Intramuscular oxytocin versus oxytocin/ergometrine versus carbetocin for prevention of primary postpartum haemorrhage after vaginal birth: study protocol for a randomised controlled trial (the IMox study). Postpartum haemorrhage remains a major cause of maternal mortality and morbidity worldwide. Active management of the third stage of labour reduces the risk of postpartum haemorrhage. Oxytocin and oxytocin/ergometrine are commonly used in the UK, with oxytocin/ergometrine being more effective at preventing moderate, but not severe, blood loss. Many guidelines specifically recommend using oxytocin for all vaginal births, as it is associated with fewer adverse events. However, a survey conducted by the Southmead Hospital Maternity Research Team revealed that 71.4% of UK obstetric units still
A randomised controlled trial comparing oxytocin and oxytocin + ergometrine for prevention of postpartum haemorrhage at caesarean section. Globally 166 000 women die annually as a result of obstetric haemorrhage. More than 50% of these deaths occur in sub-Saharan Africa. Uterine atony is the commonest cause of severe postpartum haemorrhage (PPH). Bleeding at or after caesarean section (CS ) is responsible for >30% of maternal deaths due to obstetric haemorrhage in South Africa (SA). To compare oxytocin alone with oxytocin + ergometrine in terms of primary prophylaxis for PPH at the time of CS. This was a double-blind randomised controlled interventional study comparing oxytocin with oxytocin + ergometrine administered during CS. Patients were randomised to receive oxytocin alone intravenously
identified 7 RCTs (n = 3738) that met inclusion criteria. One trial included women giving birth vaginally or by cesarean section, while the others included only vaginal births. Agents evaluated included oxytocin (6 trial arms), misoprostol plus oxytocin (4 trials arms), misoprostol (3 trial arms), and fixed-dose oxytocin/ergometrine plus oxytocin infusion (1 trial arm). Data using this last regimen were . These included fever (RR: 3.0; 95% CI: 2.6-3.6; absolute risk increase: 32.1%; NNH: 3) and vomiting (RR: 1.9; 95% CI: 1.2-3.0; absolute risk increase: 2.9%; NNH: 34).CaveatsThe quality of evidence for these analyses ranged from very low to high, with most data rated low or moderate certainty. No studies including injectable prostaglandins, ergometrine, or oxytocin/ergometrine as first line agents were
approach can be used, although this is more likely in the non-obstetric inversion.[1, 14, 15]If this is unsuccessful, hysterectomy, which may be life-saving, is the final option.If placenta is still present, careful examination and removal are required to ensure it is not abnormally adherent.General anaesthetic or uterine relaxant is then stopped and replaced with oxytocin, ergometrine or prostaglandins
of reduced effectiveness of oxytocin in preventing PPH from uterine atony. Although heat stable and effective in preventing PPH, misoprostol is also subject to degradation due to exposure to moisture and produces some side-effects. Other uterotonics (including ergometrine and combinations of oxytocin, ergometrine and misoprostol) are also available and used with varying safety and effectiveness profiles
has speculated that the rising prevalence of maternal obesity in developed countries may explain the increase in postpartum hemorrhage incidence.Uterotonic drugs are recommended to reduce blood loss and the risk of postpartum hemorrhage (PPH) after Cesarean delivery.There are several prophylactic uterotonic agents available for use, including oxytocin, oxytocin/ergometrine, and carbetocin
(AMTSL), requires prophylactic utero-tonic drugs as oxytocin, ergometrine malate and combinations of them , They must be administered by injection.Misoprostol is synthetic prostaglandin (PGE1 analogue), with utero-tonic properties, has been proposed as an alternative strategy for prevention of PPH in settings where oxytocin use is not handy. It has important advantages over oxytocin, including
bleeding is one hundred thousand per year (6). Therefore, it is essential to reduce bleeding during and after CS to diminish maternal mortality and morbidity (7). The most successful technique for decreasing PPH is the active third stage labor management, requiring prophylactic uterotonic drugs like oxytocin, ergometrine malate, prostaglandins (E1, E2, and F2α), and combinations of them, or hemostatic
: MedicationsMedications commonly used in the management of the third stage of labor include oxytocin, ergometrine/ergonovine, Syntometrine, misoprostol, carboprost tromethamine (Hemabate), and carbetocin.Previous References 1. Cunningham FG, Gant NF, Leveno KJ, et al. Conduct of normal labor and delivery. Williams Obstetrics. 21st ed. New York, NY: McGraw-Hill; 2001. 320-5. 2. Donald I. Postpartum
