Customised management of the third stage of labour.
BACKGROUND
Postpartum haemorrhage (PPH) rates are increasing worldwide. The rate is particularly high in women undergoing an induced or augmented labour. In response to this, we altered our hospital's protocol for the management of the third stage of labour to recommend Syntometrine, in preference to oxytocin alone, for women being induced or augmented. We set out to assess the impact of the protocol change on the PPH rate.


METHODS
A random sample of 1200 women who had a singleton, term vaginal birth before and after the protocol change was taken. Exclusion criteria were then applied to match PPH risk status. Using a quasi-experimental study design, PPH rates were compared between women who had received oxytocin or Syntometrine for third stage management.


RESULTS
Five hundred and forty-nine women received oxytocin prior to the protocol change and were compared with 333 women who received Syntometrine after protocol change. There was no difference in the PPH rate with respect to uterotonic used (P = 0.9). There was no evidence of an interaction between labour type, third stage uterotonic and PPH (P = 0.4). PPH rates were lowest for women who laboured spontaneously and received Syntometrine (19% oxytocin, 14% Syntometrine). The PPH rate was unchanged by uterotonic in women whose labour was augmented (34% for both). PPH was more common in women being induced who received Syntometrine (22% oxytocin, 27% Syntometrine). None of these differences were statistically significant.


CONCLUSIONS
Compared to oxytocin, Syntometrine did not reduce the rate of PPH in women with augmented or induced labour. Other approaches to reducing PPH rates are required.
Monash Women's Services, Monash Health, Melbourne, Victoria, Australia.
Edward
E
Springhall
Monash Women's Services, Monash Health, Melbourne, Victoria, Australia.|The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, Victoria, Australia.|Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.
Euan M
EM
Wallace
Monash Women's Services, Monash Health, Melbourne, Victoria, Australia.
Lynne
L
Stewart
Monash Women's Services, Monash Health, Melbourne, Victoria, Australia.
Michelle
M
Knight
Monash Women's Services, Monash Health, Melbourne, Victoria, Australia.|The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, Victoria, Australia.
Joanne C
JC
Mockler
The Ritchie Centre, The Hudson Institute of Medical Research, Melbourne, Victoria, Australia.|Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.
Miranda
M
Davies-Tuck
D000328:Adult; D002985:Clinical Protocols; D004874:Ergonovine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007749:Labor Stage, Third; D007751:Labor, Induced / Q000706:statistics & numerical data; D010120:Oxytocics / Q000627:therapeutic use*; D010121:Oxytocin / Q000627:therapeutic use*; D006473:Postpartum Hemorrhage / Q000453:epidemiology* / Q000517:prevention & control; D011247:Pregnancy; D055815:Young Adult
D010120:Oxytocics; C038346:syntometrine; D010121:Oxytocin; D004874:Ergonovine
Syntometrine; oxytocin; postpartum haemorrhage; third stage; uterotonic