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Intramuscular Versus Intravenous Oxytocin to Prevent Postpartum Hemorrhage at Vaginal Delivery

Randomized Controlled Trial

Adnan, N.; Conlan-Trant, R.; McCormick, C.; Boland, F.; Murphy, D.J.

Obstetric Anesthesia Digest: June 2019 - Volume 39 - Issue 2 - p 86
doi: 10.1097/01.aoa.0000557670.63645.6d
Mother, Fetus, Neonate
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(BMJ. 2018;362:k3546)

Postpartum hemorrhage (PPH) is a leading cause of maternal mortality and has been increasing over the last 15 years in many developed countries. While uterotonic drugs such as oxytocin have been established as useful tools in preventing PPH, the best administration method remains unclear. When given intramuscularly, a uterotonic effect will be obtained in 3 to 7 minutes, with the effect lasting 30 to 60 minutes. Intravenous oxytocin has an effect almost immediately and the plateau concentration is reached at 30 minutes. However, intravenous administration has been associated with hypotension and tachycardia. At these investigators’ medical center, the practice of administering oxytocin 10 international units (IU) intravenously after delivery was changed in 2010 to intramuscular oxytocin, following Royal College of Obstetricians and Gynaecologists guidelines. This randomized, controlled trial, the Labour Oxytocin Route (LabOR) was prompted by concerns from midwives and obstetricians at the study center regarding a perceived rise in PPH after this change in practice was adopted. The LabOR trial aimed to determine whether intravenous oxytocin 10 IU was more effective than intramuscular oxytocin 10 IU at preventing PPH after vaginal delivery.

Academic Department of Obstetrics and Gynaecology, Trinity College, University of Dublin & Coombe Women & Infants University Hospital, Dublin, Republic of Ireland

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