Delivery Of Shoulder Research Articles

STUDI KASUS: MANUVER MC ROBERT PADA PERTOLONGAN PERSALINAN DENGAN DISTOSIA BAHU

Shoulder dystocia is an obstetric emergency because of the limited time of delivery where the normal value of the time interval for delivery of the head and delivery of the whole body is 24 seconds, but in the case of shoulder dystocia, it lasts 79 seconds resulting in fetal trauma and complications for the mother. Its occurrence is difficult to predict after the head is born, the head is like a turtle and the shoulder delivery is difficult. Mc Robert's Manuver is most effective for front shoulder delivery assistance. One of the factors causing shoulder dystocia is multiparity and maternal power during childbirth. This case study describes the management of midwifery care for Mrs. R, a 31 year old multiparous woman, who experienced shoulder dystocia during labour. Handling efforts carried out by the Mc Robert Manuver method. Case studies use assistive devices in the form of a midwifery care format for mothers giving birth and status sheets or patient documentation and a list of interview questions. Data analysis used is data collection, data interpretation, identification of diagnoses, immediate needs and collaboration, planning, implementation, evaluation and drawing conclusions. The result of the case study is the delivery process with basic assistance in shoulder dystocia using the Mc Robert Manuver method. Health workers must be able to master the skills of emergency delivery assistance in efforts to treat shoulder dystocia.

Introducing a novel technique to reduce severe perineal injuries during delivery: the “shoulder-up” maneuver

To investigate if introducing a novel technique to assist the delivery of the posterior shoulder (the “shoulder-up” maneuver) in a tertiary referral unit may positively impact on the rate of severe perineal injuries. Single-center retrospective interventional study including all vaginal deliveries between April 1st 2020 and March 31st 2022. On March 1st, 2021, a bundle to raise the awareness on the perineal wounds prevention at the delivery of posterior shoulder had been introduced. The “shoulder-up” maneuver, which consists in a slow, controlled delivery of the posterior shoulder under direct visualization of perineal plane after the disengagement of anterior shoulder (see the attached figure), had been included as a standard of care. All midwives and physicians completed a full theoretical and practical course to learn the maneuver at the moment of the bundle introduction. A propensity score matching analysis was performed to assess the effect of the “shoulder-up” maneuver on the risk of perineal tears adjusting for those variables that resulted to be independently associated to more severe perineal injury (nulliparity, gestational age at delivery, peridural analgesia, vacuum extraction and birthweight > 4Kg at delivery). We matched a total of 3652 patients (1826 per arm); the analysis showed a significant increase in intact perineum rate (59.5% vs 66.4%, p = 0.009) and a significant reduction in the incidence of 2nd (30.7% vs 25.8%, p = 0.006) and 3rd-4th degree perineal wounds (2.8% vs 1.2%, p < .001) after the introduction of the bundle. Episiotomy rate did not significantly change before and after the maneuver adoption (7.0 % vs 6.5%, p = 0.702). Our study showed that after the introduction of the “shoulder-up” maneuver as a standard of care in the assistance to vaginal delivery the rate of severe perineal wounds significantly decreased.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Sublingual Misoprostol Vs Intravenous Methyl ergotamine in reducing blood loss after delivery – A randomized controlled trial

