A double-blind randomised controlled trial of oxytocin bolus plus placebo infusion versus oxytocin bolus plus oxytocin infusion at elective caesarean section.

INTERVENTION: For the management of the third stage of labour at elective caesarean section, a single dose intravenous bolus injection of 5 IU (international units) oxytocin plus 20 IU (international units) oxytocin intravenous infusion (rate 250mls hour infused over 4 hours). CONDITION: Elective caesarean section Postpartum haemorrhage Uterine atony PRIMARY OUTCOME: Requirement for additional uterotonic measures SECONDARY OUTCOME: A change in postnatal day 1 haemoglobin ("Hb") (compared to preoperative measurement). A return to theatre within 24 hours in order to arrest bleeding/haemorrhage. Composite serious maternal morbidity/mortality (Admission to High Dependency Unit/Intensive Care Unit "HDU/ITU", Prolonged postnatal stay (> 5 days), hysterectomy, haematologic dysfunction (e.g disseminated intravascular coagulation, laparotomy, blood loss >1,000mls, death Number of women administered blood products (packed red cells, platelets, fresh frozen plasma). Volume of fluid (crystalloid/colloid) replacement required to correct hypovolaemia. INCLUSION CRITERIA: Pregnancy: Singleton only Fetus: Alive only Gestation: 37 weeks ‐ 41 weeks Surgery: Elective lower segment caesarean section Anaesthesia: Regional anaesthesia (spinal, epidural, combined spinal epidural (CSE)) Past medical history: No significant maternal medical or obstetric disorders Parity: <3 (equal to or less than 3): Pre‐op Haemoglobin: "Hb" > (equal to or more than) 100g/dl Language: Fluency in English Age: >18 years of age (equal to or more than)