Using intraumbilical vein injection of oxytocin in routine practice with active management of the third stage of labor: a randomized controlled trial.
OBJECTIVE
To estimate the efficacy of the routine use of intraumbilical vein injection of oxytocin with active management of the third stage of labor in reducing blood loss and length of the third stage.


METHODS
In this prospective, randomized, double-blind trial, 412 women undergoing vaginal delivery who did not have risk factors for postpartum hemorrhage were randomly allocated to receive either 20 international units oxytocin diluted with 26 mL saline (n=207) or 30 mL saline (n=205) by intraumbilical vein injection. Active management of the third stage of labor (prophylactic injection of 10 international units oxytocin within 2 minutes of birth, early clamping of the umbilical cord, and controlled cord traction) was used in both groups. The primary outcome was mean blood loss during the third and fourth stages of labor.


RESULTS
The mean estimated blood loss was significantly lower in women treated with oxytocin compared with women in the placebo group (195.3+/-81.0 mL compared with 288.3+/-134.1 mL, respectively; P<.001). The third stage of labor was significantly shorter in the oxytocin group than in the placebo group (4.5+/-1.6 minutes compared with 7.9+/-3.4 minutes, respectively; P<.001). The percentages of placentas remaining undelivered beyond 15 minutes were 0% in the oxytocin group and 4.4% in the placebo group (P=.002).


CONCLUSIONS
The use of intraumbilical injection of oxytocin with the active management of the third stage of labor significantly reduced postpartum blood loss and the duration of the third stage.


BACKGROUND
ClinicalTrials.gov, www.clinicaltrials.gov, NCT01094028.


METHODS
I.
Güngördük
Kemal
K
From Mardin Women and Children Hospital, Mardin, Turkey; and the Department of Obstetrics and Gynecology, Istanbul Bakirkoy Women and Children Hospital, Istanbul, Turkey.
Asicioglu
Osman
O
Besimoglu
Berhan
B
Güngördük
Ozgu Celikkol
OC
Yildirm
Gokhan
G
Ark
Cemal
C
Tekirdağ
Ali Ismet
AI
D000328:Adult; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007749:Labor Stage, Third / Q000187:drug effects*; D010120:Oxytocics / Q000008:administration & dosage*; D010121:Oxytocin / Q000008:administration & dosage*; D018457:Placenta, Retained / Q000517:prevention & control*; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D014471:Umbilical Veins; D055815:Young Adult
D010120:Oxytocics; D010121:Oxytocin