Timing of oxytocin administration to prevent post-partum hemorrhage in women delivered by cesarean section: A systematic review and metanalysis.

<h4>Background</h4>There is no consensus on the best timing for prophylactic oxytocin administration during cesarean section (CS) to prevent post-partum hemorrhage (PPH).<h4>Objectives</h4>Assess the effects of administrating prophylactic oxytocin at different times during CS...

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Autores principales:	Maria Regina Torloni, Monica Siaulys, Rachel Riera, Ana Luiza Cabrera Martimbianco, Rafael Leite Pacheco, Carolina de Oliveira Cruz Latorraca, Mariana Widmer, Ana Pilar Betrán
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/b4f123a66f5c4ef5be141fbdaf97c1bc
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spelling	oai:doaj.org-article:b4f123a66f5c4ef5be141fbdaf97c1bc2021-12-02T20:07:20ZTiming of oxytocin administration to prevent post-partum hemorrhage in women delivered by cesarean section: A systematic review and metanalysis.1932-620310.1371/journal.pone.0252491https://doaj.org/article/b4f123a66f5c4ef5be141fbdaf97c1bc2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0252491https://doaj.org/toc/1932-6203<h4>Background</h4>There is no consensus on the best timing for prophylactic oxytocin administration during cesarean section (CS) to prevent post-partum hemorrhage (PPH).<h4>Objectives</h4>Assess the effects of administrating prophylactic oxytocin at different times during CS.<h4>Methods</h4>We searched nine databases to identify relevant randomized controlled trials (RCT). We pooled results and calculated average risk ratios (RR), mean differences (MD), and 95% confidence intervals (CI). We used GRADE to assess the overall evidence certainty.<h4>Results</h4>We screened 13,389 references and included four trials. We found no statistically significant differences between oxytocin given before versus after fetal delivery on PPH (RR 0.60, 95%CI 0.15-2.47; 1 RCT, N = 300) or nausea/vomiting (RR 1.21, 95%CI 0.69-2.13; 1 RCT, N = 300). There was a significant reduction in the need for additional uterotonics when oxytocin was given immediately before uterine incision versus after fetal delivery (RR 0.37, 95%CI 0.18-0.73; I2 = 0%; 2 RCTs; N = 301). Oxytocin given before fetal delivery significantly reduced intra-operative blood loss (MD -146.77mL, 95%CI -168.10 to -125.43; I2 = 0%; 3 RCTs, N = 601) but did not change the incidence of blood transfusion (RR 0.50, 95%CI 0.13-1.95; I2 = 0%; 2 RCTs, N = 301) or hysterectomy (RR 3.00; 95%CI 0.12-72.77; I2 = 0%; 2 RCTs, N = 301). One trial (N = 100) compared prophylactic oxytocin before versus after placental separation and found no significant differences on PPH, additional uterotonics, or nausea/vomiting.<h4>Conclusions</h4>In women having pre-labor CS, there is limited evidence indicating no significant differences between prophylactic oxytocin given before versus after fetal delivery on PPH, nausea/vomiting, blood transfusion, or hysterectomy. Earlier oxytocin administration may reduce the volume of blood loss and need for additional uterotonics. There is very limited evidence suggesting no significant differences between prophylactic oxytocin given before versus after placental separation on PPH, need for additional uterotonic, or nausea/vomiting. The overall certainty of the evidence was mostly low or very low due to imprecision. Protocol: CRD42020186797.Maria Regina TorloniMonica SiaulysRachel RieraAna Luiza Cabrera MartimbiancoRafael Leite PachecoCarolina de Oliveira Cruz LatorracaMariana WidmerAna Pilar BetránPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 6, p e0252491 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Maria Regina Torloni Monica Siaulys Rachel Riera Ana Luiza Cabrera Martimbianco Rafael Leite Pacheco Carolina de Oliveira Cruz Latorraca Mariana Widmer Ana Pilar Betrán Timing of oxytocin administration to prevent post-partum hemorrhage in women delivered by cesarean section: A systematic review and metanalysis.