BACKGROUND Postpartum hemorrhage is a very important cause of maternal mortality worldwide. According to WHO, 20 million of morbidities and 33 % of maternal mortality can be attributed to PPH worldwide. WHO states that misoprostol can also be used to prevent PPH, due to its beneficial effects in low income settings.&#x0D; OBJECTIVE The objective of the study was to compare the effectiveness of sublingual misoprostol in reducing blood loss with that of methyl ergotamine in first two hours after delivery.&#x0D; METHODOLOGY It was a randomized controlled, single center, double blind trial of sublingual misoprostol versus intravenous methyl ergotamine for control of blood loss in 82 women with singleton pregnancies at term who underwent delivery at Sir Ganga Ram hospital. Participants were divided randomly into two groups (A and B). Randomization was done by Microsoft Excel 5.0 random number generator. The participants were given either misoprostol 600 micrograms sublingually immediately or injection methyl ergotamine 0.2 mg at time of delivery of anterior shoulder of baby. The outcome measures studied were blood loss, blood transfusions, drop in hemoglobin and side effects of both drugs.&#x0D; RESULTS Mean age of women in Misoprostol group was 25.76±3.48years. Mean age of methyl ergotamine was 26.0 3.67 years Mean gestational age of women in Misoprostol group was 39.73±1.32 and mean gestational age of women in methyl ergotamine group was 40.09±1.22 weeks. Before delivery mean Hb level was statistically same in both group but post-delivery mean Hb level was significantly dropped in other group. I.e. p-value=0.000165.In Misoprostol group none had blood transfusion while in methyl ergotamine group 4(9.76%) women had blood transfusion but this difference was not statistically significant. Nausea, vomiting and hypertension were significantly higher in methyl ergotamine group. However for pyrexia and shivering an opposite trend was seen for Misoprostol when compared with methyl ergotamine.&#x0D; CONCLUSION Results of this trial showed that sublingual misoprostol is more effective as compared to intravenous methyl ergotamine. It has many advantages including easy transport, storage and oral route which make it a good uterotonic agent in low-resource areas. It was also associated with lesser side effects

Introduction of Posterior Axilla Sling Traction in Simulated Shoulder Dystocia.

Objective Aim of this study was to introduce posterior axilla sling traction (PAST) in delivering providers and nursing staff as an adjunct to the management of shoulder dystocia and evaluate comfort in performing the maneuver. Methods A presimulation questionnaire had given to all participants. A brief training on how to perform PAST was also given. A simulated shoulder dystocia was run where usual maneuvers failed. Participants used PAST for delivery of posterior shoulder, delivery of posterior arm, and to assist with rotation. Participants were then given a post-simulation questionnaire. A Chi-squared test was used to evaluate comfort with performing the procedure pre and post-simulation. Results Data were collected from 43 participants at pre and post-simulation. Designations (attending, resident, midwife, registered nurse) and responses were recorded to the questionnaires. There was a statistically significant increase in the number of providers and nurses who would feel comfortable using PAST for shoulder dystocia management and for rotational maneuvers. Ninety-three percent of participants would consider using PAST in future shoulder dystocia when usual maneuvers failed. Conclusion PAST is an adjunct to management of shoulder dystocia that has not previously been taught in our facility. The majority of participants in our simulation felt comfortable with using PAST.

A randomized controlled trial of intra-umbilical vein ergometrine as compared to intramuscular oxytocin for management of third stage of labor

Aim: To compare the use of intra-umbilical vein injection (IUVI) of ergometrine, with the standard oxytocin intramuscular injection for management of third stage of labor. Materials and Methods: Two groups of women who delivered vaginally of a singleton were randomly assigned to receive 0.2 mg of ergometrine diluted in 10 cc of normal saline via the umbilical vein after clamping of the cord, or to receive oxytocin 5 IU intramuscularly, at delivery of anterior shoulder, plus 10 cc saline via umbilical vein for management of third stage of labor. The primary outcome was the amount of blood loss and the duration of third stage of labor. Secondary outcome included: postpartum hemorrhage (PPH), severe PPH (> 1,000 ml), retained placenta necessitating manual removal, and observed side effects. Results: A total of 1,035 women were recruited, 501 actually received 0.2 mg of ergometrine diluted in 10 cc of normal saline via the umbilical vein, group A, and 517 received oxytocin 5 IU at delivery of anterior shoulder plus 10 cc saline via umbilical vein, group B. Seventeen had no records available. No difference was observed between the two groups' demographic data. The amount of blood loss was slightly higher (270 vs. 230 cc, respectively) in the group of patients who received IUVI ergometrine of than those who received parenteral oxytocin ((p = 0.014). There was no statistically significant difference in the number of PPH (both mild and severe) cases between the two groups. However blood transfusion was needed for only one patient who received oxytocin (group B) for PPH. Additional uterotonics were required in both groups with no significant difference (p = 0.077), between the two groups. Manual removal of the placenta was required for 12 retained placentae of group B, as compared to only nine in group A (p = 0.66). Conclusion: There was a minimal significant increase in the amount of blood loss, without increasing the prevalence of PPH. Local injection at the placental site showed a trend to decrease the need for operative intervention (manual removal of the placenta) than traditional use of oxytocin. Future studies are needed.

