical questions, answered by an expert
Q&A with Haywood L. Brown, MD (January 2011)
