A Standardized Postpartum Oxytocin Protocol to Reduce Hemorrhage Treatment: Outcomes by Delivery Mode

Postpartum hemorrhage prophylaxis guidelines lack consensus and do not address the major factor of delivery mode. This creates quality and safety concerns. The objective of this study was to evaluate the effect of implementing a standardized prophylaxis protocol on postpartum hemorrhage treatment by delivery mode.

A secondary analysis was conducted of all women ≥ 24 weeks' gestational age who delivered from January 2010 to June 2015 at one perinatal center. Women were grouped according to delivery pre-protocol (nonstandardized postpartum oxytocin) or post-protocol (standardized postpartum oxytocin). This retrospective cohort study compared outcomes by delivery mode. The primary outcome was treatment for postpartum hemorrhage or uterine atony.

A total of 16,811 women were studied, stratified by three delivery modes: spontaneous vaginal (n = 10,542), operative vaginal (n = 963), and cesarean (n = 5,306). Delivery post-protocol introduction was associated with a lower treatment rate of postpartum hemorrhage for spontaneous vaginal (5.7% vs. 3.1%; p < 0.001) and cesarean (9.4% vs. 7.8%; p = 0.036) modes. Delivery post-protocol introduction was associated with a decreased risk of the primary composite outcome across all modes: spontaneous vaginal (adjusted odds ratio [AOR] = 0.537; 95% confidence interval [CI]: 0.442-0.653), operative vaginal (AOR = 0.490; 95% CI: 0.285-0.842), and cesarean (AOR = 0.812; 95% CI: 0.666-0.988).

A standardized oxytocin protocol was associated with a lower postpartum hemorrhage treatment rate for cesarean and vaginal deliveries, but not for operative vaginal deliveries. The prophylactic effect of our higher dose protocol had the strongest benefit with women delivering vaginally.