ROUTINE OXYTOCIN IN THE 3RD STAGE OF LABOR - A PLACEBO-CONTROLLED RANDOMIZED TRIAL

Objective To compare intravenous oxytocin administration (Partocon(R) 10 IU) with saline solution in the management of postpartum haemorrhag e in the third stage of labour. Design A double-blind, randomised cont rolled trial involving 1000 parturients with singleton fetuses in ceph alic presentation and undergoing vaginal delivery, randomly allocated to treatment with oxytocin (n = 513) or 0.9% saline solution (n = 487) . Setting Labour ward at a central county hospital. Main outcome measu res Mean blood loss (total, and before and after placenta delivery); f requencies of blood loss > 800 mL, need of additional oxytocic treatme nt, postpartum haemoglobin < 10 g/dL; and duration of postpartum hospi talisation. Results As compared with saline solution, oxytocin adminis tration was associated with significant reduction in mean total blood loss (407 versus 527 mL), and in frequencies of postpartum haemorrhage > 800 mL (8.8% versus 15.2%), additional treatment with metylergometr ine (7.8% versus 13.8%), and postpartum Hb < 10 g/dL (9.7% versus 15.2 %), and a nonsignificant increase in the frequency of manual placenta removal (3.5% versus 2.3%). There was no group difference in the mean duration of postpartum hospitalisation (4.6 versus 4.5 days, respectiv ely). Conclusions Administration of intravenous oxytocin in the third stage of labour is associated with an approximately 22% reduction in m ean blood loss, and approximately 40% reductions in frequencies of pos tpartum haemorrhage (> 500 mL or > 800 mL) and of postpartum haemoglob in < 10 g/dL. Identification of risk groups for oxytocin treatment doe s not seem worthwhile. Oxytocin is a cheap atoxic drug and should be g iven routinely after vaginal delivery.