Recommended Oxytocin Dosing for Lower Segment Caesarean Section (LSCS)
For LSCS, administer 5-10 IU of oxytocin as a slow IV or intramuscular injection at the time of delivery of the fetus to reduce the incidence of postpartum hemorrhage. 1
Rationale for Oxytocin Administration in LSCS
Oxytocin administration during cesarean delivery serves several critical purposes:
- Induces sustained myometrial contraction
- Promotes placental separation
- Occludes uterine blood vessels
- Prevents postpartum hemorrhage
Evidence-Based Dosing
The French National College of Gynecologists and Obstetricians (CNGOF) and French Society of Anesthesia and Intensive Care Medicine (SFAR) guidelines specifically recommend:
- 5-10 IU of oxytocin administered as slow IV or intramuscular injection at the time of fetal delivery 1
- This dosing is consistent with recommendations for prevention of postpartum hemorrhage
Administration Methods
Bolus Administration
- A 5 IU bolus appears to be effective for achieving adequate uterine contraction in elective cesarean sections 2
- Higher doses (>5 IU) may cause more significant hemodynamic changes without additional clinical benefit
Infusion Following Bolus
- Following the initial bolus, an oxytocin infusion may be beneficial:
- A study showed that adding a 20 IU oxytocin infusion over 4 hours after the initial 5 IU bolus significantly reduced blood loss compared to bolus alone (456.0 ml vs 569.8 ml, p=0.046) 3
Special Considerations
Patients at Risk for Uterine Atony
- For patients with risk factors for uterine atony, a continuous infusion of oxytocin following the initial bolus is recommended
- Research suggests that an oxytocin infusion may be adequate without the need for a bolus in some cases, even in high-risk patients 2
Monitoring During Administration
- Continuous monitoring of maternal vital signs is essential during oxytocin administration
- If signs of uterine hyperstimulation occur, the oxytocin infusion should be discontinued 1
- Fetal heart rate should be continuously monitored if the fetus is still in utero
Alternative Approaches
A "rule of threes" algorithm has been studied as an alternative approach:
- Initial dose of 3 IU oxytocin
- Assessment of uterine tone at 3-minute intervals
- This approach resulted in lower total oxytocin doses (mean 4.0 vs 8.4 IU) compared to continuous infusion while achieving adequate uterine tone 4
Potential Side Effects
Be aware of potential adverse effects of oxytocin administration:
- Hypotension
- Tachycardia
- Water intoxication (with prolonged high-dose infusions)
- Uterine hyperstimulation
Key Points to Remember
- Administer oxytocin immediately after delivery of the fetus
- Use slow IV or intramuscular injection to minimize hemodynamic effects
- Consider additional infusion in patients at high risk for postpartum hemorrhage
- Monitor maternal vital signs closely during administration
- Be prepared to discontinue oxytocin if adverse effects occur
Following these evidence-based recommendations for oxytocin administration during LSCS will help optimize maternal outcomes by reducing the risk of postpartum hemorrhage while minimizing potential adverse effects.