Management of third stage of labour: use of intramuscular syntometrine and intravenous oxytocin

ABSTRACT

The routine prophylactic administration of an uterotonic agent is an integral part of active management of the third stage of labor, helping to prevent postpartum haemorrhage [PPH]. The two most widely used uterotonic agents are ergometrine-oxytocin [Syntometrine _] [a combination of oxytocin, 5 international units [iu] and ergometrine, 0.5 mg] and oxytocin, [Syntocinon _] 10 international units [iu]. To compare the efficacy and safety of intravenous oxytocin, with intramuscularly syntometrine in the managementof third stage of labor. Experimental study. Department of obstetrics and gynaecology Combined Military Hospital Peshawar. Over one year period from March 2005 to March 2006. A total 200 women having singleton pregnancy and vaginal delivery admitted in maternity ward were divided in two treatment groups by simple random sampling using random number tables, 100 patients received 2 ml Syntometrine, [a combination of oxytocin, 5iu and ergometrine meleate 0.5mg] intramuscularly and 100 patients received 10iu of intravenous syntocinon at the delivery of anterior shoulder of the fetus. The use of intravenous oxytocin,, was associated with a reduction in postpartum blood loss [P<0.001] but there was no difference in the risk of post partum hemorrhage, in the need for repeated oxytocin injections and the drop in peripartum hemoglobin level between the two groups, and need for blood transfusion. There was also no difference in the risk of prolonged third stage, or manual removal placenta. The use of syntometrine was associated with a higher risk of hypertension [RR 2.39,95% Cl 1.00-5.70] other side effects were mild in nature with no differences between the two groups. There are no important clinical differences in the effectiveness of intramuscular syntometrine and. Intravenous oxytocin for the prevention of post partum blood loss. Intravenous oxytocin is less likely to cause hypertension and other side effect profiles are low