Effects of Motherwort Injection Versus Intramuscular Oxytocin for Preventing Postpartum Hemorrhage Among Women Who Underwent Cesarean Section

Ming-Xi Li; Chun-Rong Liu; Meng Chen; Hong-Cai Shang; Wen Wang; Xiao-Chao Luo; Ling Li; Ya-Na Qi; Yi-Quan Xiong; Shi-Yao Huang; Jing Wang; Kang Zou; Xing-Hui Liu; Jing Tan; Xin Sun

doi:10.3389/fphar.2022.859495

Effects of Motherwort Injection Versus Intramuscular Oxytocin for Preventing Postpartum Hemorrhage Among Women Who Underwent Cesarean Section

Front Pharmacol. 2022 Mar 21:13:859495. doi: 10.3389/fphar.2022.859495. eCollection 2022.

Authors

Ming-Xi Li^{1

2

3}, Chun-Rong Liu^{1

2

3}, Meng Chen⁴, Hong-Cai Shang⁵, Wen Wang^{1

2

3}, Xiao-Chao Luo^{1

2

3}, Ling Li^{1

2

3}, Ya-Na Qi^{1

2

3}, Yi-Quan Xiong^{1

2

3}, Shi-Yao Huang^{1

6}, Jing Wang^{1

2

3}, Kang Zou^{1

2

3}, Xing-Hui Liu⁴, Jing Tan^{1

2

3}, Xin Sun^{1

2

3}

Affiliations

¹ Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
² NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China.
³ Sichuan Center of Technology Innovation for Real World Data, Chengdu, China.
⁴ Department of Obstetrics and Gynecology, and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.
⁵ Beijing University of Chinese Medicine and Pharmacology, Key Laboratory of Chinese Internal Medicine of MOE and Beijing, Beijing, China.
⁶ Sichuan Evidence-Based Medicine Center of Traditional Chinese Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.

Abstract

Objectives: Subject to ethical constraints, real-world data are an important resource for evaluating treatment effects of medication use during pregnancy and the postpartum period. This study investigated whether motherwort injection, a traditional Chinese medicine preparation, was more effective than intramuscular (IM) oxytocin for preventing postpartum hemorrhage (PPH) in a real-world setting when intravenous (IV) oxytocin is administered. Methods: We conducted an active-controlled, propensity-score matched cohort study using an established pregnancy registry database. Women who underwent cesarean section and received IV oxytocin at the third stage of labor were included. We used an active-comparator design to minimize indication bias, in which we compared IM motherwort injection in the uterus versus IM oxytocin, both on top of IV oxytocin use. We applied 1:1 propensity-score matching (PSM) to balance patient baseline characteristics and used a logistic regression model to estimate treatment effect (i.e., risk difference (RD) and odds ratio (OR)) by using the counterfactual framework. The outcomes of interest were blood loss over 500 ml within 2 h after delivery (PPH, primary) and blood loss over 1,000 ml (severe PPH, secondary). We conducted four sensitivity analyses to examine the robustness of the results. Results: A total of 22,519 pregnant women underwent cesarean sections, among which 4,081 (18.12%) PPH and 480 (2.13%) severe PPH occurred. Among included women, 586 (2.60%) were administrated with IM motherwort injection, and 21,933 (97.40%) used IM oxytocin. After PSM, patient baseline characteristics were well balanced. Compared with IM oxytocin, the use of IM motherwort injection was associated with significantly lower risk of PPH (RD -25.26%, 95% CI -30.04% to -20.47%, p < 0.001; OR 0.25, 95% CI 0.18 to 0.32, p < 0.001) and severe PPH (RD -3.58%, 95% CI -5.87% to -1.30%, p < 0.001; OR 0.39, 95% CI 0.20 to 0.71, p < 0.002). Sensitivity analyses showed that the results were similar. Conclusion: With the use of data from a real-world setting, the findings consistently showed that among women undergoing cesarean section who had received IV oxytocin, the additional use of IM motherwort injection could achieve a lower risk of PPH as compared to the additional use of IM oxytocin. Our study suggested a paradigm for investigating the treatment effect of Chinese herbal medicine in the real-world practice setting.

Keywords: Chinese herbal medicine preparation; motherwort injection; postpartum hemorrhage; pregnancy registry database; real-world study.