Introduction: The third and forth stages of labor which involve the separation and expulsion of the placenta and an hour immediately following delivery are the two critical phases. Many maternal deaths in the developing countries result from complications of the third stage of labor and postpartum hemorrhage. Active management of labor and use of oxytocic drugs can reduce postpartum hemorrhage. This study compares the effects of oxytocin and SYNTOMETRINE in preventing postpartum hemorrhage which is an important problem causing maternal morbidity and mortality after delivery.Materials and Methods: A clinical trial was designed to study 618 patients admitted to Zahedan Ghods Birth Center in 2001 for normal delivery. The patients were ran randomly divided into two groups. All Pregnancies were singleton, normotensive (BP<140/90) and free from medical disease. After exiting the anterior shoulder of fetus, 5 IU of oxytocin in the first group and 0.5 mg ergometrine plus 5 IU of oxytocin in the second group was injected intramuscularly. The abnormal postpartum hemorrhage by obstetrician's estimation, the need for repeated oxytocic or other interventions and less than 100 mm Hg fall in systolic blood pressure was determined. The length of third stage was determined for all of the patients.Results: Among the first group there were 20 cases (%6.47) with abnormal hemorrhage, compared to 8 cases (%2.58) in the second group. There was a significant difference between the two groups in postpartum hemorrhage (p<0.05) (using Chi-square test, CI=%95). There was no significant difference between two groups concerning the duration of third stage and the need for manual removal of placenta. The side effects were uncommon and the incidence of hypertention (Bp>140/90) was not different between two groups. Conclusion: some studies do not recommend the use of SYNTOMETRINE, believing that there is no clinical difference in the effectiveness of oxytocin and SYNTOMETRINE, whereas SYNTOMETRINE can case hypertention and retained placenta. Our results similar to other researches show that SYNTOMETRINE is more effective than oxytocin in preventing postpartum hemorrhage.

Background: Postpartum hemorrhage is a significant cause of maternal mortality and morbidity, worldwide.Objectives: The aim of this study was to compare the efficacy between carbetocin and SYNTOMETRINE in prevention of postpartum hemorrhage.Materials and Methods: This study was a double blind randomized clinical trial that carried out on 200 pregnant women referred to Shabiehkhani maternity center of Kashan, during 2011. The first group received intramuscular SYNTOMETRINE and the second group received intramuscular carbetocin after placental delivery. All of the participants were followed for 24 hours and blood pressure, pulse rate, uterine tone, hemoglobin concentration at first and 24 hours after delivery, and the need for additional uterotonic drugs and drug side effects were evaluated. Finally all data were analyzed using t-test, chi square tests and logistic regression.Results: The mean fall in hemoglobin level in the carbetocin group was significantly lower than the SYNTOMETRINE group (P<0.001). Also there were significant differences between the two groups, regarding additional uterotonic drug requirements (P=0.002). Moreover systolic blood pressure and uterine tone immediately and 30 minutes after drug administration were significantly different (P<0.001). Incidence rate of tachycardia in the carbetocin group was 13%, in contrast to 5% in the SYNTOMETRINE group (P=0.04).Conclusions: This study revealed that carbetocin is more effective than SYNTOMETRINE in prevention of postpartum hemorrhages. Thus it can be used as a good alternative of SYNTOMETRINE for low-risk women.

Background: One of the main etiologies of maternal mortality is obstetrical hemorrhage. The first step in decreasing hemorrhage is the use of uterotonic drugs in the third stage of labor.Objective: To compare the efficacy and safety of intravenous oxytocin and intramuscular SYNTOMETRINE in management of the third stage of labor.Methods: This randomized double blind clinical trial was carried out at Kosar Hospital, Qazvin (Iran) in 2005. A total of 800 women having a singleton pregnancy and vaginal delivery were randomized to receive either 1 ml of SYNTOMETRINE intramuscularly, or 10 units of intravenous oxytocine following delivery of the anterior shoulder of fetus. Hemoglobin level pre- and 24 hours post-delivery, duration of third stage, need for re-administration of uterotonic drugs, need for manual removal of placenta, and unpleasant side effects including nausea, vomiting, headache and hypertension were recorded. The data were analyzed using chi-square test.Findings: Mean drop percent of hemoglobin level in oxytocin group was 3.7±2.54% and in SYNTOMETRINE group 3.6±2.49% with no significant difference, statistically. There was also no statistically significant difference between the need for re-administration of uterotonic drugs, duration of third stage of labor, need for manual removal of placenta and the maternal side effect in two groups.Conclusion: Regarding the efficacy and side effects of intravenous oxytocin and intramuscular SYNTOMETRINE, no difference was found.

