{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T15:12:52Z","timestamp":1776093172935,"version":"3.50.1"},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We sought to evaluate the impact of a prospective change in practice to dual pharmacologic prophylaxis with oxytocin and misoprostol for patients at moderate or high risk for postpartum hemorrhage (PPH) based on validated hemorrhage risk assessments on PPH rates, quantitative blood loss (QBL) amounts, and morbidities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A quality improvement effort was undertaken with the addition of sublingual misoprostol prophylaxis immediately after birth for patients with moderate or high risk for hemorrhage during pre\u2010birth PPH risk assessment, 200\u2009\u03bcg for moderate and 400\u2009\u03bcg for high risk. \u201cOxytocin only\u201d prophylaxis was administered June 2021 to April 2022 and \u201cdual agent\u201d prophylaxis was given April 2022 to April 2023. Inclusion criteria: deliveries \u226520\u2009weeks' gestation with moderate or high\u2010risk pre\u2010birth PPH risk assessment. Exclusion criteria: missing QBL, gestational age &lt;20\u2009weeks or low PPH risk. Primary outcomes were QBL at delivery and total postpartum blood loss (PPBL). Secondary outcomes were PPH rate (\u2265\u20091000\u2009mL) and a composite of maternal morbidity. Data were captured electronically retrospectively for both time periods, with morbidities confirmed by chart review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 2104 (47.9%) patients were treated with oxytocin only prophylaxis and 2293 (52.1%) patients were in the intervention period with dual agent prophylaxis. The cesarean delivery rate for the oxytocin only group was 37.3%, and 39.2% for the dual agent prophylaxis group. Postpartum hemorrhage rate was similar between the two groups, but composite morbidity was significantly lower for the dual agent prophylaxis group (0.4% vs. 1.4% for single agent prophylaxis;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). In a subgroup analysis of cesarean delivery, PPH rate and composite morbidity were significantly lower for the dual agent prophylaxis group after adjusting for potential confounders (PPH rate: odds ratio [OR]: 0.76, 95% confidence interval [CI]: 0.60\u20130.95,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.02; composite morbidity: OR: 0.31, 95% CI: 0.12\u20130.69,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.004).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Dual agent prophylaxis with oxytocin and misoprostol immediately after delivery was associated with a significant reduction in total blood loss, PPH rates, and composite morbidity compared to oxytocin only prophylaxis in patients undergoing cesarean birth. Prospective studies are warranted to assess replicability and safety.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.70541","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T11:52:40Z","timestamp":1761220360000},"page":"266-273","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevention of postpartum hemorrhage in moderate and high\u2010risk patients: Addition of prophylactic misoprostol"],"prefix":"10.1002","volume":"173","author":[{"given":"Ashlesha K.","family":"Dayal","sequence":"first","affiliation":[{"name":"New York\u2010Presbyterian Queens  Flushing New York USA"},{"name":"Weill Cornell Medicine  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel W.","family":"Skupski","sequence":"additional","affiliation":[{"name":"New York\u2010Presbyterian Queens  Flushing New York USA"},{"name":"Weill Cornell Medicine  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosalyn","family":"Chan\u2010Akeley","sequence":"additional","affiliation":[{"name":"New York\u2010Presbyterian Queens  Flushing New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liping","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Vagelos College of Physician and Surgeons Columbia University  New York New York USA"},{"name":"Department of Epidemiology, Mailman School of Public Health Columbia University  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shai","family":"Bejerano","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Vagelos College of Physician and Surgeons Columbia University  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dinakar","family":"Velagala","sequence":"additional","affiliation":[{"name":"New York\u2010Presbyterian Queens  Flushing New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dena","family":"Goffman","sequence":"additional","affiliation":[{"name":"NewYork\u2010Presbyterian\/Columbia University Irving Medical Center  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,10,23]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"New York State Maternal Mortalityand Morbidity Adivsory Council Report.2023Albany NY: New York State Department of Health."},{"key":"e_1_2_9_3_1","unstructured":"New York State Maternal Mortality Review Report on Pregnancy\u2010Associated Deaths 2018\u20132020.2023Albany NY: New York State Department of Health."},{"key":"e_1_2_9_4_1","unstructured":"LagrewDMJ SakowskiC CapeV McCormickE MortonCH.Improving Health Care Response to Obstetric Hemorrhage V3.0 A California Maternal Quality Care Collaborative Toolkit.2022."},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogn.2021.04.007"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002351"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogn.2021.04.006"},{"issue":"4","key":"e_1_2_9_8_1","first-page":"Cd011689","article-title":"Uterotonic agents for preventing postpartum haemorrhage: a network meta\u2010analysis","volume":"4","author":"Gallos ID","year":"2018","journal-title":"Cochrane Database Syst 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Hemorrhage (PPH) Risk Asssessment Table\u00a01.1 in AWHONN Postpartum Hemorrhage Project.2017Association of Women's Health Obstetric and Neonatal Nurses."},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/1552-6909.1219"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003564"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2015-004411"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.2147\/RMHP.S179632"},{"key":"e_1_2_9_28_1","unstructured":"Joint Commission.PC Standards for Maternal Safety.2020Accessed May 23 2024.https:\/\/www.jointcommission.org\/standards\/r3\u2010report\/r3\u2010report\u2010issue\u201024\u2010pc\u2010standards\u2010for\u2010maternal\u2010safety#.YvEVg3bMKUl"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD011689.pub4"},{"issue":"2","key":"e_1_2_9_30_1","first-page":"CD007412","article-title":"Active versus expectant management for women in 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