Journal of Reproduction & Infertility

Journal of Reproduction & Infertility

A comparison between oxytocin and syntometrine for preventing postpartum hemorrhage

Authors
Maryam Khooshideh 1
Ali Shahriari 2
1 Department of Obstet . and Gynecol Ghods Birth Center, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
2 Department of Anesthesiology, Ghods Birth Center, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
Abstract
Introduction: The third and forth stages of labor which involve the separation and expulsion of the placenta and an hour immediately following delivery are the two critical phases. Many maternal deaths in the developing countries result from complications of the third stage of labor and postpartum hemorrhage. Active management of labor and use of oxytocic drugs can reduce postpartum hemorrhage. This study compares the effects of oxytocin and syntometrine in preventing postpartum hemorrhage which is an important problem causing maternal morbidity and mortality after delivery. Materials and Methods: A clinical trial was designed to study 618 patients admitted to zahedan Ghods Birth Center in 2001 for normal delivery. The patients were randomly divided into two groups. All Pregnancies were singletone, normotensive (BP < 140/90) and free from medical disease. After exiting the anterior shoulder of fetus, 5 IU of oxytocin in the first group and 0.5 mg ergometrine plus 5 IU of oxytocin in the second group was injected intramusculary. The abnormal postpartum hemorrhage by obstetrician’s estimation, the need for repeated oxytocic or other interventions and less than 100 mm Hg fall in systolic blood pressure was determined. The length of third stage was determined for all of the patients. Results: Among the first group there were 20 cases (%6.47) with abnormal hemorrhage, compared to 8 cases (%2.58) in the second group. There was a significant difference between the two groups in postpartum hemorrhage (p < 0.05) (using Chi-square test,CI=%95). There was no significant difference between two groups concerning the duration of third stage and the need for manual removal of placenta. The side effects were uncommon and the incidence of hypertention (Bp > 140/90) was not different between two groups. Conclusion: some studies do not recommend the use of syntometrine, believing that there is no clinical difference in the effectiveness of oxytocin and syntometrine, whereas syntometrine can cause hypertention and retained placenta. Our results similar to other researches show that syntometrine is more effective than oxytocin in preventing postpartum hemorrhage.
Keywords
oxytocin
postpartum hemorrhage
Syntometrine
third stage of labor
Uterine atony
Cunningham F.G., Norman F.G., Kenneth G.L. Conduct of normal labor and delivery. Williams Obsetrics. 21th Edition, New York, Mc Graw- Hill.2001;pp:321-325.
Bennett V.R., Lindak B.R. Myles textbook for midwives.12th Edition, Churcill Living Stone, 1996;l1:353-358.
James D.K., Street P.J. Postpartum hemorrhage and other problems of the third stage. Hig risk pregnancy. 2nd Edition. W.B Saunders, London. 2000;pp:231-1247.
Mitchell G., Elbourne D.E., Ashurst H.A., The salford third stage trial: Oxitocin plus ergometrine versus oxytocion alone.J Current Clinic Tri. 1993; 13:282-3.
Chan A.S., Ng P.S., Sin W.K., TANg L.C., Cheung K.B. A multicenter randomized controlled trial of oral misoprostol and IM syntometrine in the management of the third stage of labour. Hum Reprod.2001;16(1):31-35.
McCormick M.L., Sanghvi H.C., Kinzie B., Mclntosh N. Preventing Postpartum hemorrage in low– resource. Int J Gynaecol Obstet.2002;77 (3): 267-75.
