The Effect of Intrauterine Oxytocin-Soaked Gauze on Postoperative Bleeding in Cesarean Section: A Double-Blind Randomized Clinical Trial

Every year, childbirth remains one of the most significant risks to a woman's health, with excessive bleeding after delivery standing as a leading cause of death worldwide. When a baby is born, the uterus must contract tightly to seal off the blood vessels that once nourished the placenta. If these muscles remain soft or unresponsive, blood can pour out unchecked. To prevent this, doctors routinely give a hormone called oxytocin, which acts like a signal for the uterus to squeeze. However, the standard way of delivering this hormone—through a vein in the arm—can sometimes cause the heart to race or blood pressure to drop dangerously low, creating a new set of risks for the mother. This delicate balance between stopping the bleeding and keeping the mother stable has driven researchers to look for gentler ways to deliver the medicine directly to the source of the problem.

A team of scientists in Iran set out to test a simple, low-tech idea: could they soak a piece of sterile gauze in oxytocin and place it directly inside the uterus during a cesarean section to see if it would work better than the usual methods? They conducted a carefully controlled experiment involving 120 women who were scheduled for planned cesarean deliveries. The researchers divided these women into three groups. One group received the standard care of a dry gauze used for cleaning, another received gauze soaked in plain salt water, and the third group received gauze soaked in a solution containing the hormone oxytocin. Crucially, the women and the staff measuring the results did not know which group any woman belonged to, ensuring that the findings would be based purely on the physical effects of the treatment. While all women received the standard hormone treatment through their veins as part of routine safety, the researchers wanted to see if adding this local, direct application provided any extra protection against blood loss.

The results of the study were clear and measured with precision. The women who received the oxytocin-soaked gauze lost significantly less blood during the surgery compared to the other two groups. On average, the group with the hormone-soaked gauze lost about 440 milliliters of blood. In contrast, the group with the salt-water gauze lost about 540 milliliters, and the group with the dry gauze lost the most, averaging 625 milliliters. The difference was not just a matter of a few drops; the gap was substantial enough to be statistically significant, suggesting that the direct application of the hormone helped the uterus contract more effectively right where it was needed. Furthermore, the women in the oxytocin group maintained more stable blood pressure throughout the procedure. While the other two groups saw their blood pressure drop noticeably after the surgery, the women who received the oxytocin gauze kept their blood pressure steady, avoiding the sudden dips that can sometimes complicate recovery.

Beyond the volume of blood lost, the researchers looked at how the women's bodies responded to the procedure. They measured levels of hemoglobin and hematocrit, which are indicators of how much oxygen-carrying capacity remains in the blood after losing fluid. The women in the oxytocin group experienced a much smaller drop in their hematocrit levels compared to the control groups, reinforcing the finding that they had lost less blood overall. Interestingly, the study found no increase in serious side effects or complications for the women receiving the oxytocin gauze. Their heart rates remained stable, and they did not suffer from the cardiovascular issues sometimes associated with high doses of oxytocin given through the vein. The only notable physical change was a slight drop in body temperature for all groups, which is common after surgery, but this did not differ significantly between the groups in a way that suggested the treatment caused harm.

This study suggests that placing a gauze soaked in oxytocin directly into the uterus during a cesarean section is a safe and effective way to reduce bleeding. By delivering the medicine right to the uterine wall, the treatment appears to help the muscle contract more efficiently without triggering the systemic side effects that can occur when the drug circulates through the entire body. The researchers noted that while this method worked well in their single hospital setting, larger studies involving more women and different locations would be needed to confirm these findings universally. For now, the evidence points to a simple, inexpensive addition to surgical care that could help keep mothers safer and more stable during one of the most critical moments of childbirth.