Background: Postpartum Hemorrhage (PPH) is one of the primary causes of maternal
mortality and morbidity during the third stage of labor. Oxytocin is the gold standard uterotonic
agent for the prevention of PPH.
Objective: We aimed to compare the efficacy of oxytocin administered Intramuscularly (IM) or
Intravenously (IV) for the preventive management of PPH.
Methods: We searched six databases for relevant clinical trials evaluating the administration of oxytocin
for the prevention against PPH through July 2019. Data on blood loss, PPH (≥500 ml), severe
PPH (≥1000 ml), blood transfusion, the change in hemoglobin, the use of additional uterotonics, and
the incidence of retained placenta were extracted and pooled in a meta-analysis model using
RevMan version 5.3.
Results: Seven studies with a total of 6996 participants were included. IM oxytocin group was
associated with higher incidence rates of PPH (≥500 ml) (RR=1.35; p=0.003), severe PPH (≥1000
ml) (RR=1.58; p=0.04), and blood transfusion (RR=2.43; p=0.005). In terms of blood loss, the IV
route was superior to the IM route (SMD= 0.15; p=0.00001). However, we observed no statistically
significant difference between the two routes regarding the change in Hb (SMD=-0.02; p=0.72) and
the use of additional uterotonics (RR=0.96, p= 0.94).
Conclusion: IV oxytocin infusion is maybe superior to IM injection for the management of PPH.
Further studies with larger sample sizes are still needed to support these findings.