Active versus expectant management of third stage of labour: the Hinchingbrooke randomised controlled trial

Rogers, Jane; Wood, Juliet; McCandlish, Rona; Ayers, Sarah; Truesdale, Ann; Elbourne, Diana

doi:10.1016/s0140-6736(97)09409-9

Cited by 284 publications

(184 citation statements)

References 9 publications

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“…15,16 Furthermore, doses of oxytocin given during caesarean delivery appear to be empirical and extrapolated from studies on vaginal delivery, in which oxytocic drugs used routinely appear to reduce the risk of postpartum haemorrhage by about 40%. [29][30][31] A slow intravenous bolus dose of 5 units of oxytocin following delivery of the infant is currently recommended to decrease blood loss. 31 Recent studies suggest that the oxytocin dose given during elective CS could be reduced and that an infusion gives haemodynamic advantages.…”

Section: Discussionmentioning

confidence: 99%

ST depression at caesarean section and the relation to oxytocin dose. A randomised controlled trial

Jonsson

Hanson

Lidell

et al. 2009

BJOG

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Objective To investigate whether there is a difference in occurrence of electrocardiogram changes suggestive of myocardial ischaemia between two different doses of oxytocin.Design Double-blind randomised controlled trial Setting University hospital in Sweden.Population A total of 103 healthy women undergoing elective caesarean section under spinal anaesthesia.Methods The participants were randomised to 5 or 10 units of oxytocin, given as an intravenous bolus. A Holter monitor was used to record electrocardiograms and non invasive blood pressure and heart rate (HR) was monitored. A blood sample was obtained 12-hour postoperatively.Main outcome measures Depression of the ST segment. Secondary outcomes: symptoms, Troponon I levels, mean arterial pressure (MAP), HR and blood loss.Results There was a significant difference in occurrence of ST depressions associated with oxytocin administration, 4 (7.7%) with 5 and 11 (21.6%) with 10 units, P < 0.05. The absolute risk reduction was 13.9% (95% confidence interval, 0.5-27.3). Decrease of mean MAP from baseline to 2 minutes differed, being 9 mmHg in the 5 unit group and 17 mmHg in the 10 unit group (P < 0.01). The increase in mean HR did not differ. Troponin I levels were increased in four subjects (3.9%). There were no differences in occurrence of symptoms, Troponin I levels, or estimated blood loss.Conclusion ST depressions were associated with oxytocin administration significantly more often in subjects receiving 10 units compared with 5 units. Interventions to prevent hypotension during caesarean section may reduce the occurrence of ST depressions on electrocardiograms.

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Section: Discussionmentioning

confidence: 99%

ST depression at caesarean section and the relation to oxytocin dose. A randomised controlled trial

Jonsson

Hanson

Lidell

et al. 2009

BJOG

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“…5 Active management of third stage of labour (AMTSL) can prevent PPH and thereby prevent maternal death. [6][7][8][9] Different uterotonics are available for AMTSL among which oxytocin is found to be effective in reducing the risk of PPH by 50%. 10,11 It has also been advocated by the WHO during the active management of third stage of labour 5 .…”

Section: Introductionmentioning

confidence: 99%

A comparative study of efficacy of oxytocin, methylergometrine and misoprostol in prevention of post-partum haemorrhage

Alam

Shyam

Goswami

2017

Int J Reprod Contracept Obstet Gynecol

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Background: To compare the efficacy of oxytocin, methylergometrine and misoprostol in active management of third stage of labour (AMTSL).Methods: A clinical study was conducted on 330 low risk pregnant women with a healthy singleton pregnancy and spontaneous onset of labour at term; allocated into three groups where active management of third stage of labour was done with either Oxytocin 10 IU intramuscular, or Methylergometrine 0.2 mg intramuscular, or tab Misoprostol 600µg sublingual on 110 women each group. Primary parameter was blood loss during labour. Secondary parameters were the duration of third stage of labour and changes in haemoglobin level.Results: Blood loss during labour in Oxytocin group was 145.86±11.53 ml, which was significantly less than that in Methylergometrine (164.02±9.36 ml) and Misoprostol groups (183.18±9.70 ml), but no patient in any of the groups had blood loss more than 200ml. Duration of third stage of labour was significantly less in Oxytocin group (5.13±1.91 mins) than in. Methylergometrine (6.16±1.85 mins), and Misoprostol groups (6.47±1.51 mins). No patient had prolonged third stage in any of the groups. There was no significant change in pre-and post-delivery haemoglobin levels in all the groups.Conclusions: Though injectable uterotonics are effective for active management of third stage of labour (AMTSL), misoprostol can also be effectively used, especially in settings where there is no adequate trained personnel and drug storage facility.

