Oxytocin In Active Management Research Articles

A randomized controlled study comparing oral misoprostol with intramuscular oxytocin in active management of third stage of labour.

The study aimed to compare the effectiveness and side effects of 600 μg of oral Misoprostol with 10 international units (IU) intramuscular oxytocin in managing the third stage of labor. This open-label, randomized controlled trial included 260 low-risk women in the second stage of labor with anticipated vaginal delivery. They were randomly assigned, to receive either 600 μg of misoprostol orally or 10 IU of oxytocin intramuscularly. The primary outcomes were blood loss during delivery and incidence of postpartum hemorrhage, evaluated using intention-to-treat analysis. Significance was set at P≤0.05. Baseline characteristics were similar in both groups (P>0.05). The misoprostol group had a significantly lower blood loss than that of the oxytocin group (306.57±176.44 mL vs. 349.37±135.50 mL; relative difference, -12.251 [95% confidence intervals [CI], -22.528 to -1.575]; P=0.012). Incidence of postpartum hemorrhage was similar in both the groups (relative risk [RR], 0.952 [95% CI, 0.543 to 0.671]; P=0.865). Additional oxytocic therapy requirement was also comparable (RR, 1.143 [95% CI, 0.671 to 1.947]; P=0.623). Nausea, shivering, and mean increase in temperature were significantly more common in the misoprostol group than in the oxytocin-parturient group. In this study, 600 μg oral misoprostol was superior to intramuscular 10 IU oxytocin in reducing blood loss at birth, and equally effective in preventing postpartum hemorrhage. However, misoprostol exhibited more side effects compared to that of oxytocin.

Comparative Efficacy of Syntometrine Versus Oxytocin in Active Management of Third Stage of Labour

Objective: The study's objective is to examine the effectiveness of syntometrine and oxytocin in actively managing the third stage of labour in order to lower the risk of PPH and other undesirable third stage outcomes. Study Design: Randomized/Prospective study Place and Duration: Gynae & Obs department of Combined Military Hospital Peshawar for the duration from 1st June 2021 to 30th November 2021. Methods: This study comprised of 140 females of third stage labour. Age of the females was 18-40 years. After getting informed written consent detailed demographics of enrolled cases were recorded. Patients were equally divided in two groups. Group I had 70 patients and received syntometrine (5 IU Synthetic Oxytocin and 0.5 mg ergometrine maleate) and in group II oxytocin was given to 70 females. Outcomes among both groups were recorded in terms of blood loss and postpartum hemorrhage. SPSS 23.0 was used to analyze all data. Results: The mean age of the patients was 28.3±6.18 years and had mean BMI 27.6±11.25 kg/m2. Mean gestational age was 36.11±5.19 weeks. Frequency of primigravida was 80 (57.1%). Frequency of emergency delivery was found in 85 (60.7%) cases while 55 (39.3%) females admitted to OPD. 72 (51.4%) females were from rural areas and 67 (47.8%) cases were educated. We found that mean blood loss in group II was higher 165.1±8.66 ml as compared to group I 118.7±9.39 ml with p value <0.005. There was no any PPH found in group I while in group II PPH found in 3 (4.3%) cases. Frequency of hypertension was higher in group I. We found higher number of adverse outcomes among females of syntometrine group as compared to oxytocin group. Conclusion: In this study we concluded that use of syntometrine in third stage of labour was effective and useful in terms of reduction in blood loss and PPH as compared to oxytocin while frequency of adverse events and hypertension was higher in syntometrine group as compared to oxytocin. Keywords: Pregnant Females, Third Stage Labour, Syntometrine, Oxytocin, Blood Loss

Comparison of sublingual misoprostol with intramuscular oxytocin in active management of the third stage of labor

Comparison of sublingual misoprostol with intramuscular oxytocin in active management of the third stage of labor

Comparing the Effectiveness of Transrectal Misoprostol with Intravenous Oxytocin in Active Management of Third Stage of Labour in Preventing Post-partum Hemorrhage

