Oxytocin dosin'

Lancet published work sponsored by Bill and Melinda Gates last month.click HERE. The setting was hospitals in the developing world, and the paper concludes that 800mcg of sublingual misoprostol is equivalent to 40 units of intravenous oxytocin in treating PPH in parturients who have already had prophylactic oxytocin at delivery. The treatments were equally effective and very effective in the group of 809 women with PPH: 89% of the M group and 90% of the O group were deemed to have had control of bleeding by 20 minutes; six women went on to have hysterectomy and two died. The misoprostol group suffered more side effect of shivering and fever.

The oxytocin was given as a 40 unit infusion over 15 minutes, not the often cited 40 units in 1000 ml over 4 hours. This is consistent with my view that too little oxytocin is often used in emergency cases and too much in elective caesarean section.