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Recording

Oral Plenary Session I and Late-Breaking

Oral Plenary Sessions

(7) Association of Postpartum Oxytocin Dose and Postpartum Hemorrhage

Monday, February 12, 2024

5:15 PM – 5:30 PM

Location: Potomac Ballroom, Ballroom Level

Primary & Presenting Author(s)

Ashley E. Shea, MD, MPH

MFM Fellow
University of Alabama at Birmingham
Birmingham, AL, United States

Coauthor(s)

CW

Candice Woolfolk, PhD

Research Statistician
Washington University School of Medicine in St. Louis
St. Louis, MO, United States
Vasiliki B. Orfanakos, MD

Resident Physician
University of Alabama at Birmingham
Birmingham, AL, United States
Alison G. Cahill, MD

Professor
University of Texas at Austin, Dell Medical School
Austin, TX, United States
Methodius G. Tuuli, MBA, MD, MPH

Chace-Joukowsky Professor and Chair
Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University
Providence, RI, United States
Sindhu K. Srinivas, MD, MSCE

Professor, Vice Chair for Quality and Safety, Physician Lead, Women's Health Service Line Penn Medicine
Perelman School of Medicine, University of Pennsylvania
Philadelphia, Pennsylvania, United States
GM

George A. Macones, MD, MSCE

The University of Texas at Austin
Austin, TX, United States
Alan T. Tita, MD, PhD

Professor
University of Alabama at Birmingham
Birmingham, AL, United States
Akila Subramaniam, MD, MPH (she/her/hers)

Associate Professor
Center for Women’s Reproductive Health, University of Alabama at Birmingham
Birmingham, AL, United States

Objective: The most effective dose of prophylactic oxytocin for the prevention of postpartum hemorrhage (PPH) is unknown. Our objective was to compare rates of PPH and the need for additional PPH interventions between postpartum (PP) high dose (80 units) and lower dose (10-30 units) oxytocin regimens.

Study Design: Secondary analysis of a multicenter randomized control trial of 2,404 nulliparous women between 5/2014-12/2017 with term singleton pregnancies that investigated immediate versus delayed pushing in women in the 2nd stage. PP oxytocin regimens were ascertained from each of the 6 participating centers and categorized as high dose (80 units/500 mL over 1 hour after placental delivery) and lower dose (10-30 units/500-1000 mL over 1-4 hours). The primary outcome was a composite of uterotonic use, any blood transfusion, and PPH (see figure footnote). Secondary outcomes included individual composite components. Outcomes were compared between groups and logistic regression was used to estimate adjusted odds ratios and 95% confidence intervals using the lower dose group as the reference.

Results: All 2,404 patients from the primary RCT were included: 455 (19%) in the high dose group and 1,949 (81%) in the lower dose group. Women in the high dose group were more likely to be younger, African American, obese, have magnesium sulfate exposure, and achieve vaginal delivery. Compared to lower dose oxytocin, patients receiving higher oxytocin doses had nearly a 50% reduction in odds of the primary composite outcome (aOR 0.53 [95% CI 0.34, 0.82]), primarily driven by a >50% decreased odds of PPH (aOR 0.44 [0.27-0.72])(Figure). While frequencies of other secondary outcomes were lower in the high dose group; there was no difference in odds of these outcomes after multivariable adjustment. Stratified analysis of low (10-20 units), moderate (30 units), and high dose (80 units) was consistent with primary results.

Conclusion: High dose PP oxytocin was associated with lower rates of PPH than traditional oxytocin doses. Future multicenter trials of PP oxytocin dose should be performed to improve outcomes.