A Randomised Controlled Trial of Intravenous versus Intramuscular Oxytocin in the Prevention of Postpartum Hemorrhage during the Third Stage of Labor

Abstract

             The objective of this study was to compare the effectiveness of intravenous or intramuscular oxytocin administration in the prevention of postpartum hemorrhage during the third stage of labor. It was conducted as
a randomized controlled study among singleton pregnant women underwent vaginal delivery in Khon Kaen Hospital during February – June 2012. The participants were randomly allocated into two groups: group 1 received intravenous oxytocin after delivery of the fetal shoulder and group 2 received intramuscular oxytocin. The primary outcome was the incidence of postpartum hemorrhage, and secondary outcomes were postpartum
blood loss, prolonged third stage of labor, additional oxytocin requirement, other additional drugs, blood transfusion, and hypotension during the third stage of labor. Four hundred and fifty pregnant women were enrolled (225 cases in each group). It was found that the incidence of postpartum hemorrhage in intravenous group and intramuscular oxytocin group was 2.2% and 4.8%, respectively. There was no significant difference in the incidence of postpartum hemorrhage (RR 0.45, 95%CI 0.16-1.28). The postpartum blood loss in intravenous oxytocin was significantly lower than that of muscular oxytocin (116.3 ± 6.9 ml vs 154.4 ± 10.5 ml (p<0.05)). There was no significant difference in the incidence of prolonged third stage of labor, change in hemoglobin levels 24 hours after delivery, hypotension and blood transfusion in both groups. Additional oxytocin requirement was similar between the two groups. Thus, intravenous oxytocin was associated with lower postpartum hemorrhage and postpartum blood loss when compared to intramuscular oxytocin in the management of the third stage of labor.
Key words: oxytocin, third stage of labor, postpartum hemorrhage, hypotension