Prophylactic oxytocin is associated with an increased risk of postpartum haemorrhage compared to prophylactic oxytocin-ergometrine in active management of the third stage of labour
Author(s): Brook A.; Martindale E.; Hamer F.; Choudhari Y.
Source: BJOG: An International Journal of Obstetrics and Gynaecology; Mar 2017; vol. 124 ; p. 55
Publication Date: Mar 2017
Publication Type(s): Conference Abstract
Abstract:Introduction Oxytocin (Syntocinon) may be associated with a rise in primary postpartum haemorrhage (PPH) compared with oxytocin-ergometrine (Syntometrine). The Royal College of Obstetricians and Gynaecologists has endorsed oxytocin as single agent in the active management of the third stage. We evaluated the local PPH incidence after vaginal delivery to coincide with a change in practice from oxytocin-ergometrine to oxytocin. Methods Data was extracted from an electronic record of deliveries. The change to 10 units IM oxytocin as third stage agent was introduced mid-August 2016. We scrutinized clinically significant PPH (>1000 ml) occurring both pre- and postintervention. Results 1414 vaginal deliveries occurred from June-October 2016. Median blood loss was 350 ml (50-4000). Overall, 99 cases of PPH occurred with median blood loss 1507 ml (1000-4000). PPH incidence at baseline was 7%, increasing to 9% in the 2 months after switchover. This would account for an additional 28 cases of PPH (>1000 ml) in the period and 168 additional cases per annum in our unit. Oxytocin was associated with a significant increase in PPH risk when compared to oxytocin-ergometrine (58/595 9.7% versus 39/549 7.1%; chi2 P = 0.03). Need for additional oxytocics increased following the change and was lower in those receiving syntometrine (14.7 versus 19.4%; chi2 P = 0.01). Multiple binary logistic regression revealed that choice of oxytocic was a significant determinant of PPH (B 0.636; P = 0.015). Conclusion Although national guidelines endorse oxytocin rather than oxytocin-ergometrine for an active third stage, local experience suggests a significant impact on PPH risk.
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