Prophylactic oxytocin during third stage labour may reduce risk of blood loss

Oxytocin ergometrine may reduce blood loss compared to ergot alkaloids during third stage labor, revealed a review published in the Cochrane Systematic Review.

Once a baby is born, the womb (uterus) continues to contract, causing the placenta to separate from the wall of the uterus. The mother then delivers the placenta, or 'after-birth'. This is called expectant management of the third stage of labor. Active management of the third stage involves three components: 1) giving a drug (a uterotonic) to help contract the uterus; 2) clamping the cord early (usually before, alongside, or immediately after giving the uterotonic); 3) traction is applied to the cord with counter-pressure on the uterus to deliver the placenta (controlled cord traction)

Oxytocin is a uterotonic medication that promotes increased uterine tone and contractions and is commonly administered immediately following delivery of the infant's shoulder as part of AMTSL. This review considers the efficacy and safety of oxytocin prophylaxis in the third stage of labor compared with no uterotonics, a placebo, ergot alkaloids, and in combination with ergometrine compared with ergot alkaloids.

The authors searched for evidence in March 2019 and identified six trials that met the inclusion criteria for the review. Outcomes from an additional 1100 women from these six trials were combined with those from the previous version of this review for a total of 10,018 women (23 trials). The majority of trials contributing information to this review were found to be at high risk of bias. The quality of evidence ranged from very low to moderate, and for most outcomes was assessed as low to very low quality.

Their results showed that compared to no uterotonics or placebo, oxytocin may reduce the risk of blood loss and the need for additional uterotonics. The effect of oxytocin compared with ergot alkaloids is uncertain with regards to blood loss, need for additional uterotonics, and need for blood transfusion, but may increase the risk of a third stage greater than 30 minutes.

Whether or not this translates into increased risk of needing a manual placental removal is uncertain. This potential risk of retained placenta must be weighed against the possible increased risk of side effects with ergot alkaloids, including diastolic hypertension, vomiting, and headaches. While the combination of oxytocin and ergometrine may slightly reduce the risk of blood loss compared to ergot alkaloids, the certainty of this conclusion is low given the poor quality of contributing studies.

Major takeaways of the review

• Prophylactic oxytocin compared with no uterotonics may reduce blood loss and the need for additional uterotonics.


• The effect of oxytocin compared to ergot alkaloids is uncertain with regards to blood loss, need for additional uterotonics, and blood transfusion.


• Oxytocin may increase the risk of a prolonged third stage compared to ergot alkaloids, although whether this translates into increased risk of manual placental removal is uncertain.


• This potential risk must be weighed against the possible increased risk of side effects associated with ergot alkaloids.


• Oxytocin-ergometrine may reduce blood loss compared to ergot alkaloids, however, the certainty of this conclusion is low.

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DOI:10.1002/14651858.CD001808.pub3