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| ORIGINAL ARTICLE |
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| Year : 1991 | Volume
: 37
| Issue : 4 | Page : 219-20 |
Umbilical vein oxytocin in the management of third stage of labour.
Athavale RD, Nerurkar NM, Dalvi SA, Bhattacharya MS
Department of Obstetrics and Gynaecology, K. E. M. Hospital, Parel, Bombay, Maharashtra.
Correspondence Address:
Department of Obstetrics and Gynaecology, K. E. M. Hospital, Parel, Bombay, Maharashtra.
The aim of the study was to evaluate the efficacy of intra-umbilical oxytocin in minimizing the blood loss during 3rd and 4th stage of labour. Seventy-five pregnant multigravidas without any obstetric or medical complications were studied. It was found that the expulsion of the placenta was rapid as compared to the group treated with normal saline but not with methylergometrine. The drop in hemoglobin and hematocrit was comparable in patients receiving intra-umbilical oxytocin and those with active management of 3rd stage with methylergometrine.
How to cite this article:
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 |
How to cite this URL:
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 [serial online] 1991 [cited 2021 Feb 26];37:219. Available from: https://www.jpgmonline.com/text.asp?1991/37/4/219/754 |
Haemorrhage during 3rd and 4th stage of labour accounts for a large fraction of the total puerperal blood loss. It is also an important cause of maternal morbidity in our country. In view of this a study was undertaken to determine effect of oxytocin injection into the umbilical vein during the 3rd and 4th stage blood loss.
Seventy-five pregnant women were studied. Multigravidas with vertex presentation with no obstetric and medical complications and who have not received any oxytocin in labour were divided into 3 groups:
Group I: Patients from this group were administered intra-umbilical oxytocin (20 units in 20 ml normal saline) after delivery of the baby.
Group II: Patients from this group received intra-umbilical normal saline (20 ml) after delivery of the baby.
Group III: Systemic methylergometrine was injected to patients in this group at the delivery of the anterior shoulder.
Patients in Group II received methylergometrine at the end of the first hour of delivery or earlier when required.
Labour was monitored through the first and second stages and delivery was conducted by second or third year residents.
On admission to the labour room haemoglobin (Hb) and haematocrit (PCV) estimation was done Ad was repeated 24 hours after delivery. Blood loss in the first hour after delivery was measured (a) by weighing the blood clots and (b) measuring the difference in the weight of the pads (given to the patient immediately after delivery) at the end of the 1st hour.
No patient had a placenta retained for more than 15 minutes and none of them required manual removal. Average expulsion time for each group is presented in [Table - 1]. [Table - 1] also indicates average blood loss, drop in Hb and PCV values for each group. Eight patients from Group II had significant bleeding within the first 30 min. (P < 0.05) and required methylergometrine for control.
The above results clearly indicate that the expulsion of the placenta is faster with intra-umbilical oxytocin (Gr. I) but there is no significant difference between the drop in Hb and PCV In Gr. I and Gr. III patients.
The failure to expedite placental expulsion and minimize post-partum bleeding in Gr. 11 clearly indicates that it is not the volume of the bolus, which causes placental expulsion.
The blood loss within the first hour of delivery (4th stage) is an important precipitating factor for puerperal anaemia. Third stage of labour is generally managed by observation until separation and expulsion of the placenta, which is followed by administration of methylergometrine. Delayed separation eventually leads to more bleeding.
However, if methylergometrine is injected at the time of the delivery of anterior shoulder, then the expulsion time decreases without the theoretical risk of retained placenta. Golan et al [2] proposed that the injection of intra- umbilical oxytocin leads to a high concentration of oxytocin at the uterine wall and may be the cause of the rapid placental expulsion.
Intra-umbilical oxytocin is therefore, a useful alternative in patients where methylergo metrine is contraindicated or in cases where intravenous fluids need to be restricted[1]. For optimum effect, rapid injection immediately after clamping of the cord is essential. Hence patients requiring cord blood collection, cord segment for blood gases etc, involved a time lapse and were not included in our study. Primigravidas and multigravidas requiring epsiotomy showed fluctuations in the results due to variations in the blood loss and were therefore excluded from the present study. However, intra-umbilical injections can be used in both these groups.
| 1. |
Chestnut DH, Wilcox LL. Influence of umbilical vein administration of oxytocin in the third stage of labour: a randomized double-blind placebo-controlled study. Amer J Obstet & Gynecol 1987; 157:160-162.  |
| 2. | Golan A, (Baruch) Lidor AL, Wexler S, David MP. A new method for management of the retained placenta. Amer J Obstet & Gynecol 1983; 146:708-709.
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