Background: PPH which is 500 ml or more blood loss in 24 hours of birth . Uterine atony has been the commonest cause of PPH. To prevent PPH uterotonics like oxytocin and misoprostol should be given. Intravenous route of oxytocin has rapid effect, but is associated with cardiovascular side effects like rise in heart rate and decrease in blood pressure. Slower rate of absorption, lower peak levels and reduced adverse effects is seen with misoprostol given rectally when compared to sublingual and oral routes. This study aims to compare the effectiveness of transrectal misoprostol and intravenous oxytocin in preventing post-partum haemorrhage.
 Objectives: To compare the effectiveness of 600mcg transrectal misoprostol with 10IU intravenous oxytocin in active management of third stage of labour in preventing PPH and recommend technique for active management of third stage of labour in preventing PPH.
 Methodology: Women randomized into two groups for prevention of PPH and are given 600ug of misoprostol per rectally and 10IU oxytocin intravenously. Duration of third stage, the blood volume in kidney tray and additional blood loss in sterile surgical pads for 24hrs will be noted. The blood loss due to episiotomy will be taken as 50ml.Need of additional uterotonics(oxytocin or misoprostol), blood transfusion, removal of placenta manually, haemoglobin before and after delivery will be noted. Monitoring of patients for vital signs, uterine tone, fundal height and vaginal bleeding for 2 hour will be done.
 Result: The expected outcome of the study will be a significant difference in the blood loss during third stage of labour and 24 hours in post-partum period when uterotonics like oxytocin or misoprostol are used in managing third stage of labour actively.
 Conclusion: Our study will show the effect of intravenous oxytocin and transrectal misoprostol in managing third stage of labour actively to prevent post-partum hemorrhage.

Carbetocin versus Oxytocin in Active Management of 3rd stage of Labour following Vaginal Delivery

Background: Every day more than 220 women around the world die from severe bleeding after childbirth. Globally post-partum hemorrhage is the number one direct cause of maternal mortality. Most postpartum hemorrhages are caused by uterine atony and occur in the immediate postpartum period. Most of these tragic deaths can be prevented by active management of third stage of labour. Active management of the third stage of labor should be practiced routinely to decrease the risk of postpartum hemorrhage. Oxytocin is used for enhancing uterine contraction after delivery. But oxytocin has some limitations like shorter half- life, less contraction time and more side effects, whereas carbetocin has prolonged duration of action which ensures more contraction time and less adverse effects. This study was done to see the efficacy and safety of carbetocin over oxytocin for prevention of PPH after vaginal delivery.
 Methodology: A randomized controlled clinical trial was conducted in the Department of Obstetrics and Gynecology, Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh over a period of 9 months from January 2015 to September 2015. Ninety four patients undergoing vaginal delivery at term were randomized into two groups receiving either 10IU oxytocin or 100 μg carbetocin. Outcome measures such as primary PPH, massive blood loss, need for additional uterotonic drug, additional blood transfusion as well as adverse effects were documented.
 Results: In this study, massive blood loss did not occur none of patients in carbetocin group. But massive blood loss occured 6.4% women of oxytocin group. Further fundal massage , immediate blood transfusion and additional uterotonics didn’t need any patient in carbetocin group. In oxytocin group, fundal massage required in 8.5% of women, blood transfusion needed in 10.6% patients and additional uterotonics needed in 10.6% women. Average amount of blood loss was 88 ml less in carbetocin group and adverse effects of drugs were almost similar in both group. Primary PPH developed in oxytocin group 8.5% but none of patients had developed PPH in carbetocin group.
 Conclusion: Carbetocin is an effective new drug than oxytocin for prevention of postpartum hemorrhage in vaginal delivery.
 Bioresearch Commu. 7(1): 927-931, 2021 (January)

A Comparative Study: Is Misoprostol as Effective as Oxytocin in Active Management of Third Stage of Labor?

Background: The third stage of labor is that period from birth of the infant until the delivery of the placenta. Active management of the third stage of labor plays an important role in reducing maternal morbidity and mortality. Oxytocin is an effective drug in preventing postpartum hemorrhage (PPH) however; it requires a controlled environment and intramuscular administration. Misoprostol is an orally active uterotonic agent,stable at room temperature.The purpose of this study was to compare the efficacy of misoprostol with oxytocin in active management of third stage of labor.
 Materials and Methods: This was a hospital based study carried out in Paropakar Maternity and Women Hospital, Kathmandu, Nepal during six months period from February 2012 to July 2012. One hundred patients fulfilling inclusion criteria were recruited to receive either 10 unit of IM oxytocin or 600 mcg of oral misoprostol for the management of the third stage of labor.
 Results: The mean blood loss in misoprostol and oxytocin group was 209±76.7ml and 197±68.8 ml respectively with p value-0.41 which was insignificant. Similarly mean hemoglobin change was also not significant. The additional uterotonics needed in misoprostol was higher (9 cases) than that in oxytocin (5 cases) but it was also not significant. Shivering and fever were significantly high among misoprostol group than in oxytocin group.
 Conclusion: Efficacy of oxytocin and misoprostol is equal in active management of third stage of labor.

