What is the recommended dose of oxytocin (Oxytocin) for a Lower Segment Caesarean Section (LSCS)?

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

1. Administer oxytocin immediately after delivery of the fetus
2. Use slow IV or intramuscular injection to minimize hemodynamic effects
3. Consider additional infusion in patients at high risk for postpartum hemorrhage
4. Monitor maternal vital signs closely during administration
5. 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.