Prophylactic oxytocin for the third stage of labour

Cochrane Review by Cotter A, Ness A, Tolosa J

This record should be cited as: Cotter AM, Ness A, Tolosa JE. Prophylactic oxytocin for the third stage of labour. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD001808. DOI: 10.1002/14651858.CD001808.

ABSTRACT

Title

Prophylactic oxytocin for the third stage of labour

Background

Complications of the third stage of labour are a significant cause of maternal mortality worldwide.

Objectives

To examine the effect of oxytocin given prophylactically in the third stage of labour on maternal and neonatal outcomes.

Search strategy

We searched the Cochrane Pregnancy and Childbirth Group's Specialised Register of Controlled Trials (December 2004).

Selection criteria

Randomised or quasi-randomised controlled trials including pregnant women anticipating a vaginal delivery where oxytocin was given prophylactically for the third stage of labour.

Data collection and analysis

The review authors independently assessed trial quality and extracted data. Analysis was by intention to treat. Subgroup analyses were based on extent of selection bias, oxytocin in the context of active or expectant management of the third stage, and timing of administration. Results are presented as relative risks, and weighted mean difference, both with 95% confidence intervals using a fixedeffect model.

Main results

Fourteen trials are included. In seven trials involving over 3000 women, prophylactic oxytocin showed benefits (reduced blood loss (relative risk (RR) for blood loss greater than 500 ml 0.50; 95% confidence interval (CI) 0.43 to 0.59) and need for therapeutic oxytocics (RR 0.50; 95% CI 0.39 to 0.64) compared to no uterotonics. In six trials involving over 2800 women, there was little evidence of differential effects for oxytocin versus ergot alkaloids, except that oxytocin was associated with fewer manual removals of the placenta (RR 0.57; 95% CI 0.41 to 0.79), and with the suggestion of less raised blood pressure (RR 0.53; 95% CI 0.19 to 1.52) than with ergot alkaloids. In five trials involving over 2800 women, there was little evidence of a synergistic effect of adding oxytocin to ergometrine versus ergometrine alone.

Authors' conclusions

Oxytocin appears to be beneficial for the prevention of postpartum haemorrhage. However, there is insufficient information about other outcomes and side-effects hence it is difficult to be confident about the trade-offs for these benefits. There seems little evidence in favour of ergot alkaloids alone compared to either oxytocin alone, or to ergometrine-oxytocin, but the data are sparse. More trials are needed in domiciliary deliveries in developing countries, which shoulder most of the burden of third stage complications.

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