Does route matter? Impact of route of oxytocin administration on postpartum bleeding: A double-blind, randomized controlled trial


Autoři: Jill Durocher aff001;  Ilana G. Dzuba aff001;  Guillermo Carroli aff002;  Elba Mirta Morales aff003;  Jesus Daniel Aguirre aff003;  Roxanne Martin aff001;  Jesica Esquivel aff003;  Berenise Carroli aff002;  Beverly Winikoff aff001
Působiště autorů: Gynuity Health Projects, New York, New York, United States of America aff001;  Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina aff002;  Hospital Materno Neonatal E.T. de Vidal, Corrientes, Argentina aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222981

Souhrn

Objective

We assessed the impact of intravenous (IV) infusion versus intramuscular (IM) oxytocin on postpartum blood loss and rates of postpartum hemorrhage (PPH) when administered during the third stage of labor. While oxytocin is recommended for prevention of PPH, few double-blind studies have compared outcomes by routes of administration.

Methods

A double-blind, placebo-controlled randomized trial was conducted at a hospital in Argentina. Participants were assigned to receive 10 IU oxytocin via IV infusion or IM injection and a matching saline ampoule for the other route after vaginal birth. Blood loss was measured using a calibrated receptacle for a 1-hour minimum. Shock index (SI) was also calculated, based on vital signs measurements, and additional interventions were recorded. Primary outcomes included: the frequency of blood loss ≥500ml and mean blood loss.

Results

239 (IV infusion) and 241 (IM) women were enrolled with comparable baseline characteristics. Mean blood loss was 43ml less in the IV infusion group (p = 0.161). Rates of blood loss ≥500ml were similar (IV infusion = 21%; IM = 24%, p = 0.362). Women in the IV infusion group received significantly fewer additional uterotonics (5%), than women in the IM group (12%, p = 0.007). Women with PPH in the IM group experienced a larger increase in SI after delivery, which may have influenced recourse to additional interventions.

Conclusions

The route of oxytocin administration for PPH prevention did not significantly impact measured blood loss after vaginal birth. However, differences were observed in recourse to additional uterotonics, favoring IV infusion over IM. In settings where IV lines are routinely placed, oxytocin infusion may be preferable to IM injection.

Klíčová slova:

Hemorrhage – Intravenous injections – Labor and delivery – Postpartum hemorrhage – Prophylaxis – Randomized controlled trials – Routes of administration – Oxytocin


Zdroje

1. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014; 2: e323–33. doi: 10.1016/S2214-109X(14)70227-X 25103301

2. Bateman BT, Berman MF, Riley LE, Leffert LR. The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth Analg 2010; 110: 1368–73. doi: 10.1213/ANE.0b013e3181d74898 20237047

3. World Health Organization. WHO recommendations: uterotonics for the prevention of postpartum haemorrhage. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO.

4. 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.

5. Sentilhes L, Goffinet F, Vayssiere C, Deneux-Tharaux C. Comparison of postpartum haemorrhage guidelines: discrepancies underline our lack of knowledge. BJOG 2017; 124: 718–22. doi: 10.1111/1471-0528.14305 27699997

6. FIGO Safe Motherhood and Newborn Health Committee. Prevention and treatment of postpartum hemorrhage in low-resource settings. Int J Gynecol Obstet 2012; 117: 108–18.

7. RCOG. Prevention and management of postpartum haemorrhage: Green-top guideline No. 52. BJOG 2017; 124: e106–49. doi: 10.1111/1471-0528.14178 27981719

8. ACOG. Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol 2017; 130: e168–86. doi: 10.1097/AOG.0000000000002351 28937571

9. Shields L, Lagrew D, Lyndon A. Uterotonic medications for prevention and treatment of postpartum hemorrhage. 2015: CMQCC Obstetric Hemorrhage Toolkit, Version 2.0.

10. Sheldon WR, Durocher J, Winikoff B, Blum J, Trussell J. How effective are the components of active management of the third stage of labor? BMC Pregnancy Childbirth 2013; 13: 46. doi: 10.1186/1471-2393-13-46 23433172

11. Dzuba I, Durocher J, Dilbaz B, Gelisen O, Ngoc NTN, Montesinos R, et al. Route of administration of oxytocin in prevention of postpartum hemorrhage. Int J Gynecol Obstet 2012; 119: S333.