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“…• Isofluarne with nitrous oxide for pain relief in labour Anaesthesia, 1999, 54, pages 1166-1172 ........................................................................................................................................................................................................................................... Certainly the use of isoflurane 0.75% for anaesthesia during Caesarean section was not associated with a higher blood loss than the use of 50% nitrous oxide alone [9] and the mean blood loss observed was similar to that seen after straightforward labour in women at low risk of haemorrhage [10]. Mean blood loss in the Hinchingbrooke randomised trial into active vs. expectant management of the third stage of labour was 336.5 ml (SEM 8.8) with expectant treatment and 268.5 ml (SEM 9.0) with active treatment compared with the mean of 241 ml (SEM 13.0) seen here.…”

Section: J a S Ross Et Almentioning

confidence: 78%

The use of 0.25% isoflurane premixed in 50% nitrous oxide and oxygen for pain relief in labour

et al. 1999

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SummaryThe addition of 0.25% isoflurane to 50% nitrous oxide in oxygen provides more effective pain relief in labour than 50% nitrous oxide alone. This study was carried out to determine whether self-administration by demand valve of 0.25% isoflurane in 50% nitrous oxide in oxygen premixed in cylinders at 13.7 MPa (IN 2 O) was practical and safe during labour. Two hundred and twentyone mothers used IN 2 O in labour after 50% nitrous oxide had become inadequate for pain relief. Data on IN 2 O use was recorded during labour and details of the course of labour and opioid usage were taken from the clinical notes. The duration of IN 2 O use was 0.1-12.35 h (median 2.3). Thirty-two mothers (14.5%) required an epidural and intolerance to IN 2 O was seen in a maximum of 17 cases (7.7%). One hundred and twenty-six cases were primiparous and 93 parous with 151 deliveries being spontaneous and 70 interventional, of which 12 were by Caesarean section. Maternal blood loss was 20-1500 ml (median 200 ml). Apgar scores at 1 and 5 min were unaffected by IN 2 O use although a positive correlation was found between the use of opioids and the number of neonates with a 1-min score below 8 and the number requiring resuscitation. Six neonates had an Apgar score below 8 at 5 min, but their condition was adequately explained by factors other than the sedative technique used. Self-administered IN 2 O was found to be a safe and practical technique for sedation in labour when 50% nitrous oxide alone had become inadequate. The addition of isoflurane 0.2% or 0.25% to Entonox (premixed nitrous oxide : oxygen, 50/50, v/v) has been shown to provide more relief of pain from the contractions of labour than Entonox alone [1,2]. Such studies, however, have necessitated administration of the agent by an anaesthetist present in the labour room. Accordingly, we have premixed isoflurane with Entonox as a 0.25% vapour to form a stable and homogenous gas mixture stored at 13.7 MPa (IN 2 O) [3]. This mixture can be self-administered by women in labour using the same equipment as is required for Entonox. As in the case of Entonox, the premixture of any self-administered analgesic or sedative inhalational agents increases safety when used under the supervision of a nurse or paramedic. If the standard precautions are taken regarding cylinder storage and layering of the gas mixture is prevented, the oxygen cannot run out ahead of the other constituents, unduly high concentrations of active agent cannot be given and no mixing valves are required [4]. The demonstration of an improved level of analgesia for IN 2 O in comparison with Entonox under the necessarily controlled environment of the trials to date [1, 2] does not show that the addition of isoflurane to Entonox would be either safe or practical in the management of pain during labour in day-to-day midwifery practice. We therefore describe here the clinical course of 221 cases of selfadministration of premixed IN 2 O in labour under the control of the attendant midwife without direct supervision by medica...

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Active versus expectant management of third stage of labour: the Hinchingbrooke randomised controlled trial

Cited by 284 publications

References 9 publications

ST depression at caesarean section and the relation to oxytocin dose. A randomised controlled trial

ST depression at caesarean section and the relation to oxytocin dose. A randomised controlled trial

A comparative study of efficacy of oxytocin, methylergometrine and misoprostol in prevention of post-partum haemorrhage

The use of 0.25% isoflurane premixed in 50% nitrous oxide and oxygen for pain relief in labour

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