Comparative Study of Intramyometrial Oxytocin Versus Continuous Oxytocin Infusion given among Low segment transverse cesarean section for control of blood loss done at St. Martin de Porres Charity Hospital. GENERAL OBJECTIVES:
To determine the significance of intramyometrial oxytocin ( 1 amp=10 untis oxytocin, 5 units each diluted in 10 cc isotonic solution) IMM injected in each cornu of the uterus versus with oxytocin continuous infusion ( 1 amp= 10 units oxytocin incorporated in 1 liter D5LR/D5NM) IV during low segment transverse cesarean section for control of blood loss SPECIFIC OBJECTIVES:
1. To compare the estimated operative blood loss between two groups immediately after delivery and 2 hours post-operative 2. To measure the results of initial and 24 hours post-operative repeat hemoglobin and hematocrit with intramyometrial oxytocin (IMM) 3. To measure the results of initial and 24 hours post-operative repeat hemoglobin and hematocrit with oxytocin continuous infusion (IV)
4. To determine the need of another uterotonic agents such additional 10 units oxytocin incorporated in 1000cc Lacter Ringer or normal maintenance solution with maximum of 30 units oxytocin , ergometrine 1 amp IV and misoprotol tablet per rectum in the control of blood loss and prevent uterine atony. 5. To compare the side effects between the two groups
REVIEW OF RELATED LITERATURE
One of the complications of cesaraen section is postpartum hemorrhage. This constitute a major maternal morbidity worldwide. Obstetrics hemorrhage is one resulting in blood loss of more than 500ml in vaginal delivery and 1000ml in cesarean section. The gold standard measurement for control of blood loss would include pre and postdelivery red blood cells, hematocrit and drape or pad measurements. Oxytocin is the most commonly used uterotonics agent after spontaneous vaginal or operative delivery to maintain the uterus on its contractility state to minimize blood loss and prevent postpartum hemorrhage or uterine atony. Prophylactic routine use of Oxtyocin has been shown to reduce the incidence of Postpartum hemorrhage by up to 40%. Oxytocin is a peptide, so it cannot be given orally, it is given by intravenous or intramyometrial.. The half life of oxytocin is 3 minutes. It’s action concentrated mostly on the fundal area of the uterus
Oxytocin indirectly stimulated contraction of uterine smooth muscle by increasing the calcium permeability of uterine myometrial tissue. The drug increases the amplitude and frequency of uterine contractions. Divya Mangla et al¹ conducted a prospective ramdomized study of 150 women undergone cesarean section. The women were divided into three groups. In Group 1 (n=50) 20 units of oxytocin in 500cc Ringer lactate as continuous infusion I.V after separation of the placenta given. Group II (n=50) 5 units oxytocin is diluted in 10cc of normal saline solution and 5 cc injected in each cornu of uterus after separation of the placenta. In group III (n=50) 5 units oxytocin is diluted in 10 cc normal saline solution and 5 cc injected in each cornu of the uterus before placental separation. Blood loss were calculated by number of mops soaked and amount of blood in suction jar. The study showed that intramyometrial injection of oxytocin when given before separation of the placenta was to be most effective methods to increase uterine contraction, reducing incidence of postpartum hemorrhage and thus decrease maternal morbidity.
Dennehy et al ² conducted a double-blind clinical trial in 40 parturients for elective cesarean section that were randomized in two groups. One litre Ringer’s lactate was administered I.V before intrathecal injection of 1.7 ml bupivacaine 0.75% and 0.3 mg morphine. All patients received simultaneous I.V and Intramyometrial injection after removal of the placenta. Patient in groupr 1 received 5 IU (10 IU.ml-1) oxytocin I.V. and 2 ml saline intramyometrial. Group 2 patients received 0.5ml...
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