Misoprostol versus oxytocin in preventing postpartum hemorrhage: A randomized controlled trial

Objective: To compare low dose sublingual misoprostol with the standard 10 IU of intramuscular oxytocin in active management of third stage of labor. Materials and Methods: A total of 104 women with term pregnancy were randomized to receive either 200 μg misoprostol sublingually or 10 IU oxytocin intramuscularly after vaginal delivery. Primary outcome measured was mean blood loss and incidence of primary postpartum hemorrhage (PPH). Secondary outcome measured included duration of third stage of labor, side effects of drugs and need for additional oxytocics to treat life‑threatening hemorrhage. Results: A total of 104 women with term pregnancy in two groups of 52 were studied. The mean blood loss with sublingual misoprostol and oxytocin groups was 320.58 ± 244.12 vs. 253.27 ± 171.74 ml; P = 0.11. There was no significant differences between the misoprostol and oxytocin groups with regard to the incidence of PPH (19.2% vs. 13.5% respectively; P = 0.43). More women in the misoprostol group experienced side effects compared with those in oxytocin group; however, the difference was not statistically significant ( P = 0.26). The mean duration of third stage of labor was similar and the difference was statistically not significant (6.65 ± 3.47 vs. 6.08 ± 3.07 minutes) ( P = 0.38), as well as need for additional oxytocics (13.5% vs. 5.8% P = 0.18) misoprostol and oxytocin, respectively. Conclusion: Sublingual misoprostol has similar efficacy to standard intramuscular oxytocin in preventing PPH following vaginal birth. Misoprostol at 200 μg with its thermostability may be an effective alternative to intramuscular oxytocin in active management of third stage of labor. Keywords: Primary postpartum hemorrhage; misoprostol; uterotonics

Comparison of intramuscular methylergometrine, rectal misoprostol, and low-dose intravenous oxytocin in active management of the third stage of labor.

Objective:Active management of the third stage of labor (AMTSL) is a critical intervention for the prevention of postpartum hemorrhage (PPH), which is still the most common cause of maternal morbidity and mortality worldwide. The objective of the study is to compare the effect of intramuscular methylergometrine, rectal misoprostol, and low-dose intravenous oxytocin in the AMTSL in terms of amount of blood loss and duration of the third stage of labor, cost-effectiveness, and side effect profile.Materials and Methods:Seventy-five pregnant patients admitted in the maternity ward for vaginal delivery from February 2017 to February 2018 received either intramuscular methylergometrine (0.2 mg) or rectal misoprostol (400 mcg) or low-dose intravenous oxytocin (5 units oxytocin in 100 mL normal saline) for AMTSL. Data were recorded in three groups: Group A (methylergometrine), Group B (misoprostol), and Group C (oxytocin) consisting of 25 cases each.Results:Mean blood loss was found to be least in methylergometrine group (246.87 ± 65.44 mL) as compared to misoprostol (346.13 ± 58.35 mL) and oxytocin (334.5 ± 69.20 mL) (P = 0.000) Mean duration of the third stage of labor was also least in methylergometrine group (6.21 ± 1.58 min) (P = 0.0008).Conclusion:Although methylergometrine was found to have higher incidence of side effects such as nausea, vomiting, headache, and raised blood pressure, it was found to be the most effective drug for minimizing blood loss in the third stage of labor. In remote places where healthcare facilities are limited and drugs cannot be administered by parenteral route, rectal misoprostol remains an alternative.

