Prophylactic Intramyometrial Oxytocin before Placenta Delivery during Cesarean Section Prevents Postpartum Hemorrhage

Objectives: To compare efficacy of intramyometrial oxytocin vs intravenous oxytocin infusion in reducing blood loss during cesarean section. Materials and methods: A prospective randomized controlled trial of 150 women undergoing cesarean section was done. Women undergoing cesarean section were randomly divided into three groups according to method of administration of oxytocin. In group I (n = 50): 20 units of oxytocin in 500 cc of ringer lactate as continuous infusion I/V after separation of placenta was given. In group II (n = 50): 5 units of oxytocin is diluted in 10 cc of normal saline and 5 cc injected in each cornu of uterus after separation of placenta. In group III (n = 50): 5 units of oxytocin is diluted in 10 cc of normal Saline and 5 cc injected in each cornu of uterus before separation of placenta. Blood loss was calculated by number of mops soaked and amount of blood in suction jar. Results: Average blood loss was found to be more in group I 606 cc, while in group II average blood loss was 460 ml which further decreased to 412 cc in group III. There was an additional observation that the 6% cases where I/V oxytocin infusion could not prevent uterine atony while immediate uterine contraction was achieved with intramyometrial oxytocin. Conclusion: Intramyometrial injection of oxytocin when given before separation of placenta was found to be most effective method to increase uterine contraction, reducing incidence of postpartum hemorrhage and thus decreasing cesarean morbidity.