A Double-Blinded, Randomized Controlled Trial of Oxytocin at the Beginning versus the End of the Third Stage of Labor for Prevention of Postpartum HemorrhageHuh W.K. · Chelmow D. · Malone F.D.
Divisions of Maternal-Fetal Medicine and General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Tufts University School of Medicine/Tufts-New England Medical Center, Boston, Mass., USA
Do you have an account?
- Rent for 48h to view
- Buy Cloud Access for unlimited viewing via different devices
- Synchronizing in the ReadCube Cloud
- Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00
Article / Publication Details
Objective: The objective of this study was to compare the administration of oxytocin at the beginning and end of the third stage of labor for the prevention of postpartum hemorrhage. Methods: Patients with documented singleton pregnancies were randomly assigned to two groups. The first received 10 units of oxytocin intramuscularly at delivery of the anterior shoulder of the fetus and an identical appearing placebo injection following delivery of the placenta. The second received the opposite medication sequence. The study was double blinded. Blood loss was measured by weighing all fluids collected, visual estimation, and serial blood counts. Results: 27 women received oxytocin at the delivery of the fetal shoulder and 24 after the placenta. Oxytocin given after placenta delivery resulted in lower blood loss (345 vs. 400 ml, p = 0.28), lower collection bag weight (763 vs. 833 g, p = 0.55), lower change in HgB (–1.26 vs. –1.32 g, p = 0.86), lower ΔHCT (–3.43 vs. –3.64%, p = 0.85), and a shorter third stage of labor duration (8.6 vs. 9.2 min, p = 0.75). The incidence of postpartum hemorrhage, defined as estimated blood loss >500 ml (0 vs. 14.8%) was significantly lowered with oxytocin following placental delivery (p = 0.049). Conclusions: In our study, postpartum hemorrhage was less frequent when oxytocin administration was delayed until after placenta delivery.
© 2004 S. Karger AG, Basel
- Moir JC: The obstetrician bids and the uterus contracts. Br Med J 1964;ii:1025–1029.
- Prendiville W, Elbourne D, Chalmers I: The effects of routine oxytocic administration in the management of the third stage of labour: An overview of the evidence from controlled trials. Br J Obstet Gynaecol 1988;95:3–16.
- Li XF, Fortney JA, Kotelchuck M, Glover LH: The postpartum period: The key to maternal mortality. Int J Gynecol Obstet 1996;54:1–10.
Elbourne DR, Prendiville WJ, Carroli G, Wood J, McDonald S: Prophylactic use of oxytocin in the third stage of labor. The Cochrane Database of Systematic Reviews, 2003, p 1.
- Soriano D, Dulitzki M, Schiff E, Barkai G, Mashiach S, Seidman DS: A prospective cohort study of oxytocin plus ergometrine compared with oxytocin alone for prevention of postpartum hemorrhage. Br J Obstet Gynaecol 1996;103:1068–1073.
- Jackson KW, Allbert JR, Schemmer GK, Elliot M, Humphrey A, Taylor J: A randomized trial comparing oxytocin administration before and after placental delivery in the prevention of postpartum hemorrhage. Am J Obstet Gynecol 2001;185:873–877.
Article / Publication Details
Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.