description	<h4>Background</h4>There is no consensus on the best timing for prophylactic oxytocin administration during cesarean section (CS) to prevent post-partum hemorrhage (PPH).<h4>Objectives</h4>Assess the effects of administrating prophylactic oxytocin at different times during CS.<h4>Methods</h4>We searched nine databases to identify relevant randomized controlled trials (RCT). We pooled results and calculated average risk ratios (RR), mean differences (MD), and 95% confidence intervals (CI). We used GRADE to assess the overall evidence certainty.<h4>Results</h4>We screened 13,389 references and included four trials. We found no statistically significant differences between oxytocin given before versus after fetal delivery on PPH (RR 0.60, 95%CI 0.15-2.47; 1 RCT, N = 300) or nausea/vomiting (RR 1.21, 95%CI 0.69-2.13; 1 RCT, N = 300). There was a significant reduction in the need for additional uterotonics when oxytocin was given immediately before uterine incision versus after fetal delivery (RR 0.37, 95%CI 0.18-0.73; I2 = 0%; 2 RCTs; N = 301). Oxytocin given before fetal delivery significantly reduced intra-operative blood loss (MD -146.77mL, 95%CI -168.10 to -125.43; I2 = 0%; 3 RCTs, N = 601) but did not change the incidence of blood transfusion (RR 0.50, 95%CI 0.13-1.95; I2 = 0%; 2 RCTs, N = 301) or hysterectomy (RR 3.00; 95%CI 0.12-72.77; I2 = 0%; 2 RCTs, N = 301). One trial (N = 100) compared prophylactic oxytocin before versus after placental separation and found no significant differences on PPH, additional uterotonics, or nausea/vomiting.<h4>Conclusions</h4>In women having pre-labor CS, there is limited evidence indicating no significant differences between prophylactic oxytocin given before versus after fetal delivery on PPH, nausea/vomiting, blood transfusion, or hysterectomy. Earlier oxytocin administration may reduce the volume of blood loss and need for additional uterotonics. There is very limited evidence suggesting no significant differences between prophylactic oxytocin given before versus after placental separation on PPH, need for additional uterotonic, or nausea/vomiting. The overall certainty of the evidence was mostly low or very low due to imprecision. Protocol: CRD42020186797.
format	article
author	Maria Regina Torloni Monica Siaulys Rachel Riera Ana Luiza Cabrera Martimbianco Rafael Leite Pacheco Carolina de Oliveira Cruz Latorraca Mariana Widmer Ana Pilar Betrán
author_facet	Maria Regina Torloni Monica Siaulys Rachel Riera Ana Luiza Cabrera Martimbianco Rafael Leite Pacheco Carolina de Oliveira Cruz Latorraca Mariana Widmer Ana Pilar Betrán
author_sort	Maria Regina Torloni
title	Timing of oxytocin administration to prevent post-partum hemorrhage in women delivered by cesarean section: A systematic review and metanalysis.
title_short	Timing of oxytocin administration to prevent post-partum hemorrhage in women delivered by cesarean section: A systematic review and metanalysis.
title_full	Timing of oxytocin administration to prevent post-partum hemorrhage in women delivered by cesarean section: A systematic review and metanalysis.
title_fullStr	Timing of oxytocin administration to prevent post-partum hemorrhage in women delivered by cesarean section: A systematic review and metanalysis.
title_full_unstemmed	Timing of oxytocin administration to prevent post-partum hemorrhage in women delivered by cesarean section: A systematic review and metanalysis.
title_sort	timing of oxytocin administration to prevent post-partum hemorrhage in women delivered by cesarean section: a systematic review and metanalysis.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/b4f123a66f5c4ef5be141fbdaf97c1bc
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Timing of oxytocin administration to prevent post-partum hemorrhage in women delivered by cesarean section: A systematic review and metanalysis.

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