Intravenous Oxytocin versus Intramuscular Oxytocin for the Management of Postpartum Hemorrhage: A Systematic Review and Meta-Analysis

Author(s): Mahmoud Ahmed Ebada*, Abdelmagid M. Elmatboly, Galal Baligh

Journal Name: Current Drug Research Reviews
(Formerly Current Drug Abuse Reviews)

Volume 12 , Issue 2 , 2020

Become EABM
Become Reviewer
Call for Editor

Graphical Abstract:


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.

Keywords: Intramuscular oxytocin, intravenous oxytocin, postpartum hemorrhage, vaginal delivery, meta-analysis, uterotonic effect.

Rajan PV, Wing DA. Postpartum hemorrhage: evidence-based medical interventions for prevention and treatment. Clin Obstet Gynecol 2010; 53(1): 165-81.
[] [PMID: 20142654]
Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet 2006; 367(9516): 1066-74.
[] [PMID: 1658405]
Hogan MC, Foreman KJ, Naghavi M, et al. Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium development goal 5. Lancet 2010; 375(9726): 1609-23.
[] [PMID: 20382417]
Sheldon WR, Blum J, Durocher J, Winikoff B. Misoprostol for the prevention and treatment of postpartum hemorrhage. Expert Opin Investig Drugs 2012; 21(2): 235-50.
Al-Zirqi I, Vangen S, Forsen L, Stray-Pedersen B. Prevalence and risk factors of severe obstetric haemorrhage. BJOG 2008; 115(10): 1265-72.
[] [PMID: 18715412]
Bouwmeester FW, Bolte AC, van Geijn HP. Pharmacological and surgical therapy for primary postpartum hemorrhage. Curr Pharm Des 2005; 11(6): 759-73.
[] [PMID: 15777231]
Davies GAL, Tessier JL, Woodman MC, Lipson A, Hahn PM. Maternal hemodynamics after oxytocin bolus compared with infusion in the third stage of labor: a randomized controlled trial. Obstet Gynecol 2005; 105(2): 294-9.
[] [PMID: 15684155]
Wedisinghe L, Macleod M, Murphy DJ. Use of oxytocin to prevent haemorrhage at caesarean section--a survey of practice in the United Kingdom. Eur J Obstet Gynecol Reprod Biol 2008; 137(1): 27-30.
[] [PMID: 17544563]
Miller S, Lester F, Hensleigh P. Prevention and treatment of postpartum hemorrhage: new advances for low-resource settings. J Midwifery Womens Health 2004; 49(4): 283-92.
[] [PMID: 15236707]
Rall TW, Schleifer LS. Oxytocin, prostaglandins, ergot alkaloids, and other drugs; tocolytic agents. The Pharmacol Bas of Thera 1985; pp. 926-45.
Westhoff G, Cotter AM, Tolosa JE. Prophylactic oxytocin for the third stage of labour to prevent postpartum haemorrhage. Cochrane Database Syst Rev 2013; (10): CD001808
[] [PMID: 24173606]
Choy CMY, Lau WC, Tam WH, Yuen PM. A randomised controlled trial of intramuscular syntometrine and intravenous oxytocin in the management of the third stage of labour. BJOG 2002; 109(2): 173-7.
[] [PMID: 11905429]
Soriano D, Dulitzki M, Schiff E, Barkai G, Mashiach S, Seidman DS. A prospective cohort study of oxytocin plus ergometrine compared with oxytocin alone for prevention of postpartum haemorrhage. Br J Obstet Gynaecol 1996; 103(11): 1068-73.
[] [PMID: 8916990]
Thomas JS, Koh SH, Cooper GM. Haemodynamic effects of oxytocin given as i.v. bolus or infusion on women undergoing Caesarean section. Br J Anaesth 2007; 98(1): 116-9.
[] [PMID: 17142825]
Oladapo OT, Okusanya BO, Abalos E. Intramuscular versus intravenous prophylactic oxytocin for the third stage of labour. Cochrane Database Syst Rev 2018; 9.
[] [PMID: 30246877]
Shamseer L, Moher D, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 2015; 349.
[] [PMID: 25555855]
