Management of the Third Stage of Labor

Management of the Third Stage of Labor

Patrocinadores

Patrocinador principal: Yariv yogev

Fuente Rabin Medical Center
Resumen breve

To compare the efficacy of three different protocols of third stage management in preventing PPH.

Descripción detallada

The third stage of labor refers to the period following the completed delivery of the newborn until the completed delivery of the placenta. The length of the third stage and its complications are affected by the uterine contractility and the duration of placental separation. The normal duration of third stage in nulliparous as well as in multiparous women is less than 30 minutes. There is strong evidence supporting the routine administration of uterotonic agents for the prevention of post-partum hemorrhage (PPH), in order to enhance natural uterine contraction in the third stage of labor, thus reducing the occurrence of PPH by 40%.

There is a joint policy statement between the International Confederation of Midwives (ICM), the International Federation of Gynecology and Obstetrics (FIGO) and the World Health Organization (WHO), all of which recommend active management of the third stage of labor in order to prevent PPH. active management led to a reduction in PPH incidence, maternal Hemoglobin<9g/dL and need for blood transfusion. (4-7).

Active management of the third stage of labor involves prophylactic uterotonic treatment, early cord clamping and controlled cord traction to deliver the placenta. (2) Oxytocin is the first agent of choice for PPH prophylaxis because of its high efficacy and a low incidence of associated side effects. (6-9). Cotter et al found that the use of Oxytocin for PPH prophylaxis in the third stage of labor decreased the rate of maternal blood loss greater than 500 ml by approximately 50%. (10).

Oxytocin route of administration is either intravenously (IV) or intramuscularly (IM), with no significant difference in PPH incidence (9). This is based on a pharmacokinetic research from 1972 which found no difference between the absorption rates in both routes of administration. Since then no further research targeting this question was preformed. (11-12). recent guidelines from WHO, FIGO and ICM all recommended the use of 10 IU Oxytocin IM. (4, 7,13).

Previous studies have investigated the effect of intra-umbilical vein Oxytocin injection in reducing blood loss during the third stage of labor. This route of administration directs treatment to the placental bed and uterine wall, resulting in earlier uterine contraction and placental separation. However, limited published literature is available evaluating the effect of umbilical vein oxytocin injection in routine practices for active management of the third stage of labor. A prospective, randomized controlled trial of 412 women found that intra-umbilical injection of oxytocin alongside active management of the third stage of labor significantly reduced postpartum blood loss and the duration of the third stage (14).

Other uterotonic agents including Syntometrine (IM), Ergometrine (IM or IV) and Misoprostol (IM), can be used in active management of the third stage of labor. However, high quality evidence regarding their efficacy compared to Oxytocin is scarce. (9-10)

Estado general Unknown status
Fecha de inicio September 2015
Fecha de Terminación January 2017
Fecha de finalización primaria January 2017
Fase Phase 3
Tipo de estudio Interventional
Resultado primario
Medida Periodo de tiempo
Change in Hemoglobin concentration during labor first and second day after delivery
Resultado secundario
Medida Periodo de tiempo
Blood count (CBC) on the first and second day after delivery first and second day after delivery
Inscripción 500
Condición
Intervención

Tipo de intervención: Drug

Nombre de intervención: Oxytocin

Descripción: The study group: divided into two groups: • Intramuscular treatment: pregnant women, 34-41 weeks of gestation, which were treated with 10 IU of IM Oxytocin during the third stage of labor. • Combined treatment: pregnant women, 34-41 weeks of gestation, which were treated with 10 IU of IM Oxytocin together with 10 IU of IV Oxytocin in 100 ml NaCl 0.9% during the third stage of labor.

Otro nombre: Pitocin

Tipo de intervención: Drug

Nombre de intervención: Oxytocin in 100 ml NaCl 0.9%

Descripción: The control group: pregnant women, 34-41 weeks of gestation, which were treated with 10 IU of IV Oxytocin in 100 ml NaCl 0.9% during the third stage of labor. (this is the routine practice in our department).

Etiqueta de grupo de brazo: The control group

Elegibilidad

Criterios:

Inclusion Criteria:

- Singleton pregnancy.

- 34-41 weeks of gestation.

- Maternal age between 18 and 45.

Exclusion Criteria:

- Women who enter delivery room during the active phase of labor (cervical dilatation greater than 5 cm)

- Coagulation defects

- VAS score>3 (pain score)

- Women with early PPH

- Suspected placental abruption

Género: Female

Edad mínima: 18 Years

Edad máxima: 45 Years

Voluntarios Saludables: No

Oficial general
Apellido Papel Afiliación
Yariv Yogev, professor Principal Investigator Director, Division of obstetrics and delivery
Contacto general

Apellido: Yariv Yogev, professor

Teléfono: 9723-9377490

Email: [email protected]

Fecha de verificación

September 2015

Fiesta responsable

Tipo: Sponsor-Investigator

Afiliación del investigador: Rabin Medical Center

Nombre completo del investigador: Yariv yogev

Título del investigador: Prof. Yariv Yogev Director, Division of obstetrics and delivery

Tiene acceso ampliado No
Condición Examinar
Número de brazos 3
Grupo de brazo

Etiqueta: Intramuscular treatment:IV

Tipo: Experimental

Descripción: pregnant women, 34-41 weeks of gestation, which were treated with 10 IU of IM Oxytocin during the third stage of labor.

Etiqueta: Combined treatment:IV+IM

Tipo: Experimental

Descripción: pregnant women, 34-41 weeks of gestation, which were treated with 10 IU of IM Oxytocin together with 10 IU of IV Oxytocin in 100 ml NaCl 0.9% during the third stage of labor.

Etiqueta: The control group

Tipo: Active Comparator

Descripción: pregnant women, 34-41 weeks of gestation, which were treated with 10 IU of IV Oxytocin in 100 ml NaCl 0.9% during the third stage of labor. (this is the routine practice in our department).

Información de diseño del estudio

Asignación: Randomized

Modelo de intervención: Parallel Assignment

Propósito primario: Treatment

Enmascaramiento: None (Open Label)

Fuente: ClinicalTrials.gov