Ideal Time of Oxytocin Infusion During Cesarean Section (I-TOPICS)

This study will evaluate if the timing of oxytocin administration in cesarean deliveries will affect the amount of maternal blood loss. Half of participants will receive oxytocin after delivery of the fetal anterior shoulder and the other half will receive oxytocin after delivery of the placenta. We hypothesize that administering oxytocin after delivery of the shoulder, will result in less overall maternal blood loss.

Oxytocin is a routinely administered medication for both vaginal and cesarean deliveries in the third stage of labor, as part of standard of care in the United States. This medication helps to reduce overall blood loss, by functioning as a uterotonic. Currently evidence is lacking to direct timing of oxytocin administration in cesarean deliveries. This study will evaluate both estimated and quantitative blood loss for both groups of patients. It will also compare the change from pre-operative to post-operative hemoglobin levels.

Blood Loss, Surgical, Postpartum Hemorrhage, Bleed Pregnancy, Pregnancy Related, Cesarean Section Complications

Double blind: Obstetricians, Anesthesiologists and patients will be blinded. Only nurses will be aware of timing of oxytocin administration

One bag of 500 ml 0.9% NaCl (normal saline) will be hung by Anesthesia when the fetal anterior shoulder delivers. After the placenta is delivered, then one bag of 500 ml 0.9% NaCl with 30 units of Oxytocin (Oxytocin solution) will be hung by Anesthesia. This amount of fluid is part of standard of care.

One bag of 500 ml 0.9% NaCl with 30 units of Oxytocin (Oxytocin solution) will be hung by Anesthesia when the fetal anterior shoulder delivers. After the placenta is delivered, then one bag of 500 ml 0.9% NaCl (normal saline) will be hung by Anesthesia. This amount of fluid is part of standard of care.

Oxytocin is administered after delivery of the fetal anterior shoulder, rather than being administered after delivery of the placenta

Inclusion Criteria: Women undergoing cesarean section at Loyola Hospital Women who read and speak the English and/or Spanish language Women age 18 or older Exclusion Criteria: Women who deliver vaginally Gestation under 37 weeks and 0 days Women with coagulopathies Multiple gestation pregnancies Antepartum hemorrhage for example abruption Placental abnormalities for example previa, accreta

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