Faculty of Midwifery, Babol University of Medical Sciences, Iran

Abstract

Introduction: This stage of delivery is probably the most dangerous stage, because mother is threatened by bleeding the main of the study was to test the hypothesis that injection of oxytocin after delivery decreases the prevalence of bleeding and shorten the duration of third stage of delivery. Measurement of the amount of fetomaternal transfusion was the second object.

Material and Methods: This research was done on 230 single fetus. Gestational ages less than 34 weeks and Rh ^- patients were omitted. The first group was injected 10 units of oxytocine intramuscularly immediately after delivery.

In the second group was no injection, 25 persons from the first group and 27 persons from the second group randomly kleihauer test was performed before and one half hour after delivery in order to measure the amount of feto-maternal blood transfusion. Results: The mean of the third stage in the group who were injected oxytocine immediately after placenta delivery was 4.2 minutes and for the second group was 5 minutes.

There was no significant difference in the mean times in two group three cases (2.6%) relation of placenta was noticed.

The mean Volume of bleeding in the third stage on first and second group was 54.9 and 72.5 ml and the differences were not statically significance. In the first group, the amount of fetus blood transfusion to mother was 27 and in the second group was 26.4 ml. There was no significant difference in feto-maternal Blood transfusion. Conclusion: the basis of this findings, we suggest no to inject oxytocine in the third stage.

Introduction

The third stage of labor often is scarcely considered (1) For most parturient the third stage of labor is short and uneventful; placenta separation has been reported to occur within two contractions after delivery of the neonate (2). This stage is thought to be the most dangerous stage of labor because of the risk of significant hemorrhage (1).

Management of the third stage of labor Content: Active management of third stage; routine administration an oxytocin ,cord clamping before placental delivery and cord traction. The available data suggest that routine administration of oxytocics results in an important reduction in the risk of postpartum hemorrhage. The odds of this risk were reduced by a bout 60 percent. The effect of prophylactic oxytocic on retention of the placenta is still not clear. There is some suggestion from limited data routine administration of Oxytocics increases the risk of retained placenta (4).

Fetal-maternal transplacenta hemorrhage, in small amounts, occurs in approximately 75% of all pregnancies in our population (5). The cord ligation and the use of oxytocics drug increases the blood pressure within the placental vasculature during the third stage of labor. (6). Fetal-maternal trancplacenta hemorrhage is clinically important only in cases of very large hemorrhage important, Massive transplacenta hemorrhage may cause fetal death, fetal distress, hydrops, hypovolemia shock and anemia (7).

Maternal complications range from blood transfusion like reaction (8) to Rh sensitization with problems in subsequent pregnancy (9).The objective of this study was to assess the effect of injection of oxytocine after delivery on blood loss, duration of third stage of delivery, measurment of the a mount of fetomaternal transfusion.

Maternal and Methods

This research was done on 230 single fetus case. Gestation age less than 34 weeks and Rh^- patient were omitted. Experimental cases were randomly classified in to two groups, In the first group injected 10 unit of oxytocine intramuscularly immediately after delivery. In the second group there was no injection oxytocine. The placenta was delivered by brandt Androw’s method. The time of delivery of placenta was noted and the massaging gently to ensure Contraction patient also routinely received oxytocin after delivery of the placenta, A placenta was considered retained if not delivered by manual removal. In mediately delivery a kidney dish was taken and the blood volume from completed deliver until delivery of the placenta was collected and noted. 25 persons from the first group and 27 persons from the second group randomly kleihauer test was performed before and half hours after delivery in order to measure the amount of fetomaternal blood transfusion. The groups had comparable similarities in regards to the age, duration of stage1 and 2 of labor previous third stage abnormality Sections, gravidity, induction of labor and method of vaginal deliveries

Results

The average duration of separation of placenta in the group who were injected oxytocin immediately after placenta delivery was 3.07 minutes and in the other group was 4.08 minutes which shows statistically significant difference (p<0.019)

In two groups, the average duration from separation of placenta until Completed delivery of placenta Were Similar (in first group 1.01 minutes and in the group 1.37 minutes).

Fig 1 shows duration of third stage of labor. The average duration of stage 3 in the first group was 4.2 minutes and the second group was 5.0 minutes. There was no significant difference in the mean times in two groups. In the first group, there was no relation of placenta but in the second group three cases (2.6%) relation of placenta was noticed.

Fig1: duration of third stage of labor

Fig 2 shows volume hemorrhage third stage. The mean volume of bleeding in the third stage of first and second group was 54.9 and 75.5 ml respectively the differences were not statically significant in the first group, the amount of fetus blood transfusion to mother was 27 and in the second group was 26.4 ml.

There was no significant difference in fetomaternal blood transfusion.

Fig2: volume hemorrhage third stage of labor

Conclusion

The results document that no significant difference in the mean time and amount of material blood loss of third stage of delivery in injected no injected patients.

Prendville et al. (1988) reported, on physiological group, third stage was longer (median is min V 5 min) (10)

Pierr, et al. (1992) reported that the duration of third stage is significantly shorter in the active group than in the Control group (11).

Prendville, et al. shows that amount of maternal blood loss in the third stage was reduced by the use of oxytocine injection (12) but Cunnigham (1993) reported that it is reduced with active management (13). Retained placenta is one of the most serious complications of child birth and if left untreated, maternal death many follow from hemorrhage vary or infection (14).

Pirre et al (1992), reported that is no significant difference between the two groups for retained placenta (11)

In our study risk of placenta hemorrhage was reduced by the use of prophylactic oxytocine.

Fetomaternal transfusion occurs in varying degrees in all pregnancies. However, the rhesus- negative baby is likely to be affected as a consequence of such a transfusion (15) the possibility of RG immune globulin failure exist when a fetomaternal hemorrhage exceeds 25 to 30 ml of whole blood only one 30 micrograms vial of RH immune globulin is administered (16).

In this study, the volume of transfusion was varied from 0-55 ml. Comparison of group revealed no difference in rate of fetal hemorrhage.

Thomas, et al. reported that, routine prophylactic administration increases the risk of fetomaternal hemorrhage (17).

On the basis this finding which indicated no significant difference in the mean time of third stage of labor inject no injected patients, and fetomaternal blood transfusion administration of oxytocine have no significant difference on the above mentioned cases therefore, we suggest not inject oxytocine in the third stage.

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