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Obstetric Quality and Safety

Poster Session 3

(890) Oxytocin Regimens to Prevent Postpartum Hemorrhage: Comparison of Two Cohorts Matched by Propensity Score Analysis

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

To compare the efficacy of two different prophylactic oxytocin regimens (10 IU intramuscular injection vs 5 IU intravenous bolus) in preventing postpartum hemorrhage (PPH) after vaginal delivery


Study Design:

Single-center retrospective cohort study including all vaginal deliveries between June 1st 2022 and January 31st 2023 at a tertiary referral unit. On October 1st 2022 the oxytocin regimen for PPH prophylaxis after vaginal delivery was switched from 10 IU intramuscular injection to 5 IU intravenous bolus, administered at the time of shoulder delivery. This amendment was introduced as standard of care in the local protocol for active management of the third stage of labor. The incidence of PPH > 500 mL was compared between the patients who gave birth before and after the implementation of the new protocol. A 1:1 propensity score matching of the 2 groups was done for the variables that proved to be independently associated with PPH

Results:

In the study period, 1509 patients had a vaginal birth at our tertiary care unit (753 in the standard-care group and 756 in the new protocol group) and were enrolled in the study population. Of these, 262 (17.4%) had postpartum hemorrhage > 500 mL. At binomial analysis, nulliparity (48.6% vs 68.7%, P < .001), labor induction (31.4% vs 46.9%, P < .001), manual placenta removal (0.6% vs 9.5%, P < .001) and birthweight (3310 ± 518 vs 3528 ± 512, P < .001) were independently associated with the incidence of PPH. Following propensity score matching for the above cited factors, 294 patients from the standard protocol group vs 294 exposed to the new protocol were compared. A significant decrease in the incidence of PPH was noted with the use of intravenous vs intramuscular oxytocin (18.4% vs 8.8%, P < .001) although after matching a higher rate of perineal tears was allocated in the former group


Conclusion:

Administering an intravenous bolus of 5 IU of oxytocin seems more effective than an intramuscular injection of 10 IU in preventing PPH after vaginal delivery