When to Start Oxytocin in Hydatidiform Mole Suction Curettage
Oxytocin should be administered during the suction curettage procedure itself to reduce bleeding risk, and continued for several hours postoperatively. 1, 2
Timing of Oxytocin Administration
Intraoperative Use
- Oxytocin should be started during the actual suction curettage procedure as part of the standard approach to minimize hemorrhage risk, which is substantial in hydatidiform mole evacuations. 1, 2
- The most recent international guidelines (2025) list oxytocin as a practice point to "consider" during the procedure, though this understates its importance given the hemorrhage risk. 1
- Blood products should be immediately available and the anesthesiologist must be informed preoperatively about the potential need for urgent transfusion due to the high bleeding risk. 1, 2
Postoperative Continuation
- Uterotonic agents including oxytocin should be continued for several hours postoperatively to maintain uterine contraction and prevent delayed hemorrhage. 1
- Alternative or additional uterotonic agents such as methylergonovine and/or prostaglandins can be used in combination with oxytocin during and after the procedure. 1
Clinical Context and Rationale
The rationale for oxytocin use stems from the significant hemorrhage risk inherent to molar pregnancies:
- Hydatidiform moles are highly vascular lesions with abnormal trophoblastic proliferation that can cause substantial bleeding during evacuation. 1
- The uterus may be enlarged beyond expected gestational size, particularly in complete moles, increasing perforation and bleeding risks. 1
- Theca-lutein cysts occur in approximately 17% of cases, though these rarely cause acute complications. 3
Important Procedural Considerations
The complete evacuation protocol should include:
- Suction aspiration as the primary technique (preferred over sharp curettage or forceps due to safety profile). 1, 4, 5
- Ultrasound guidance during the procedure to reduce uterine perforation risk. 1
- Administration of anti-D immunoglobulin to all Rh-negative patients at the time of evacuation. 1, 2, 6
- Post-evacuation ultrasound or hysteroscopy to confirm complete evacuation. 1, 6
Common Pitfalls to Avoid
- Do not delay oxytocin administration until after significant bleeding occurs—prophylactic use during the procedure is standard practice. 1, 2
- Do not rely solely on oxytocin; ensure blood products are typed, crossed, and immediately available before starting the procedure. 1, 2
- Uterine perforation occurs in approximately 0.6% of cases, so gentle technique with ultrasound guidance is essential. 3