Abstract
Background Motherwort injection, a common traditional Chinese medicine, is widely used for the prevention of postpartum hemorrhage (PPH), which has been found to be potential benefit in clinical practice. Objectives This study aimed to conduct a rigorous systematic review of randomized evidence to offer a comprehensive overview regarding the efficacy and safety of motherwort injection in maternal women with virginal delivery. Methods We included all randomized controlled trials involving pregnant women in vaginal delivery comparing motherwort injection or combination of motherwort injection and oxytocin with oxytocin alone for preventing postpartum hemorrhage. Paired reviewers independently screened citations, assessed risk of bias, and extracted data. Random-effects model by Mantel-Haenszal method was applied to pool the data. Predefined subgroup analyses and sensitivity analyses were conducted to explore the heterogeneity and robustness of results. The GRADE approach was used to rate the quality of evidence. Main Results 37 randomized controlled trials involving 7887 participants were included, all of which were at moderate to high risk of bias. Meta-analyses of eight trials showed no significant difference in blood loss and PPH events between oxytocin versus motherwort injection (very low quality). However, pooling of 29 trials suggested a reduced risk of blood loss (within 2 hours: MD -55.06mL, 95% CI -84.06 to -26.06; within 24 hours: MD -85.57 mL, 95% CI -94.26 to -76.88, very low quality), PPH events (RR 0.29, 95% CI 0.21 to 0.39, low quality), and adverse events (Peto OR 0.53, 95% CI 0.40 to 0.70, very low quality) in participants treated with motherwort injection and oxytocin versus oxytocin alone. Conclusions The current evidence supports the suggestion that the additional use of motherwort injection on oxytocin had a preferable outcome. However, given that the evidence is not definitive with low quality, further careful designed and conducted randomized controlled trials in larger population are warranted to conform the effects.
Highlights
Approximately 830 women died every singer day due to complications during pregnancy or childbirth in 2015 (MMR was 216/1000000) [1]
Hemorrhage was the leading direct cause of maternal deaths globally (27.1%), and more than two-thirds of hemorrhage deaths were postpartum hemorrhage (PPH) [3]. Almost all of these death (99%) occurred in low and middle-income countries [1]. 80% of PPH in pregnant women caused by uterine atony and most of these maternal deaths are preventable with necessary medication [4,5,6]
37 trials involving 7887 women were proved eligible (Figure 1). These trials were all conducted in China between 2009 and 2018; the sample size ranged from 50 to 800; and the age of pregnant women ranged from 18 to 42. 28 trials assessed the combined treatment versus oxytocin alone, and eight compared motherwort injection with oxytocin (Table 1)
Summary
Approximately 830 women died every singer day due to complications during pregnancy or childbirth in 2015 (MMR was 216/1000000) [1]. This study aimed to conduct a rigorous systematic review of randomized evidence to offer a comprehensive overview regarding the efficacy and safety of motherwort injection in maternal women with virginal delivery. We included all randomized controlled trials involving pregnant women in vaginal delivery comparing motherwort injection or combination of motherwort injection and oxytocin with oxytocin alone for preventing postpartum hemorrhage. Meta-analyses of eight trials showed no significant difference in blood loss and PPH events between oxytocin versus motherwort injection (very low quality). Given that the evidence is not definitive with low quality, further careful designed and conducted randomized controlled trials in larger population are warranted to conform the effects
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