Oxytocin Prophylaxis for Prevention of Postpartum Hemorrhage After Cesarean Delivery: Intravenous or Intramyometrial?

Abstract

Introduction and Aim: Postpartum hemorrhage (PPH) is a significant challenge after cesarean delivery. Oxytocin used to prevent uterine atony and reduce blood loss. However, there is no consensus on the standard route of administration. The current work aimed to investigate the efficacy and safety of intramyometrial versus intravenous route administration of oxytocin for reduction of PPH after cesarean sections.

Patients and methods: The study included 200 women, submitted for elective cesarean delivery from June 2019 through June 2021. They were divided into two equal groups, the intravenous injection of oxytocin (5 IU). The second for intramyometrial injection of 5 IU of oxytocin. Recorded data included blood pressure, heart rate, uterine contractility, before surgery, directly after injection of oxytocin and for 15 minutes. Pre- and post-operative hemoglobin was used as a reflection of blood loss. Finally, operative time and postoperative complications were recorded.

Results: Both groups were comparable regarding obstetric history, CS indications, delivery mode, operative time, uterine contractility and postoperative complications. There was a significant increase of systolic blood pressure at 1, 2 3, and 4 min, and a significant increase of DBP at 2, 3, 4, 5, 6, 8, 11, 12, 13,1 14, and 15 min after oxytocin administration, in the intravenous than the intramyometrial group. Heart rate significantly reduced in intravenous than the intramyometrial group at the first minute. The hemoglobin deficit was significantly higher among the intramyometrial group (1.05±0.31 vs 0.87±0.39 g/dl). Postoperative complications were fever (5%), urinary tract infection (7%) and wound infection (6%).

Conclusion: Intramyometrial injection of oxytocin had more transient hypotension and increased blood loss. Thus, it could be said that, the intramyometrial route had no clinical advantages over the intravenous route. However, taking into considerations the possible risk factors for blood loss, the current results could be explained with caution.