A PROSPECTIVE COHORT STUDY OF OXYTOCIN PLUS ERGOMETRINE COMPARED WITHOXYTOCIN ALONE FOR PREVENTION OF POSTPARTUM HEMORRHAGE

Objective To determine the safety and efficacy of intramuscular oxytoc in plus ergometrine compared to intravenous oxytocin for prevention of postpartum haemorrhage, and the significance of administration at the end of the second stage of labour compared with that after the third stage. Design A prospective cohort study. Setting A university affilia ted tertiary medical centre. Participants Two thousand one hundred and eighty-nine women delivering singletons during 40 consecutive weeks. Main outcome measures Postpartum haemorrhage (> 500 ml), prolonged thi rd stage (> 30 min), retained placenta (> 60 min), elevated blood pres sure (systolic > 150 mmHg, diastolic > 100 mmHg). Results The rate of postpartum haemorrhage was not significantly different for oxytocin-er gometrine compared with oxytocin, when administered at the end of the second stage of labour (odds ratio 1.10, 95% confidence interval (CI) 0.75-1.61) or after the third stage (odds ratio 0.95, 95% CI 0.68-1.34 ). The patients receiving oxytocics at the end of the second stage of labour had significantly lower rates of postpartum haemorrhage, for bo th oxytocin-ergometrine (odds ratio 0.69, 95% CI 0.49-0.98) and oxytoc in (odds ratio 0.60, 95% CI 0.41-0.87), compared with those treated af ter the third stage. Conclusion Administration of oxytocin alone is as effective as the use of oxytocin plus ergometrine in the prevention o f postpartum haemorrhage, but associated with a significantly lower ra te of unpleasant maternal side effects. Oxytocics administered after d elivery of the fetal head compared with after the placental expulsion are associated with a significantly lower rate of postpartum haemorrha ge.