A double-blinded, randomized controlled trial of oxytocin at the beginning versus the end of the third stage of labor for prevention of postpartum hemorrhage.
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 DeltaHCT (-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.
Huh
Warner K
WK
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tufts University School of Medicine/Tufts-New England Medical Center, Boston, Mass. 02111, USA.
Chelmow
David
D
Malone
Fergal D
FD
D000328:Adult; D016001:Confidence Intervals; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007273:Injections, Intramuscular; D007747:Labor Stage, First; D007749:Labor Stage, Third; D010121:Oxytocin / Q000008:administration & dosage*; D006473:Postpartum Hemorrhage / Q000188:drug therapy* / Q000517:prevention & control*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011322:Primary Prevention / Q000379:methods; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment; D016896:Treatment Outcome
D010121:Oxytocin