Study of clinical profile of meconium aspiration syndrome in relation to gestational age and birth weight and their immediate outcome at Narayana Medical College Hospital, Nellore, India

Background: Meconium staining of the amniotic fluid occurs in approximately 13% of live births; this percentage increases with increasing gestational age at delivery. MAS occurs in approximately 5% of infants born through MSAF. This study was undertaken to understand the factors causing MAS and clinical profile of meconium aspiration syndrome in relation to gestational age and birth weight and their immediate outcome.Methods: The present study is a prospective study of 58 neonates admitted to NICU fulfilling the criteria of MAS were included in the study over a period of 2 years. The babies who were born with meconium stained liquor, suctioning was done by the obstetricians first at the delivery of shoulder and then handed over to pediatrician and depending upon whether the meconium is present below the vocal cords or not and whether baby is vigorous or not, endotracheal intubation and bag and tube ventilation was given. The babies with clinical features MAS were admitted to NICU and were observed for their immediate outcome in the hospital.Results: During the study period, out of 4994 deliveries, 882 (17.6%) babies had meconium stained liquor and out of these 882 babies, 58 (6.5%) babies had MAS. Out of 426 cases of respiratory distress admitted to NICU, 58 (13.6%) cases diagnosed of MAS. MAS occurred most commonly in babies having fetal distress and in mothers with history of PIH. It is seen more commonly in babies born through caesarean section and in term babies with mean gestational age of 38-40 weeks of gestation and mean birth weight of 2.68 Kg. It was most commonly associated with babies who were depressed at birth and most common cause of mortality was due to birth asphyxia contributing 37.5% of cases of MAS.Conclusions: MAS is an entity which is commonly seen in term and post term babies with birth weight &gt;2.5 Kg.

Perineal techniques during the second stage of labour for reducing perineal trauma.

Perineal techniques during the second stage of labour for reducing perineal trauma.

Two-step shoulder delivery method reduces the incidence of shoulder dystocia

io compare two-step method ot shoulder delivery with one-step for the maternal and neonatal outcomes. This was a randomized controlled clinical trial. Women scheduled for vaginal delivery without severe complications were enrolled and randomly arranged into two groups. Women in study group were delivered by two-step method for shoulder delivery, that is to wait for at least one contraction after head delivery, and naturally delivery of shoulder. Women in controlled group were delivered by one-step method, that is after the head was delivered, gentle press of head was applied to facility shoulder delivery. Maternal and neonatal outcomes as Apgar score, rate of shoulder dystocia, and postpartum bleeding were recorded. Interval of head to shoulder was timed in second. The study group had lower rate of shoulder dystocia than that in control group (X²= 4.27,p =0.03), no increasing of asphyxia, and postpartum bleeding. The average interval of head to shoulder in study group was longer than that in control group. There was no difference in interval between shoulder dystocia vs. normal birth group, neither was there a difference in interval between asphyxia babies and normal babies group. By two-step method, the mean value of head to shoulder interval was 59.025 seconds, 95% CI (20.000-150.000 seconds), mean+2xSD = 148.927 seconds. In one-step group, mean was 44.172 seconds, 95% CI= (10.000~105.000 seconds), mean +2xSD = 94.812 seconds. Two-step method of shoulder delivery had a lower rate of shoulder dystocia than one-step method, no increasing of neonatal asphyxia and postpartum bleeding. The longer interval of head to shoulder did not relate to shoulder dystocia and asphyxia. The normal value of head to shoulder interval might be longer than 60 seconds.

Comparative analysis of prophylactic intramuscular 15 PGF2α 125 μg V/s intravascular methylergometrine for prevention of atonic post-partum haemorrhage (PPH) in high risk cases.