Efficiency and Tolerance of Misoprostol versus Oxytocin in the Active Management of the Third Period of Delivery at the University Maternity Porto-Novo, Benin

Objective: To assess the efficiency and tolerance of misoprostol versus oxytocin in Active Management of the Third Period of Childbirth. Framework and Method of Study: The study was carried out at the Porto-Novo university maternity in Benin. The hospital is level 3. He acted in a randomized clinical trial with a descriptive and comparative aim referred from 1st January 2017 to 31st December 2017. We included all eligible women in labor in the delivery room during the study period and at that gestational age was greater than or equal to 37 weeks of amenorrhea, delivery was done through vaginal birth and delivered with a live birth and agreed to participate in the study. The cases eligible by order of admission were grouped in blocks of two, “Misoprostol” and “Oxytocin” corresponding to the Active Management of the Third Period of delivery. The data collected were captured and analyzed using the SPSS version 20 software. For the comparison of the results, we used the chi-square statistical test and the difference was assumed to be statistically significant for a p ≤ 0.05. The confidentiality of parturient was respected. Results: we recorded 1234 of which were delivered via vaginal birth. The Active Management of the Third Period of Delivery was carried out in 1202 parturients. According to our inclusion criteria, 892 parturients were retained for the study, of which 446 for each group. The average age of parturients was 26.94 ± 5.65 years. Almost pregnancies were mono-fetal (95.7% vs. 93.5%). The average time to expel the placenta after utero-tonic administration was 4.05 ± 0.27 min in the “Misoprostol” group versus 3.82 ± 0.52 min in the “Oxytocin” group (p > 0.05). We had only 9 cases of placental retention in the group “Misoprostol” versus 5 cases in the “Oxytocin” group. Most of the parturients had blood loss less than 500 ml (96.2% vs. 96.6%). The frequency of delivery hemorrhage was 3.8% in the “Misoprostol” group versus 3.4% in the “Oxytocin” group. The mean blood volume lost was 284.33l ± 13.31 ml in the “Misoprostol” group versus 225.94 ± 21.52 ml in the “oxytocin” group. Maternal prognosis was generally good in both groups. Conclusion: Misoprostol may be an alternative in Active Management of the Third Period of Delivery especially in developing countries where the cold chain is often lacking.

Carboprost Versus Oxytocin for Active Management of Third Stage of Labor: A Prospective Randomized Control Study.

Postpartum hemorrhage is the single largest and leading cause of maternal morbidity and mortality not only in developing countries but also in developed countries. The present study is an attempt to evaluate the scope of using prophylactic intramuscular carboprost tromethamine 125μg in comparison with intramuscular oxytocin 10 units for the active management of third stage of labor. Two hundred pregnant women at term with spontaneous onset of labor were included in the study and were randomly divided into 2 groups of 100 women each. Group A and group B were given injection oxytocin 10 units and injection carboprost tromethamine 125μg intramuscularly, respectively, at the time of delivery of anterior shoulder. The main outcome measures with respect to third stage of labor were: duration, blood loss by volume, difference in hemoglobin, need for additional oxytocics and side effects. Subjects who received carboprost tromethamine 125μg showed a significant reduction in duration of third stage of labor (p<0.05) and blood loss (p<0.01) when compared to the subjects who received oxytocin 10 units. Likelihood of occurrence of postpartum hemorrhage was reduced without significant side effects except for diarrhea. Additional need for other uterotonics after carboprost was significantly less compared to oxytocin. Intramuscular carboprost 125μg is a better cost-effective alternative as compared to 10 units intramuscular oxytocin in active management of third stage of labor.

