Objective: This is a single blinded, randomized controlled trial on women with singleton term pregnancy delivered by cesarean section to compare the efficacy of a single intravenous injection of carbetocin with a standard d 8-hour intravenous infusion of oxytocin. Methods: The trial was conducted in the delivery unit of a tertiary hospital from January 1, 2011 to June 30, 2011. Sixty two patients were randomized to receive either a single injection of carbetocin or an 8-hour infusion of oxytocin. Outcome measures were intraoperative blood loss, uterine tonicity and need for uterotonics. Results: The mean estimated blood loss with carbetocin was significantly less with a P value of < 0.01 (483.87 ml). Intravenous injection of 100mcg of carbetocin-produced tetanic uterine contractions within 3 minutes, lasting for about 5 minutes, followed by rhythmic contractions for a futher 50 ± 20 minutes. Need for uterotonic intervention was clinically indicated in two (6.45%) of the women given IV carbetocin compared to 12 (38.71%) of the women given IV oxytocin infusion. Adverse effects of the treatments .were not significantly different between the two groups. Conclusion: Carbetocin was superior to oxytocin in the outcome parameters measured. Estimated blood loss and the need for additional uterotonic agents were lower in the carbetocin group. Uterine tone and early involution of the uterus is likewise better in the carbetocin group.
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Maternal mortality continues to be a major public health concern inspite of the advances in technology and research. Worldwide, postpartum hemorrhage (PPH) is cited as the major cause of mortality and morbidity, more so in developing countries. Active management of third stage of labor (AMTSL) is the treatment of choice in preventing PPH.

OBJECTIVE: The goal of this study was to determine the efficacy of intraumbilical vein injection of oxytocin versus IV oxytocin infusion in the AMTSL. It is meant to provide an alternate route that is more efficacious and practical.

METHODS: In this prospective, randomized, single-blinded clinical trial comparing the efficacy of intraumbilical vein (IUV) injection of oxytocin versus oxytocin IV infusion, 80 subjects were assigned to 2 groups according to the route of oxytocin. Primary outcome measures were duration of third stage of labor and amount of blood loss. Secondary outcome measures were the need for additional uterotonic agent, need for transfusion, uterine tone and acceptability to the examiner.

RESULTS: Blood loss was significantly lower in the IUV group compared to IV group (386.11±214.49 vs 516.22±139.95) while duration of third stage was longer in the IUV group (318±190.31 vs 271.49±200.60). The difference in hemoglobin pre and post-delivery is significantly lower in the UIV group (0.85±0.84 vs 1.29±1.13). Adequate uterine tone was achieved immediately after IUV oxytocin, thereby eliminating the need for Methylergometrine.

CONCLUSION: Intraumbilical vein injection of oxytocin in the active management of labor is an effective alternate route in preventing postpartum hemorrhage.

Human ; Methylergonovine ; Postpartum Hemorrhage ; Oxytocin ; Maternal Mortality ; Labor, Obstetric ; Delivery, Obstetric ; Parturition ; Hemoglobins