Randomised Control Trial of 3 IU Intravenous Oxytocin Bolus With 7 IU Oxytocin Infusion Versus 10 IU Intramuscular Oxytocin in the Third Stage of Labour in the Prevention of Postpartum Hemorrhage

Intravenous (IV) oxytocin during vaginal delivery has been rarely used since an intramuscular (IM) route or IV infusion have been preferred in this regard. The trial aimed to compare the low-dose IV bolus 3 IU of oxytocin, along with 7 IU oxytocin infusion with 10 IU oxytocin infusion in cesarean section.

A parallel control randomized study was conducted on a total of 320 consenting term pregnant women based on the inclusion criteria. The participants were randomized into either 3 IU IV bolus and 7 IU infusion of oxytocin or 10 IU of IM oxytocin following vaginal delivery. The difference in pre- and post-delivery hemoglobin (Hb) levels, tone of the uterus, hemodynamic changes, adverse effects of the drug, and the need for additional uterotonics and blood transfusions were assessed based on the aim of the study.

Based on the results, more women with severe blood loss were found in the IM oxytocin group in comparison to the IV bolus with infusion group following vaginal delivery. In addition, more women had a drop in the Hb of 3 gm/dL in the IM oxytocin group compared to the IV bolus-infusion group (11% vs. 4%, odds ratio=0.768, P=0.469) although there was no statistical significance in this respect. The tone of the uterus was firmer in the IV bolus with infusion group at 3 and 5 minutes. Eventually, the difference in hemodynamic changes, side effects, and the need for additional uterotonics or blood transfusions was not significant.

In general, an IV bolus of 3 IU with a 7 IU infusion of oxytocin is as safe as and more effective than the IM injection of 10 IU of oxytocin at the time of vaginal delivery for the prevention of postpartum hemorrhage.