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.

中文翻译：

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益母草注射液预防阴道分娩妇女产后出血：随机证据的系统回顾和荟萃分析。

背景。益母草注射液是一种常见的中药，广泛用于预防产后出血（PPH），在临床实践中发现其具有潜在的益处。目标。本研究旨在对随机证据进行严格的系统评价，以全面概述益母草注射液对处女分娩的产妇的有效性和安全性。方法。我们纳入了所有涉及阴道分娩孕妇的随机对照试验，比较益母草注射液或益母草注射液与催产素联合用药与单独使用催产素预防产后出血的效果。配对审稿人独立筛选引文、评估偏倚风险并提取数据。应用Mantel-Haenszal 方法的随机效应模型来汇集数据。进行预定义的亚组分析和敏感性分析，以探讨结果的异质性和稳健性。GRADE 方法用于评估证据的质量。主要结果。纳入了 37 项随机对照试验，涉及 7887 名参与者，所有这些试验都存在中度至高偏倚风险。八项试验的荟萃分析显示，催产素与益母草注射液在失血量和 PPH 事件方面没有显着差异（质量非常低）。然而，29 项试验的汇总表明失血风险降低（2 小时内：MD -55.06mL，95% CI -84.06 至 -26.06；24 小时内：MD -85.57 mL，95% CI -94.26 至 -76.88，与接受益母草注射液和催产素治疗的受试者相比，接受益母草注射液和催产素治疗的受试者的 PPH 事件（RR 0.29，95% CI 0.21 至 0.39，低质量）和不良事件（Peto OR 0.53，95% CI 0.40 至 0.70，极低质量）单独使用催产素。结论。目前的证据支持这样的建议，即在催产素的基础上额外使用益母草注射液具有更好的结果。然而，鉴于证据不明确且质量较低，有必要在更大的人群中进一步仔细设计和进行随机对照试验以验证效果。