Oxytocin Dosing and Uterotonic Escalation
CA-2 ·
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6 points
In a network meta-analysis of 46 trials, carbetocin probably reduced the need for additional uterotonics by 185 per 1000 cases versus oxytocin, and oxytocin worked best when started as a bolus.
PMID 34534498
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A 3 IU slow bolus was noninferior to the standard 5 IU for 24-hour blood loss at elective caesarean, and produced less vomiting (6% versus 24%).
PMID 29151071
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Prior exposure to oxytocin desensitises the uterine oxytocin receptor, so a woman already on an oxytocin infusion in labour will need different dosing than an elective case.
PMID 21415725
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The international consensus recommends a small initial bolus of oxytocin followed by a titrated infusion, because standard recommended doses are higher than required and risk acute cardiovascular effects.
PMID 31347151
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Bolus-plus-infusion regimens gave slightly less blood loss than bolus alone, initial boluses under 5 IU reduced nausea, and total doses of 5-9 IU increased the need for additional uterotonics versus 10-19 IU.
PMID 33957113
kept
The ED90 for adequate uterine contraction at elective caesarean in non-labouring women was 0.35 IU — a fraction of the 5 IU historically given — with 100% response by 1.0 IU.
PMID 15516392
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