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CONFERENCE PROCEEDING
Oxytocin prophylaxis for postpartum hemorrhage prevention among physiologic births under midwifery care in Ontario, Canada (2015-2022)
1
McMaster University, Health Research Methods- Evidence- and Impact HEI, Hamilton, Canada
2
McMaster University, McMaster Midwifery Research Centre, Hamilton, Canada
3
McMaster University, Obstetrics and Gynecology, Hamilton, Canada
4
Better Outcomes Registry & Network BORN Ontario, BORN Ontario, Ottawa, Canada
Eur J Midwifery 2026;10(Supplement 1):A537
ABSTRACT
BACKGROUND:
While oxytocin prophylaxis is recommended for all births to prevent postpartum hemorrhage (PPH), its effects following physiologic birth remain uncertain.
OBJECTIVES:
To estimate the causal effect of oxytocin prophylaxis versus physiologic care during the third stage of labour on PPH following physiologic birth.
METHODS:
We conducted a population-based cohort study of all individuals in Ontario, Canada (2015-2022) under midwifery care during the third stage of labour with a low-risk physiologic birth. Outcomes were PPH and PPH requiring transfusion. Covariates were selected using causal diagrams. Propensity scores were estimated and used to apply inverse probability of treatment weighting. Adjusted relative risks (aRR) and 95% confidence intervals (CI) were estimated using modified Poisson regression. Analyses were stratified by parity. The study was approved by the Hamilton Integrated Research Ethics Board.
RESULTS:
The final analytic cohort included 51,397 physiologic births (nulliparous: n= 13,862; parous: n= 37,535). Oxytocin prophylaxis was administered in 84.1% of nulliparous and 83.5% of parous births. Among nulliparas, PPH occurred in 4.8% births and PPH requiring transfusion in 3.0 per 1,000 births. Compared to physiologic care, the aRR of PPH and PPH with transfusion with oxytocin prophylaxis was 1.17 (95% CI, 0.93-1.46) and 0.89 (95% CI, 0.37-2.14), respectively. Among parous individuals, PPH occurred in 3.9% births; transfusion was rare (1.7 per 1,000 births). The aRR of PPH and PPH with transfusion was 1.33 (95% CI, 1.12-1.57) and 0.90 (95% CI, 0.44-1.84), respectively.
CONCLUSIONS:
Oxytocin prophylaxis was associated with a modestly increased risk of PPH compared to physiologic care, with more precise estimates among parous individuals. Estimates for PPH requiring transfusion were imprecise and did not demonstrate clear benefit.
KEY MESSAGE:
Physiologic third stage care is a safe option for low-risk physiologic births under midwifery care in Ontario, Canada. Poster session 1 (Group A)
While oxytocin prophylaxis is recommended for all births to prevent postpartum hemorrhage (PPH), its effects following physiologic birth remain uncertain.
OBJECTIVES:
To estimate the causal effect of oxytocin prophylaxis versus physiologic care during the third stage of labour on PPH following physiologic birth.
METHODS:
We conducted a population-based cohort study of all individuals in Ontario, Canada (2015-2022) under midwifery care during the third stage of labour with a low-risk physiologic birth. Outcomes were PPH and PPH requiring transfusion. Covariates were selected using causal diagrams. Propensity scores were estimated and used to apply inverse probability of treatment weighting. Adjusted relative risks (aRR) and 95% confidence intervals (CI) were estimated using modified Poisson regression. Analyses were stratified by parity. The study was approved by the Hamilton Integrated Research Ethics Board.
RESULTS:
The final analytic cohort included 51,397 physiologic births (nulliparous: n= 13,862; parous: n= 37,535). Oxytocin prophylaxis was administered in 84.1% of nulliparous and 83.5% of parous births. Among nulliparas, PPH occurred in 4.8% births and PPH requiring transfusion in 3.0 per 1,000 births. Compared to physiologic care, the aRR of PPH and PPH with transfusion with oxytocin prophylaxis was 1.17 (95% CI, 0.93-1.46) and 0.89 (95% CI, 0.37-2.14), respectively. Among parous individuals, PPH occurred in 3.9% births; transfusion was rare (1.7 per 1,000 births). The aRR of PPH and PPH with transfusion was 1.33 (95% CI, 1.12-1.57) and 0.90 (95% CI, 0.44-1.84), respectively.
CONCLUSIONS:
Oxytocin prophylaxis was associated with a modestly increased risk of PPH compared to physiologic care, with more precise estimates among parous individuals. Estimates for PPH requiring transfusion were imprecise and did not demonstrate clear benefit.
KEY MESSAGE:
Physiologic third stage care is a safe option for low-risk physiologic births under midwifery care in Ontario, Canada. Poster session 1 (Group A)
| eISSN: | 2585-2906 |
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