A comparison between Oxytocin alone versus combined therapy in postpartum females with uterine atony: a cross-sectional study in Damascus, Syria

Background Uterine atony, defined as the failure of the uterus to contract adequately following delivery, is the leading cause of postpartum hemorrhage (PPH), accounting for over half of all cases. Despite oxytocin being the first-line uterotonic agent, many cases require escalation to second-line therapies such as misoprostol, methylergonovine, or mechanical interventions. Identifying the most effective management strategy is critical to reducing maternal morbidity and improving recovery outcomes. Objective aims to collect the data surrounding this area, assess the incidence of complications due to uterine atony, and compare the efficacy of oxytocin monotherapy, versus with methylergonovine, or misoprostol, or the combination of prostaglandin and uterine tamponade. Methods This retrospective cross-sectional study included 402 women diagnosed with uterine atony at Al Zahrawi Hospital for Obstetrics and Gynecology in Damascus, Syria, between January 2022 and June 2025. Patients were grouped based on treatment received: oxytocin alone (n = 169) or combination therapy (n = 231), which included misoprostol, methylergonovine, uterine tamponade, or multiple interventions. Primary outcomes were hysterectomy and bleeding severity. Secondary outcomes included transfusion need, hospital stay duration, and associations with clinical variables. Data were analyzed using Chi-square tests and descriptive statistics. Results Hysterectomy was required in 35 cases (8.7%), and transfusion in 35 cases (8.7%), with no statistically significant difference between treatment groups. Significant associations were found between treatment type and age, gestational age, parity, anemia status, bleeding amount, and hospital stay duration ( p < 0.05). Combination therapy was associated with reduced postpartum complications and shorter hospital stays. Conclusion While hysterectomy and transfusion rates did not differ significantly between groups, combination therapy showed potential benefits in reducing postpartum complications and hospital stay duration. Further prospective studies are warranted to confirm these findings and guide clinical practice.