An evidence-based oxytocin protocol for the third stage of labor to improve hemorrhage outcomes

Abstract

Objective: To assess the use of an evidence-based oxytocin protocol for management of the third stage of labor to decrease non-beneficial clinical variation and improve clinical outcomes.

Design: This is a cohort study of pregnant patients delivering before implementation of an evidence-based oxytocin protocol compared to patients delivering after implementation of an evidence-based oxytocin protocol.

Setting: A level III maternal care referral hospital with an average delivery volume of approximately 3000 deliveries.

Participants: Pregnant patients delivering over a 60-month period from January 2013 to December 2017.

Intervention: An evidence-based oxytocin protocol: 3 units of oxytocin administered over 3 minutes, with a second 3-unit bolus if inadequate tone, then oxytocin infusion at 18 units/hour × 1 hour and then 3.6 units/hour for 3 hours.

Main outcome measures: Postpartum hemorrhage (PPH) rate (EBL ≥500 ml for vaginal and ≥1000 ml for cesarean).

Results: Data from 14 603 deliveries were analyzed, 8408 pre-protocol and 6195 post-protocol. We demonstrated a significant decrease in PPH from 5.2% to 2.9% (P < 0.001) and a small but non-significant increase in the transfusion rate from 1.8% to 2.3% (P = 0.11).

Conclusion: A standardized oxytocin infusion protocol in the third stage of labor resulted in a significant decrease in PPH for both vaginal and cesarean deliveries.

Keywords: oxytocin infusion; postpartum hemorrhage; prevention; quality improvement; standardization.