Effect of administration routes of oxytocin on hemoglobin in neonates with delayed umbilical cord clamping: a multi-centre randomized controlled clinical trial

TL;DR

This study found no significant difference in neonatal hemoglobin levels when comparing two oxytocin administration methods during cesarean sections with delayed cord clamping.

Contribution

The study is the first to compare intravenous and intramyometrial oxytocin routes in neonates with delayed cord clamping.

Findings

No significant difference in neonatal hemoglobin levels between intravenous and intramyometrial oxytocin administration.

Secondary outcomes like jaundice phototherapy and feeding at 1 month were similar in both groups.

Intravenous administration required a higher intraoperative infusion volume compared to intramyometrial.

Abstract

To evaluate the effect of intravenous infusion versus intramyometrial injection of oxytocin on hemoglobin levels in neonates with delayed umbilical cord clamping during cesarean section.

The multi-centre randomized controlled trial was performed at three hospitals from February to June 2023. Women with term singleton gestations scheduled for cesarean delivery were allocated to receive an intravenous infusion of 10 units of oxytocin or a myometrial injection of 10 units of oxytocin during the surgery. The primary outcome was neonatal hemoglobin at 48 to 96 h after birth. Secondary outcomes were side-effects of oxytocin, postpartum haemorrhage, phototherapy for jaundice, feeding at 1 month, maternal and neonatal morbidity and re-admissions.

A total of 360 women were randomized (180 women in each group). The mean neonatal hemoglobin did not show a significant difference between the intravenous infusion group (194.3 ± 21.7 g/L) and the intramyometrial groups (195.2 ± 24.3 g/L) (p = 0.715). Secondary neonatal outcomes, involving phototherapy for jaundice, feeding at 1 month and neonatal intensive care unit admission were similar between the two groups. The maternal outcomes did not differ significantly between the two groups, except for a 200 mL higher intraoperative infusion volume observed in the intravenous group compared to the intramyometrial group.

Among women undergoing elective cesarean delivery of term singleton pregnancies, there was no significant difference in neonatal hemoglobin at 48 to 96 h after birth between infants with delayed cord clamping, whether the oxytocin was administrated by intravenous infusion or intramyometrial injection.

Chinese Clinical trial registry: ChiCTR2300067953 (1 February 2023).

The online version of this article (10.1007/s00404-024-07543-w) contains supplementary material, which is available to authorized users.

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