St depression at caesarean section and the relation to oxytocin dose: a randomised controlled trial
2010 (English)In: BJOG : an international journal of obstetrics and gynaecology, ISSN 1470-0328, Vol. 117, no 1, 76-83 p.Article in journal (Refereed) Published
Objective To investigate whether there is a difference in occurrence of electrocardiogram changes suggestive of myocardial ischaemia between two different doses of oxytocin. Design Double-blind randomised controlled trial Setting University hospital in Sweden. Population A total of 103 healthy women undergoing elective caesarean section under spinal anaesthesia. Methods The participants were randomised to 5 or 10 units of oxytocin, given as an intravenous bolus. A Holter monitor was used to record electrocardiograms and non invasive blood pressure and heart rate (HR) was monitored. A blood sample was obtained 12-hour postoperatively. Main outcome measures Depression of the ST segment. Secondary outcomes: symptoms, Troponon I levels, mean arterial pressure (MAP), HR and blood loss. Results There was a significant difference in occurrence of ST depressions associated with oxytocin administration, 4 (7.7%) with 5 and 11 (21.6%) with 10 units, P < 0.05. The absolute risk reduction was 13.9% (95% confidence interval, 0.5-27.3). Decrease of mean MAP from baseline to 2 minutes differed, being 9 mmHg in the 5 unit group and 17 mmHg in the 10 unit group (P < 0.01). The increase in mean HR did not differ. Troponin I levels were increased in four subjects (3.9%). There were no differences in occurrence of symptoms, Troponin I levels, or estimated blood loss. Conclusion ST depressions were associated with oxytocin administration significantly more often in subjects receiving 10 units compared with 5 units. Interventions to prevent hypotension during caesarean section may reduce the occurrence of ST depressions on electrocardiograms.
Place, publisher, year, edition, pages
2010. Vol. 117, no 1, 76-83 p.
caesarean section, regional anaesthesia, oxytocin, heart, ischemia, hypotension, electrocardiography
Medical and Health Sciences
Research subject Obstetrics and Gynaecology
IdentifiersURN: urn:nbn:se:uu:diva-100466DOI: 10.1111/j.1471-0528.2009.02356.xISI: 000272566600013PubMedID: 19781043OAI: oai:DiVA.org:uu-100466DiVA: diva2:210373