Objectives : To assess, evaluate and compare the safety and efficacy of intramuscular 15 PGF2? 125 ?g and intravenous 0.2mg methylergometrine during active management of third stage of labour in high risk women who are prone to develop atonic postpartum haemorrhage. Methods : 150 women at high risk factors of developing atonic PPH were divided into two groups. Group A received methylergometrine 0.2 mg intravenously and group B received 125mg PGF2a intramuscularly at the time of delivery of anterior shoulder prophylactically. Duration of third stage of labour, amount of blood loss, side effects of drugs used and complications, if any were noted and analyzed. Results : Amount of blood loss was more in group A as compared to group B. Diarrhoea was seen in 3 cases in prostaglandin group, none in methylergometrine group. Nausea, vomiting were seen in 2 women in each group. Conclusions : Prophylactic intramuscular 15 PGF2? 125 ?g is a better alternative to prophylactic intravenous methylergometrine 0.2 mg in high risk women who are more prone to develop atonic PPH.

The effect of maneuvers for shoulder delivery on perineal trauma: a randomized controlled trial.

Approximately 85% of vaginal deliveries are accompanied by perineal trauma. The objective of this trial was to compare the incidence of perineal trauma after primary delivery of either the anterior or posterior shoulder during vaginal delivery. This was a randomized single-blinded trial comparing primary delivery of either the anterior or posterior shoulder in women having their first vaginal delivery. Primary outcome was any perineal trauma. Results were analyzed according to the intention-to-treat principle and supplemented with a per-protocol and as-treated analysis. Between June 2013 and March 2015, 650 women were randomized, and 543 (posterior, n = 281; anterior, n = 262) were included in the final intention-to-treat analysis. Most group characteristics were similar. The frequency of any perineal trauma did not differ between the two groups (posterior: 91.5%, anterior: 90.5%; odds ratio 1.130, 95% confidence interval 0.628-2.032, p = 0.684). The results did not change after adjustment for basic characteristics with significant group differences (a1 odds ratio 1.174, 95% confidence interval 0.632-2.179, p = 0.612) or predefined risk factors (a2 odds ratio 1.139, 95% confidence interval 0.599-2.166, p = 0.691). The rate of perineal trauma also did not differ between the groups in a "per-protocol" and "as-treated" analysis. There was no difference in the degree of perineal trauma after primary delivery of either the anterior or posterior shoulder. Consequently both maneuvers for shoulder delivery can be used at vaginal delivery, but further trials are warranted before certain methods can be recommended.

Normal Range of Head-to-body Delivery Interval by Two-step Delivery.

Background:The one-step method was routine practices in China, scientific evidence to support this intervention is scarce. The purpose of this study was to observe the natural process of head-to-body delivery interval by waiting for at least one contraction (two-step) after head delivered in normal birth.Methods:From March 1 to March 30 in 2015 at Haikou Maternal and Child Hospital in China, normal vaginal birth with normal baby condition were recorded by video. Videotapes were transferred to computer then replayed and observed.Results:Ninety-two cases were enrolled in this study. The average head-to-body delivery interval by two-step delivery was 71.04 ± 61.02 s, (mean + 2 standard deviation = 193.07 s, 95% confidence interval [15.65–229.15] s). Fifty-one patients (51/92, 55.43%) were <60 s, 41 patients (41/92, 44.57%) were over 60 s. Shoulders delivered at the first contraction were 96.74% (89/92), 3.26% (3/92) had delivered by the second contraction. Shoulders emerged from perineum were 71.73% (66/92), 15.21% (14/92) transversely, and 13.04% (12/92) emerged from under pubic arch. Babies cried before the shoulder were 31.52% (29/92), cried after birth 52.17% (48/92), and 16.30% (15/92) did not cry after birth. Baby activities included as making faces, sucking, and bubbled from mouth and noses, and the lighter blue color of skin with good perfusion.Conclusions:The average time of head-to-body delivery interval was longer than 60 s by two-step delivery. Majority shoulders were delivered at the first contraction. Majority shoulders emerged from perineum rather from under pubic arch. The routine one-step method of shoulder delivery where the downward force applied is not necessary and is not the right direction. Baby's breath, making faces, sucking, bubble from noses and mouth, and the light blue color of the faces, all those signs during shoulder delivery indicated a normal live birth.

