Prevention of postpartum hemorrhage, safety and efficacy

OBJECTIVE: This study was carried out to describe the safety and efficacy of intramuscular syntometrine (oxytocin plus ergometrine) compared to intravenous oxytocin for prevention of postpartum hemorrhage, and the difference between administration at the end of the 2nd stage of labor compared with that after delivery of the placenta.

METHODS: A prospective study was carried out at Prince Zaid Ben Al-Hussein Hospital, Tafilah, Jordan. Two thousand one hundred and sixty one women delivering singletons during 12 consecutive months were included in our study. Women received either intramuscular syntometrine (oxytocin plus ergometrine) or oxytocin alone. The drugs were used either before or after the 3rd stage of labor, in order to compare their safety and efficacy in prevention of postpartum hemorrhage.

RESULTS: There was no significant difference in the rate of postpartum hemorrhage for syntometrine compared with oxytocin, when used at the end of the 2nd stage of labor (odds ratio 1.08, 95% confidence interval 0.72-1.63) or after the 3rd stage (odds ratio 0.93, 95% confidence interval 0.65-1.34). The patients receiving oxytocics at the end of the 2nd stage of labor had significantly lower rates of postpartum hemorrhage, for both syntometrine (odds ratio 0.86, 95% confidence interval 0.59-0.1.12) and Oxytocin (odds ratio 0.59, 95% confidence interval 0.39-0.88), compared with those treated after the 3rd stage.

CONCLUSION: Oxytocin alone is as effective as the use of syntometrine (ergometrine plus oxytocin) in the prevention of postpartum hemorrhage, but associated with significantly fewer maternal side effects. Oxytocics administered after the 2nd stage of labor compared with after the 3rd stage of labor (placental expulsion) are associated with a significantly fewer rate of postpartum bleeding.