{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T01:59:53Z","timestamp":1788919193289,"version":"build-2803163510"},"reference-count":19,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[2016,11,21]]},"published-print":{"date-parts":[[2017,6]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>In women with heart disease (HD), the third stage of labour is managed with a reduced dose of oxytocin because it can have significant adverse cardiovascular effects. However, women with HD have high rates of postpartum haemorrhage (PPH); consequently, we designed a prospective study to investigate whether higher doses of oxytocin can be given safely and would reduce rates of PPH.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We performed a single centre, prospective, cohort study comparing the standard \u2018low-dose\u2019 oxytocin infusion (10\u2005U of oxytocin in 500\u2005mL of normal saline given intravenously at 36\u2005mL\/hour for 4\u2005hours (12\u2005mU\/min), n=29) to the low-dose infusion and an additional 2\u2005U of oxytocin given over 10\u2005min immediately after birth (n=30). Maternal blood pressure was measured every minute for 10\u2005min, continuous ECG (Holter) monitoring was performed and any symptoms (chest pain, dyspnoea) were recorded. Total blood loss and serum troponins were measured at 12\u2005hours.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There were no cardiac symptoms, arrhythmias, change in the ST segment or increase in serum troponins. The fall in blood pressure and increase in heart rate were greater with the additional oxytocin, but neither were statistically or clinically significant. The blood loss was significantly less in women receiving additional oxytocin (505 vs 849\u2005mL) and the proportion of women having a PPH was lower.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The use of an additional 2\u2005U of oxytocin for the management of third stage in women with HD had no cardiac consequences and was associated with a significantly lower blood loss. Further larger studies on a larger population of women with HD are needed.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/heartjnl-2016-310607","type":"journal-article","created":{"date-parts":[[2016,12,24]],"date-time":"2016-12-24T13:43:15Z","timestamp":1482586995000},"page":"945-951","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":29,"title":["The management of the third stage of labour in women with heart disease"],"prefix":"10.1136","volume":"103","author":[{"given":"Matthew","family":"Cauldwell","sequence":"first","affiliation":[{"name":"Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip J","family":"Steer","sequence":"additional","affiliation":[{"name":"Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorna","family":"Swan","sequence":"additional","affiliation":[{"name":"Adult Congenital Heart Centre, The National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anselm","family":"Uebing","sequence":"additional","affiliation":[{"name":"Adult Congenital Heart Centre, The National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A","family":"Gatzoulis","sequence":"additional","affiliation":[{"name":"Adult Congenital Heart Centre, The National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark R","family":"Johnson","sequence":"additional","affiliation":[{"name":"Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2016,12,19]]},"reference":[{"key":"2025101713235284000_103.12.945.1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehr218"},{"key":"2025101713235284000_103.12.945.2","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1016\/j.jgyn.2014.09.023","article-title":"[Epidemiology of post-partum haemorrhage]","volume":"43","author":"Deneux-Tharaux","year":"2014","journal-title":"J Gynecol Obstet Biol Reprod"},{"key":"2025101713235284000_103.12.945.3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2011.03198.x"},{"key":"2025101713235284000_103.12.945.4","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.ijcard.2016.05.068","article-title":"Why is post-partum haemorrhage more common in women with congenital heart disease?","volume":"218","author":"Cauldwell","year":"2016","journal-title":"Int J Cardiol"},{"key":"2025101713235284000_103.12.945.5","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.ijcard.2016.08.178","article-title":"The management of third stage of labour in women with heart disease needs more attention","volume":"223","author":"Cauldwell","year":"2016","journal-title":"Int J Cardiol"},{"key":"2025101713235284000_103.12.945.6","unstructured":"Cardiac Disease and Pregnancy (Good Practice Guideline No 13)- Royal College of Obstetricians and Gynaecologists- https:\/\/www.rcog.org.uk\/en\/guidelines-research-services\/guidelines\/good-practice-13\/ ."},{"key":"2025101713235284000_103.12.945.7","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aen071"},{"key":"2025101713235284000_103.12.945.8","unstructured":"Electronic medicines compendium. https:\/\/www.medicines.org.uk\/emc\/medicine\/20884 (accessed 12 Sep 2016)."},{"key":"2025101713235284000_103.12.945.9","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.ijcard.2015.06.106","article-title":"Iatrogenic anterior myocardial infarction secondary to ergometrine-induced coronary artery spasm during dilation and curettage for an incomplete miscarriage","volume":"198","author":"Ramzy","year":"2015","journal-title":"Int J Cardiol"},{"key":"2025101713235284000_103.12.945.10","doi-asserted-by":"crossref","unstructured":"Westhoff G , Cotter AM , Tolosa JE . Prophylactic oxytocin for the third stage of labour to prevent postpartum haemorrhage. Cochrane Database Syst Rev 2013;(10):CD001808. doi:10.1002\/14651858.CD001808.pub2","DOI":"10.1002\/14651858.CD001808.pub2"},{"key":"2025101713235284000_103.12.945.11","doi-asserted-by":"crossref","first-page":"1568","DOI":"10.1111\/1471-0528.13372","article-title":"Regulatory barriers to academically funded randomised controlled trials involving medicines","volume":"122","author":"Cauldwell","year":"2015","journal-title":"BJOG"},{"key":"2025101713235284000_103.12.945.12","doi-asserted-by":"crossref","first-page":"2164","DOI":"10.1111\/1471-0528.13831","article-title":"The epidemiology and outcomes of women with postpartum haemorrhage requiring massive transfusion with eight or more units of red cells: a national cross-sectional study","volume":"123","author":"Green","year":"2015","journal-title":"BJOG"},{"key":"2025101713235284000_103.12.945.13","unstructured":"Lewis G . The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving Mothers\u2019 Lives: reviewing maternal deaths to make motherhood safer 2003\u20132005. The Seventh Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. London: CEMACH, 2007."},{"key":"2025101713235284000_103.12.945.14","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aen273"},{"key":"2025101713235284000_103.12.945.15","doi-asserted-by":"crossref","first-page":"32","DOI":"10.4103\/0970-9185.105790","article-title":"Oxytocin administration during cesarean delivery: Randomized controlled trial to compare intravenous bolus with intravenous infusion regimen","volume":"29","author":"Bhattacharya","year":"2013","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"2025101713235284000_103.12.945.16","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2009.02356.x"},{"key":"2025101713235284000_103.12.945.17","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aep137"},{"key":"2025101713235284000_103.12.945.18","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-6576.2009.02080.x"},{"key":"2025101713235284000_103.12.945.19","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.ijoa.2015.08.009","article-title":"The effects of prophylactic bolus phenylephrine on hypotension during low-dose spinal anesthesia for cesarean section","volume":"25","author":"Lee","year":"2016","journal-title":"Int J Obstet Anesth"}],"container-title":["Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/heartjnl-2016-310607","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T20:24:00Z","timestamp":1760732640000},"score":1,"resource":{"primary":{"URL":"https:\/\/heart.bmj.com\/lookup\/doi\/10.1136\/heartjnl-2016-310607"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,12,19]]},"references-count":19,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2017,5,31]]},"published-print":{"date-parts":[[2017,6]]}},"alternative-id":["10.1136\/heartjnl-2016-310607"],"URL":"https:\/\/doi.org\/10.1136\/heartjnl-2016-310607","relation":{},"ISSN":["1355-6037","1468-201X"],"issn-type":[{"value":"1355-6037","type":"print"},{"value":"1468-201X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,12,19]]}}}