Association between Oxytocin Use during Dilation and Evacuation and Estimated Blood Loss

Abstract

Objectives: Many providers use oxytocin during dilation and evacuation (D&E) to prevent or treat hemorrhage. Evidence to support this practice is scarce. We sought to describe the association between oxytocin use, estimated blood loss (EBL), and surgical outcomes during D&E. Study Design: Women undergoing D&E (≥14 weeks) between 2010 and 2014 were included in this retrospective cohort study to assess the association between oxytocin use and EBL. We also determined whether sociodemographic and health-related factors were associated with higher EBL and whether oxytocin use was associated with a lower complication rate. Mean EBL was compared with a t-test. Excessive blood loss, defined as EBL at or above 250 ml, demographics, and complications were compared with a chi-square and Fisher's Exact tests. Logistic regression was performed. Our database, which included 649 women undergoing D&E, had the ability to detect a 7.5% difference in excessive blood loss. Results: Oxytocin was used in 68.3% of the procedures. Asian (p= 0.02) and Native Hawaiian/Pacific Islander (p=0.03) race, abortion indication (p=0.008) and higher gestational age (p<0.001) were associated with osytocin use. Mean EBL [133.1 (sd=133.9) ml versus 105 ml (73.8), p<0.001] and excessive blood loss (11.1% vs. 4.9%, p=0.01) were higher in the oxytocin group. No significant difference in complication rates emerged (4.7% with oxytocin vs. 4.4% without, p=0.579). The adjusted OR for excessive blood loss was 1.61 (95% Cl 0.77, 3.77) when women received oxytocin. Conclusions: Oxytocin use during D&E did not have a significant association with surgical outcomes including EBL and complications in our population. Implications: Routine use of interventions for bleeding, such as intravenous oxytocin, should be based on scientific evidence or not performed. Findings from our study provide information on how oxytocin use is associated with blood loss during D&E.