12. 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; 4: 362.

13. Charles D, Anger H, Dabash R, Darwish E, Ramadan MC, Mansy A, 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 Pregnancy Childbirth 2019; 19: 38. doi: 10.1186/s12884-019-2181-2 30658605

14. Gibbens D, Boyd NR, Crocker S, Baumber S, Chard T. The circulating levels of oxytocin following intravenous and intramuscular administration of Syntometrine. J Obstet Gynaecol Br Commonw 1972; 79: 644–6. doi: 10.1111/j.1471-0528.1972.tb14215.x 5043430

15. Oladapo OT, Okusanya BO, Abalos E. Intramuscular versus intravenous prophylactic oxytocin for the third stage of labour. Cochrane Database Syst Rev 2018; 9: CD009332. doi: 10.1002/14651858.CD009332.pub3 30246877

16. Le Bas A, Chandraharan E, Addei A, Arulkumaran S. Use of the "obstetric shock index" as an adjunct in identifying significant blood loss in patients with massive postpartum hemorrhage. Int J Gynaecol Obstet 2014; 124: 253–5. doi: 10.1016/j.ijgo.2013.08.020 24373705

17. Nathan HL, El Ayadi A, Hezelgrave NL, Seed P, Butrick E, Miller S, et al. Shock index: an effective predictor of outcome in postpartum haemorrhage? BJOG 2015; 122: 268–75. doi: 10.1111/1471-0528.13206 25546050

18. Carroli G1, Cuesta C, Abalos E, Gulmezoglu AM. Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol 2008;22: 999–1012. doi: 10.1016/j.bpobgyn.2008.08.004 18819848

19. Prendiville W, O’Connell M. Active Management of the Third Stage of Labor. In: B-Lynch C, Keith L, Lalonde A, Karoshi M, editors. A Textbook of PostPartum Hemorrhage: A comprehensive Guide to Evaluation, Management and Surgical Intervention, first edition. London: Sapiens Publishing; 2006. p. 462.

20. Borovac-Pinheiro A, Pacagnella RC, Cecatti JG, Miller S, El Ayadi AM, Souza JP, et al. Postpartum hemorrhage: new insights for definition and diagnosis. Am J Obstet Gynecol. 2018; 219: 162–8. doi: 10.1016/j.ajog.2018.04.013 29660298

21. El Ayadi AM, Nathan HL, Seed PT, Butrick EA, Hezelgrave NL, Shennan AH, et al. Vital sign prediction of adverse maternal outcomes in women with hypovolemic shock: the role of shock index. PLoS One 2016; 11: e0148729. doi: 10.1371/journal.pone.0148729 26901161

22. Kohn JR, Dildy GA, Eppes CS. Shock index and delta-shock index are superior to existing maternal early warning criteria to identify postpartum hemorrhage and need for intervention. J Matern Fetal Neonatal Med. 2019; 32: 1238–44. doi: 10.1080/14767058.2017.1402882 29113517


Článek vyšel v časopise

PLOS One


2019 Číslo 10

Nejčtenější v tomto čísle

Tomuto tématu se dále věnují…


Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

Léčba bolesti v ordinaci praktického lékaře
nový kurz
Autoři: MUDr. PhDr. Zdeňka Nováková, Ph.D.

Revmatoidní artritida: včas a k cíli
Autoři: MUDr. Heřman Mann

Jistoty a nástrahy antikoagulační léčby aneb kardiolog - neurolog - farmakolog - nefrolog - právník diskutují
Autoři: doc. MUDr. Štěpán Havránek, Ph.D., prof. MUDr. Roman Herzig, Ph.D., doc. MUDr. Karel Urbánek, Ph.D., prim. MUDr. Jan Vachek, MUDr. et Mgr. Jolana Těšínová, Ph.D.

Léčba akutní pooperační bolesti
Autoři: doc. MUDr. Jiří Málek, CSc.

Nové antipsychotikum kariprazin v léčbě schizofrenie
Autoři: prof. MUDr. Cyril Höschl, DrSc., FRCPsych.

Všechny kurzy
Kurzy Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Nemáte účet?  Registrujte se

Zapomenuté heslo

Zadejte e-mailovou adresu se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se