Oxytocics, Delivery & Post-operative Care
๐ง Oxytocin โ give it carefully
- Never a rapid bolus. Give a dilute infusion โ ~10โ20 units in 1000 mL crystalloid at 40โ80 mU/min.
- A bolus of oxytocin causes โ SVR with reflex tachycardia (and transient โ PVR) โ dangerous in MS.
โ Avoid โ Methylergometrine (ergometrine)
Causes severe hypertension, โ HR and โ PVR โ contraindicated in mitral stenosis / pulmonary hypertension.
Carboprost (PGFโฮฑ) also raises PVR and can cause bronchospasm โ use with great caution / avoid in PAH. Manage uterine atony with the oxytocin infusion, uterine massage and surgical measures first.
๐๏ธ Post-operative care
- Nurse in a HDU/ICU โ the post-partum autotransfusion makes the first 24โ48 h the highest-risk window for pulmonary oedema.
- Adequate multimodal analgesia โ paracetamol, NSAIDs, opioids, LA/epidural, TAP block, rectus-sheath & ilioinguinal blocks (opioid-sparing, avoids tachycardia from pain).
- Watch for the key complications: pulmonary hypertension, pulmonary oedema and cardiac failure; continue anticoagulation planning (AF, prosthetic valve).