THE USE OF OXYTOCIN INJECTION INTO THE UMBILICAL VEIN FOR THE MANAGEMENT OF THE THIRD STAGE OF LABOR

Abstract

The third stage of labor is the most important stage because its complications are direct causes of maternal morbidity and mortality. Most of the complications of the third stage are preventable by proper and careful management of the third stage. The management of the third stage of labor is still controversial, some authors advocate conservative management while others prefer active management to shorten the third stage and avoid its complications. The active management of the third stage of labor is the management which is recommended by most obstetricians. Recently, injection of oxytocin into the umbilical vein after cord clamping and cutting was suggested to effect placental separation, shorten the third stage duration and reduce third stage blood loss. The present study aimed at investigating the effectiveness of the prophylactic use of intraumbilical vein oxytocin injection on the third stage duration and the third stage blood loss. The study aimed also at identification of the best concentration of intraumbilical vein oxytocin injection suitable for prophylactic use in the third stage of labor. The present study included a total of 250 selected pregnant females in labor who were divided into 3groups. Group 1 control group - included 50 women. They received no injections during the third stage. Group 2 included 100 women who received intraumbilical injection of 10 IU of oxytocin diluted in 20 ml of saline after cord clamping. Group 3 included 100 women who received intraumbilical injection of 20 IU of oxytocin diluted in 20 ml of saline after cord clamping. The duration of the third stage was recorded and the amount of blood loss during the third stage was measured directly and objectively. The present study revealed the following: 1. The intraumbilical oxytocin administration shortens the duration of the third stage of labor and reduces the third stage blood loss compared with the conservative management. 2. Intraumbilical injection of oxytocin 1 IU per ml is more effective in shortening the duration of the third stage and reducing blood loss compared with an intraumbilical injection of oxytocin 0.5 IU per ml. 3. The effect of intraumbilical oxytocin injection on the third stage of labor is concentration- dependent. Increasing the concentration of oxytocin is more effective in shortening the duration and reducing the blood loss of third stage. We concluded that the injection of oxytocin into the umbilical vein after cord clamping has a significant effect on shortening the duration and reducing the amount of blood loss of the third stage of labor. Therefore, we recommend the intraumbilical vein injection of 20 IU of oxytocin diluted in 20 ml of saline after cord clamping as a simple, reliable, effective and safe method for active management of the third stage of labor. However, the effect of other concentrations of intraumbilical oxytocin on the third