Intraumbilical Oxytocin Compared to Placental Cord Drainage in the Management of Third Stage of Labor: A Randomized Controlled Study

Abstract

Abstract Objective: To compare the effectiveness of intraumbilical oxytocin and placental cord drainage in the management of third stage of labor. Design: A prospective randomized clinical trial. Setting: At Ain Shams University Maternity Hospital. Subjects: One hundred and fifty pregnant women between 18-35 years of age with normal pregnancy and a singleton fetus at a gestational age of 37 - 42 weeks in a cephalic presentation with neonatal birth weight of 2500 to 4500 grams recruited from the delivery ward of our hospital. Methods: The 150 study participants were randomly allocated into three groups either 20 units of oxytocin injected in the umbilical vein after clamping (Group A, n = 50), placental cord drainage (Group B, n = 50) or no intervention (Group C, n = 50). Main outcome measure: Duration of the third stage of labor. Secondary outcome measures: Retained placenta, need for manual removal of placenta and the drop in Hb postpartum. Results: There’s significant statistical difference between all groups regarding the duration of the third stage of labour (p >0.05). The duration was significantly shorter in the study groups A&B than the control group C, with significantly shorter duration in group B compared to Group A (P1 is 0.001 > 0.05). There’s statistical difference between all groups regarding Hb reduction (p>0.05). Hemoglobin level was significantly reduced in the control group C than the study groups A&B (P2 is 0.016>0.05 and P3 is 0.0001>0.05) with significantly higher reduction in group A than Group B (P1 is 0.001>0.05). As regard Retained placenta and the need for manual removal of placenta there is non-significant increase in the control group C (2 cases) which is not statistically significant (p<0.05) while there were no cases in study groups A&B. Conclusion: The present study demonstrated that the use of intraumbilical injection of oxytocin and placental cord drainage significantly reduced the duration of the third stage in addition a significant decrease in the hemoglobin drop postpartum, however there were non-significant reduction of Retained placenta and the need for manual removal of placenta, larger studies are necessary to confirm these findings.