Estimated blood loss in pregnant women with cardiac disease compared with low risk women: a restrospective cohort study

Table 1 Dose and route of oxytocin for management of the third stage in women with and without cardiac disease in our unit

Oxytocic agents used for active management of the 3rd stage	Spontaneous vaginal delivery	Rotational delivery in theatre
All women without cardiac disease in accordance with NICE guidelines on intrapartum care.	10 i.u. oxytocin, intramuscular (im)	5 i.u. oxytocin intravenous (iv), given as a slow bolus over 3–5 min
Women with cardiac disease except those listed below.	10 i.u. oxytocin, im	5 i.u. oxytocin iv given as a an infusion over 10 min through a pump
Women with the following cardiac conditions: • Single ventricle • Fontan circulation • Valvar stenosis • Severely impaired ventricular function [< 30% Ejection Fraction (EF)]	Management is individualised with consideration of a 5 iu infusion over 10 min through a pump

The key difference in the administration of oxytocin in our population of low risk women and women with cardiac disease is that intravenous administration occurs over a 10 min interval instead of a slow bolus over 3–5 min. The dose of oxytocin is the same. This regime differs from the RCOG good practice recommendation which advocates a lower dose of 2 i.u. ocytocin given over 10–20 min at elective CS; and 5 i.u oxytocin intramuscularly, or 2 i.u oxytocin over 10 min for women who have a vaginal delivery

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