Intramuscular versus intravenous prophylactic oxytocin for the third stage of labour

Oladapo, Olufemi T.; Okusanya, Babasola O; Ábalos, Edgardo

doi:10.1002/14651858.cd009332.pub3

Cited by 14 publications

(8 citation statements)

References 37 publications

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“…Another study attempted to calculate the least bolus dose of oxytocin that could be required in scheduled C-sections and for C-sections done for difficult labor. It was recommended that the 1 IU of oxytocin for elective C-section and 1-1.5 IU bolus oxytocin for cesareans done for labor progress should be administered in this regard (17). The World Health Organization advises 10 IU oxytocin either IV or IM for the prevention of postpartum hemorrhage (18).…”

Section: Discussionmentioning

confidence: 99%

Randomised Control Trial of 3 IU Intravenous Oxytocin Bolus With 7 IU Oxytocin Infusion Versus 10 IU Intramuscular Oxytocin in the Third Stage of Labour in the Prevention of Postpartum Hemorrhage

Biradar

Yaliwal

Kori

et al. 2020

International Journal of Women’s Health and Reproduction Scienc

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Objectives: Intravenous (IV) oxytocin during vaginal delivery has been rarely used since an intramuscular (IM) route or IV infusion have been preferred in this regard. The trial aimed to compare the low-dose IV bolus 3 IU of oxytocin, along with 7 IU oxytocin infusion with 10 IU oxytocin infusion in cesarean section. Materials and Methods: A parallel control randomized study was conducted on a total of 320 consenting term pregnant women based on the inclusion criteria. The participants were randomized into either 3 IU IV bolus and 7 IU infusion of oxytocin or 10 IU of IM oxytocin following vaginal delivery. The difference in pre- and post-delivery hemoglobin (Hb) levels, tone of the uterus, hemodynamic changes, adverse effects of the drug, and the need for additional uterotonics and blood transfusions were assessed based on the aim of the study. Results: Based on the results, more women with severe blood loss were found in the IM oxytocin group in comparison to the IV bolus with infusion group following vaginal delivery. In addition, more women had a drop in the Hb of 3 gm/dL in the IM oxytocin group compared to the IV bolus-infusion group (11% vs. 4%, odds ratio=0.768, P=0.469) although there was no statistical significance in this respect. The tone of the uterus was firmer in the IV bolus with infusion group at 3 and 5 minutes. Eventually, the difference in hemodynamic changes, side effects, and the need for additional uterotonics or blood transfusions was not significant. Conclusions: In general, an IV bolus of 3 IU with a 7 IU infusion of oxytocin is as safe as and more effective than the IM injection of 10 IU of oxytocin at the time of vaginal delivery for the prevention of postpartum hemorrhage.

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Section: Discussionmentioning

confidence: 99%

Randomised Control Trial of 3 IU Intravenous Oxytocin Bolus With 7 IU Oxytocin Infusion Versus 10 IU Intramuscular Oxytocin in the Third Stage of Labour in the Prevention of Postpartum Hemorrhage

Biradar

Yaliwal

Kori

et al. 2020

International Journal of Women’s Health and Reproduction Scienc

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“…Globally, dystocia is most commonly treated with the intravenous administration of oxytocin [9][10][11] . Besides being used for augmentation, oxytocin is commonly used for induction of labor, pre-labor rupture of membranes (PROM), and PPH 9,[12][13][14][15] . Risks associated with the use of oxytocin are uterine hyper-stimulation, fetal hypoxia and asphyxia, uterine rupture and PPH 9,16,17 .…”

Section: Introductionmentioning

confidence: 99%

Oxytocin and emergency caesarean section in a medium-sized hospital in Pakistan: A cross-sectional study

Lukasse¹,

Hovda²,

Thommessen³

et al. 2020

Eur J Midwifery

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INTRODUCTION One of the most common complications during labor is prolonged labor (dystocia), which is associated with risks for the mother and fetus. Dystocia is usually treated with oxytocin, which is also used to induce labor. Oxytocin may not have the desired effect of progress and can negatively affect the fetus, thus resulting in an emergency caesarean section (CS). The aim of this study was to describe obstetric practice, use of oxytocin and its association with an emergency CS. METHODS A cross-sectional retrospective register study was conducted that included all women who gave birth during 2014 and 2015 at a hospital in a large city in Pakistan. RESULTS A total of 6652 women gave birth to 6767 newborns, 66.8% were multiparous and 33.2% primiparous women. Of the primiparous women, 78.9% had a spontaneous vaginal birth, 1.2% an elective CS and 14.4% an emergency CS. Of the multiparous women, 81.9% had a spontaneous vaginal birth, 8.0% an elective CS and 6.7% an emergency CS. Operative vaginal birth was 2.1% among primiparous and 0.2% among multiparous women. Oxytocin for induction or augmentation was administered to 60.0% of primiparous and 30.5% of multiparous women. Oxytocin during the first stage of labor was associated with an increased risk for emergency CS for both primiparous and multiparous women. CONCLUSIONS Despite the association between oxytocin and emergency CS, the CS rate was low in this hospital. The majority of the women gave birth vaginally, even with a breech presentation. Few operative vaginal births were performed.

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“…An earlier pharmacokinetic investigation, published in 1972, on circulating oxytocin levels, also found that plasma levels rose more rapidly following IV administration in the third stage of labor and reached a higher peak than after IM [14]. Importantly though, a 2018 Cochrane review identified a lack of randomized controlled trials that compared the safety and effectiveness of prophylactic oxytocin when administered via different routes [15]. It is also noted that relatively few studies of prophylactic oxytocin have been blinded [4].…”

Section: Introductionmentioning

confidence: 99%

“…It is also 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].…”

Section: Introductionmentioning

confidence: 99%

Does route matter? Impact of route of oxytocin administration on postpartum bleeding: A double-blind, randomized controlled trial

et al. 2019

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ObjectiveWe 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.MethodsA 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.Results239 (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.ConclusionsThe 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.

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Intramuscular versus intravenous prophylactic oxytocin for the third stage of labour

Abstract: Analysis 1.6. Comparison 1 IM vs IV prophylactic oxytocin in the 3rd stage of labour, Outcome 6 Blood transfusion. Analysis 1.7. Comparison 1 IM vs IV prophylactic oxytocin in the 3rd stage of labour, Outcome 7 Third stage duration >

Cited by 14 publications

References 37 publications

Randomised Control Trial of 3 IU Intravenous Oxytocin Bolus With 7 IU Oxytocin Infusion Versus 10 IU Intramuscular Oxytocin in the Third Stage of Labour in the Prevention of Postpartum Hemorrhage

Randomised Control Trial of 3 IU Intravenous Oxytocin Bolus With 7 IU Oxytocin Infusion Versus 10 IU Intramuscular Oxytocin in the Third Stage of Labour in the Prevention of Postpartum Hemorrhage

Oxytocin and emergency caesarean section in a medium-sized hospital in Pakistan: A cross-sectional study

Does route matter? Impact of route of oxytocin administration on postpartum bleeding: A double-blind, randomized controlled trial

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