AIMS & OBJECTIVES

To compare the haemodynamic effects of two regimes of intravenous oxytocin infusion in caesarean delivery with respect to:

1) The pulse rate 2) The mean arterial pressure. 3) Any ECG changes 4) Events of side effects like nausea, vomiting, flushing, chest pain etc 5) Uterine tone

STUDY METHOD AND METHODOLOGY

STUDY SUBJECT:

Full term pregnant females of ASA I and II between the age group of 20 to 40 years scheduled for CesareanDelivery under spinal anaesthesia.

INCLUSION CRITERIA

1) Full term pregnant females scheduled for cesarean delivery consenting for the study 2) Patients in the age group of 20-40 years 3) Categorized under ASA I and II. 4) Annexure: ASA classification. 5) Posted for emergency or elective cesarean delivery under spinal anaesthesia.

EXCLUSION CRITERIA 1)

Complicated obstetrics with an increased risk of atony or excessive bleeding like known placenta praevia, multiple gestation more than previous two LSCS, history of PPH.

2) Cardiovascular instability like pre-ecclampsia, essential hypertension. 3) Systemic illnesses such as severe anaemia, bleeding diasthesis and significant cardiovascular disease.

ASA GRADING

Grade I: - A normal healthy patient

Grade II:-A patient with mild systemic disease (that does not limit activity)

Grade III:-A patient with severe systemic disease (that limits physical activity but not incapacitating)

Grade IV:-A patient with severe systemic disease that is a constant threat to life

Grade V:-A moribund patient that is not expected to survive

Grade VI:-Declared brain dead patient whose organs are being removed for donor purpose

Suffix with ‘E’ in emergency setting.

STUDY PROCEDURE

Informed consent will be taken from all the patients included in the study. Pre op evaluation and relevant investigations shall be recorded. Following the above, patients will be randomly allocated into two groups by using the random table Oxytocin infusion is prepared as follows. Group I: 2 units in 50 ml NS Group II: 5 units in 50 ml NS.

The infusion is prepared by one investigator administered by another investigator who is blinded of the study. When the patient arrives in the OT, she is attached to the non-invasive multipurpose monitor and baseline pulse, systolic, diastolic and mean arterial blood pressure, ECG, respiratory rate and oxygen saturation is recorded. An IV line is secured and 500mlof RL is infused. Subarachanoid block is performed and the highest sensory dermatome segment blocked is recorded, Once the cesarean section commences and the baby is delivered, the infusion is started at the rate of 10ml/min so as to infuse the initial bolus of oxytocin in the first 5 minutes, followed by maintenance infusion at the rate of 2 units/hr prepared separately as 20 unit in 500ml RL.

The vital parameters such as pulse, systolic blood pressure, diastolic blood pressure, mean arterial pressure, ECG changes and side effects such as nausea, vomiting, flushing, chest pain and uterine contractions are noted every 1 minute for 10 minutes after starting the infusion and thereafter for every 3 minutes for the first 30 minutes and every 15 minutes for the duration of the surgery. Any additional rescue uterotonics administered are recorded. Intraoperative blood loss is assessed and urine output is measured. Uterine tone is assessed by 4 point scale (1- atonic; 2-inadequately contracted; 3- adequately contracted; 4- well contracted) Post operative monitoring is done in the recovery room and the vital parameters are recorded every half hour.

STATISTICAL ANALYSIS

Appropriate statistical analysis will be applied