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.

A randomized controlled trial of sublingual misoprostol and intramuscular oxytocin for prevention of postpartum hemorrhage.

In India, two third of maternal deaths occur in rural areas where there is lack of transportation facilities, lack of refrigeration to store the injectable uterotonic drug such as oxytocin, lack of skilled personnel to administer them and lack of sterile syringes and needles. Hence, this study was conceived to evaluate misoprostol as a safe, effective, easily administered non-parenteral drug in the prevention of postpartum hemorrhage. This study was conducted during the period from August 2012 to July 2014. Low risk women with singleton pregnancy at term admitted for vaginal delivery were eligible for the study. A total of 500 women were randomized to two groups, 250 in each group, either to receive 400 mcg misoprostol sublingually or 10 units oxytocin intramuscularly at the delivery of anterior shoulder. Patient factors, labor parameters, blood loss and side effects were noted. The women in both the groups were well matched with respect to age, parity, gestational age and labor parameters. There was statistical significance in the blood loss (p = 0.04) between the two groups. The average blood loss was 70 ml in misoprostol group and 75 ml in oxytocin group. Shivering was the statistically significant side effect (p = 0.004) in the misoprostol group and nausea was the statistically significant side effect (p = 0.003) in the oxytocin group. Sublingual misoprostol is as effective as intramuscular oxytocin as a prophylactic oxytocic in the active management of third stage of labor for prevention of postpartum hemorrhage.

Head to Shoulder Interval in 92 Cases Normal Birth with Good Baby Condition by Two Step Shoulder Delivery Method

Purpose of investigation: Observation of natural process of head to shoulder interval by waiting for at least one contraction (two-step method) after head delivered in normal birth. Method: From 1st to the end of mar. In 2015 at Haikou maternal and child hospital in China, women in vaginal delivery meet the criteria were recorded by video from head crown to shoulder and to body delivered. 92 cases normal vaginal birth with normal baby condition were recorded, video tapes were transfer to computer then replayed and observed. Interval of head crown to head delivery and head to shoulder delivery, babies' activities during birth were recorded from video at same time. Result: 1. The mean time of head to shoulder interval by waiting for a contraction is (71.043 ± 61.015) sec, mean+2Std. =193.073sec, 95% CI (15.65-229.15) sec. 2. 55.43 % (51/92) percent interval of head to shoulder were less than 60 sec, 39.1% (36/92) were over 60sec and less than 190 sec. 5.4 %( 5/92) over 190 sec. 3. 71.734% (66/92) shoulders were emerged from perineum, 15.217% (14/92) transversely, 13.04% (12/92) emerged from under pubic. 4. 22 % percent babies breathed before shoulder delivery, some after, some did not cry at all, but had normal heartbeat and breath Patten. Conclusion: 1. Head to shoulder delivery interval is longer than 60 sec by two step method of shoulder delivery. The majority shoulders emerged from perineum rather from under pubic. 96.73% (89/92) cases shoulders were delivered at the first contraction after head delivered, only 3.27% (3/92) cases had delivered by twice contractions. 2. Babies activities during delivery of shoulder included breath, making faces, sucking, bubble from noses and mouth, and the color of the face, all those signs indicated the normal live birth.

Oxytocin versus Methylergometrine in the Active Management of Third Stage of Labour

Objective: To compare the efficacy of Oxytocin versus Methylergometrine in active management of third stage of labour in reducing risk of postpartum hemorrhage. Methods: This study was carried out by randomly assigning into two groups with 150 women in each group. Group 1 included patients who received injection Oxytocin 10 IU intramuscular within one minute of the birth of the baby. Injection Methylergometrine (0.2 mg) was given intravenously at the delivery of anterior shoulder of the baby to women in Group 2. Outcome measures were the duration of third stage, blood loss, pre and post-delivery hematocrit, side effects and incidence of PPH. Statistical analysis was done using Chi square test, Fischers test, Mann Whitney test, and t test. p

