A Cochrane review «Prophylactic oxytocin for the third stage of labour to prevent postpartum haemorrhage»1 «Salati JA, Leathersich SJ, Williams MJ et al. Prophylactic oxytocin for the third stage of labour to prevent postpartum haemorrhage. Cochrane Database Syst Rev 2019;(4):CD001808. »1 included 24 studies with a total of 10 018 subjects. Prophylactic oxytocin compared with placebo reduced the risk of postpartum haemorrhage (PPH) greater than 500 mL or 1000mL, and the need for therapeutic uterotonics (table «Oxytocin compared to no uterotonics or placebo for the third stage of labour to prevent postpartum haemorrhage »1). The benefit of prophylactic oxytocin to prevent PPH greater than 500 mL was seen in all subgroups. There was no difference in preventing PPH greater than 500 mL with prophylactic oxytocin compared to ergot alkaloids (RR 0.84, 95% CI 0.56 to 1.25; 10 trials, n=3082). Use of prophylactic oxytocin was associated with fewer side effects compared with use of ergot alkaloids.
| Outcome | Relative effect (95% CI) | Risk with no uterotonics | Risk with oxytocin (95% CI) | № of participants (studies) |
|---|---|---|---|---|
| Blood loss 500 mL or more after delivery | RR 0.51 (0.37 to 0.72) | 239 per 1000 | 122 per 1000 (89 to 172) | 4162 (6) |
| Need for additional uterotonics | RR 0.54 (0.36 to 0.80) | 114 per 1000 | 62 per 1000 (41 to 91) | 3135 (4) |
| Blood loss 1000 mL or more after delivery | RR 0.59 (0.42 to 0.83) | 48 per 1000 | 29 per 1000 (20 to 41) | 4123 (5) |
| Third stage greater than 30 minutes | RR 2.55 (0.88 to 7.44) | 6 per 1000 | 16 per 1000 (5 to 45) | 1947 (1) |
Another Cochrane review and meta-analysis «Uterotonic agents for preventing postpartum haemorrhage: a network meta‐analysis»2 «Gallos ID, Yunas I, Devall AJ, et al. Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis. Cochrane Database Syst Rev 2025;4(4):CD011689. »2 included 122 studies with a total of 121 931subjects. All agents were effective for preventing PPH 500 mL or greater when compared with placebo or no treatment. Ergometrine plus oxytocin (RR 0.76, 95% CI 0.64 to 0.90) and misoprostol plus oxytocin (RR 0.70, 95% CI 0.57 to 0.87) reduced PPH ≥ 500 mL compared with oxytocin. All agents except ergometrine and injectable prostaglandins were effective for preventing PPH 1000 mL or greater when compared with placebo or no treatment.
A third Cochrane review «Intravenous versus intramuscular prophylactic oxytocin for reducing blood loss in the third stage of labour»3 «Oladapo OT, Okusanya BO, Abalos E et al. Intravenous versus intramuscular prophylactic oxytocin for the third stage of labour. Cochrane Database Syst Rev 2020;(11):CD009332. »3 included 7 studies with a total of 7 817 subjects. Compared to intramuscular administration, intravenous administration of oxytocin in the third stage of labour carried a lower risk for postpartum haemorrhage (PPH) ≥ 500 mL (average risk ratio (RR) 0.78, 95% CI 0.66 to 0.92; 6 trials; n=7731), blood transfusion (aRR 0.44, 95% CI 0.26 to 0.77; 4 trials; n=6684), and PPH ≥ 1000 mL (aRR 0.64, 95% CI 0.43 to 0.94; 2 trials; n=1512).