Administration of Uterotonics after Caesarean Section
(CHBAH, CMJAH, RMMCH) WITS, Feb 2017. For review: Feb 2018
Actively bleeding cases or ongoing uterine atony
Cardiac and severe PET patients
Patient should come with an IV line (Line A) in situ, at 125 ml/hr or at 80 ml/hr for cardiac and hypertensive patients, dedicated for fluid resuscitation.
Insert second IV line (Line B) pre-operatively. Line B must have a dial-a-flow for dedicated oxytocin administration.
Line A can be removed in recovery once the patient is fully fluid resuscitated.
Prophylaxis
- Oxytocin 2.5 IU IVI slow bolus (over 30 s) at delivery of anterior shoulder (provided there is no twin).
- Immediately start oxytocin infusion 40 IU/1000 ml Ringer’s Lactate or Balsol at 125 ml/hr in the dedicated oxytocin line - (Equivalent to 42 drops/min from a ’20 dropper’ administration set)
- If ongoing uterine atony, repeat oxytocin 2.5 IU IVI bolus.
Actively bleeding cases or ongoing uterine atony
Actively look for the cause and manage accordingly.
- Call for senior surgical and / anaesthetic help
- Syntometrine 1 ampoule IMI (into deltoid muscle) if no contra-indications
- Tranexamic acid 1g IVI
- Increase oxytocin to 80 IU/1000 ml at 125 ml/hr
- If no response, give Misoprostol 400 – 600 μg sublingual / rectal.
Concurrent resuscitative (fluids/blood products etc.) and surgical (B-Lynch etc.) measures need to be taken to manage ongoing bleeding.
Cardiac and severe PET patients
- Oxytocin 2.5 IU IVI slow bolus (over 30 s) at delivery of anterior shoulder (provided there is no twin).
- Immediately start oxytocin infusion 40 IU/200 ml at 25 ml/hr.
EVACS after ICA or TOP
- Oxytocin 2.5 IU IVI slow bolus (over 30 s).
- Oxytocin infusion 20 IU/1000 ml at 125 ml/hr.