Intraumbilical Vein Injection of Oxytocin and the Third Stage of Labor: Randomized Double-Blind Placebo Trial

ABSTRACT

The objective of this study was to determine whether intraumbilical injection of oxytocin shortens the third stage of labor. A randomized, double-blind, placebo-controlled trial was used to assess the effectiveness of an intraumbilical injection of oxytocin on the duration of the third stage. Following randomization, each of 79 women received 30 mL of saline (n = 40) or 20 U of oxytocin in 30 mL of saline (n = 39). The primary outcome of interest was the effect on the duration of the third stage. Secondary outcomes examined were change in hemoglobin and percentage of undelivered placenta after 15 minutes. There was no difference in the duration of the third stage between the two groups (7.8 ± 6.1 min in the saline-only group versus 5.9 ± 2.6 min in the oxytocin group). The change in hemoglobin was significantly lower in the oxytocin group (1.3 ± 0.9 g/dL in the oxytocin group versus 1.8 ± 0.9 g/dL in the saline-only group). The percentage of undelivered placentas beyond 15 minutes was significantly lower in the oxytocin group (0% in the oxytocin group versus 12.5% in the saline-only group). The study concluded that intraumbilical vein injection of oxytocin reduced the rate of placentas remaining undelivered beyond 15 minutes and subsequent blood loss.

KEYWORDS

Third stage of labor - intraumbilical vein injection - retained placenta

REFERENCES

• 1 Gulmezoglu A M, Villar J, Ngoc N T et al.. WHO multicentre randomised trial of misoprostol in the management of the third stage of labour.  Lancet. 2001;  358 689-695
• 2 Dombrowski M P, Bottoms S F, Saleh A A, Hurd W W, Romero R. Third stage of labor: analysis of duration and clinical practice.  Am J Obstet Gynecol. 1995;  172 1279-1284
• 3 Niebyl J R, Simpson J L, Gabbe S G, Senkarik M, Cooley M. Obstetric hemorrhage. In: Gabbe SG, Simpson JL, Niebyl JR, Galan H Obstetrics: Normal and Problem Pregnancies. 4th ed. Philadelphia, PA; Churchill Livingston 2002: 503-538
• 4 Weeks A D. The retained placenta.  Afr Health Sci. 2001;  1 36-41
• 5 Chang J, Elam-Evans L D, Berg C J et al.. Pregnancy-related mortality surveillance-United States, 1991-1999.  MMWR Surveill Summ. 2003;  52 1-8
• 6 Abouzahr C. Antepartum and postpartum haemorrhage. In: Murray CJ, Lopez AD Health Dimensions of Sex and Reproduction. Boston; Harvard University Press 1998: 172-174
• 7 Magann E F, Evans S, Chauhan S P, Lanneau G, Fisk A D, Morrison J C. The length of the third stage of labor and the risk of postpartum hemorrhage.  Obstet Gynecol. 2005;  105 290-293
• 8 Carroli G, Bergel E. Umbilical vein injection for management of retained placenta.  Cochrane Database Syst Rev. 2001;  (4) CD001337
• 9 Nordstrom L, Fogelstam K, Fridman G, Larsson A, Rydhstroem H. Routine oxytocin in the third stage of labour: a placebo controlled randomised trial.  Br J Obstet Gynaecol. 1997;  104 781-786
• 10 Gazvani M R, Luckas M J, Drakeley A J, Emery S J, Alfirevic Z, Walkinshaw S A. Intraumbilical oxytocin for the management of retained placenta: a randomized controlled trial.  Obstet Gynecol. 1998;  91 203-207
• 11 Athavale R D, Nerurkar N M, Dalvi S A, Bhattacharya M S. Umbilical vein oxytocin in the management of third stage of labour.  J Postgrad Med. 1991;  37 219-220
• 12 Dahiya P, Puri M, Rathee S. Influence of intraumbilical oxytocin on the third stage of labour.  Indian J Med Sci. 1995;  49 23-27
• 13 Reddy V V, Carey J C. Effect of umbilical vein oxytocin on puerperal blood loss and length of the third stage of labor.  Am J Obstet Gynecol. 1989;  160 206-208
• 14 Kovavisarach E, Rojsangruang S. Effect of umbilical vein oxytocin injection on the third stage of labor: a randomized controlled study.  J Med Assoc Thai. 1998;  81 693-697
• 15 Bider D, Zolti M, Menashe Y, Dulitzky M, Mashiach S, Ben-Rafael Z. Oxytocin or saline injected intra-umbilically did not influence the third stage of labor.  Acta Obstet Gynecol Scand. 1991;  70 321-323
• 16 Carroli G, Belizan J M, Grant A, Gonzalez L, Campodonico L, Bergel E. Intra-umbilical vein injection and retained placenta: evidence from a collaborative large randomised controlled trial. Grupo Argentino de Estudio de Placenta Retenida.  Br J Obstet Gynaecol. 1998;  105 179-185
• 17 Chestnut D H, Wilcox L L. Influence of umbilical vein administration of oxytocin on the third stage of labor: a randomized, double-blind, placebo-controlled study.  Am J Obstet Gynecol. 1987;  157 160-162
• 18 Young S B, Martelly P D, Greb L, Considine G, Coustan D R. The effect of intraumbilical oxytocin on the third stage of labor.  Obstet Gynecol. 1988;  71 736-738
• 19 Ozcan T, Sahin G, Senoz S. The effect of intraumbilical oxytocin on the third stage of labour.  Aust N Z J Obstet Gynaecol. 1996;  36 9-11
• 20 Rogers J, Wood J, McCandlish R, Ayers S, Truesdale A, Elbourne D. Active versus expectant management of third stage of labour: the Hinchingbrooke randomised controlled trial.  Lancet. 1998;  351 693-699
• 21 Herman A, Weinraub Z, Bukovsky I et al.. Dynamic ultrasonographic imaging of the third stage of labor: new perspectives into third-stage mechanisms.  Am J Obstet Gynecol. 1993;  168 1496-1499
• 22 Pipingas A, Hofmeyr G J, Sesel K R. Umbilical vessel oxytocin administration for retained placenta: in vitro study of various infusion techniques.  Am J Obstet Gynecol. 1993;  168 793-795