Intramuscular oxytocin administration before vs. after placental delivery for the prevention of postpartum hemorrhage: A randomized controlled prospective trial

Abstract

Objective: Postpartum hemorrhage is still the most significant cause of maternal mortality and morbidity worldwide. Our aim was to evaluate the effect of timing of oxytocin administration on postpartum hemorrhage incidence in parturients with low-risk for postpartum hemorrhage.

Study design: A randomized controlled trial was completed on 343 women at a level-three care hospital. In group 1, 10 IU of oxytocin was injected intramuscularly within the first minute following the delivery of the fetus. Group 2 received 10 IU of intramuscular oxytocin immediately following placental delivery. The primary outcome parameters were the incidence of postpartum hemorrhage and the measured blood loss.

Results: The rate of postpartum hemorrhage, defined as estimated blood loss >500 mL, did not differ significantly between the two groups (7/172 (4.1%) in group 1 vs. 10/171 (5.8%) in group 2, P = .45). The mean blood loss did not differ significantly between the two groups (192.18 ± 135.7 in group 1 vs. 198.92 ± 165.4 mL in group 2, P = .68). The duration of the third stage was significantly shorter in group 1. There were no significant differences between the two groups with respect to the mean changes in hemoglobin and hematocrit, postpartum 24th hour hemoglobin and hematocrit, the additional use of oxytocin, manual expulsion of placenta, curettage, blood transfusion demand, uterine atony, and lengthening of the third stage.

Conclusion: In a level-three care hospital, timing of intramuscular oxytocin administration did not influence the incidence of postpartum hemorrhage in women with low risk of postpartum hemorrhage.

Keywords: Active management; Postpartum hemorrhage; Third stage of labor; Timing of oxytocin.