Effect of Diluted Intraumbilical Administeration of Oxytocin on the Third Stage of Labor: A Randomized Clinical Trial

Document Type : Original Article

Authors

1 Department of Midwifery, Islamic Azad University, Ahvaz Branch, Ahvaz, Iran.

2 Arvand International Division, Ahvaz Jundishapur University of Medical Sciences, Ahvaz. Iran

Abstract

 
Background and Objective: Postpartum hemorrhage is an important cause of maternal morbidity and mortality. Active management of third stage of labor including the use of uterotonic agents could be effective in reduction of postpartum hemorrhage and peripartum mortality and morbidity. This study aimed to compare the efficacy of intraumbilical injection of diluted oxytocin with intravenous infusion of oxytocin in the active management of third stage of labor.
Subjects and Methods: This randomized clinical trial was done on 102 vaginal delivery primiparous pregnant women. Women in first group (n=51) received 20 units of diluted oxytocin in 20 ml of 0.9% N/S injected in the umbilical vein. Women in second group (n=51) received 20 units of diluted oxytocin intra­venously. The primary outcome measurement was the mean duration of third stage of labor and mean changes in post-delivery hemoglobin. Data were analyzed using SPSS Ver.15.0, descriptive statistics, t test and Chi square with 95% of confidence interval.
Results: Mean duration of third stage of labor in intraumbilical group (3.50±0.97 min) was significantly shorter than intravenous group (5.16±1.13 min) (P=0.001). Also women in intravenous group had lower amount of post-delivery hemoglobin (9.66±0.91 g/dl) than women in intraumbilical group (10.42±0.70 g/dl) (P=0.001).
Conclusion: It seems that active management of the third stage of labor using intraumbilical oxytocin compared with intravenous infusion of oxytocin can reduce the length of third stage of labor and, after delivery, less drop in hemoglobin level.

Keywords


1-Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Gilstrap LC, Wenstrom KD. Williams obstetrics. 22nd ed. McGraw-Hill, 2005: 201-230.
2-Al-Zirqi I, Vangen S, Forse´n L, Stray-Pedersen B. Effects of onset of labour and mode of delivery on severe postpartum haemorrhage. Am J Obstet Gynecol. 2009; 201:273.e.l_273.e.9.
3-Goerke K, Steller J, Valet A. Clinical manual of obstetrics and gynaecology. Jena, Germany: Gustav Fischer Publisher; 1997:245-6
4-Shaver DC, Phelan ST, Beckmann CRB, Ling FW. Clinical manual of obstetrics. New York, NY: McGraw-Hill Inc; 1993:340
5-World Health Organization. WHO recommendations for the prevention of postpartum haemorrhage. Geneva (Switzerland): WHO; 2006
6-Neri A, Goldman J, Gans B. Intra-umbilical vein injection of Pitocin. A new method in the management of the third stage of labor. Harefuah 1966;70:351–3
7-Sivalingam N, Surinder S. Is there a place for intra-umbilical oxytocin for the management of retained placenta? Med J Malaysia 2001;56:451–9
8-Nardin JM, Weeks A, Carroli G. Umbilical vein injection for management of retained placenta. Cochrane Database Syst Rev. 2011 May 11; (5):CD001337.
9-Habek D, Franicevic´ D. Intraumbilical injection of uterotonics for retained placenta. Int J Gynaecol Obstet 2007;99:105–9
10-Rogers MS, Yuen PM, Wong S. Avoiding manual removal of placenta: evaluation of intra-umbilical injection of uterotonics using the Pipingas technique for management of adherent placenta. Acta Obstet Gynecol Scand 2007;86:48 –54.
11-Weeks AD, Alia G, Vernon G, Namayanja A, Gosakan R, Majeed T, et al. Umbilical vein oxytocin for the treatment of retained placenta (Release Study): a double-blind, randomized controlled trial. Lancet 2010;375:141–7.
12-Kore S, Srikrishna S, Hedge A, AmbiyeVR, Vaidya PR. Active management of third stage of labour with intraumbilical oxytocin injection. J Obstet Gynaecol India 2000;50(3):54-5
13-Ojha N, Malla DS. Active management of third stage of labour by oxytocin: Umbilical vein versus intramuscular use. N J Obstet Gynaecol 2007;2(1):13-16
14-Devi LA, Singh RM, Singh MC. Intraumbilical vein injection of oxytocin in the third stage of labour. J Med Society 2003; 17: 8-10.
15-Ghylmiyyah LM, Wehbe SA, Saltzman SL, Ehleben C, Sibai BM. Intraumblical vein injection of oxytocin and the third stage of labor: Randomized double-blind placebo trial 2007; 24: 347-51
16-Altman DG. Practical statistics for medical research. London: Chapman and Hall.
1991:396-403
17-Gu¨ngördu¨k K, Asicioglu O, Besı˙moglu B, Gu¨ngördu¨k OC, Yildirm G, Ark C, Tekirdag AI. Using Intraumbilical Vein Injection of Oxytocin in Routine Practice With Active Management of the Third Stage of Labor A Randomized Controlled Trial. OB & GYN 2010; 116 (3):619-624
18-Nasohi J, Falak Aflaki. The magnitude of Hemoglobin-drop in obstetrics and gynecologic operations. Is routine Hb check necessary? Sci J Hamdan Univ Med Sci. 2003; 4(30): 43-46 [In Persian]
19-Tehseen F, Anwar A, Arfat Y. Intraumbilical veinous injection oxytocin in the active management of third stage of labour. J Coll Physicians Surg Pak 2008;18:551-4
20-Dahiya P, Puri M, Rathee S. Influence of intraumbilical oxytocin on the third stage of labour. Indian J Med Sci 1995;49(2):23-7
21-Habek D, Franičević D. Intraumbilical injection of uterotonics for retained placenta. Int J Gynecol Obstet 2007; 99: 105-9
22-Golan A, Lidor AL, Wexler S, David MP. A new method for the management of the retained placenta. Am J Obstet Gynecol 1983; 146:708-9