Ergometrine 500micrograms/1ml / Oxytocin 5units/1ml solution for injection ampoules

BackgroundPostpartum haemorrhage (PPH) is the leading cause of maternal mortality. Uterotonics are the mainstay of PPH prevention.ObjectivesTo compare the efficacy of misoprostol and oxytocin for the prevention of PPH and to evaluate the trustworthiness of these randomised controlled trials (RCTs).Search strategy and selection criteriaSeven databases were searched for peer-reviewed literature meeting the inclusion criteria of RCTs comparing misoprostol and oxytocin for the prevention of PPH.Data collection and analysisData were collected by two independent reviewers. Individual participant data (IPD) were meta-analysed for outcomes PPH ≥ 500 and ≥ 1000 mL. RCTs that did not share IPD were classified as trustworthy or not, and aggregate data were meta-analysed according to trustworthiness.Main resultsOf 79 eligible RCTs, 10 (12.7%) provided IPD, of which 6 were included. Analysis of IPD showed PPH ≥ 500 mL to be significantly higher in the misoprostol than in the oxytocin group (2022 participants, aOR 1.84, 95% CI 1.43-2.34). For PPH ≥ 1000 mL, analysis of IPD showed that misoprostol and oxytocin were comparable (2022 participants, OR 1.14, 95% CI 0.68-1.91). Of the 69 studies that did not provide IPD, 23 (33.3%) were assessed as trustworthy. Analysis of trustworthy data (IPD and 23 aggregate data RCTs) showed no difference between misoprostol and oxytocin for PPH ≥ 500 mL (24 334 participants, OR 1.01, 95% CI 0.69-1.49), while misoprostol was associated with a significantly increased risk of PPH ≥ 1000 mL compared to oxytocin (25 249 participants, OR 1.36, 95% CI 1.16-1.59).ConclusionsOf 79 RCTs comparing misoprostol and oxytocin for the prevention of PPH, 36.7% met trustworthiness criteria. Oxytocin is comparable to misoprostol for preventing PPH and may be superior for preventing severe PPH.

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Background: Oxytocin is the gold standard uterotonic agent for prevention of postpartum hemorrhage. However, there is no consensus with clear evidence about the side-effects of oxytocin administered intravenously or intramuscularly for management of the third stage of labor. We conducted a systematic review and meta-analysis of randomized controlled trials to evaluate the side-effects of intravenously or intramuscularly oxytocin for preventing postpartum hemorrhage in the third stage of labor. Methods: Six representative databases were searched from the inception to July 2023. Randomized controlled trials which explored the intravenously and intramuscularly oxytocin and provided at least one side-effect were included. Statistical analysis included random or fixed-effect meta-analyses using relative risk. Results: Nine studies included, involving 8,295 participants. Ten types of side-effects were reported. There was no statistical difference in hypotension (RR = 1.01, 95%CI = 0.88-1.15), anemia (0.98, 0.83-1.15), tachycardia (0.90, 0.69-1.17), shivering (0.90, 0.69-1.17), headache (0.86, 0.31-2.37), nausea (0.70, 0.20-2.42), vomiting (0.97, 0.26-3.58), uvular edema (0.82, 0.23-2.91), diarrhea (0.97, 0.26-3.58), and fever (0.97, 0.26-3.58) between intravenously or intramuscularly groups. Conclusion: There are no significant differences of side-effects between intravenously and intramuscularly administration of oxytocin for preventing postpartum hemorrhage in the third labor. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=407571.

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BackgroundObstetric haemorrhage, particularly postpartum haemorrhage (PPH), remains a significant global health challenge and a leading cause of maternal mortality. Despite advancements in understanding and preventing PPH, haemorrhage remains a leading cause of maternal mortality worldwide. The aim of this study was to review the current literature on the use of uterotonic drugs, particularly oxytocin, in reducing perinatal mortality during prehospital deliveries.MethodsIn December 2024, a comprehensive search was conducted across PubMed, Web of Science, Embase, and Scopus, yielding 108 records, of which four studies met the inclusion criteria.ResultsThe limited evidence underscores the need for targeted research and adherence to international obstetric guidelines to improve PPH management and maternal outcomes. In some countries, the only uterotonic drug available in all EMS teams is oxytocin; in others, there is none. Emergency Medical Services (EMS) play a critical role in providing lifesaving interventions during obstetric emergencies, often serving as the first and sometimes only point of medical contact for women experiencing complications during childbirth.ConclusionThere is a lack of high-quality clinical studies evaluating the effectiveness of uterotonic agents in EMS operations and their role in treating postpartum haemorrhage in prehospital settings. Addressing this gap requires targeted research to generate robust evidence and inform the development of standardized protocols. Such efforts could enhance the timely management of PPH, ultimately reducing maternal mortality and improving outcomes in resource-limited and prehospital environments. By bridging the evidence gap, EMS systems worldwide can be better equipped to handle obstetric emergencies effectively.

