The GDG acknowledged that either intravenous or intramuscular oxytocin is effective in preventing PPH and both routes of administration are currently recommended by WHO for this indication.

• While noting that the balance of effects favours intravenous oxytocin for important health outcomes, the GDG placed its emphasis on other considerations (including feasibility and impacts on resources, health equity and women’s comfort), as well as studies suggestive of possible safety concerns with a rapid intravenous bolus of oxytocin. In instances where women already have intravenous access (for another medical indication), it is recommended to administer oxytocin intravenously.
• The GDG acknowledged existing WHO recommendations against the routine use of intravenous fluids during labour and childbirth, with emphasis on the widespread and unnecessary use of routine administration of intravenous fluids for all women in labour in many health facilities in low-, middle- and high-income settings that increases cost and has an impact on resource use (42). The GDG emphasized that intravenous access should not be placed routinely for the sole purpose of administering intravenous oxytocin for PPH prevention.
• The GDG noted that the previous trials considered for this question have all administered an oxytocin dose of 10 IU intravenously for PPH prevention during vaginal birth. However, the speed of injection ranged from 1 minute (for bolus injection) to 40 minutes (for infusion) and volume of dilution from 1 mL (for bolus injection) to 1000 mL of saline (for infusion). There is no direct evidence comparing the different regimens for administering intravenous oxytocin during vaginal birth, and there were no safety concerns (such as hypotension or tachycardia) in trials comparing slow intravenous administration of 10 IU oxytocin over 1 minute with 10 IU intramuscular oxytocin (43, 44). However, observational studies in women undergoing caesarean section suggest that rapid intravenous results in harmful haemodynamic effects (44, 45). Therefore, the GDG suggests avoiding a rapid injection, and agreed that the 10-IU oxytocin dose should preferably be diluted and administered slowly (over 1–2 minutes).
• This recommendation reflects available evidence from direct comparison of intravenous versus intramuscular oxytocin during vaginal birth. For women undergoing caesarean section, WHO currently recommends 10 IU for PPH prevention without preference for intravenous or intramuscular route (10).
• This recommendation does not relate to the use of oxytocin for other obstetric indications (such as labour induction).