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ST depression at caesarean section and the relation to oxytocin dose. A randomised controlled trial

  1. M Jonsson1,
  2. U Hanson1,
  3. C Lidell2,
  4. S Nordén-Lindeberg1

Article first published online: 14 SEP 2009

DOI: 10.1111/j.1471-0528.2009.02356.x

Issue

BJOG: An International Journal of Obstetrics & Gynaecology

BJOG: An International Journal of Obstetrics & Gynaecology

Volume 117, Issue 1, pages 76–83, January 2010

Additional Information

How to Cite

Jonsson, M., Hanson, U., Lidell, C. and Nordén-Lindeberg, S. (2010), ST depression at caesarean section and the relation to oxytocin dose. A randomised controlled trial. BJOG: An International Journal of Obstetrics & Gynaecology, 117: 76–83. doi: 10.1111/j.1471-0528.2009.02356.x

Author Information

  1. 1

    Department of Women’s and Children’s Health Uppsala University, Uppsala, Sweden

  2. 2

    Department of Clinical Physiology Uppsala University Hospital, Uppsala, Sweden

*M Jonsson, Department of Women’s and Children’s Health, Uppsala University, SE-751 85 Uppsala, Sweden. Email maria.jonsson@kbh.uu.se

Publication History

  1. Issue published online: 9 DEC 2009
  2. Article first published online: 14 SEP 2009
  3. Accepted 21 July 2009. Published Online 14 September 2009.

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Keywords:

  • Caesarean section;
  • electrocardiography;
  • heart;
  • hypotension;
  • ischaemia;
  • oxytocin;
  • regional anaesthesia

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.

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