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1.ObjectiveTo perform a network meta-analysis to specify the route of administration that maximises the effectiveness of each of the available prophylactic uterotonics without increasing the risk for side effects. 2.Data sourcesLiterature searches on 12th September 2022 included: CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform. The reference lists of the retrieved study records were also searched. 3.Study eligibility criteriaPopulation: Randomized controlled trials involving women in the third stage of labour after a vaginal or caesarean delivery in hospital or community settings.InterventionsSystemically administered prophylactic uterotonics of any route and dose for primary postpartum hemorrhage prevention. Comparison: Any other prophylactic uterotonic, or a different route or dose of a given uterotonic, or placebo, or no treatment. Outcomes (primary): postpartum hemorrhage ≥ 500 mL and ≥ 1000 mL. 4.Study appraisal and synthesis methodsRisk of bias and trustworthiness assessments were performed, according to Cochrane's guidance. Direct, indirect and network meta-analyses were conducted, and results were summarized either as risk ratio or mean difference with 95% confidence intervals for dichotomous and continuous outcomes, respectively. The certainty of generated evidence was assessed according to the GRADE approach. Cumulative probabilities were calculated and the surface under the cumulative ranking curve was used to create a ranking of the available drugs. 5.ResultsOne hundred eighty-one studies involving 122,867 randomised women were included. Most studies were conducted in hospital settings in lower-middle income countries and involved women delivering vaginally. When compared with intramuscular oxytocin, carbetocin (RR 0.58, 95 % CI 0.40-0.84) and oxytocin (RR 0.75, 95 % CI 0.59-0.97) by an intravenous bolus, and intramuscular ergometrine plus oxytocin combination (RR 0.71, 95 % CI 0.56-0.91) are probably more effective in preventing primary postpartum hemorrhage. Intramuscularly administered oxytocin and carbetocin by an intravenous bolus have a favourable side effects profile. 6.ConclusionsGenerated evidence was generally moderate and global inconsistency was low. Carbetocin and oxytocin by an intravenous bolus, and intramuscular ergometrine plus oxytocin combination are probably the top uterotonics for primary postpartum hemorrhage prevention. Large scale studies exploring different routes of administration for available prophylactic uterotonics, and women's views should be conducted.

Abstract licence: CC BY-NC-SA

BackgroundPost-partum haemorrhage (PPH) is a common complication of labour.ObjectiveTo assess the effectiveness of oxytocin in comparison to no treatment for preventing PPH.Selection criteriaPublished and unpublished randomised controlled trials (RCTs) comparing systemic oxytocin to placebo or no intervention for preventing PPH were included. We did not apply language restrictions.Search strategyWe identified RCTs from the Cochrane network meta-analysis on uterotonics for preventing PPH and updated the search via: Ovid MEDLINE, Embase via Ovid, Web of Science, CENTRAL, CINAHL Plus and clinicaltrials.gov.Data collection and analysisAn Individual participant data (IPD) meta-analysis.Main resultsOf 14 eligible RCTs, four provided IPD (n = 4304; 51.7% received oxytocin and 48.4% received placebo or no intervention). Meta-analysis of IPD showed that oxytocin decreased the risk of PPH ≥ 500 mL (aOR 0.59; 95% CI 0.46 to 0.74) and PPH ≥ 1000 mL (aOR 0.51; 95% CI 0.32 to 0.80). Of 10 RCTs that did not share data, seven met trustworthiness criteria while three did not. Trustworthy IPD and aggregate data (AD) from RCTs meeting trustworthiness criteria (n = 6003) showed that oxytocin significantly reduced the rate of PPH ≥ 500 mL (aOR 0.53; 95% CI 0.45 to 0.62) and PPH ≥ 1000 mL (aOR 0.59; 95% CI 0.48 to 0.71). RCTs not meeting trustworthiness criteria reported a larger risk reduction of oxytocin for PPH ≥ 500 mL (n = 1027; aOR 0.37; 95% CI 0.03 to 4.03) and PPH ≥ 1000 mL (n = 1157; aOR 0.13; 95% CI 0.01 to 1.45).ConclusionsProphylactic oxytocin reduces the risk of PPH ≥ 500 mL and PPH ≥ 1000 mL compared to no treatment. Twenty-one percent of RCTs did not meet our pre-defined trustworthiness criteria, underlining the importance of integrity assessment in evidence synthesis.

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