Prospective randomized trial of oxytocin administration for active management of the third stage of labor

Abstract

Objective: To determine the most efficient route and timing of oxytocin administration for active management of the third stage of labor.

Methods: A prospective randomized study was done at one center in Ankara, Turkey, between January and October 2010. Women with a singleton pregnancy (>37 weeks) who had a live vaginal birth were randomly allocated to four groups: iv-A (intravenous oxytocin after delivery of the fetus), iv-B (when anterior shoulder seen), im-A (intramuscular oxytocin after delivery), and im-B (when anterior shoulder seen). Postpartum blood loss within the first hour, hemoglobin, hematocrit, and duration of the third stage were compared.

Results: A total of 600 eligible women were recruited; 150 were assigned to each group. Postpartum blood loss, prepartum and postpartum hemoglobin and hematocrit, and need for additional uterotonics were similar among groups (P>0.05). The duration of the third stage of labor and changes in hemoglobin and hematocrit were significantly reduced in group iv-B (P<0.05). Among women not exposed to oxytocin before delivery, postpartum blood loss was significantly lower in group iv-B (P=0.019). Labor augmentation was related to significantly increased postpartum blood loss in all groups except iv-A.

Conclusion: Although postpartum blood loss was similar in all groups, early intravenous administration seemed to have beneficial effects. ClinicalTrials.gov: NCT01954186.

Keywords: Active management of third stage of labor; Labor augmentation; Oxytocin; Postpartum hemorrhage.