European Journal of Cardiovascular Medicine

Postpartum hemorrhage (PPH) continues to be a major cause of maternal morbidity and mortality in both developing and wealthy countries despite significant therapeutic improvements. ^1,2, This is one of the most difficult complications a clinician will encounter. The third stage of labor is the most essential stage, and its effective management would dramatically lower maternal mortality as postpartum hemorrhage, which accounts for 30% of maternal fatalities in India, is the primary cause of maternal mortality.³ . The keys to reducing its impact are prevention, early recognition, and rapid, appropriate intervention. The prevention of PPH should be a routine practice for those who provide intrapartum care. It is important to establish procedures that will make it easier to identify women who could be particularly at risk for PPH and to treat quickly if there is significant bleeding. All staff members should have access to and knowledge of the proper medications and equipment..

Globally, around 11% of live-birthing women, or 14 million women annually, have severe PPH. ⁴. The major burden of this is borne by women in the underdeveloped and developing countries. Desai and Jani quote the incidence of PPH to be 3-6% of all normal deliveries ⁵. The rate is higher with operational deliveries, particularly those performed under general anaesthesia. It is estimated that 3.9% of vaginal deliveries and 6.4% of caesarean sections are affected. The incidence of PPH is bound to be higher in rural India, where women have limited access to healthcare facilities, while the actual incidence is difficult to ascertain. PPH is one of the leading causes of maternal mortality. PPH is responsible for 15.5% of maternal fatalities in India. ⁶. Reducing the risk of postpartum hemorrhage through routine active management of the third stage of labor could have a significant role in lowering maternal mortality and morbidity in modern obstetrics. The reduction in issues related with the third stage of labor has been attributed to the prudent use of various oxytocic medications delivered after fetal birth and a shift from expectant to active intervention.^7,8.

Traditionally used drugs for PPH prevention include oxytocin, methylergometrine, and carboprost (15 methylPGF2). ⁹. According to recent studies, there are still significant disparities in third-stage labor management practice around the world. ^{10, 11}. The use of oxytocic medications after fetal delivery has been found to minimize the incidence of PPH by 40%. However, it is associated with a variety of side effects, including nausea, vomiting, and hypertension, as well as postpartum eclampsia, intracerebral haemorrhage, myocardial infarction, cardiac arrest, and pulmonary oedema. ¹² PGF2 analogue carboprost tromethamine. It is administered with a single intramuscular injection. It has no adverse effects such as hypertension. ¹³. The WHO experiment also showed that adding CCT did almost nothing to prevent hemorrhage. Women who got CCT bled 10 ml less (on average) than women who delivered their placenta naturally. However, there was a significant difference in the length of the third stage: the third stage was six minutes longer in the women who did not get CCT. The authors agreed that this can be a significant period of time, not only for the lady, but also for the management of a busy labor and delivery unit.

Parenteral PGF2 (marketed as Carboprost) is primarily used to treat intractable PPH. There is limited experience with parenteral PGF2 for routine use in the third stage. In the third stage of labor, findings suggest that intramuscular prostaglandins are more effective than injectable oxytocin and ergometrine at lowering blood loss. However, worries about safety, side effects, and expense have restricted its usage in low-risk women.¹⁴

The current study compares the efficacy, side effects, and safety of intramuscular PGF2 (Carboprost) 125 mcg versus intramuscular oxytocin (10 units) for active third-stage labor management.

Hospital based Randomized comparative study was done at Department of Gynaecology and Obstetrics, Midnapore Medical College and Hospital from January 2017 to June 2018.

The sample size was 100, with 50 cases in each group.

Inclusion Criteria-

Primigravida or multigravida with singleton pregnancy with cephalic presentation with no obstetric complication in whom vaginal delivery was anticipated.

Exclusion Criteria-

1. Patient with hypersensitivity to drugs
2. Preeclampsia, Eclampsia,
3. Severe anaemia <7gm/dl,
4. Multiple pregnancies,
5. Poly or Oligohydramnios,
6. Grand multipara,
7. Previous history of lower segment caesarean section.
8. Gestation age <37week and >41week,
9. Induction of labour,
10. Instrumental delivery,
11. Prolonged labour,
12. IUFD,
13. Placenta previa and other cause of APH,
14. Macrosomia fetal wt >4kg,
15. Respiratory disease, Cardiac disease, Renal or Liver disease, Epilepsy, Psychiatric disease,
16. Past history of PPH,
17. Patients unwilling to participate

Table: Distribution of mean age, BMI, gestational age, duration of 3rd stage of labor, Amount of blood loss (ml) and Hb Change in two group