A Cochrane review included 20 studies with a total of 10 806 subjects. Prophylactic oxytocin compared with placebo reduced the risk of postpartum haemorrhage (PPH) greater than 500 mL, (RR 0.53; 95% CI 0.38 to 0.74; 6 trials, n=4203 women; I² = 78%) and the need for therapeutic uterotonics (RR 0.56; 95% CI 0.36 to 0.87; 4 trials, n=3174 women; I² = 58%). The benefit of prophylactic oxytocin to prevent PPH greater than 500 mL was seen in all subgroups. Decreased use of therapeutic uterotonics was only seen in the following subgroups: randomised trials with low risk of bias (RR 0.58; 95% CI 0.36 to 0.92; 3 trials, n=3122; I² = 69%); trials that performed active management of the third stage (RR 0.39; 95% CI 0.26 to 0.58; 1 trial, n=1901); trials that delivered oxytocin as an IV bolus (RR 0.57; 95% CI 0.39 to 0.82; 1 trial, n=1000); and in trials that gave oxytocin at a dose of 10 IU (RR 0.48; 95% CI 0.33 to 0.68; 2 trials, n=2901; I² = 27%). Prophylactic oxytocin was superior to ergot alkaloids in preventing PPH greater than 500 mL (RR 0.76; 95% CI 0.61 to 0.94; 5 trials, n=2226; I² = 0%). Use of prophylactic oxytocin was associated with fewer side effects compared with use of ergot alkaloids; including decreased nausea between delivery of the baby and discharge from the labour ward. There was no benefit seen in the combination of oxytocin and ergometrine versus ergometrine alone in preventing PPH greater than 500 mL (RR 0.90; 95% CI 0.34 to 2.41; 5 trials, n=2891; I² = 80%). In all three comparisons, there was no difference in mean length of the third stage or need for manual removal of the placenta between treatment arms.
Date of latest search: 24 June 2013