Abstract
Aim: We examined whether a reduction in the dose of uterotonic agents before amniotomy affects the amount of intrapartum hemorrhage.
Methods: Women who underwent planned painless vaginal delivery through labor induction with oxytocin and amniotomy at our hospital (n=294) were included in this study. The amount of intrapartum hemorrhage was compared among patients divided into the following two groups: (1) the oxytocin down dose (ODD) group (n=134), in which the dose of oxytocin was halved before amniotomy (from January to December 2023); and (2) the non-ODD group (n=160), in which the dose of oxytocin was not reduced before amniotomy (from January to December 2022).
Results: The incidence of postpartum massive hemorrhage (PPMH) did not differ between the two groups. However, while obstetrical disseminated intravascular coagulation (DIC) was not observed in the ODD group, five patients in the non-ODD group experienced obstetrical DIC, although not significant. Among patients with obstetrical DIC, uterine-type amniotic fluid embolism (AFE) was suspected in two patients.
Conclusions: The findings of this study indicate that, while amniotomy for labor induction poses a potential risk of obstetrical DIC and AFE, careful use of uterotonic agents may reduce this risk.
