Flanagan Madeline, Rattan Arsheeya, Au Ling Shan, Patabendige Malitha, Whigham Carole-Ann, Jans Suze, Cofie Patience, Hofmeyr G Justus, Rosseland Leiv Arne, Weeks Andrew, Li Wentao, Mol Ben W J
Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.
Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Victoria, Australia.
BJOG. 2025 Jul 16. doi: 10.1111/1471-0528.18279.
Post-partum haemorrhage (PPH) is a common complication of labour.
To assess the effectiveness of oxytocin in comparison to no treatment for preventing PPH.
Published and unpublished randomised controlled trials (RCTs) comparing systemic oxytocin to placebo or no intervention for preventing PPH were included.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.
We 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.
An Individual participant data (IPD) meta-analysis.
Of 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).
Prophylactic 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.
产后出血（PPH）是分娩的常见并发症。
评估催产素与不进行治疗相比在预防产后出血方面的有效性。
纳入已发表和未发表的随机对照试验（RCT），这些试验比较了全身性催产素与安慰剂或不进行干预以预防产后出血的效果。我们没有设置语言限制。
我们从Cochrane网络荟萃分析中识别出关于宫缩剂预防产后出血的随机对照试验，并通过以下途径更新检索：Ovid MEDLINE、通过Ovid检索的Embase、Web of Science、CENTRAL、CINAHL Plus和clinicaltrials.gov。
个体参与者数据（IPD）荟萃分析。
在14项符合条件的随机对照试验中，4项提供了个体参与者数据（n = 4304；51.7%接受催产素治疗，48.4%接受安慰剂或不进行干预）。个体参与者数据的荟萃分析表明，催产素降低了产后出血≥500 mL的风险（调整后比值比[aOR]为0.59；95%置信区间[CI]为0.46至0.74）以及产后出血≥1000 mL的风险（aOR为0.51；95% CI为0.32至0.80）。在10项未共享数据的随机对照试验中，7项符合可信度标准，3项不符合。来自符合可信度标准的随机对照试验的可信个体参与者数据和汇总数据（n = 6003）表明，催产素显著降低了产后出血≥500 mL的发生率（aOR为0.53；95% CI为0.45至0.62）以及产后出血≥1000 mL的发生率（aOR为0.59；95% CI为0.48至0.71）。不符合可信度标准的随机对照试验报告，催产素对产后出血≥500 mL（n = 1027；aOR为0.37；95% CI为0.03至4.03）和产后出血≥1000 mL（n = 1157；aOR为0.13；95% CI为0.01至1.45）的风险降低幅度更大。
与不进行治疗相比，预防性使用催产素可降低产后出血≥500 mL和产后出血≥1000 mL的风险。21%的随机对照试验不符合我们预先定义的可信度标准，这凸显了在证据综合过程中进行完整性评估的重要性。
