Prophylactic Oxytocin before Versus after Placental Delivery to Reduce Blood Loss in Vaginal Delivery: A Randomized Controlled Trial

Background: PPH has been a leading cause of maternal death around the globe. Prophylactic oxytocin is one of the main components of the active management of the third stage of labor to reduce blood loss. The timing of administration of prophylactic oxytocin varies considerably worldwide and it may have significant impact on the maternal and neonatal well-being.

Objectives: To assess the efficacy and safety of the timing of administration of prophylactic oxytocin via intramuscular route (before compared to after placental delivery) on blood loss in vaginal delivery. Methods: It is a double blinded study in which 403 patients were randomized in two groups to receive oxytocin 10 IU IM either before or after placental delivery. Primiparous patients, patients with high risk for PPH and those with multiple vaginal or cervical tears were excluded from the study. All patients underwent controlled cord traction, immediate cord clamping.

Results: Our results have shown that there were no statistically significant differences between the two study groups regarding the estimated blood loss (P=0.39), incidence of PPH (P=0.78), length of third stage of labor in minutes (P=0.29), the rates of retained placenta (P=0.77) and the need for additional uterotonic (P=0.96).

Conclusion: The administration of prophylactic intramuscular oxytocin after placental expulsion in vaginal delivery has the same efficacy and safety as when it is used before placental delivery and it is considered an easier alternative especially if there is only a single birth attendant.

Author(s): Amr AA Nadim, Amr H Yehia and Reham Marie Farghal

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