Behuria Sasmita, Sahu Mahija, Mohanty Minakshi, Behera Swayamprava, Mohapatra Kirtirekha, Patnaik Ranjita, Jena Satyajit
Obstetrics and Gynecology, Srirama Chandra Bhanj Medical College and Hospital, Cuttack, IND.
Obstetrics and Gynecology, Maharaja Krushna Chandra Gajapati Medical College and Hospital, Brahmapur, IND.
Cureus. 2023 Feb 15;15(2):e35026. doi: 10.7759/cureus.35026. eCollection 2023 Feb.
Objective To study the efficacy of intraoperative IV oxytocin and intramuscular (IM) oxytocin versus conventional intramuscular oxytocin alone for active management of the third stage of labor in lower segment cesarean section (CS). The study was performed to determine the effect of 5 IU (International Unit) oxytocin infusion at the time of skin incision and that of 10 IU IM oxytocin infusion after delivery in reducing blood loss during and after CS, in comparison with the effect of administrating conventional 10 IU IM oxytocin in the same time period. In addition, it assessed the ability of the IV+IM oxytocin group to reduce the need for additional uterotonic as well as its safety determination and postoperative blood transfusion in CS. Materials and methods It is a randomized control study. The effect of 5 IU of oxytocin infusion at the time of skin incision and 10 IU of IM oxytocin (IV+IM) in reducing blood loss during and after the CS was compared to conventional 10 IU IM oxytocin. Results The study showed that the IV+IM group had a mean blood loss of 316.5 ± 74.36 ml, while the IM group had a mean loss of 403.90 ± 107.2 ml (p-value < 0.001) from placental delivery to the end of CS. A total of 90% of the patients in the IV+IM group had blood loss <50 ml compared to 95% of patients in the IM group who had a blood loss between 50 and 100 ml range from the end of cesarean to two hours postpartum. When total blood loss was compared in both groups, 84% of patients had a blood loss between 300 and 400 ml, compared to 81% of the patients in the IM group who had blood loss of 400-500 ml. Total blood loss in the IM group was 483.20 ± 115.86 ml, which was significantly higher compared to the IV group, 362.60 ± 78.07 ml (p-value=<0.001). Conclusion 5IU oxytocin infusion at the time of skin incision and 10 IU IM oxytocin after delivery of the baby significantly reduced the amount of blood loss, need for blood transfusion, and additional uterotonics during and after lower segment CS.
目的 研究术中静脉注射缩宫素和肌内注射缩宫素与单纯传统肌内注射缩宫素相比，在子宫下段剖宫产术中对第三产程进行积极处理的疗效。本研究旨在确定在皮肤切开时静脉输注5国际单位（IU）缩宫素以及分娩后肌内注射10 IU缩宫素在减少剖宫产术期间及术后失血方面的效果，并与同期给予传统10 IU肌内注射缩宫素的效果进行比较。此外，评估静脉注射+肌内注射缩宫素组减少额外宫缩剂需求的能力及其安全性以及剖宫产术后输血情况。材料与方法 这是一项随机对照研究。将皮肤切开时静脉输注5 IU缩宫素和肌内注射10 IU缩宫素（静脉注射+肌内注射）在减少剖宫产术期间及术后失血方面的效果与传统10 IU肌内注射缩宫素进行比较。结果 研究表明，从胎盘娩出至剖宫产术结束，静脉注射+肌内注射组平均失血量为316.5±74.36毫升，而肌内注射组平均失血量为403.90±107.2毫升（p值<0.001）。静脉注射+肌内注射组90%的患者失血量<50毫升，相比之下，肌内注射组95%的患者在剖宫产术结束至产后两小时失血量在50至100毫升之间。比较两组的总失血量时，静脉注射+肌内注射组84%的患者失血量在300至400毫升之间，而肌内注射组81%的患者失血量在400 - 500毫升之间。肌内注射组总失血量为483.20±115.86毫升，明显高于静脉注射组的362.60±78.07毫升（p值=<0.001）。结论 在皮肤切开时静脉输注5 IU缩宫素以及胎儿娩出后肌内注射10 IU缩宫素可显著减少子宫下段剖宫产术期间及术后的失血量、输血需求和额外宫缩剂的使用。
