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Motherwort Injection for Preventing Postpartum Hemorrhage in Women with Vaginal Delivery: A Systematic Review and Meta-Analysis of Randomized Evidence.

Abstract

Background

Motherwort injection, a common traditional Chinese medicine, is widely used for the prevention of postpartum hemorrhage (PPH), which has been found to be potential benefit in clinical practice.

Objectives

This study aimed to conduct a rigorous systematic review of randomized evidence to offer a comprehensive overview regarding the efficacy and safety of motherwort injection in maternal women with virginal delivery.

Methods

We included all randomized controlled trials involving pregnant women in vaginal delivery comparing motherwort injection or combination of motherwort injection and oxytocin with oxytocin alone for preventing postpartum hemorrhage. Paired reviewers independently screened citations, assessed risk of bias, and extracted data. Random-effects model by Mantel-Haenszal method was applied to pool the data. Predefined subgroup analyses and sensitivity analyses were conducted to explore the heterogeneity and robustness of results. The GRADE approach was used to rate the quality of evidence.

Main Results

37 randomized controlled trials involving 7887 participants were included, all of which were at moderate to high risk of bias. Meta-analyses of eight trials showed no significant difference in blood loss and PPH events between oxytocin versus motherwort injection (very low quality). However, pooling of 29 trials suggested a reduced risk of blood loss (within 2 hours: MD -55.06mL, 95% CI -84.06 to -26.06; within 24 hours: MD -85.57 mL, 95% CI -94.26 to -76.88, very low quality), PPH events (RR 0.29, 95% CI 0.21 to 0.39, low quality), and adverse events (Peto OR 0.53, 95% CI 0.40 to 0.70, very low quality) in participants treated with motherwort injection and oxytocin versus oxytocin alone.

Conclusions

The current evidence supports the suggestion that the additional use of motherwort injection on oxytocin had a preferable outcome. However, given that the evidence is not definitive with low quality, further careful designed and conducted randomized controlled trials in larger population are warranted to conform the effects.

Authors+Show Affiliations

Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China.Editorial Office of the Chinese Journal of Evidence-Based Medicine, West China Hospital, Chengdu 610041, China.School of Preclinical and Forensic Medicine, Sichuan University, Chengdu 610041, China.Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31354850

Citation

Yu, Jiajie, et al. "Motherwort Injection for Preventing Postpartum Hemorrhage in Women With Vaginal Delivery: a Systematic Review and Meta-Analysis of Randomized Evidence." Evidence-based Complementary and Alternative Medicine : ECAM, vol. 2019, 2019, p. 1803876.
Yu J, Cai Y, Su G, et al. Motherwort Injection for Preventing Postpartum Hemorrhage in Women with Vaginal Delivery: A Systematic Review and Meta-Analysis of Randomized Evidence. Evid Based Complement Alternat Med. 2019;2019:1803876.
Yu, J., Cai, Y., Su, G., & Li, Y. (2019). Motherwort Injection for Preventing Postpartum Hemorrhage in Women with Vaginal Delivery: A Systematic Review and Meta-Analysis of Randomized Evidence. Evidence-based Complementary and Alternative Medicine : ECAM, 2019, p. 1803876. doi:10.1155/2019/1803876.
Yu J, et al. Motherwort Injection for Preventing Postpartum Hemorrhage in Women With Vaginal Delivery: a Systematic Review and Meta-Analysis of Randomized Evidence. Evid Based Complement Alternat Med. 2019;2019:1803876. PubMed PMID: 31354850.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Motherwort Injection for Preventing Postpartum Hemorrhage in Women with Vaginal Delivery: A Systematic Review and Meta-Analysis of Randomized Evidence. AU - Yu,Jiajie, AU - Cai,Yujia, AU - Su,Guanyue, AU - Li,Youping, Y1 - 2019/07/01/ PY - 2019/03/01/received PY - 2019/06/12/accepted PY - 2019/7/30/entrez PY - 2019/7/30/pubmed PY - 2019/7/30/medline SP - 1803876 EP - 1803876 JF - Evidence-based complementary and alternative medicine : eCAM JO - Evid Based Complement Alternat Med VL - 2019 N2 - Background: Motherwort injection, a common traditional Chinese medicine, is widely used for the prevention of postpartum hemorrhage (PPH), which has been found to be potential benefit in clinical practice. Objectives: This study aimed to conduct a rigorous systematic review of randomized evidence to offer a comprehensive overview regarding the efficacy and safety of motherwort injection in maternal women with virginal delivery. Methods: We included all randomized controlled trials involving pregnant women in vaginal delivery comparing motherwort injection or combination of motherwort injection and oxytocin with oxytocin alone for preventing postpartum hemorrhage. Paired reviewers independently screened citations, assessed risk of bias, and extracted data. Random-effects model by Mantel-Haenszal method was applied to pool the data. Predefined subgroup analyses and sensitivity analyses were conducted to explore the heterogeneity and robustness of results. The GRADE approach was used to rate the quality of evidence. Main Results: 37 randomized controlled trials involving 7887 participants were included, all of which were at moderate to high risk of bias. Meta-analyses of eight trials showed no significant difference in blood loss and PPH events between oxytocin versus motherwort injection (very low quality). However, pooling of 29 trials suggested a reduced risk of blood loss (within 2 hours: MD -55.06mL, 95% CI -84.06 to -26.06; within 24 hours: MD -85.57 mL, 95% CI -94.26 to -76.88, very low quality), PPH events (RR 0.29, 95% CI 0.21 to 0.39, low quality), and adverse events (Peto OR 0.53, 95% CI 0.40 to 0.70, very low quality) in participants treated with motherwort injection and oxytocin versus oxytocin alone. Conclusions: The current evidence supports the suggestion that the additional use of motherwort injection on oxytocin had a preferable outcome. However, given that the evidence is not definitive with low quality, further careful designed and conducted randomized controlled trials in larger population are warranted to conform the effects. SN - 1741-427X UR - https://www.unboundmedicine.com/medline/citation/31354850/Motherwort_Injection_for_Preventing_Postpartum_Hemorrhage_in_Women_with_Vaginal_Delivery:_A_Systematic_Review_and_Meta-Analysis_of_Randomized_Evidence L2 - https://dx.doi.org/10.1155/2019/1803876 DB - PRIME DP - Unbound Medicine ER -
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