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Infusing oxytocin at skin incision significantly reduces blood loss and haemoglobin decline during caesarean delivery compared with administration after foetal head delivery.
A randomized controlled trial has found that initiating oxytocin infusion at the time of skin incision during elective caesarean delivery reduces maternal blood loss compared with starting the infusion after fetal head delivery.
Postpartum haemorrhage (PPH) remains a key cause of maternal morbidity, yet the optimal timing of oxytocin use during caesarean section remains uncertain. Researchers conducted an open-label, parallel-arm randomized trial at a tertiary care centre to evaluate whether earlier oxytocin administration could improve outcomes.
The study enrolled 68 women with singleton term pregnancies in cephalic presentation who were scheduled for elective pre-labour caesarean delivery. Volunteers were randomly assigned to get an oxytocin infusion at a rate of 6 milli-international units/min beginning either:
All participants were subsequently treated with a 5 International Unit (IU) oxytocin bolus after head delivery, followed by continuous oxytocin infusion for 4 hours postpartum. The primary endpoint was maternal blood loss. Secondary outcomes were hemoglobin decline, ease of fetal head delivery, need for additional uterotonic agents, maternal adverse effects, and neonatal outcomes. Women who received oxytocin at skin incision experienced lower blood loss than those who started treatment after foetal head delivery (Table 1).
The intervention group showed:
The study also assessed factors such as hypotension and delivery characteristics, with no meaningful differences reported between the groups. The findings suggest that administering oxytocin prior to uterine incision, beginning at skin incision, may boost uterine contractility earlier in the procedure and help restrict blood loss during elective caesarean section without compromising maternal or neonatal safety.
Indian Journal of Medical Research
Prophylactic oxytocin infusion for reducing blood loss during elective caesarean delivery: A randomised controlled trial
Praveena Govindan et al.
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