Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2004;2004(1):CD000201.
doi: 10.1002/14651858.CD000201.pub2.

Prophylactic ergometrine-oxytocin versus oxytocin for the third stage of labour

S McDonald  1 , J M Abbott, S P Higgins
Affiliations
Review

Prophylactic ergometrine-oxytocin versus oxytocin for the third stage of labour

S McDonald et al. Cochrane Database Syst Rev. 2004.

Abstract

Background: The routine prophylactic administration of an uterotonic agent is an integral part of active management of the third stage of labour, helping to prevent postpartum haemorrhage (PPH). The two most widely used uterotonic agents are: ergometrine-oxytocin (Syntometrine) (a combination of oxytocin 5 international units (iu) and ergometrine 0.5 mg) and oxytocin (Syntocinon).

Objectives: To compare the effects of ergometrine-oxytocin with oxytocin in reducing the risk of PPH (blood loss of at least 500 ml) and other maternal and neonatal outcomes.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group trials register (May 2003).

Selection criteria: Randomised trials comparing ergometrine-oxytocin use with oxytocin use in women having the third stage of labour managed actively.

Data collection and analysis: We independently assessed trial eligibility and quality and extracted data. We contacted study authors for additional information.

Main results: Six trials were included (9332 women). Compared with oxytocin, ergometrine-oxytocin was associated with a small reduction in the risk of PPH using the definition of PPH of blood loss of at least 500 ml (odds ratio 0.82, 95% confidence interval 0.71 to 0.95). This advantage was found for both a dose of 5 iu oxytocin and a dose of 10 iu oxytocin, but was greater for the lower dose. There was no difference detected between the groups using either 5 or 10 iu for the stricter definition of PPH of blood loss at least 1000 ml. Adverse effects of vomiting, nausea and hypertension were more likely to be associated with the use of ergometrine-oxytocin. When heterogeneity between trials was taken into account there were no statistically significant differences found for the other maternal or neonatal outcomes.

Reviewer's conclusions: The use of ergometrine-oxytocin as part of the routine active management of the third stage of labour appears to be associated with a small but statistically significant reduction in the risk of PPH when compared to oxytocin for blood loss of 500 ml or more. No statistically significant difference was observed between the groups for blood loss of 1000 ml or more. A statistically significant difference was observed in the presence of maternal side-effects, including elevation of diastolic blood pressure, vomiting and nausea, associated with ergometrine-oxytocin use compared to oxytocin use. Thus, the advantage of a reduction in the risk of PPH, between 500 and 1000 ml blood loss, needs to be weighed against the adverse side-effects associated with the use of ergometrine-oxytocin.

PubMed Disclaimer

Conflict of interest statement

One of the review authors (SJ McDonald) is an author on one of the included studies within the review. A second review author (JM Abbott) assessed this study for inclusion and extracted the data.

