Published: 2019-11-26

Intravenous oxytocin bolus and infusion versus infusion alone on the blood loss during caesarean section

Priyanka Mathe, Suniti Kale, Aruna Batra, Achla Batra, Shipra Aggrawal, Abhishek Nagarajappa


Background: PPH is one of the leading causes of maternal mortality in the world. In India >30% maternal mortality is because of PPH.

Methods: 250 females posted for LSCS were randomised into 2 groups. Group A: 5U oxytocin bolus + 40U oxytocin infusion @125 ml/hour in 500 ml saline. Group B: 5 ml Saline bolus + 40 U oxytocin infusion

Primary outcome was to measure blood loss (objective and subjective). Secondary outcomes were time for uterine hardening, additional uterotonic agents, hemodynamic changes, side effects and need for blood transfusion within 24 hours of LSCS.

Results: Blood loss was significantly less in Group A in objective as well as subjective assessment (p<0.001). Requirement for additional oxytocin bolus was significantly higher in Group B as compared Group A (p=0.025). Postoperative hematocrit of Group A was higher than that of Group B (p<0.001). Transfusion requirement was significantly higher (p=0.04) in Group B (9.6% versus 3.2%). There was no significant difference in hemodynamics between the groups in the intraoperative period (p>0.05). However, during the postoperative period increase in heart rate was noted in Group B (p<0.05). Vomiting was the only major side effect observed, which was higher in Group A (5.6% versus 3.2%).

Conclusions: Combination of 5U oxytocin bolus followed by an infusion of 40 U oxytocin given over 4 hours routinely in ASA grade I and ASA grade II parturient significantly decreases the operative blood loss during LSCS without causing any hemodynamic variability. This regimen provides better uterine contractility, lesser need for additional utero-tonic agents and lesser requirement of blood transfusion.


Hemodynamic variation, Lower (uterine) segment caesarean section, Maternal mortality, Objective blood loss, Oxytocin, Post-partum haemorrhage, Subjective blood loss

Full Text:



Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323-33.

WHO. WHO recommendations for the prevention and treatment of postpartum haemorrhage. Geneva: Dept. of reproductive health and research. WHO; 2012:1-41.

Charles D, Anger H, Dabash R, Darwish E, Ramadan MC, Mansy A, et al. Intramuscular injection, intravenous infusion, and intravenous bolus of oxytocin in the third stage of labor for prevention of postpartum hemorrhage: a three-arm randomized control trial. BMC Preg Child. 2019;19(1):38.

Thomas JS, Koh SH, Cooper GM. Haemodynamic effects of oxytocin given as i.v bolus or infusion on women undergoing caesarean section. Br J Anaesth. 2007;98:116-9.

ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists Number 76, October 2006: postpartum hemorrhage. Obstet Gynecol. 2006;108(4):1039-47.

Sheehan SR, Wedisinghe L, Macleod M, Murphy DJ. Implementation of guidelines on oxytocin use at caesarean section: a survey of practice in Great Britain and Ireland. Eur J Obstet Gynecol Reprod Biol. 2010;148(2):121-4.

Mavrides E, Allard S, Chandraharan E, Collins P, Green L, Hunt BJ, et al. on behalf of the Royal College of Obstetricians and Gynaecologists. Prevention and management of postpartum haemorrhage. BJOG. 2016;124:e106-e149.

Gallos ID, Papadopoulou A, Man R, Athanasopoulos N, Tobias A, Price MJ, et al. Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis. Cochrane Database Syst Rev. 2018;12:CD011689.

Sheehan SR, Montgomery AA, Carey M, McAuliffe FM, Eogan M et al. Oxytocin bolus versus oxytocin bolus and infusion for control of blood loss at elective caesarean section: double blind placebo controlled randomised trial. BMJ. 2011;343:1-11.

Shook PR, Schultz JR, Reynolds JD, Barbara P, Spahn TE, DeBalli P. Estimating blood loss for cesarean section - how accurate are we Anesthesiol. 2003;98:1.

Murphy DJ, MacGregor H, Munishankar B, McLeod G. A randomised controlled trial of oxytocin 5IU and placebo infusion versus oxytocin 5IU and 30IU infusion for the control of blood loss at elective caesarean section- pilot study. Eur J Obstet Gynecol Reprod Biol. 2009;142(1):30-3.

King KJ, Douglas MJ, Unger W, Wong A, Robert A. R. Five-unit bolus oxytocin at caesarean delivery in women at risk of atony: a randomized, double-blind, controlled trial. 2010;111:1460-6.

Abdullah M, Khurshid T, Raheel, Ghauri A, Abassi T. Oxytocin iv bolus vs infusion; haemodynamic effects in women undergoing caesarean section. Prof Med J. 2012;19(3).