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Does Labor Augmentation with Oxytocin her and ot C M h il n d i H s e c i a l n t i l h Mansy, Clinics Mother Child Health 2017, 14:3 C Clinics in Mother and Child Health DOI: 10.4172/2090-7214.1000268 ISSN: 2090-7214 Research Article Open Access Does Labor Augmentation with Oxytocin Increase the Risk of Postpartum Hemorrhage? A Randomized Controlled Trial Amr Mansy* Obstetrics & Gynecology, Faculty of Medicine, Alexandria University, Egypt *Corresponding author: Amr Mansy, Obstetrics & Gynecology, Faculty of Medicine, Alexandria University, Egypt, Tel: +201227494992; Fax: +201227494992; E-mail: [email protected] Received date: June 04, 2017; Accepted date: August 22, 2017; Published date: September 02, 2017 Copyright: ©2017 Mansy A. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Labour augmentation aims to shorten labour so prevent complications related to prolonged labour. There is evidence that a significant proportion of women with uncomplicated pregnancies are subjected to routine augmentation of labour with oxytocin in spite of the general rule that labour augmentation should only be performed for valid indications. Obstetric hemorrhage is one of the leading causes of maternal mortality in developing countries, accounting for 10%-30% of direct maternal deaths. The aim of the study was to compare between labour augmentation with oxytocin and no augmentation on the total volume of blood loss during vaginal delivery. The study included 250 cases admitted to the emergency department in El-Shatby maternity university hospital, group A (Oxytocin group) 125 cases received augmentation by oxytocin infusion using 2.5 IU oxytocin in 500 cc saline with a slow rate of 20-30 drops/minute, group B (Control group) 125 cases received only 500 cc saline. The amount of blood loss during the 3rd stage of labor and the 1st hour after delivery of the placenta (4th stage) have been estimated. Results showed that the total volume of blood loss in group A ranged from 100 to 700 ml with the mean of 230.9 ± 99.3 ml, on the other hand it ranged from 100 to 650 ml with mean of 181.5 ± 83.1 ml in group B. the calculated p value was 0.001, so there was a significant statistical difference between both groups regarding the total volume of blood loss, so we concluded that use of oxytocin in labor augmentation increase the volume of blood loss. Keywords: Oxytocin; Postpartum haemorrhage; Labor fifth Millennium Development Goal, evidence-based guideline was augmentation required for their health workers to comprehensively improve intrapartum care through appropriate patient selection and use of Introduction effective interventions. In this regard, the World Health Organization (WHO) published recommendations for induction of labour to Difficult labour or dystocia is defined as slow progress of labour consolidate the guidance for effective interventions related to caused by inefficient uterine contractions, abnormal fetal presentation intrapartum care [7]. Obstetric hemorrhage is one of the leading or position, inadequate bony pelvis or abnormal maternal pelvic soft causes of maternal mortality in developing countries, accounting for tissues. It is associated with maternal and perinatal morbidity and 10%-30% of direct maternal deaths [8]. Clinical studies of the effect of mortality [1]. The incidence of difficult labour is not accurately known oxytocin administration during labour on the risk of PPH have as there is no universal consensus about the definition of delayed first reported conflicting results [9]. In this study authors tried to find an stage of labour [2]. The term “Failure to progress” has become an effect of labour augmentation using oxytocin infusion on the risk of increasing description of delayed labour and one of the leading causes development of postpartum hemorrhage. of caesarean section [3]. Augmentation of labour is the process of uterine stimulation using intravenous oxytocin infusion to increase Study Objectives frequency, duration and intensity of contractions after the onset of spontaneous labour. It is used to treat delayed labour when uterine contractions are not strong or coordinated enough to cause cervical Primary objective dilatation [4]. Labour augmentation aims to shorten labour so prevent To compare between labour augmentation with oxytocin and no complications related to prolonged labour. There is evidence that a augmentation on the total volume of blood loss during vaginal significant proportion of women with uncomplicated pregnancies are delivery. subjected to routine augmentation of labour with oxytocin in spite of the general rule that labour augmentation should only be performed Secondary objective for valid indications [5]. To study the effect of labour augmentation by oxytocin on the There have also been reports of unstructured use of labour development of postpartum hemorrhage (PPH), conversion to augmentation, where women are given oxytocin inadequately or cesarean section (CS), fetal and maternal adverse effects. unnecessarily. Augmentation with synthetic oxytocin may result in uterine hyperstimulation, adverse effects as fetal hypoxia and uterine rupture [6]. For low-income countries to remain on track towards the Clinics Mother Child Health, an open access journal Volume 14 • Issue 3 • 1000268 ISSN:2090-7214 Citation: Mansy A (2017) Does Labor Augmentation with Oxytocin Increase the Risk of Postpartum Hemorrhage? A Randomized Controlled Trial. Clinics Mother Child Health 14: 268. doi:10.4172/2090-7214.1000268 Page 2 of 6 Methods • If the condition persisted cesarean section was offered as fetal blood sampling and fetal blood pH were not available at our • Trial Design: Double blinded randomized controlled trial. hospital. • Method or randomization: Closed envelope. Any case developed signs of uterine hyperstimulation in both • Alexandria University Ethics Committee approval was obtained. groups was subjected to hold augmentation (if belonged to oxytocin • Participants: The study included 250 cases admitted to the group), advised to lie on her left lateral position and received emergency department in El-Shatby maternity university hospital Intravenous terbutaline as Ventolin® 0.5 mg/ml, using a 1 mL syringe, fulfilled the study eligibility criteria. 0.5 mL (250 µg) of terbutaline was drawn up then added to a 10 mL syringe and made up to 10 mL with sodium chloride 0.9% (25 µg/mL), Eligibility criteria given slowly intravenous in 50 µg boluses up to 250 µg, maternal pulse 1. Any multiparous woman with one or more successful non monitoring was ensured whilst bolus doses administered. complicated vaginal delivery. Once the cervix was fully dilated all women were transferred to the 2. All women admitted in the latent phase of 1st stage of labour. delivery room with her infusion and continuous fetal monitoring was 3. Cephalic presentation, with engaged head. done, no anaesthesia was administered except local anesthesia if 4. Intact membrane. episiotomy was needed, after delivery of the anterior shoulder all cases 5. Frequent uterine contractions with cervical dilatation ≤ 3 cm of both groups were subjected to the active management of 3rd stage with cervical effacement ≥ 50%. approved by our hospital: 6. Age 20 to 35 years. • Bladder emptying. 7. Gestational age: Full term. • 10 IU oxytocin infusion. 8. Expected fetal weight 2500 to 3500 kg. • Controlled cord traction. 9. Hb ≥ 10 gm/dl on admission. • Uterine massage. 10. No contraindications of vaginal delivery. After clamping of the cord a clean disposable plastic sheet that was 11. No contraindications of oxytocin or tocolytic use (as terbutaline previously folded on delivery table, would be unfolded under the if needed) as hypertension, hyperthyroidism and cardiac diseases. woman buttocks and its lower end being directed to a calibrated jug to estimate the amount of blood loss. Interventions The amount of blood loss during the 3rd stage of labor and the 1st After signing a well-informed written consent to declare their hour after delivery of the placenta (4th stage) would be estimated. participation in the study, all cases were divided randomly using a During the 4th stage any signs of uterine atony were observed and closed envelope method into two groups: recorded, also any need for other oxytocics as oxytocin, misoprostol or Group A (Oxytocin group): 125 cases received augmentation by Carbetocin was recorded. Any case required further interventions for oxytocin infusion using 2.5 IU oxytocin in 500 cc saline with a slow PPH management as surgical intervention also been recorded. rate of 20-30 drops/min. Indications of cesarean section in both groups: Group B (Control group): 125 cases received only 500 cc saline. • Failure of progress of labour (as failure of head decent in spite of After randomization and enrollment in the study, all cases of both full cervical dilatation) with fetal or maternal distress. groups have been checked for the following parameters: • Uterine hyperstimulation not responding to tocolytic with persistent fetal distress. Progress of labour: • Persistent Fetal distress with expected fetal hypoxia. st • Duration of the remaining time of the 1 stage. • Other indications as severe intrapartum hemorrhage. • Fetal heart rate monitoring every one hour for 20 min to exclude abnormal heart rate pattern as late or variable decelerations, brady Outcomes or tachycardia and abnormal
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