Intramuscular versus intravenous prophylactic oxytocin for the third stage of labour

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

doi:10.1002/14651858.cd009332

Cited by 4 publications

(5 citation statements)

References 27 publications

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“…Several Cochrane systematic reviews have addressed the use of uterotonic agents to prevent PPH at vaginal delivery 9111726. The most recent review, updated in 2015, included seven studies comparing active management of the third stage of labour with physiological management using a range of uterotonic agents, including ergometrine, syntometrine, intramuscular oxytocin, and intravenous oxytocin 26.…”

Section: Discussionmentioning

confidence: 99%

“…Oxytocin is the preferred choice because it has fewer side effects than other uterotonic agents of similar efficacy, and it is the most commonly used agent worldwide 378. It can be administered intravenously or intramuscularly 9. The intramuscular route has a uterotonic effect within 3-7 minutes, which persists for 30-60 minutes, whereas the response to the intravenous route is almost instantaneous, reaching a plateau concentration at 30 minutes 10.…”

Section: Introductionmentioning

confidence: 99%

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Intramuscular versus intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery: randomised controlled trial

Adnan

Conlan-Trant

McCormick

et al. 2018

BMJ

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ObjectiveTo determine whether intravenous oxytocin is more effective than intramuscular oxytocin at preventing postpartum haemorrhage at vaginal delivery.DesignDouble blind placebo controlled randomised trial.SettingUniversity affiliated maternity unit in the Republic of Ireland.Participants1075 women aged 18 years or older, at term with a singleton pregnancy who were aiming for a vaginal delivery with an actively managed third stage of labour.InterventionsWomen were allocated to an intravenous bolus of oxytocin (10 IU in 1 mL given slowly over one minute) and placebo intramuscular injection (1 mL 0.9% saline) or an intramuscular bolus of oxytocin (10 IU in 1 mL) and placebo intravenous injection (1 mL 0.9% saline given slowly over one minute) at vaginal delivery. Allocation was by a secure web based randomisation service with masking of participants and clinicians to the trial intervention.Main outcome measuresThe primary outcome was postpartum haemorrhage (PPH, measured blood loss ≥500 mL). Secondary outcomes were severe PPH (measured blood loss ≥1000 mL), need for blood transfusion, admission to a high dependency unit, and side effects to oxytocin.ResultsBetween 4 January 2016 and 13 December 2017, 1075 women were randomised and 1035 (96.3%) included in the primary and secondary analyses (517 in the intravenous oxytocin group and 518 in the intramuscular oxytocin group). The incidence of PPH was not significantly lower in the intravenous group (18.8%, 97/517) compared with intramuscular group (23.2%, 120/518): adjusted odds ratio 0.75 (95% confidence interval 0.55 to 1.03). The incidence of severe PPH, however, was significantly lower in the intravenous group (4.6%, 24/517) compared with intramuscular group (8.1%, 42/518): 0.54 (0.32 to 0.91) as was the need for blood transfusion (1.5% v 4.4%, 0.31, 0.13 to 0.70) and admission to a high dependency unit (1.7% v 3.7%, 0.44, 0.20 to 0.98). The number needed to treat to prevent one case of severe PPH was 29 (95% confidence interval 16 to 201) and to prevent one case of blood transfusion was 35 (20 to 121). The incidence of side effects to oxytocin was not increased in the intravenous group compared with intramuscular group (4.1% v 5.2%, 0.75, 0.42 to 1.35).ConclusionIntravenous oxytocin for the third stage of labour results in less frequent severe PPH, blood transfusion, and admission to a high dependency unit than intramuscular oxytocin, and without excess side effects.Trial registrationCurrent Controlled Trials ISRCTN14718882.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intramuscular versus intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery: randomised controlled trial

Adnan

Conlan-Trant

McCormick

et al. 2018

BMJ

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“…A 2021 systematic review and meta-analysis of seven randomized controlled trials (RCTs; N57,817) compared the effectiveness of oxytocin administered IV versus IM for prophylactic management of the third stage of labor after vaginal birth. 1 The review included trials in hospital settings in six countries (Egypt, Argentina, Mexico, Thailand, Turkey, and Ireland). Patients were women with singleton pregnancies at term who underwent vaginal delivery and were given oxytocin either IV (10 units through bolus or infusion) or IM (10 units) after delivery of anterior shoulder, delivery of baby, or cord clamping.…”

