Intramuscular versus intravenous prophylactic oxytocin for the third stage of labour

Abstract

There is a general agreement that oxytocin given either through the intramuscular or intravenous route is effective in reducing postpartum blood loss. However, it is unclear whether the subtle differences between the mode of action of these routes have any effect on maternal and infant outcomes. To determine the comparative effectiveness and safety of oxytocin administered intramuscularly or intravenously for prophylactic management of the third stage of labour after vaginal birth. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 December 2011). Randomised trials comparing intramuscular with intravenous oxytocin for prophylactic management of the third stage of labour after vaginal birth. We excluded quasi-randomised trials. Two review authors planned to independently assess trials for inclusion, assess risk of bias and extract data. The search strategies identified no trials for consideration but we identified one ongoing study. There is no evidence from randomised trials to evaluate the comparative benefits and risks of intramuscular and intravenous oxytocin when given to prevent excessive blood loss after vaginal birth. Randomised trials with adequate design and sample sizes are needed to assess whether the route of prophylactic oxytocin after vaginal birth affects maternal or infant outcomes. Such trials should be large enough to detect clinically important differences in major side effects reported in observational studies and also to consider the acceptability of the intervention to mothers and providers as important outcomes.