Lokugamage A.U., Sullivan K.R., Niculescu I. A randomized study comparing rectally admhnhstered misoprostol versus syntometrine combined with an oxytocin infusion for the cessation of primary post partum hemorrage. Acta Obstet Gynecol Scand.2001;80(9):835-9.
Elbourne D.R., Prendiville W.J., Carroli G. Prophylactic of oxytocin in the third stage of labour. Cochrane Database Syst Rev.2001; (4): CD001808.
Bertram G. Z., Emertius.P.H .Basic &Clinical Pharmacology. 8thedition. New York Mc Graw Hill. 2001;639-640,282-286.
Yeun P.M., Chan N.S.T., Yim S.F. Random-ized double blind comparison of syntometrine and syntocinon in the management of the third stage of labour. Br J Obsetet Gynecol. 1995;102:372-380.
Garcia J., Garforth S., Ayers S. The policy and practice of midwifery study: Introduction and methods. Midwifery.1987;302-9.
Embrey M.P. Simultaneous intramuscular injection of oxytocin and ergometrine. a tocogra-phic study. Br Med J.1961;1:1737-1738.
Soriano D., Dulitzki., M.C., Schiff E. A prospective Cohort study of oxytocin plus ergometrine compared with oxytocin alone for prevention of postpartum hemorrhage. Br J Obsetet Gynecol.1996;l103:1068-1073.
Abu Omar A.A. Prevention of post partum hemorrage ,safety and efficacy. Saudi Med J. 2001;22(12):1118-21.
Nieminen U., Jarvinen P.A. A comparative syudy of different medical treatment of the third stage of labor. Ann Chir Gynecol.1963;53:424-429.
Dochety P.W., Hooper M. Choice of an oxytocic agent for routine use at delivery. J Obsetet Gynecol.1981;2:60-5.
Domoulin J.G. A rel of the use of ergometrine. J Obstet Gynecol. 1981;1:178-181.
Mc Donald S., Prendiville W.J., Elbourne D. Prophylactic syntometrine versus oxytocin for delivery placenta. Cochrane Database Sys Rev. 2000;(2):CD000201.
Elbourne D.R. Prophylactic syntometrine versus oxytocin in third stage of labour. In: Enkin M.W., Kearse M.J.N.C., Renfrew M.J., Neilson J.P., (Editors). Pregnancy and Childbirth module, Review No 02999. Oxford: update Software,1993.
John K., Stene: Christopher M. Grande, Anestesia for trauma .Anesthesia Ronald D., Miller M.D.4th Edition, New York, Churchill Livhngstone.1996;66:2165.
Choy C.M., Lau W.C., Tam W.H. A randomized controlled trial of intramuscular syntometrine and intravenous oxytocin in the management of the third stage of labour. BJOG. 2002;109(2):173-7.
Joy S.D., Sanchez-Ramos L.Misoprostol use during the third stage of labour. Int J Gynaecol Obstet.2003; 82(2):143-52.
Elbourne D., Prendiville W.J. Choice of oxitocic preparation for routine use in the management of the third stage of labour: an overview evidence from controlled trials. Br J Obstet Gynaecol.1988;95(1):17-30.
Mc Donald S.J., Prendiville W.J., Blair E. Randomized controlled trial of oxytocin alone versus oxytocin and ergometrine in active management of the third stage of labor. BMJ. 1993;307:1167–1171.
Thilanganthan B., Cutner A., Larimer J. Management of the third stage of labour in women at low risk of postpartum heamorrhage. Eur J Obstet Gynecol Bio.1993;48:19-2.
Khan G.Q., John I.S., Chan T. Third stage trial:oxitocin versus syntometrine in the active management of the third stage of labour.Eur J Obstet Gynecol Reprod Biol.1955;58(2):147-51.
Bamigboye A.A., Merrell D.A., Hofmeyr misoprostol with synto metrine for management G.J. Randomized Comparison of rectal of third stage of labor. Acta Obstet Gynecol Scand.1988;77(2):178-81.
Cook C.M., Spurrett B., Murray H.A. Randomized clinical trial compring oral misoprostol and synthetic oxytocin or syntometrine in the third stage of labour. Aust NZJ Obstet Gynecol.1999;39(4):414-9.
Journal of Reproduction & Infertility
Volume 5, Issue 1
Winter 2004
Pages 52-61