Intramuscular or Intravenous Oxytocin to Prevent Postpartum Hemorrhage?
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Describe the study design used by Adnan et al. (BMJ 2018) to test the hypothesis as to whether IV oxytocin is more effective than IM oxytocin for the prevention of PPH following vaginal delivery 2. Discuss the results and conclusions of the study
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Oct 29 2018 through Oct 29 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Designated for 0.1 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.
Following vaginal delivery, women were randomized to either
IV bolus of oxytocin (10 IU in 1 mL given slowly over one minute) and placebo intramuscular injection (1 mL 0.9% saline)
IM bolus of oxytocin (10 IU in 1 mL) and placebo IV injection (1 mL 0.9% saline given slowly over one minute)
Primary outcome: PPH (measured blood loss ≥500 mL)
Severe PPH (measured blood loss ≥1000 mL) | Blood transfusion | Admission to a high dependency unit | Side effects to oxytocin
1,035 women were included
The incidence of PPH was not significantly different between the two groups
IV oxytocin: 18.8%
IM oxytocin: 23.2%
Adjusted odds ratio (aOR) 0.75 (95% CI, 0.55 to 1.03)
The IV group had lower incidence of severe PPH
IV oxytocin: 4.6%
IM oxytocin: 8.1%
aOR 0.54 (95% CI, 0.32 to 0.91)
The IV group had lower blood transfusion rates
IV oxytocin: 1.5%
IM oxytocin: 4.4%
aOR 0.31 (95% CI, 0.13 to 0.70)
The IV group had a lower rate of admission to a high dependency unit
IV oxytocin: 1.7%
IM oxytocin: 3.7%
aOR 0.44 (95% CI, 0.20 to 0.98)
Number needed to treat
To prevent one case of severe PPH, NNT was 29 (95% CI, 16 to 201)
To prevent one case of blood transfusion, NNT was 35 (95% CI, 20 to 121)
There was no difference in side effects
IV oxytocin reduced rates of severe PPH, blood transfusion, and admission to a high dependency unity
The authors discuss potential harms of IV oxytocin such as a potential risk for transient hypotension and tachycardia
Risk for hypotension associated with ‘rapid’ bolus in women receiving anesthesia for cesarean delivery
The authors state
The current study provides important evidence on the safety of intravenous oxytocin 10 IU administered as a slow bolus injection over one minute after exclusion of women with a history of cardiovascular disease.
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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