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Study selection, data extraction and quality assessment were conducted by two investigators independently. We pooled results in fixed effects meta-analyses and calculated average risk ratio (RR), mean difference (MD) and 95% CI. We used GRADE to assess the overall quality of evidence for each outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Three trials (180\u2009women) were included in the review. All studies compared intramyometrial (IMY) versus intravenous oxytocin in women having prelabour CS. IMY compared with intravenous oxytocin administration may result in little or no difference in the incidence of postpartum haemorrhage (RR 0.14, 95%\u2009CI 0.01 to 2.70; N=100 participants; 1 RCT), hypotension (RR 1.00, 95%\u2009CI 0.29 to 3.45; N=40; 1 RCT), headache (RR 3.00, 95%\u2009CI 0.13 to 69.52; N=40; 1 RCT) or facial flushing (RR 0.50, 95%\u2009CI 0.05 to 5.08; N=40; 1 RCT); IMY oxytocin may reduce nausea\/vomiting (RR 0.13, 95%\u2009CI 0.02 to 0.69; N=140; 2 RCTs). We are very uncertain about the effect IMY versus intravenous oxytocin on the need for additional uterotonics (RR 0.82; 95%\u2009CI 0.25 to 2.69; N=140; 2 RCTs). IMY oxytocin may reduce blood loss slightly (MD \u221257.40\u2009mL, 95%\u2009CI \u2212101.71 to \u221213.09; N=40; 1 RCT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There is limited, low to very low certainty evidence on the effects of IMY versus intravenous oxytocin at CS for preventing blood loss. The evidence is insufficient to support choosing one route over another. More trials, including studies that assess intramuscular oxytocin administration, are needed on this relevant question.<\/jats:p><\/jats:sec><jats:sec><jats:title>PROSPERO registration number<\/jats:title><jats:p>CRD42020186797.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2021-051793","type":"journal-article","created":{"date-parts":[[2021,9,16]],"date-time":"2021-09-16T16:57:59Z","timestamp":1631811479000},"page":"e051793","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Route of oxytocin administration for preventing blood loss at caesarean section: a systematic review with meta-analysis"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4944-0720","authenticated-orcid":false,"given":"Maria Regina","family":"Torloni","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Siaulys","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Riera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Luiza Cabrera","family":"Martimbianco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael Leite","family":"Pacheco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9146-4684","authenticated-orcid":false,"given":"Carolina de Oliveira Cruz","family":"Latorraca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana","family":"Widmer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Pilar","family":"Betran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,9,16]]},"reference":[{"key":"2021091609552066000_11.9.e051793.1"},{"key":"2021091609552066000_11.9.e051793.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2012.08.018"},{"key":"2021091609552066000_11.9.e051793.3","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1016\/j.jgyn.2014.10.004","article-title":"[Obstetric and anesthetic specificities in the management of a postpartum hemorrhage (PPH) associated with cesarean section]","volume":"43","author":"Parant","year":"2014","journal-title":"J Gynecol Obstet Biol Reprod"},{"key":"2021091609552066000_11.9.e051793.4","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1016\/j.jgyn.2014.09.023","article-title":"[Epidemiology of post-partum haemorrhage]","volume":"43","author":"Deneux-Tharaux","year":"2014","journal-title":"J Gynecol Obstet Biol Reprod"},{"key":"2021091609552066000_11.9.e051793.5","doi-asserted-by":"crossref","first-page":"e323","DOI":"10.1016\/S2214-109X(14)70227-X","article-title":"Global causes of maternal death: a WHO systematic analysis","volume":"2","author":"Say","year":"2014","journal-title":"Lancet Glob Health"},{"key":"2021091609552066000_11.9.e051793.6","unstructured":"World Health Organization . 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