Evidence map›Paper›PMID 34081734›Full record

SynthesisPloS one2021

Timing of oxytocin administration to prevent post-partum hemorrhage in women delivered by cesarean section: A systematic review and metanalysis.

Maria Regina Torloni, Monica Siaulys, Rachel Riera, Ana Luiza Cabrera Martimbianco, Rafael Leite Pacheco, Carolina de Oliveira Cruz Latorraca, Mariana Widmer, Ana Pilar Betrán

Open access · goldAbstract readMeta-AnalysisSystematic Review
In one paragraph

Synthesis in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
4.0field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 1 synthesis or guideline pooled it, 15 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Trial
  4. In reply.Journal of anesthesia · 2026
    Article
  5. Article
  6. Article
  7. Article
  8. Article
  9. Carbetocin Controls Intraoperative Blood Loss and Thickness of Myometrium in Scar Uterus Cases.Evidence-based complementary and alternative medicine : eCAM · 2022
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 6 institutions in 2 countries.

Maria Regina TorloniDepartment of Obstetrics, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil.ORCID 0000-0003-4944-0720
Monica SiaulysDepartment of Anesthesiology, Hospital e Maternidade Santa Joana, São Paulo, SP, Brazil.
Rachel RieraEvidence Based Healthcare Postgraduation Program, Department of Medicine, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Ana Luiza Cabrera MartimbiancoEvidence Based Healthcare Postgraduation Program, Department of Medicine, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Rafael Leite PachecoEvidence Based Healthcare Postgraduation Program, Department of Medicine, Universidade Federal de São Paulo, São Paulo, SP, Brazil.ORCID 0000-0001-7487-8471
Carolina de Oliveira Cruz LatorracaEvidence Based Healthcare Postgraduation Program, Department of Medicine, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Mariana WidmerDepartment of Reproductive Health and Research, World Health Organization, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland.
Ana Pilar BetránDepartment of Reproductive Health and Research, World Health Organization, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland.ORCID 0000-0002-5631-5883
Hospital e Maternidade Celso Pierro · BRWorld Health Organization · CHCentro Universitário São Camilo · BRHospital Sírio-Libanês · BRUniversidade Federal de São Paulo · BRUniversidade Metropolitana de Santos · BR

Funding

World Health Organization 001
6 · The paper itself

Abstract

backgroundThere is no consensus on the best timing for prophylactic oxytocin administration during cesarean section (CS) to prevent post-partum hemorrhage (PPH).

objectivesAssess the effects of administrating prophylactic oxytocin at different times during CS.

methodsWe searched nine databases to identify relevant randomized controlled trials (RCT). We pooled results and calculated average risk ratios (RR), mean differences (MD), and 95% confidence intervals (CI). We used GRADE to assess the overall evidence certainty.

resultsWe screened 13,389 references and included four trials. We found no statistically significant differences between oxytocin given before versus after fetal delivery on PPH (RR 0.60, 95%CI 0.15-2.47; 1 RCT, N = 300) or nausea/vomiting (RR 1.21, 95%CI 0.69-2.13; 1 RCT, N = 300). There was a significant reduction in the need for additional uterotonics when oxytocin was given immediately before uterine incision versus after fetal delivery (RR 0.37, 95%CI 0.18-0.73; I2 = 0%; 2 RCTs; N = 301). Oxytocin given before fetal delivery significantly reduced intra-operative blood loss (MD -146.77mL, 95%CI -168.10 to -125.43; I2 = 0%; 3 RCTs, N = 601) but did not change the incidence of blood transfusion (RR 0.50, 95%CI 0.13-1.95; I2 = 0%; 2 RCTs, N = 301) or hysterectomy (RR 3.00; 95%CI 0.12-72.77; I2 = 0%; 2 RCTs, N = 301). One trial (N = 100) compared prophylactic oxytocin before versus after placental separation and found no significant differences on PPH, additional uterotonics, or nausea/vomiting.

conclusionsIn women having pre-labor CS, there is limited evidence indicating no significant differences between prophylactic oxytocin given before versus after fetal delivery on PPH, nausea/vomiting, blood transfusion, or hysterectomy. Earlier oxytocin administration may reduce the volume of blood loss and need for additional uterotonics. There is very limited evidence suggesting no significant differences between prophylactic oxytocin given before versus after placental separation on PPH, need for additional uterotonic, or nausea/vomiting. The overall certainty of the evidence was mostly low or very low due to imprecision. Protocol: CRD42020186797.

Indexed as

Cesarean SectionFemaleHumansOxytocinPostpartum HemorrhageOxytocin

Identifiers

PMID34081734
PMCPMC8174699
OpenAlexW3163994359

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.