2020 Cochrane Update: IV vs IM Oxytocin for PPH Prevention?
BACKGROUND AND PURPOSE:
In this update, Oladapo et al. (Cochrane Systematic Review, 2020) assessed the comparative effectiveness and safety of IV vs IM oxytocin administration for prophylactic management of the third stage of labor following vaginal birth
Systematic review and meta-analysis (through December 2019)
Studies compared IV vs IM oxytocin for prophylactic management of the third stage of labor after vaginal birth
Two review authors independently assessed studies for inclusion and risk of bias, extracted data and checked them for accuracy
Certainty of evidence was assessed with GRADE criteria
7 trials | 7817 women
Oxytocin administered just after the birth of the anterior shoulder or soon after birth
Overall risk of bias: moderate or low risk
Certainty of evidence: generally moderate to high
IV oxytocin was associated with a lower risk for
PPH (≥500 mL): Average risk ratio (RR) 0.78 (95% CI, 0.66 to 0.92; 6 trials; 7731 women)
Blood transfusion: Average RR 0.44 (95% CI, 0.26 to 0.77; 4 trials; 6684 women)
IV oxytocin probably reduces the risk of PPH ≥1000 mL (moderate certainty evidence)
Average RR 0.65 (95% CI, 0.39 to 1.08; 4 trials; 6681 women)
There was a reduction in the risk of PPH ≥ 1000 mL with IV oxytocin in all but one study
Only 256 women | Only 3% of total events
If this one study was removed, the treatment effect favored IV oxytocin
Average RR 0.61 (95% CI, 0.42 to 0.88)
No significant differences seen for additional uterotonic use (low-certainty evidence)
Average RR 0.78 (95% CI, 0.49 to 1.25; 6 trials; 7327 women)
Serious Maternal Morbidity
IV administration probably may result in a lower risk for serious maternal morbidity, but CIs did not “touch the line of no effect”
Average RR 0.47 (95% CI, 0.22 to 1.00; 4 trials; 7028 women)
No maternal deaths reported in any of the included studies (very low-certainty evidence)
There is probably little or no difference in the risk of hypotension between IM and IV administration (moderate-certainty evidence)
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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.
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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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