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Category: Volume 07 Issue 03 March 2019
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Title: Stab Intra-Myometrial Injection (SIMI) of low dose oxytocin versus parenteral oxytocin during LSCS- A comparative clinical study

Authors: Dr Sahadev Sahoo, Dr. Amit Dutta, Dr Ritam De

 DOI: https://dx.doi.org/10.18535/jmscr/v7i3.38

Abstract

Background:  In an effort to effectively reduce placental site haemorrhage in a number of cases alternative methods were sought and myometrial transfer of oxytocin by insulin syringe is the result.

Aim: This is a comparative study of 4 IU oxytocin by stab intra-myometrial injection (SIMI) and conventional 10 IU parenteral during LSCS with the objective of comparing the blood loss. 

Materials & Methods:  A prospective study of Group A 100 patients subjected to SIMI by insulin syringe and Group B 100 patients administered 10 IU of oxytocin IV after baby birth. The blood loss and adverse effects of oxytocin during LSCS compared between the 2 groups.

Results:  It’s observed that in all the emergency & elective cases of Gr. A the mean blood loss is less by 40.1 ml (482.8 ml) as compared to 522.9 ml in Gr. B cases.

Discussion: The placental site haemorrhage plays the dominant role during caesarean sections to decide the maternal mortality and morbidity. Intra-myometrial uterotonics have the effect of faster action reducing the 3rd stage time and bleeding thereby the total blood loss by 40.1 ml. in this study.

Conclusion:  SIMI of low dose oxytocin may be an alternate step for 3rd stage management and more studies may be needed in this regard.

Keywords: Stab Intra-Myometrial Injection (SIMI), Low dose oxytocin, Placental site haemorrhage, caesarean section.

References

  1. Boyle A, Reddy UM, Landy HJ, Huang CC, Driggers RW, Laughon SK. Primary cesarean delivery in the United States. Obstet Gynecol. 2013;122(1):33-40.
  2. Haider MR, Rahman MM, Moinuddin M, Rahman AE, Ahmed S, Khan MM. Ever-increasing Caesarean section and its economic burden in Bangladesh. PLoS One. 2018;13(12):e0208623.
  3. Rani PR, Begum J. Recent Advances in the Management of Major Postpartum Haemorrhage - A Review. J Clin Diagn Res. 2017;11(2):QE01-QE05.
  • Postpartum haemorrhage. https://www.nhp.gov.in/disease/gynaecology-and-obstetrics/postpartum-haemorrhage.
  1. Dolea C, AbouZahr C, Stein C. Global burden of maternal hemorrhage in the year 2000. Geneva: WHO; 2003.
  2. Ramanathan G, Arulkumaran S. Postpartum hemorrhage. J Obstet Gynaecol Can 2006; 28(11):967-973.
  3. Walfish M, Neuman A, Wlody D. Maternal haemorrhage. Br J Anaesth 2009; 103(1):i47-i56.
  4. Schuurmans N, MacKinnon C, Lane C, Etches D. Society of Obstetricians and Gynaecologists of Canada Clinical Practice Guidelines: Prevention and management of postpartum haemorrhage. 2000; 88:1-11.
  5. Belachew J, Eurenius K, Mulic-Lutvica A, Axelsson O. Placental location, postpartum hemorrhage and retained placenta in women with a previous cesarean section delivery: a prospective cohort study. Ups J Med Sci. 2017;122(3):185-189.
  6. Sebghati M, Chandraharan E. An update on the risk factors for and management of obstetric haemorrhage. Womens Health (Lond). 2017;13(2):34-40.
  7. Active management of the third stage of labour. https://apps.who.int/iris/bitstream/handle/10665/119831/WHO_RHR_14.18_eng.pdf;jsessionid=97D13522F01BB8C7B3E3881F8611C913?sequence=1.
  8. World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage. 2012. WHO: Geneva, Switzerland.
  9. Gülmezoglu AM, Lumbiganon P,  Landoulsi S, Widmer M, Abdel-Aleem H, Festin M, et al. Active management of the third stage of labour with and without controlled cord traction: a randomised, controlled, noninferiority trial. 2012 May 5; 379(9827):1721-7.
  10. Yamaguchi ET, Cardoso MM, Torres ML. Oxytocin in cesarean sections: what is the best way to use it? Rev Bras Anestesiol.2007 Jun;57(3):324-50.
  11. Diaz V, Abalos E, Carroli G. Methods for blood loss estimation after vaginal birth. Cochrane Database Syst Rev.2018 Sep 13;9: CD010980.
  12. Vejnović TR, Costa SD, Ignatov A. New Technique for Caesarean Section.  Geburtshilfe Frauenheilkd. 2012;72(9): 840-845.
  13. Mehrabadi A, Hutcheon JA, Liu S,  Bartholomew S, Kramer MS, Liston RM, et al. Contribution of placenta accreta to the incidence of postpartum hemorrhage and severe postpartum hemorrhage. Obstet Gynecol. 2015 Apr; 125(4):814-21. 
  14. Weisbrod AB, Sheppard FR, Chernofsky MR, Blankenship CL, Gage F, Wind G, et al. Emergent management of postpartum hemorrhage for the general and acute care surgeon. World J Emerg Surg.2009 Nov 25; 4:43.
  15. Tita AT, Szychowski JM, Rouse DJ, et al. Higher-dose oxytocin and hemorrhage after vaginal delivery: a randomized controlled trial. Obstet Gynecol. 2012; 119 (2 Pt 1):293-300.
  16. Dennehy KC, Rosaeg OP, Cicutti NJ, et al. Oxytocin injection after caesarean delivery: intravenous or intramyometrial? Can J Anaesth 1998; 45(7):635-639.
  17. Mangla D, Goel JK, Goel R. Prophylactic intramyometrial oxytocin before placenta delivery during caesarean section prevents postpartum hemorrhage: a prospective randomized study of 150 women. J South Asian Feder Obst Gynae 2012; 4(2):93-96.
  18. Su LL, Chong YS, Samuel M. Oxytocin agonists for preventing postpartum haemorrhage. Cochrane Database of Systematic Reviews 2009; 3:CD005457.
  19. Bai J, Sun Q, Zhai H. A comparison of oxytocin and carboprost tromethamine in the prevention of postpartum hemorrhage in high risk patients undergoing cesarean delivery. Exp Therap Med 2013; 7:46-50.

Corresponding Author

Dr Amit Dutta

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