Background: The third stage of labor is of utmost importance. Prior investigators have proposed different approaches to shorten this stage. The present study was aimed at determining the efficacy of SYNTOMETRINE, syntocinon and the physiologic approach in the management of the third stage of labor.Materials and methods: Ninety parturients enrolled for this clinical trial. They were randomly distributed in one of the 3 groups; physiologic, SYNTOMETRINE, and syntocinon. Along with the anterior shoulder appearance, 10 units of oxytocin, or 5 units of oxytocin plus 0.5mg ergometrin was intramuscularly injected in the syntocinon and SYNTOMETRINE group, respectively. Then the umbilical cord was clamped and cut immediately and finally the placenta was delivered. On the other hand, patients in the physiologic group were not given oxytocic drugs, and umbilical cord was not cut unless the pulse completely disappeared. The efficacy of these approaches was determined on the duration of the third stage of labor and its complications (bleeding during the first 2 hours, hemoglobin, hematocrit, further requirement of oxytocic drugs). Drugs-related side effects were also determined. Results: The mean duration of the third stage of labor was 7.4±2.4, 5.5±2.5, and 5.1±2.4 minutes in the physiologic, syntocinon and SYNTOMETRINE groups, respectively (p<0.001). The amount of bleeding during the first 2 hours were 230±95.2, 217±113, and 176±83.2 ml in the groups, respectively (p<0.05). Hematocrit was 33.3±4.1, 34.7±4, and 36.4±4% in the groups (p<0.05). Further demand for oxytocic drugs was reported in 16.7% of patients in the physiologic group and 13.3% of patients in the syntocinon group, whereas, there was no demand among patients who receive SYNTOMETRINE (p<0.05). Mild pain was reported in 16.7, 20 and 43.3% of patients in the physiologic, syntocinon and SYNTOMETRINE groups, respectively (p<0.05).Conclusion: In order to manage the third stage of labor, SYNTOMETRINE is better than syntocinon and syntocinon is better than the physiologic approach.

Introduction & Objective: In developing countries, postpartum hemorrhage is one of the preventable causes of maternal mortality. The aim of this study is comparison of the effect of rectal misoprostol and intramuscular syntometerine in the prevention of postpartum hemorrhage.Materials & Methods: This study was a double blind randomized clinical trial and carried on 200 pregnant women referred to Shabiehkhani maternity center in 2010. The first group received 1ml intramuscular SYNTOMETRINE and the second group received 600 µg misoprostol rectal suppositories after placental delivery. The two groups were matched for confounding variables. All of the study subjects were followed up for 24hrs and their blood pressure, pulse rate, uterine tone, before and after delivery hemoglobin, need to additional uterotonic drugs and drug side effects were evaluated and the results were recorded in an information sheet. Finally all the data were entered into SPSS software and analyzed with statistical tests.Results: The mean age of subjects was 25.61±4.75 years, mean gestational age was 38.8±1.2 weeks, and Mean neonatal birth weight was 3346.2±349.56 grams. The mean fall in hemoglobin level in misoprostol group was significantly lower than in syntometrin group (P=0.009). But there weren' t any significant differences between the two groups in uterine tone, blood pressure, and pulse rate and also in drug side effects.Conclusion: In this study we demonstrated that rectal misoprostol suppository was more effective than injection syntometrin in decreasing postpartum hemorrhage. Thus, it can be used as a choice drug for third stage management