English

BACKGROUND AND OBJECTIVES: To compare the management of third stage of labour by 400µg rectal misoprostol versus intramuscular 125 µg PGF2α and to study the side effects of the drugs. METHODS: 200 low risk women at term with spontaneous labour were studied and were randomly divided into 2 groups. Group – I were administered per rectal misoprostol 400 µg and group – II PGF2α – 125 µg respectively at delivery of anterior shoulder of foetus. Outcome with regard to duration of III stage of labour, amount of blood loss, difference in haemoglobin, need for additional oxytocics and side effects were studied. RESULTS: Significant reduction in duration of third stage (P < 0.05) and blood loss (P < 0.05) was seen in PGF2α (125 µg) group compared to misoprostol. Reduction in Hb% postpartum (after 48 hours) was also significantly less in PGF2α (125 µg) group vs.misoprostol group. Need for additional oxytocics was more in misoprostol group (10 cases) when compared to PGF2α group 17 cases. In both groups, 1 patient had retained placenta. In PGF2α gp., GI side effects like nausea (13%), vomiting (3.5), abdominal cramps (17.5%) were seen. While misoprostol group had low incidence of GI side effects; nausea (6.5%), vomiting (2%), pyrexia (18%) and shivering (24%) were seen in a higher incidence. CONCLUSION: PGF2α results in more effective reduction in duration of third stage of labour, lesser blood loss, significantly lesser reduction in Hb level after delivery and is associated with side effects like nausea, vomiting, diarrhoea and abdominal cramps while per-rectal misoprostol is less effective but with side effects like pyrexia and shivering.

A comparative study of methylergonovine and 15-methyl prostaglandin F2α in active management of third stage of labor.

ObjectivePostpartum hemorrhage is most common cause of maternal mortality. Active management of third stage of labor minimizes the risk of postpartum hemorrhage. To compare the effect of methylergonovine and 15-methyl prostaglandin F2α (15-methyl PGF2α) in active management of third stage of labor.MethodsA randomized open labelled parallel study with 50 women in normal labor, 25 in each group were included. The drugs methylergonovine (0.2 mg) intravenous and 15-methyl PGF2α (250 µg) intramuscular were administered at the time of delivery of anterior shoulder. Main outcomes measured were amount of blood loss during the first four hours of delivery and objective measurement of hemoglobin and hematocrit levels before delivery and third day postpartum.ResultsThere was no statistically significant difference in the blood loss between the two groups at delivery (P = 0.130), at 1 hour of delivery (P = 0.453). The blood loss with 15-methyl PGF2α was significantly less as compared to that of blood loss with methylergonovine at four hours of delivery (P = 0.014) and the total, i.e., during first four hours, amount of blood loss was significantly less with 15-methyl PGF2α (P = 0.026). There was no statistically significant difference in the hemoglobin and hematocrit levels measured predelivery and postpartum third day between both the drugs.ConclusionBoth the drugs were effective in controlling the amount of blood loss during the third stage of labor, 15-methyl PGF2α being more efficacious.

Sublingual 400 μg Misoprostol vs Intravenous 0.2 mg Methylergometrine for Active Management of Third Stage of Labor

ABSTRACT Objectives To compare the efficacy and side effects of sublingual 400 μg misoprostol with 0.2 mg intravenous methylergometrine in active management of third stage of labor. Materials and methods In a prospective, randomized comparative study conduted in Department of Obstetrics and Gynecology, AVBRH, Wardha, 200 women at full-term gestation, without any high risk factors were studied in two groups of 100 each, for safety and efficacy of 400 μg sublingual misoprostol in comparison to 0.2 mg intravenous methylergometrine at the delivery of anterior shoulder from December 2010 to November 2011. Main parameters used were duration of 3rd stage, amount of blood loss, need of aditional uterotonic, complications of third stage, drop in hemoglobin and side effects. Results were analyzed by Student's t-test. Results Mean duration of third stage in misoprostol group was 9.67 ± 1.98 min, amount of blood loss was 203 ± 24 ml, need of additional uterotonics was 13%, drop in hemoglobin 0.59 ± 0.79 which were almost comparable with other group and side effects were mainly shivering and pyrexia in misoprostol group and vomiting and giddiness in methergine group. Conclusion Sublingual 400 μg misoprostol is almost equally effective as intravenous methergine for active management of third stage of labor with advantage of simplicity of storage of drug, route of administration and no risk of injection associated infections, which make it very much relevant in rural scenario. How to cite this article Shrivastava D, Khamsara D, Pandey P, Bhute S. Sublingual 400 μg Misoprostol vs Intravenous 0.2 mg Methylergometrine for Active Management of Third Stage of Labor. J South Asian Feder Obst Gynae 2013;5(1):15-18.

