A randomized controlled trial comparing oxytocin administration before and after placental delivery in the prevention of postpartum haemorrhage in a tertiary care hospital in Bankura district of West Bengal, India


  • Rahul Kirtania Department of Gynecology and Obstetrics, Bankura Sammilani Medical College and Hospital, Bankura, West Bengal, India
  • Jayita Pal Department of Maternal and Child Health, Institute of Public Health, Kalyani, Nadia, West Bengal, India
  • Sisir Biswas Department of Gynecology and Obstetrics, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
  • Aditi Aich Department of Gynecology and Obstetrics, Bankura Sammilani Medical College and Hospital, Bankura, West Bengal, India




Haemorrhage, Oxytocin, Postpartum, Trial


Background: PPH is the prime cause of maternal mortality worldwide. The incidence of PPH can be drastically combatted by application of uterotonic in active management of third stage labour. Timing of its administration is a matter of concern. This study aimed to assess whether timing of administration of oxytocin would have any impact on incidence or mean blood loss of PPH.

Methods: It was a single blinded randomized controlled trial conducted in the department of Obstetrics and Gynecology, Bankura Sammilani Medical College for 6 months where 100 antenatal mothers admitted for normal delivery in labour room were allocated randomly in study and control group considering inclusion and exclusion criteria. Incidence of PPH and mean blood loss had been identified clinically by following them for 24 hours.

Results: Only 9% of study population had experienced PPH. There was no statistically significant difference in incidence of PPH with difference in timing of administration of oxytocin (p >0.05). But there was statistically significant decrease in mean blood loss if oxytocin was administered before the placental delivery. The mean blood loss with oxytocin administered before placental delivery was 296.8 ml (102.45) and after placental delivery was 452.0 (128.87) ml respectively.

Conclusions: Policy makers should keep in mind not only the incidence of PPH, but the mean blood loss amount too in a setting where anaemia in pregnancy is quite prevalent.


Nadim AA, Yehia AH, Farghal RM. Prophylactic oxytocin before versus after placental delivery to reduce blood loss in vaginal delivery: a randomized controlled trial. J Women’s Health Reprod Med. 2017;1(6):1-4.

WHO guidelines for the management of postpartum haemorrhage and retained placenta, 2009. Available at: https://apps.who.int/iris/bitstream/handle/10665/44171/9789241598514_eng.pdf;jsessionid=6932AE03ECB834C63659DCAEA0033216?sequence=1. Accessed on 12th January 2019.

WHO recommendations for the prevention and treatment of postpartum haemorrhage, 2012. Available at: https://apps.who.int/iris/bitstream/handle/10665/75411/9789241548502_eng.pdf?sequence=1. Accessed on 12th January 2019.

Anderson JM, Etches D. Prevention and management of postpartum haemorrhage. Am Family Phy. 2007;75(6):875-82.

Barbieri RL. Routine use of oxytocin at birth: just the right amount to prevent postpartum hemorrhage. OBG Manag. 2012;24(7):8-11.

Willis CE, Livingstone V. Infant insufficient milk syndrome associated with maternal postpartum hemorrhage. J Hum Lact. 1995;11:123-6.

Sert M, Tetiker T, Kirim S, Kocak M. Clinical report of 28 patients with Sheehan’s syndrome. Endocr J. 2003;50:297-301.

Reyal F, Deffarges J, Luton D, Blot P, Oury JF, Sibony O. Severe post-partum hemorrhage: descriptive study at the Robert-Debre Hospital maternity ward French. J Gynecol Obstet Biol Reprod (Paris). 2002;31:358-64.

Corwin EJ, Murray-Kolb LE, Beard JL. Low hemoglobin level is a risk factor for postpartum depression. J Nutr. 2003;133:4139-42.

Ekeroma AJ, Ansari A, Stirrat GM. Blood transfusion in obstetrics and gynaecology. Br J Obstet Gynaecol. 1997;104:278-84.

World Health Organization. Managing complication in pregnancy and childbirth: a guide for midwives and doctors. Geneva: WHO; 2000. Available at: http://www.who.int/reproductivehealth/publications/maternal_perinatal_ health/9241545879/en/index.html. Accessed on 12th January 2019.

Bais JM, Eskes M, Pel M, Bonsel GJ, Bleker OP. Postpartum haemorrhage in nulliparous women: incidence and risk factors in low and high-risk women. A Dutch population-based cohort study on standard (> or = 500 mL) and severe (> or = 1000 mL) postpartum haemorrhage. Eur J Obstet Gynecol Reprod Biol. 2004;115:166-72.

Magann EF, Evans S, Chauhan SP, Lanneau G, Fisk AD, Morrison JC. The length of the third stage of labor and the risk of postpartum hemorrhage. Obstet Gynecol. 2005;105:290-3.

Combs CA, Murphy EL, Laros RK. Factors associated with postpartum hemorrhage with vaginal birth. Obstet Gynecol. 1991;77:69-76.

Stones RW, Paterson CM, Saunders NJ. Risk factors for major obstetric haemorrhage. Eur J Obstet Gynecol Reprod Biol. 1993;48:15-8.

Jackson KW, Allbert JR, Schemmer GK, Elliot M, Humphrey A, Taylor J. A randomized controlled trial comparing oxytocin administration before and after placental delivery in the prevention of postpartum hemorrhage. Am J Obstet Gynecol. 2001;185(4):873-7.

Huh WK, Chelmow D, Malone FD. A double-blinded, randomized, controlled trial of oxytocin at the beginning versus the end of the third stage of labour for prevention of postpartum hemorrhage. Gynecol Obstet Invest. 2004;58:72-6.

Mohamadian S, Jahani SN, Mirzakhani K. The effect of the timing of oxytocin intramuscular injection on maternal bleeding during the third stage of labour. J Midwifery Womens Health. 2014;1:66-70.

Orhan EO, Dilbaz B, Aksakal SE, Altınbas S, Erkaya S. Prospective randomized trial of oxytocin administration for active management of the third stage of labor. Int J Gynaecol Obstet. 2014;127:175-9.

Soltani H, Hutchon DR, Poulose TA. Timing of prophylactic uterotonics for the third stage of labour after vaginal birth. Cochrane Database Syst Rev. 2010;8:CD006173.






Original Research Articles