Intraumbilical vein injection of oxytocin versus normal saline with active management of third stage of labour: A randomised controlled trial

Abstract

Introduction: Postpartum haemorrhage remains a leading cause of maternal mortality (25.0%) especially in developing countries. Prolonged third stage of labour owing to placenta retention and uterine atony are among the underlying cause of most cases of PPH. Intraumbilical vein injection (IUV) is inexpensive, non-surgical, non-aggressive, cheap and pharmacological method which may be included in prevention and treatment of PPH and in retained placenta.Objectives: To study the efficacy of intraumbilical vein injection of 20 IU oxytocin with comparison with normal saline and its effect of duration of 3rd stage of labour, reduction of blood loss and incidence / prevention of retained placenta.Methods: A RCT of 80 Patients in normal labour at NMCH&RC. Study group (group A - 40) will receive 20 IU(4ml) oxytocin diluted with 26 ml of normal saline intraumbilically (total 30ml) and the control group (group B - 40) will receive intraumbilical 30 ml normal saline. Medications are given directly in the umbilical vein after clamping, injection given over 1 minute. Active management of the third stage of labour (prophylactic injection of 10 IU oxytocin within 2 minutes of birth, early clamping of the umbilical cord and controlled cord traction) was used in both groups. Results: The mean estimated blood loss was significantly lower in women treated with oxytocin compared with women in the normal saline group (148.35 ml compared with 364.50 mL, respectively; P< .001). The third stage of labour was significantly shorter in the oxytocin group than in the normal saline group (2.33 minutes compared with 5.20minutes, respectively; P< .001). The percentages of placentas remaining undelivered beyond 15 minutes were 0% in both the groups. Conclusion: The use of intraumbilical injection of oxytocin with the active management of the third stage of labour significantly reduced postpartum blood loss and the duration of the third stage thereby decreasing maternal morbidity and mortality and incidence of blood transfusion.