British Journal of Obstetrics and Gynaecology zyxwvut November 1996, Vol. 103, pp. 1068-1073 A prospective cohort study of oxytocin plus ergometrine compared with oxytocin alone for prevention of postpartum haemorrhage David Soriano zyxwvutsr Resident, Mordechai Dulitzki Lecturer, Eyal Schiff Senior Lecturer, Gad Barkai Associate Professor, Shlomo Mashiach Professor, Daniel S. Seidman Research Fellow Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer and Sackler School zyx of Medicine, Tel-Aviv University, Israel Objective To determine the safety and efficacy of intramuscular oxytocin plus ergometrine compared to intravenous oxytocin for prevention of postpartum haemorrhage, and the significance of administration at the end of the second stage of labour compared with that after the third stage. Design A prospective cohort study. Setting zyxwvutsr A university affiliated tertiary medical centre. Participants Two thousand one hundred and eighty-nine women delivering singletons during 40 consecutive weeks. Main outcome measures Postpartum haemorrhage zyxwv (> 500 ml), prolonged third stage ( > 30 min), retained placenta (> 60 min), elevated blood pressure (systolic > 150 mmHg, diastolic > 100mmHg). Results The rate of postpartum haemorrhage was not significantly different for oxytocin- ergometrine compared with oxytocin, when administered at the end of the second stage of labour (odds ratio 1.10, 95 % confidence interval (CI) 0.75- 1.61) or after the third stage (odds ratio 0.95,95 % CI zyxwvut 0.68- 1-34). The patients receiving oxytocics at the end of the second stage of labour had significantly lower rates of postparturn haemorrhage, for both oxytocin- ergometrine (odds ratio 069, 95% CI 049-0.98) and oxytocin (odds ratio 0.60, 95% CI 0.41-0.87), compared with those treated after the third stage. Conclusion Administration of oxytocin alone is as effective as the use of oxytocin plus ergometrine in the prevention of postpartum haemorrhage, but associated with a significantly lower rate of unpleasant maternal side effects. Oxytocics administered after delivery of the fetal head compared with after the placental expulsion are associated with a significantly lower rate of postpartum haemorrhage. INTRODUCTION The routine use of oxytocic drugs has been estimated to reduce the risk of postpartum haemorrhage by about 40 %'. The administration of oxytocics is therefore widespread as part of the active management of the third stage of labour. However, there is no agreement regarding the type and route of administration of the oxytocic drug which offers the best efficacy and safety profile. A meta-analysis of the controlled trials examining the alternative oxytocic preparations used routin- Correspondence: Dr D. S. Seidman, Department of Pediatrics, S-226, Division of Neonatology, Stanford University School of Medicine, Stanford, California 94305-5 1 19, USA. ely in the management of the third stage of labour suggested that a mixture of oxytocin and ergo- metrine might be the drug of choice2. The authors commented that the quality of evidence was not satisfactory and thus concluded that there was scope for a controlled comparison of oxytocin plus ergometrine compared with oxytocin alone. Such an investigation would provide unbiased and more precise estimates of the relative effects on postpartum haemorrhage, blood pressure and unpleasant side effects2. Previous trial^^-^ revealed a small reduction in the risk of postpartum haemorrhage when oxytocin-rgometrine was used compared with oxytocin alone6. Sub- sequently, Mitchell et zyxw al.' and McDonald et al.' 1068 zyxwvuts 0 RCOG 1996 British Journal of Obstetrics and Gynaecology