: MedicationsMedications commonly used in the management of the third stage of labor include oxytocin, ergometrine/ergonovine, Syntometrine, misoprostol, carboprost tromethamine (Hemabate), and carbetocin.Previous References 1. Cunningham FG, Gant NF, Leveno KJ, et al. Conduct of normal labor and delivery. Williams Obstetrics. 21st ed. New York, NY: McGraw-Hill; 2001. 320-5. 2. Donald I. Postpartum
: MedicationsMedications commonly used in the management of the third stage of labor include oxytocin, ergometrine/ergonovine, Syntometrine, misoprostol, carboprost tromethamine (Hemabate), and carbetocin.Previous References 1. Cunningham FG, Gant NF, Leveno KJ, et al. Conduct of normal labor and delivery. Williams Obstetrics. 21st ed. New York, NY: McGraw-Hill; 2001. 320-5. 2. Donald I. Postpartum
: MedicationsMedications commonly used in the management of the third stage of labor include oxytocin, ergometrine/ergonovine, Syntometrine, misoprostol, carboprost tromethamine (Hemabate), and carbetocin.Previous References 1. Cunningham FG, Gant NF, Leveno KJ, et al. Conduct of normal labor and delivery. Williams Obstetrics. 21st ed. New York, NY: McGraw-Hill; 2001. 320-5. 2. Donald I. Postpartum
women; T² = 0.45, I² = 30%). Prophylactic oxytocin + ergometrine versus ergot alkaloids: There was no benefit seen in the combination of oxytocin and ergometrine versus ergometrine alone in preventing PPH greater than 500 mL (RR 0.90; 95% CI 0.34 to 2.41; five trials, 2891 women; T² = 0.89, I² = 80%). The use of oxytocin and ergometrine was associated with increased mean blood loss (MD 61.0 mL; 95% CI
loss during cesarean delivery is 487 ml, this amount is too close to the definition of postpartum hemorrhage by WHO as loss of 500 cc of blood in the first 24 hours after delivery making control of blood loss during cesarean delivery crucial to decrease maternal morbidities. Many medications used to decrease blood loss especially placental site bleeding during cesarean section including oxytocin , ergometrine, synthetic prostaglandins and recently carbetocin.Carbetocin is an oxytocin analogue containing eight amino acids .It binds to oxytocin receptors expressed on uterine muscles of pregnant women inducing tetanic uterine contractions for about 11 minutes after administration of 8-30ug intravenous followed by rhythmic uterine contractions that last for 60 to 120 minutes. Also it has a longer half
Oxytocin-ergometrine co-administration does not reduce blood loss at caesarean delivery for labour arrest To determine if intravenous infusion of a combination of oxytocin and ergometrine maleate is better than oxytocin alone to decrease blood loss at caesarean delivery for labour arrest. Prospective, double-blinded, randomised controlled trial. Mount Sinai Hospital, Toronto, Canada. Women . Blood loss was estimated based on the haematocrit values before and 48 hours after delivery. The primary outcome was the estimated blood loss, while the secondary outcomes included the use of additional uterotonics, need for blood transfusion and the incidence of adverse effects. The estimated blood loss was similar in the oxytocin-ergometrine and oxytocin-only groups; 1218 +/- 716 ml and 1299 +/- 774
OR 0.68, 95% CI 0.57-0.82, oxytocin/ergometrine OR 0.77, 95% CI 0.65-0.91), and prostaglandins administered for induction of labour. The associations were maintained when subgroups, such as primiparous women, women whose labours were neither induced nor augmented, and women not receiving epidural analgesia were considered. Prospective studies on drugs in labour are needed to investigate potential
controlled trial. Two metropolitan teaching hospitals in Perth, Western Australia. All women who expected a vaginal birth during the period of the trial. Informed consent was obtained. Postpartum haemorrhage, nausea, vomiting, and increased blood pressure. 3497 women were randomly allocated to receive oxytocin-ergometrine (n = 1730) or oxytocin (n = 1753). Rates of postpartum haemorrhage (> or = 500 ml or > or = 1000 ml) were similar in both arms (odds ratio 0.90 (0.82); 95% confidence interval 0.75 to 1.07 (0.59 to 1.14) at 500 ml (1000 ml) threshold). The use of oxytocin-ergometrine was associated with nausea, vomiting, and increased blood pressure. There are few advantages but several disadvantages for the routine use of oxytoxinergometrine when prophylactic active management of the third stage of labour
in the misoprostol group than in the oxytocin and ergometrine groups (7.0±2.2 min, 13.14±3.76 min, 22.5±4.37 min, respectively, P<0.001). Intraumbilical injection of uterotonics, namely oxytocin, ergometrine and dissolved misoprostol in saline, are closely effective in the management of retained placenta, with misoprostol being slightly more effective. This method may have a role in minimizing the need for manual