A randomized controlled trial comparing oxytocin administration before andafter placental delivery in the prevention of postpartum hemorrhage

OBJECTIVE: To determine if the timing of the administration of prophylactic oxytocin influences the incidence of postpartum hemorrhage caused by uteri ne atony, retained placenta, and third-stage duration. STUDY DESIGN: Parturients who presented for vaginal delivery were randomize d in a double-blinded fashion to receive oxytocin, 20 units in a 500-mL cry stalloid intravenous bolus, beginning upon delivery of either the fetal ant erior shoulder or placenta. For all patients, the third stage of labor was managed with controlled cord traction until placental expulsion, followed b y at least 15 seconds of fundal massage. Patients were excluded if they had a previous cesarean section, multiple gestation, antepartum hemorrhage, or bleeding disorder. RESULTS: A total of 1486 patients were enrolled: 745 in the before-placenta group and 741 in the after-placenta group. The groups were similar with re spect to gestational age, fetal weight, labor duration, maternal age, parit y, and ethnicity. The incidence of postpartum hemorrhage did not differ sig nificantly between the two groups (5.4% vs 5.8%; crude OR, 0.92; 95% Cl, 0. 59 to 1.43). There were no significant differences between the two groups w ith respect to incidence of retained placenta (2.4% vs 1.6%; OR, 1.49; 95% Cl, 0.72 to 3.08), or third-stage duration (7.7 minutes vs 8.1 minutes; P = .23). CONCLUSIONS: The administration of prophylactic oxytocin before placental d elivery does not reduce the incidence of postpartum hemorrhage or third-sta ge duration, when compared with giving oxytocin after placental delivery. E arly administration, however, does not increase the incidence of retained p lacenta.