Section: Evidence-based Answermentioning

confidence: 99%

“…A 2021 meta-analysis included one randomized prospective trial and 13 retrospective cohort studies and abstracts to assess the efficacy of oral vancomycin prophylaxis (OVP) for C difficile infections. 1 Of note, 10 of these studies examined secondary OVP in patients with prior C difficile infection (N59,258) and five studies examined primary OVP in patients without history of previous C difficile infection (N51,352). In eight of the included manuscripts and abstracts, C difficile infection was defined as diarrhea with the presence of C difficile toxin confirmed by one of the following: cytotoxin assay, enzyme-linked immunoassay, polymerase chain reaction, or endoscopic evidence of pseudomembranous colitis.…”

Section: Evidence-based Answermentioning

confidence: 99%

Does IV oxytocin compared with IM oxytocin decrease the incidence of postpartum hemorrhage during the 3rd stage of labor?

Marpaung¹,

Panzer²

2022

EBPR

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A randomised control trial of parent and child training programmes (versus wait list control) for children with ADHD-type behaviours: a pilot stud. Child Care Pract. 2019; 25(4):419438. [STEP 2] 3. Wolraich ML, Hagan JF Jr, Allan C, et al; Subcommittee on children and adolescents with attention deficit/hyperactive disorder. Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents.

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“…Oxytocin is a potent uterotonic agent that enhances the uterine tone and contractility and is commonly used for labor induction and postpartum hemorrhage management. [1][2][3][4][5][6][7][8][9] The response of a target tissue relies on the concentration of the circulating hormone and affinity and concentration of tissue receptors. 10 Notwithstanding, considering that oxytocin contracts the uterine smooth muscle and increases the uterine tone, many clinicians favor its use during surgical evacuation for missed abortion to attempt to minimize blood loss and reduce the risk for uterine perforation.…”

Section: Introductionmentioning

confidence: 99%

The timing of intravenous oxytocin administration is crucial to minimize perioperative blood loss during first-trimester suction curettage for missed abortion

Yang

Chang

Chao

et al. 2022

Journal of the Chinese Medical Association

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Background: Oxytocin is commonly used to reduce blood loss during suction curettage for missed abortion. However, the potential of oxytocin to mitigate blood loss in early pregnancy remains controversial. Based on the hypothesis that the “timing” of oxytocin administration may be a critical factor, we investigated whether the timing of intravenous (IV) administration is associated with reduced perioperative blood loss during first-trimester suction curettage for missed abortion. Methods: The medical charts of 146 patients with ultrasound-confirmed first-trimester missed abortion who underwent suction curettage with IV oxytocin administration were retrospectively reviewed. Results: Among the patients, 67 received 10 IU of IV oxytocin before suction curettage (early-oxytocin administration group), while 79 patients received 10 IU of IV oxytocin after suction curettage (late-oxytocin administration group). The demographic features between the two groups did not significantly differ. However, there was a lower proportion of nulliparous patients in the early-oxytocin administration group than in the late-oxytocin administration group (38.8% vs 60.8%, p = 0.006). The perioperative blood loss amount was significantly lower in the early-oxytocin administration group than in the late-oxytocin administration group (60 [range: 50–100] vs 100 [range: 30–250] mL, p = 0.001). Moreover, the multivariate logistic regression analysis showed that the early-oxytocin administration group had a lower risk for a perioperative blood loss amount of ≥100 mL than the late-oxytocin administration group (0.23 [range: 0.10–0.55], p = 0.001); a gestational age of 9–12 weeks (p = 0.009) was found to be associated with an increased risk for a perioperative blood loss amount of ≥100 mL. Conclusion: Compared with late-oxytocin administration, early-oxytocin administration could reduce perioperative blood loss during first-trimester suction curettage for missed abortion. However, the results require further investigation.

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Intramuscular versus intravenous prophylactic oxytocin for the third stage of labour

Cited by 4 publications

References 27 publications

Intramuscular versus intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery: randomised controlled trial

Intramuscular versus intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery: randomised controlled trial

Does IV oxytocin compared with IM oxytocin decrease the incidence of postpartum hemorrhage during the 3rd stage of labor?

The timing of intravenous oxytocin administration is crucial to minimize perioperative blood loss during first-trimester suction curettage for missed abortion

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