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

被引:33
作者
Charles, Dyanna [1 ]
Anger, Holly [1 ]
Dabash, Rasha [1 ]
Darwish, Emad [2 ]
Ramadan, Mohamed Cherine [3 ]
Mansy, Amr [2 ]
Salem, Yomna [3 ]
Dzuba, Ilana G. [1 ]
Byrne, Meagan E. [1 ]
Breebaart, Miral [4 ]
Winikoff, Beverly [1 ]
机构
[1] Gynu Hlth Projects, 220 East 42nd St,Suite 710, New York, NY 10010 USA
[2] Alexandria Univ, Shatby Matern Hosp, Alexandria, Egypt
[3] El Galaa Teaching Hosp, 41 El Galaa, Cairo, Egypt
[4] 16B Dr Mostafa El Diwani, Cairo, Egypt
基金
比尔及梅琳达.盖茨基金会;
关键词
Postpartum hemorrhage; Postpartum blood loss; Oxytocin; Oxytocic; Route of administration; Third stage of labor; Bolus oxytocin; Intravenous oxytocin; Intramuscular oxytocin; Oxytocin prophylaxis; MISOPROSTOL; MANAGEMENT; EFFICACY; SYNTOMETRINE; SYNTOCINON; 3RD-STAGE;
D O I
10.1186/s12884-019-2181-2
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
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 10IU 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 500ml 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 500ml 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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页数:8
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