A Randomized Controlled Study of Prophylactic Use of Umbilical Vein Oxytocin in The Management of Third Stage of Labor.

The present study has been undertaken to evaluate the efficacy of umbilical vein oxytocin in minimising the blood loss during third and fourth stage of labor in comparison with umbilical vein injection of saline only and with systemic methylergometrine. We performed a randomised control study involving three hundred women who were randomized into 3 groups of hundred women in each group.. Group 1 received umbilical vein injection of oxytocin. Group 2 received intraumbilical vein saline injection while subjects in group 3 were managed with systemic methylergometrine,0.2mg intravenous at the delivery of anterior shoulder The primary outcome was measured in terms of duration of third stage of labor,blood loss, number of undelivered placenta and need for further oxytocics. Secondary outcomes were in terms of pre-delivery and post-delivery haemoglobin and haematocrit estimation.Intraumbilical oxytocin significantly shortens the duration of third stage of laborwhen compared with intraumbilical saline as well as systemic methylergometrine. It is also effective in reducing the amount of blood loss when compared to intraumbilical saline injection, but it was comparable in efficacy to methylergometrine in preventing amount of blood loss.

A randomized controlled trial on delayed cord clamping and iron status at 3–5 months in term neonates held at the level of maternal pelvis

Background: Delayed umbilical cord clamping (DCC) for two to three minutes after birth, results in substantial transfusion of blood from the placenta to the newborn, thus likely to improve iron status within the first months of life. However, optimal infant position during DCC in relation to mother's pelvis has not yet been determined and this maneuver has been suggested to have substantial risk of neonatal jaundice and cardiopulmonary compromise. Objective: To study the effect of DCC with the infant held at the level of mother's pelvis, compared to early cord clamping on: a) iron status at 3-5 months of age (primary outcome), b) hemoglobin and iron status in immediate postnatal period, and c) potential hazards on neonatal outcome. Methods: This randomized controlled trial was conducted on mother-infant pairs born at term by normal vaginal delivery following uncomplicated low risk pregnancies. Neonates were randomized to early cord clamping, done immediately after birth (≤15 seconds) and DCC (3 minutes after birth), starting from the time of shoulder delivery, with the baby held at the level of mother's pelvis. Both groups were evaluated for hematological parameters mainly, transferrin saturation and serum ferritin at 24 hours and then at 3-5 months postnatally. Results: A total of 180 mother-infants pairs were included; with 90 subjects in each group. At 3-5 months old, infants with DCC had significantly higher serum ferritin (430 vs. 228 ug/L, p < 0.001). Although hemoglobin (Hb) concentration did not differ between groups, DCC group had fewer cases with diagnosed with low serum ferritin (p < 0.001). At 24 hours postnatally, infants with DCC had significantly higher Hb (19.6 vs. 16.8 g/dl, p < 0.001) and hematocrit values (55.8 vs. 51.4%, p < 0.001) compared to early cord clamping group. None of the cases, in either group had respiratory distress or polycythemia in the immediate postnatal period with no significant difference in mean serum bilirubin level on comparing both groups. Conclusion: with the baby held at the level of mother's pelvis, DCC resulted in increased ferritin concentrations and reduced the prevalence of iron deficiency at 3-5 months of age, without demonstrable adverse neonatal effects.