title: Timing of prophylactic uterotonics for the third stage of labour after vaginal birth.
abstract: BACKGROUND
  Administration of the uterotonic drugs is one of the main components of the active management of the third stage of labour. The timing of uterotonics varies considerably across the globe and it may have significant implications on the well-being of the mothers and their babies.
  
  
  OBJECTIVE
  To assess the effect of the timing of administration of prophylactic uterotonics (before compared to after placental delivery) on the outcomes related to the third stage of labour.
  
  
  METHODS
  We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (September 2009).
  
  
  METHODS
  Randomised controlled trials examining the timing of prophylactic uterotonic drugs in the third stage of labour.
  
  
  METHODS
  Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. Data entry was checked
  
  
  RESULTS
  We included three trials involving 1671 participants; oxytocin was the only uterotonic drug that was used. The dose and route of administration of oxytocin varied among the included studies. Administration of oxytocin before and after the expulsion of placenta does not significantly influence the incidence of postpartum haemorrhage (blood loss greater than 500 ml) (risk ratio (RR) 0.81, 95% confidence interval (CI) 0.62 to 1.04; n = 1667, three trials); retained placenta (RR 1.54, 95% CI 0.76 to 3.11; n = 1667, three trials); length of third stage of labour (minutes) (mean difference (MD) -0.30, 95% CI -0.95 to 0.36; n = 1667, three trials); postpartum blood loss (ml) (MD 22.32, 95% CI -58.21 to 102.86; n = 181, two trials); changes in haemoglobin (g/dL) (MD 0.06, 95% CI -0.60 to 0.72; n = 51, one trial); blood transfusion (RR 0.79, 95% CI 0.23 to 2.73; n = 1667, three trials); the use of additional uterotonics (RR 1.10, 95% CI 0.80 to 1.52; n = 1667, three trials); the incidence of maternal hypotension (RR 2.48, 95% CI 0.23 to 26.70; n = 130, one trial) and the incidence of severe postpartum haemorrhage (blood loss 1000 ml or more) (RR 0.98, 95% CI 0.48 to 1.98; n = 130, one trial). No data on other maternal or neonatal outcome measures were available.
  
  
  CONCLUSIONS
  Administration of oxytocin before and after the expulsion of placenta did not have any significant influence on many clinically important outcomes such as the incidence of postpartum haemorrhage, rate of placental retention and the length of the third stage of labour. However, the number of available studies were limited. The only uterotonic drug used was oxytocin, mainly through intravenous infusion, therefore its extrapolation to other routes of administration should be interpreted cautiously. More studies are required to examine other maternal and neonatal outcomes using consistent approaches.
authors.affiliation: Faculty of Health and Wellbeing, Sheffield Hallam University, 32 Collegiate Crescent, Sheffield, UK, S10 2BP.
authors.forename: Hora
authors.initials: H
authors.lastname: Soltani
authors.forename: David R
authors.initials: DR
authors.lastname: Hutchon
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Poulose
mesh_terms: D036861:Delivery, Obstetric; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007749:Labor Stage, Third / Q000187:drug effects* / Q000502:physiology; D010120:Oxytocics / Q000008:administration & dosage*; D010121:Oxytocin / Q000008:administration & dosage*; D018457:Placenta, Retained / Q000517:prevention & control; D006473:Postpartum Hemorrhage / Q000517:prevention & control; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic
chemical_list: D010120:Oxytocics; D010121:Oxytocin