POSTPARTUM HAEMORRHAGE

The most common complication 0f the third stage of labour is postpartumhaemorrhage, which remains a leading cause of maternal mortality (25.0%), especially indeveloping countries. In developed countries, 3-5% of deliveries are complicated by postpartumhaemorrhage: in developing countries, it is 50 times more common .Third stage of labourwhich exceeds 30 minutes is associated with a significant risk of postpartum haemorrhage andpuerperal infection. The best preventive strategy for these complications is active managementof third stage of labour. Active management includes administration of oxytocin within oneminute of birth of baby. Objectives: To compare the mean blood loss after administration ofintra umbilical oxytocin versus intravenous oxytocin at anterior shoulder for active managementof third stage of labour. Study Design: Randomized controlled trial. Period: Six months from1-1-2013 to 30-06-2013. Setting: Department of Obstetrics and Gynaecology, Unit-III JinnahHospital Lahore. Methodology: 100 patients fulfilling selection criteria were included in thestudy from labour room. These patients were randomly divided into two groups by usinglottery method. Group-A, 50 patients were administered 10 units of oxytocin diluted in 20ml ofnormal saline intraumbilically and group-B, 50 patients were administered 5 units of oxytocinintravenous stat at anterior shoulder. Total blood loss was noted after complete delivery ofplacenta. Results: Mean age was 25.0±3.9 and 24.4±3.5 in group-A and B, respectively. Meangestational age was 38.20±0.96 weeks in group-A and 38.40±0.94 weeks in group-B. Meanblood loss in intraumbilical oxytocin group was 311.20±27.23 ml and in intravenous oxytocingroup mean blood loss was 373.60±66.47 ml. There was statistically significant differencebetween two groups (p&lt;0.001). In group-A 15 patients (30.0%) and in group-B 20 patients(40.0%) were primigravida while remaining patients were multigravida. Conclusion: The usageof intraumbilical oxytocin in active management of third stage of labour is beneficial in reducingthe blood loss in third stage and thus helps in preventing postpartum haemorrhage.

A Randomized Controlled Trail of Sublingual Misoprostol Versus Oxytocin in Active Management of the Third Stage at Caesarean Section

A Randomized Controlled Trail of Sublingual Misoprostol Versus Oxytocin in Active Management of the Third Stage at Caesarean Section

Sublingual Misoprostol versus Intramuscular Oxytocin in the Active Management of Third Stage of Labor

Objective: To compare the efficacy and safety of 400 �gm of sublingual misoprostol with 10 units of intramuscular oxytocin in activemanagement of the third stage labor.Methods: The study was carried on 200 women undergoing vaginal delivery who were randomized alternatively into two groups of 100women each. Group 1 (misoprostol group) received 400 �gm misoprostol sublingually and group 2 (oxytocin group) received injectionoxytocin 10 units intramuscularly immediately after the delivery of the baby. Primary outcomes measures were amount of blood loss anddrop in hemoglobin level. Secondary outcomes were need for additional oxytocics, manual removal of placenta, operative intervention forPPH, and side effects of the drugs. The blood loss was measured by clinical estimation by weighing the linen, sponges and pads beforeand after the delivery. Duration of the third stage of labor, need for manual removal of placenta and the use of additional uterotonics, ifrequired, were noted. One hour after the delivery, the women were asked about the side effects of the drugs like nausea, vomiting,headache, chest pain, fever, shivering, etc. Hemoglobin estimation was done at time of admission and 24 hours after the delivery. At theend of the study, the data was analyzed using student �t� test and Chi-square test.Results: The mean age was 23.44 � 3.11 years and 23.78 � 2.47 years in group 1 and 2 respectively. There was no statistically significantdifference in the duration of third stage of the labor and mean fall in hemoglobin level in the two groups ( p > 0.05). The mean blood loss was260.35 � 97.45 ml in the misoprostol group and 264.20 � 103.68 ml in oxytocin group and the difference was not statistically significant.Conclusion: It is concluded from the present study that sublingual misoprostol is as effective as intramuscular oxytocin in activemanagement of third stage of labor and a good option especially for developing tropical countries like India where most of the deliveries areconducted at periphery by a nurse, midwife or a trained dai, and it is difficult to maintain the temperature chain.

Epidural analgesia in active management of labor.

To examine the determinants of epidural analgesia in the active management of labor. To examine the association of epidural with instrumental delivery and cesarean section. Observational study in a teaching hospital with a uniform active labor management and availability of epidural analgesia on demand. A thousand consecutive nulliparous women at term, were assessed. Requests for epidural anesthesia were predominantly expressed at the time the patient was notified that spontaneous labor was going to be augmented by the administration of oxytocin, or later, when this latter treatment caused labor to be subjectively more arduous. In induced labor, the same observation applied to a greater degree, still. Operative delivery was significantly more frequent in patients with epidural. However, when the incidence of operative delivery was adjusted for the use of oxytocin, the significance between patients with epidural versus the others abated. The use of oxytocin in active management of labor results in a high demand for epidural when this is available on demand. This, however, need not be associated with an increased incidence of operative delivery.