Abstract
We assessed the impact of intravenous (IV) infusion versus intramuscular (IM) oxytocin on postpartum blood loss and rates of postpartum hemorrhage (PPH) when administered during the third stage of labor. While oxytocin is recommended for prevention of PPH, few double-blind studies have compared outcomes by routes of administration. A double-blind, placebo-controlled randomized trial was conducted at a hospital in Argentina. Participants were assigned to receive 10 IU oxytocin via IV infusion or IM injection and a matching saline ampoule for the other route after vaginal birth. Blood loss was measured using a calibrated receptacle for a 1-hour minimum. Shock index (SI) was also calculated, based on vital signs measurements, and additional interventions were recorded. Primary outcomes included: the frequency of blood loss ≥500ml and mean blood loss. 239 (IV infusion) and 241 (IM) women were enrolled with comparable baseline characteristics. Mean blood loss was 43ml less in the IV infusion group (p = 0.161). Rates of blood loss ≥500ml were similar (IV infusion = 21%; IM = 24%, p = 0.362). Women in the IV infusion group received significantly fewer additional uterotonics (5%), than women in the IM group (12%, p = 0.007). Women with PPH in the IM group experienced a larger increase in SI after delivery, which may have influenced recourse to additional interventions. The route of oxytocin administration for PPH prevention did not significantly impact measured blood loss after vaginal birth. However, differences were observed in recourse to additional uterotonics, favoring IV infusion over IM. In settings where IV lines are routinely placed, oxytocin infusion may be preferable to IM injection.
Highlights
Postpartum hemorrhage (PPH) is a major cause of maternal death and morbidity worldwide and is most commonly a result of uterine atony [1,2]
It is noted that relatively few studies of prophylactic oxytocin have been blinded [4]. The authors of both systematic reviews called for more high quality research to determine if route of administration matters [4,15]. To address this gap in the evidence, we evaluated the effect of route of prophylactic administration of oxytocin on postpartum hemorrhage (PPH) outcomes, and, whether IV infusion results in less postpartum blood loss than IM injection
There were no reports of any adverse effects associated with prophylactic oxytocin administration in either study group. This double-blind, randomized controlled trial found that rates of PPH and the average volume of total blood loss were similar whether oxytocin (10 IU) was given during the third stage of labor by IV infusion or IM injection
Summary
We assessed the impact of intravenous (IV) infusion versus intramuscular (IM) oxytocin on postpartum blood loss and rates of postpartum hemorrhage (PPH) when administered during the third stage of labor. While oxytocin is recommended for prevention of PPH, few double-blind studies have compared outcomes by routes of administration
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