MANAGEMENT OF THIRD STAGE OF LABOUR;

The routine prophylactic administration of an uterotonic agent is an integralpart of active management of the third stage of labor, helping to prevent postpartum haemorrhage (PPH). The two mostwidely used uterotonic agents are: ergometrine-oxytocin (Syntometrine ®) (a combination of oxytocin, 5 internationalunits (iu) and ergometrine, 0.5 mg) and oxytocin, (Syntocinon ®) 10 international units (iu). Objective: To compare theefficacy and safety of intravenous oxytocin, with intramuscularly syntometrine in the management of third stage of labor.Study design: Experimental study. Setting: Department of obstetrics and gynaecology Combined Military HospitalPeshawar. Period: Over one year period from March 2005 to March 2006. Methods: A total 200 women havingsingleton pregnancy and vaginal delivery admitted in maternity ward were divided in two treatment groups by simplerandom 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 thedelivery of anterior shoulder of the fetus. Results: The use of intravenous oxytocin,, was associated with a reductionin postpartum blood loss (P<0.001) but there was no difference in the risk of post partum hemorrhage, in the need forrepeated oxytocin injections and the drop in peripartum hemoglobin level between the two groups, and need for bloodtransfusion. There was also no difference in the risk of prolonged third stage, or manual removal placenta. The useof syntometrine was associated with a higher risk of hypertension (RR 2.39, 95% Cl 1.00-5.70) other side effects weremild in nature with no differences between the two groups. Conclusions: There are no important clinical differencesin the effectiveness of intramuscular syntometrine and. Intravenous oxytocin for the prevention of post partum bloodloss. Intravenous oxytocin is less likely to cause hypertension and other side effect profiles are low