O207 Route of Administration of Oxytocin in Prevention of Postpartum Hemorrhage

Dzuba, Ilana G.; Durocher, Jill; Dilbaz, Berna; Gelişen, Orhan; Ngoc, Nguyen Thi Nhu; Montesinos, R.; León, Wilfrido; Blum, Jennifer; Winikoff, Beverly

doi:10.1016/s0020-7292(12)60637-7

Cited by 7 publications

(5 citation statements)

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“…The sample size calculation was derived from the expected rate of women with blood loss ≥500 ml in the two comparisons of this three-arm study: IM injection vs. IV infusion and IM injection vs. IV bolus. Based on previous studies, we expected a slightly larger difference of blood loss outcomes for the IV bolus vs. IM injection comparison, thus a smaller sample size was required for that comparison [23, 29]. We augmented sample sizes to compensate for conducting two 80% correlated comparisons (equivalent to requiring a significance level of 0.0435 for each test) and to account for a 2% attrition rate.…”

Section: Methodsmentioning

confidence: 99%

Intramuscular injection, intravenous infusion, and intravenous bolus of oxytocin in the third stage of labor for prevention of postpartum hemorrhage: a three-arm randomized control trial

Charles

Anger

Dabash

et al. 2019

BMC Pregnancy Childbirth

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BackgroundOxytocin for postpartum hemorrhage (PPH) prophylaxis is commonly administered by either intramuscular (IM) injection or intravenous (IV) infusion with both routes recommended equally and little discussion of potential differences between the two. This trial assesses the effectiveness and safety of 10 IU oxytocin administered as IM injection versus IV infusion and IV bolus during the third stage of labor for PPH prophylaxis.MethodsIn two tertiary level Egyptian maternity hospitals, women delivering vaginally without exposure to pre-delivery uterotonics were randomized to one of three prophylactic oxytocin administration groups after delivery of the baby. Blood loss was measured 1 h after delivery, and side effects were recorded. Primary outcomes were mean postpartum blood loss and proportion of women with postpartum blood loss ≥500 ml in this open-label, three-arm, parallel, randomized controlled trial.ResultsFour thousand nine hundred thirteen eligible, consenting women were randomized. Compared to IM injection, mean blood loss was 5.9% less in the IV infusion arm (95% CI: -8.5, − 3.3) and 11.1% less in the IV bolus arm (95% CI: -14.7, − 7.8). Risk of postpartum blood loss ≥500 ml in the IV infusion arm was significantly less compared to IM injection (0.8% vs. 1.5%, RR = 0.50, 95% CI: 0.27, 0.91). No side effects were reported in any arm.ConclusionsIntravenous oxytocin is more effective than intramuscular injection for the prevention of PPH in the third stage of labor. Oxytocin delivered by IV bolus presents no safety concerns after vaginal delivery and should be considered a safe option for PPH prophylaxis.Trial registrationclinicaltrials.gov #NCT01914419, posted August 2, 2013.

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Section: Methodsmentioning

confidence: 99%

Intramuscular injection, intravenous infusion, and intravenous bolus of oxytocin in the third stage of labor for prevention of postpartum hemorrhage: a three-arm randomized control trial

Charles

Anger

Dabash

et al. 2019

BMC Pregnancy Childbirth

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“…Prior to this study, research examined the effect of oxytocin route on postpartum blood loss [10–11], including a secondary analysis that explored the effectiveness of active management interventions on postpartum blood loss when used in combination or alone. That analysis found that IV administration of oxytocin alone (i.e.…”

Section: Methodsmentioning

confidence: 99%

“…That analysis found that IV administration of oxytocin alone (i.e. in the absence of other active management components performed), compared to IM oxytocin alone, was associated with a 76% reduction in the rate of PPH (p<0.001) [11]. However, when IV or IM oxytocin was given during the third stage of labor, in combination with other interventions, such as controlled cord traction, the effect of route became negligible.…”

Section: Methodsmentioning

confidence: 99%

“…However, when IV or IM oxytocin was given during the third stage of labor, in combination with other interventions, such as controlled cord traction, the effect of route became negligible. Another small randomized trial was conducted to directly compare the effect of oxytocin infusion vs. IM injection on measured blood loss following vaginal deliveries that had other components of the active management of the third stage of labor performed and documented a statistically significant reduction in measured blood loss ≥ 500ml (IV infusion: 9% (15/161) and IM: 20% (32/161); RR 0.47 95% CI 0.25–0.85) [11]. Based on this evidence[10–11], we hypothesized that administration of oxytocin via IV infusion would result in a 50% lower rate of PPH (defined as blood loss ≥500ml) than IM administration and a difference of 50ml when comparing average total blood loss between study groups.…”

Section: Methodsmentioning

confidence: 99%

“…Another small randomized trial was conducted to directly compare the effect of oxytocin infusion vs. IM injection on measured blood loss following vaginal deliveries that had other components of the active management of the third stage of labor performed and documented a statistically significant reduction in measured blood loss ≥ 500ml (IV infusion: 9% (15/161) and IM: 20% (32/161); RR 0.47 95% CI 0.25–0.85) [11]. Based on this evidence[10–11], we hypothesized that administration of oxytocin via IV infusion would result in a 50% lower rate of PPH (defined as blood loss ≥500ml) than IM administration and a difference of 50ml when comparing average total blood loss between study groups. According to available information from the site on their PPH rate and knowledge that PPH rates are highly variable [18] and are influenced by other practices during the third stage of labor [10], we selected an 18% PPH ≥500ml rate for sample size calculation.…”

Section: Methodsmentioning

confidence: 99%

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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

Oladapo

Okusanya

Ábalos

2018

Cochrane Database of Systematic Reviews

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O207 Route of Administration of Oxytocin in Prevention of Postpartum Hemorrhage

Cited by 7 publications

References 0 publications

Intramuscular injection, intravenous infusion, and intravenous bolus of oxytocin in the third stage of labor for prevention of postpartum hemorrhage: a three-arm randomized control trial

Intramuscular injection, intravenous infusion, and intravenous bolus of oxytocin in the third stage of labor for prevention of postpartum hemorrhage: a three-arm randomized control trial

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

Intramuscular versus intravenous prophylactic oxytocin for the third stage of labour

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