Oxytocin And Uterotonic Agent Use For Cesarean Delivery
Uterine Atony, Hypotension
About this trial
This is an interventional treatment trial for Uterine Atony focused on measuring Uterine Atony, Hypotension, Cesarean Delivery, Hemorrhage, Phenylephrine, Ephedrine
Eligibility Criteria
Inclusion Criteria:
- American Society of Anesthesiologists (ASA) I or II health status
- Age between 18 and 50 yrs
- Singleton pregnancies in vertex position
- Elective (without prior labor) cesarean delivery with a planned lower uterine (pfannenstiel) incision
Exclusion Criteria:
- Conditions that predispose to uterine atony and postpartum hemorrhage
Sites / Locations
- Brigham and Women's Hospital
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
Standard Care Group
Protocol Group
"Standard Care Group" (reflects current clinical regimen at BWH) will receive a 500 mL bag of oxytocin (30 IU/500 mL) to be connected to the IV, and controlled per obstetrician request. The obstetrician and anesthesiologist will be asked to consider this infusion "oxytocin". If inadequate uterine tone exists in which the obstetrician desires alternative uterotonic agents, these will be provided on their request (e.g. methylergonovine maleate (methergine) 0.2 mg IM (intramuscular) or carboprost tromethamine (hemabate) 0.25 mg IM. The time of the requests will be recorded. If uterine tone remains inadequate at 15 min, misoprostol 600 mcg will be given buccally.
"Protocol Group" will receive 3 mL syringes marked "study solution-oxytocin" which contain 3 IU oxytocin and be given IV at time of baby delivery (Time 0). Up to two additional syringes can be given at 3 and 6 mins until uterine tone adequate (as per obstetrician on graded scale). If inadequate uterine tone is noted at 9 min, the 1 mL syringe marked marked "study solution-9 min", containing methylergonovine maleate (methergine) 0.2mg, will be given IM. If inadequate uterine tone is noted at 12 min, the 1 mL syringe marked marked "study solution-12 min", containing carboprost tromethamine (hemabate) 0.25 mg, will be given IM. If uterine tone remains inadequate at 15 min, misoprostol 600 mcg will be given buccally.