Intraumbilical Vein Injection of Oxytocin in Routine Practice for Active Management of the Third Stage of Labor
Condition: Labor
Study type: Interventional
Phase: Phase 3

Summary: 
      During the first hours that follow the birth of the baby (third and fourth stages of labor),
      complications are common and can threaten the mother's life. The most common complication is
      postpartum hemorrhage (PPH), which remains a leading cause of maternal mortality (25.0%)
      especially in developing countries .Three to five percent of deliveries are complicated by
      PPH and is 50 times more common in developing countries. Retained placenta is an another
      complication of third stage of labor. It complicates 0.1-2 % of deliveries . Without prompt
      treatment, women are at high risk of hemorrhage. At present, treatment is by manual removal
      of placenta, which needs an operating theatre, a surgeon, and an anaesthetist-facilities that
      are often unavailable to women in resource-poor settings. As a result, this condition has a
      case fatality rate of nearly 10% in rural communities.

      The length of the third stage of labor, and its subsequent complications depends on a
      combination of the length of time it takes for placental separation and the ability of the
      uterine muscle to contract. Principal management of the third stage of labor is aimed at
      reducing the time of delivery of placenta so minimising serious adverse effects, such as
      blood loss and retained placenta. Active management of the third stage of labor, which
      includes prophylactic injection of 10 units of oxytocin within two minutes of birth, early
      clamping of the umbilical cord and controlled cord traction (CCT), is recommended by WHO for
      PPH prevention .

      Umbilical vein oxytocin injection directs the treatment to the placental bed and uterine
      wall, resulting in an earlier uterine contraction and placental separation. However, very
      limited published literature is available, which evaluated the effect of umbilical vein
      oxytocin injection in routine practices for active management of the third stage of labor.
      The purpose of this investigation was to find out the beneficial effect of adding
      intraumbilical vein oxytocin in reducing the blood loss during third and fourth stages of
      labor, length of third stage of labor, and reduction in the incidence of manual removal of
      retained placenta.
    


Intervention name(s): Oxytocin
Intervention type(s): Drug
Intervention description(s): 20 IU of oxytocin diluted with 26 ml of saline.The medication was injected directly in the umbilical vein after clamping. The injection was performed with a 30-ml syringe and an 18-gauge needle around 1 to 2 cm from the introitus. The solution was injected slowly over 1 minute, and at the end of the injection, the solution was milked toward the cord insertion
Intervention MeSH terms: Oxytocin
Allocation: Randomized
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Prevention
Keywords: Blood loss in the third and fourth stage of labor and the duration of third stage of labor