An evidence-based oxytocin protocol for the third stage of labor to improve hemorrhage outcomes.

To assess the use of an evidence-based oxytocin protocol for management of the third stage of labor to decrease non-beneficial clinical variation and improve clinical outcomes. This is a cohort study of pregnant patients delivering before implementation of an evidence-based oxytocin protocol compared to patients delivering after implementation of an evidence-based oxytocin protocol. A level III maternal care referral hospital with an average delivery volume of approximately 3000 deliveries. Pregnant patients delivering over a 60-month period from January 2013 to December 2017. An evidence-based oxytocin protocol: 3 units of oxytocin administered over 3 minutes, with a second 3-unit bolus if inadequate tone, then oxytocin infusion at 18 units/hour × 1 hour and then 3.6 units/hour for 3 hours. Postpartum hemorrhage (PPH) rate (EBL ≥500 ml for vaginal and ≥1000 ml for cesarean). Data from 14 603 deliveries were analyzed, 8408 pre-protocol and 6195 post-protocol. We demonstrated a significant decrease in PPH from 5.2% to 2.9% (P < 0.001) and a small but non-significant increase in the transfusion rate from 1.8% to 2.3% (P = 0.11). A standardized oxytocin infusion protocol in the third stage of labor resulted in a significant decrease in PPH for both vaginal and cesarean deliveries. International Society for Quality in Health Care 2021. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Citation

Sara C Gonzalez, Jeffrey Budge, Patricia D Butler, Maureen Higgs, Judd Whiting, Monica A Lutgendorf. An evidence-based oxytocin protocol for the third stage of labor to improve hemorrhage outcomes. International journal for quality in health care : journal of the International Society for Quality in Health Care. 2021 Feb 20;33(1)

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PMID: 33410457

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