Available online 1 March 2024, 102761

Author links open overlay panel, , , , , ABSTRACTObjective

- To prevent post-partum haemorrhage (PPH), national and international guidelines recommend the administration of a prophylactic injection of oxytocin after all vaginal births. Although additional maintenance oxytocin is not recommended in the immediate postpartum, its administration is quite common (30% of French births in 2021). To assess in a single center, the frequency and determinants associated with the administration of maintenance oxytocin in immediate postpartum.

Study design

- A retrospective observational single-centre study was conducted in a tertiary-care university centre in Paris (France), with data from April-May 2022. All women who gave birth vaginally at or after 37 weeks, except for those with immediate PPH. Univariate and multivariate analysis were performed to compare determinants between the group receiving maintenance oxytocin and the control group without this intervention. A sensitivity analysis in a population of women at low risk of PPH was performed. Maternal, obstetrical, perinatal and organisational determinants were collected.

Results

- This study included 584 patients, 278 (47.6%) of whom received maintenance oxytocin. We observed a significantly higher rate of maintenance oxytocin administration to parous women (OR 1.57, 90%CI 1.09–2.27) and women with a history of PPH (OR 2.88, 90%CI 1.08–9.08). Additional maintenance oxytocin was also administered more often when the midwife handling the birth had more than 5 years of practice since completion of training (OR 1.77, 1.24–2.53) or during night-time births (OR 1.47, 90%CI 1.03–2.10).

Conclusion

- Maintenance oxytocin administration is a frequent practice, performed for almost half the patients in our center. This practice is associated with maternal and obstetric factors, but also with health professionals' individual decisions and practices.

Section snippetsINTRODUCTION

Postpartum haemorrhage (PPH) is a frequent obstetric event that occurred in 11.6% of the births in the 2021 French national perinatal survey [1]. PPH increases women's morbidity and mortality [2]. The meta-analysis of Prendiville et al. demonstrated that prophylactic injection of oxytocin after the birth reduces the risk of PPH by a factor of three and the time to placental delivery by 10 minutes [3]. National and international guidelines therefore recommend this prophylactic oxytocin injection

Population and study design

We designed a single-centre retrospective study in a tertiary-care university maternity centre in Paris (France). We collected the data of all women who had given birth vaginally at or after 37 weeks, from 1 April through 31 May, 2022. Women were excluded if they gave birth before 37 weeks or had a caesarean birth or an immediate postpartum haemorrhage (blood loss exceeding 500 mL between the childbirth and the beginning of postpartum monitoring).

In our maternity ward, midwives oversee all

Analysis of the global population

Among the 640 women who gave birth in our maternity unit during the 2-month study period, 584 women met the inclusion criteria and 278 (47.6%) of them received maintenance oxytocin (Figure 1). The maintenance oxytocin dose was not the same for all women: 263 (94.6%) women received a 5-IU bolus of oxytocin followed by 15 IU of oxytocin in 1 litre of isotonic crystalloid, 13 (4.7%) received the 15-IU dose described above without the bolus that preceded it, and 2 (0.8%) received another dosage (10

Main results

Administration of additional maintenance oxytocin is a common practice that was used for nearly half the women in our center. Its administration is influenced by maternal and obstetrical factors (such as parity and history of PPH), organisational factors (such as night-time births) and number of midwifes’ number of years of practice after completing training.

Interpretation and comparison with the literature

In our study, 47.6% of women received maintenance oxytocin in the immediate postpartum period. This rate is higher than in the 2021 French

CONCLUSION

Nearly half the women in our study received maintenance oxytocin. This practice was influenced by maternal and obstetric factors, but also by individual decisions of health professionals. The study was carried out in a high-risk maternity hospital, probably leading healthcare professionals to over-medicalize, a trend that needs to be countered.

There is no evidence base justifying the routine administration of maintenance oxytocin; it has potential adverse effects. This highlights the importance

Declaration of completing interest

The authors declare that they have no competing interest.

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