Higgins JP, Green S. Cochrane Collaboration. Cochrane handbook for systematic reviews of interventions Cochr book ser 2008; 1-649.
Adnan N, Conlan-Trant R, McCormick C, Boland F, Murphy DJ. Intramuscular versus intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery: Randomised controlled trial. BMJ 2018.
Dagdeviren H, Cengiz H, Heydarova U, et al. Intramuscular versus intravenous prophylactic oxytocin for postpartum hemorrhage after vaginal delivery: A randomized controlled study. Arch Gynecol Obstet 2016; 294(5): 911-6.
[] [PMID: 26980230]
Oguz Orhan E, Dilbaz B, Aksakal SE, Altınbas S, Erkaya S. Prospective randomized trial of oxytocin administration for active management of the third stage of labor. Int J Gynaecol Obstet 2014; 127(2): 175-9.
[] [PMID: 25108586]
Neri-Mejía M, Pedraza-Avilés AG. Active management of the third stage of labor: Three schemes of oxytocin: randomised clinical trial Ginecol Obstet Mex 2016 May; 84(5):
[PMID: 27476252]
Choy C, Lau W, Tam W, Yuen P. A randomised controlled trial of intramuscular syntometrine and intravenous oxytocin in the management of the third stage of labour. BJOG: An Internal Journal of Obs Gyn 2002; 109(2): 173-7.
Devi AMBK. The third stage of labour: to bleed or not to bleed - revised role of intra- umbilical oxytocin in management of third stage of labour. Int J Reprod Contracept Obstet Gynecol 2017; 6(5): 1982-5.
Charles D, Anger H, Dabash R, et al. 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. BMC Preg Child 2019; 19(1): 1-8.
Brun R, Spoerri E, Schäffer L, Zimmermann R, Haslinger C. Induction of labor and postpartum blood loss. BMC Preg Child 2019; 19(1): 265.
[] [PMID: 31345178]
James AH, McLintock C, Lockhart E. Postpartum hemorrhage: when uterotonics and sutures fail. Am J Hematol 2012; 87: 16-22.
[] [PMID: 22430921]
Marshall AL, Durani U, Bartley A, et al. The impact of postpartum hemorrhage on hospital length of stay and inpatient mortality: a National Inpatient Sample-based analysis. Am J Obstet Gynecol 2017; 217(3): 344-6.
[] [PMID: 28502758]
Leavitt BG, Huff DL, Bell LA, Thurnau GR. Placental drainage of fetal blood at cesarean delivery and feto maternal transfusion: A randomized controlled trial. Obstet Gynecol 2007; 110(3): 608-11.
[] [PMID: 17766607]
Navaneethakrishnan R, Anderson A, Holding S, Atkinson C, Lindow SW. A randomised controlled trial of placental cord drainage to reduce feto-maternal transfusion. Eur J Obstet Gynecol Reprod Biol 2010; 149(1): 27-30.
[] [PMID: 20018421]
Moore ER, Anderson GC, Bergman N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev 2007; (3): CD003519
[] [PMID: 17636727]
Bateman BT, Berman MF, Riley LE, Leffert LR. The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth Analg 2010; 110(5): 1368-73.
[] [PMID: 20237047]
Soltani H, Poulose TA, Hutchon DR. Placental cord drainage after vaginal delivery as part of the management of the third stage of labour. Cochrane Database Syst Rev 2011; (9): CD004665
[] [PMID: 21901693]
Kuzume A, Sugimi S, Suga S, Yamashita H, Yasuhi I. The routine use of prophylactic oxytocin in the third stage of labor to reduce maternal blood loss J preg 2017.20173274901
[] [PMID: 29085678]
Tita ATN, Szychowski JM, Rouse DJ, et al. Higher-dose oxytocin and hemorrhage after vaginal delivery: A randomized controlled trial. Obstet Gynecol 2012; 119(2 Pt 1): 293-300.
[] [PMID: 22227638]

Rights & PermissionsPrintExport Cite as

Article Details

Year: 2020
Page: [150 - 157]
Pages: 8
DOI: 10.2174/2589977512666200628013647
Price: $65

Article Metrics

PDF: 21