Figures

1.1
1.1. Analysis
Comparison 1 Ergometrine‐oxytocin versus oxytocin (any dose), Outcome 1 Blood loss = or > 500 ml.
1.2
1.2. Analysis
Comparison 1 Ergometrine‐oxytocin versus oxytocin (any dose), Outcome 2 Blood loss = or > 1000 ml.
1.3
1.3. Analysis
Comparison 1 Ergometrine‐oxytocin versus oxytocin (any dose), Outcome 3 Manual removal of the placenta.
1.4
1.4. Analysis
Comparison 1 Ergometrine‐oxytocin versus oxytocin (any dose), Outcome 4 Blood transfusion.
1.5
1.5. Analysis
Comparison 1 Ergometrine‐oxytocin versus oxytocin (any dose), Outcome 5 Elevation diastolic blood pressure.
1.6
1.6. Analysis
Comparison 1 Ergometrine‐oxytocin versus oxytocin (any dose), Outcome 6 Vomiting.
1.7
1.7. Analysis
Comparison 1 Ergometrine‐oxytocin versus oxytocin (any dose), Outcome 7 Nausea.
1.8
1.8. Analysis
Comparison 1 Ergometrine‐oxytocin versus oxytocin (any dose), Outcome 8 Vomiting + nausea combined.
1.9
1.9. Analysis
Comparison 1 Ergometrine‐oxytocin versus oxytocin (any dose), Outcome 9 Therapeutic oxytocics.
1.10
1.10. Analysis
Comparison 1 Ergometrine‐oxytocin versus oxytocin (any dose), Outcome 10 3rd stage > 30 minutes.
1.11
1.11. Analysis
Comparison 1 Ergometrine‐oxytocin versus oxytocin (any dose), Outcome 11 3rd stage > 60 minutes.
1.12
1.12. Analysis
Comparison 1 Ergometrine‐oxytocin versus oxytocin (any dose), Outcome 12 Apgar score = or < 6 at 5 minutes.
1.13
1.13. Analysis
Comparison 1 Ergometrine‐oxytocin versus oxytocin (any dose), Outcome 13 Jaundice.
1.14
1.14. Analysis
Comparison 1 Ergometrine‐oxytocin versus oxytocin (any dose), Outcome 14 Not breastfed at discharge.
1.15
1.15. Analysis
Comparison 1 Ergometrine‐oxytocin versus oxytocin (any dose), Outcome 15 Admission to neonatal intensive care unit.
2.1
2.1. Analysis
Comparison 2 Ergometrine‐oxytocin versus oxytocin (5 iu), Outcome 1 Blood loss = or > 500 ml.
2.2
2.2. Analysis
Comparison 2 Ergometrine‐oxytocin versus oxytocin (5 iu), Outcome 2 Blood loss = or > 1000 ml.
2.3
2.3. Analysis
Comparison 2 Ergometrine‐oxytocin versus oxytocin (5 iu), Outcome 3 Manual removal of the placenta.
2.10
2.10. Analysis
Comparison 2 Ergometrine‐oxytocin versus oxytocin (5 iu), Outcome 10 3rd stage > 30 minutes.
2.11
2.11. Analysis
Comparison 2 Ergometrine‐oxytocin versus oxytocin (5 iu), Outcome 11 3rd stage > 60 minutes.
3.1
3.1. Analysis
Comparison 3 Ergometrine‐oxytocin versus oxytocin (10 iu), Outcome 1 Blood loss = or > 500 ml.
3.2
3.2. Analysis
Comparison 3 Ergometrine‐oxytocin versus oxytocin (10 iu), Outcome 2 Blood loss = or > 1000 ml.
3.3
3.3. Analysis
Comparison 3 Ergometrine‐oxytocin versus oxytocin (10 iu), Outcome 3 Manual removal of the placenta.
3.4
3.4. Analysis
Comparison 3 Ergometrine‐oxytocin versus oxytocin (10 iu), Outcome 4 Blood transfusion.
3.5
3.5. Analysis
Comparison 3 Ergometrine‐oxytocin versus oxytocin (10 iu), Outcome 5 Elevation of diastolic blood pressure.
3.6
3.6. Analysis
Comparison 3 Ergometrine‐oxytocin versus oxytocin (10 iu), Outcome 6 Vomiting.
3.7
3.7. Analysis
Comparison 3 Ergometrine‐oxytocin versus oxytocin (10 iu), Outcome 7 Nausea.
3.8
3.8. Analysis
Comparison 3 Ergometrine‐oxytocin versus oxytocin (10 iu), Outcome 8 Vomiting + nausea combined.
3.9
3.9. Analysis
Comparison 3 Ergometrine‐oxytocin versus oxytocin (10 iu), Outcome 9 Therapeutic oxytocics.
3.10
3.10. Analysis
Comparison 3 Ergometrine‐oxytocin versus oxytocin (10 iu), Outcome 10 3rd stage > 30 minutes.
3.11
3.11. Analysis
Comparison 3 Ergometrine‐oxytocin versus oxytocin (10 iu), Outcome 11 3rd stage > 60 minutes.
3.12
3.12. Analysis
Comparison 3 Ergometrine‐oxytocin versus oxytocin (10 iu), Outcome 12 Apgar = or < 6 at 5 minutes.
3.13
3.13. Analysis
Comparison 3 Ergometrine‐oxytocin versus oxytocin (10 iu), Outcome 13 Jaundice.
3.14
3.14. Analysis
Comparison 3 Ergometrine‐oxytocin versus oxytocin (10 iu), Outcome 14 Not breastfed at discharge.
3.15
3.15. Analysis
Comparison 3 Ergometrine‐oxytocin versus oxytocin (10 iu), Outcome 15 Admission to neonatal intensive care unit.
See this image and copyright information in PMC

Update of

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Choy 2002 {published data only}
    1. Choy CMY, Lau WC, Tam WH, Yuen PM. A randomised controlled trial of intramuscular syntometrine and intravenous oxytocin in the management of the third stage of labour. BJOG: an international journal of obstetrics and gynaecology 2002;109:173‐7. - PubMed
Khan 1995 {published data only}
    1. Khan G, Susheela JI, Chan T, Wani S, Hughes A, Stirrat G. Abu Dhabi third stage trial: oxytocin versus syntometrine in the active management of the third stage of labour. 27th British Congress of Obstetrics and Gynaecology; 1995 July 4‐7; Dublin, Ireland. 1995:212. - PubMed
    1. Khan GQ, John IS, Chan T, Wani S, Hughes AO, Stirrat GM. Abu Dhabi third stage trial: oxytocin versus Syntometrine in the active management of the third stage of labour. European Journal of Obstetrics & Gynecology and Reproductive Biology 1995;58:147‐51. - PubMed
McDonald 1993 {published data only}
    1. McDonald S. The Perth third stage oxytocic trial. Proceedings of National Conference on Research in Midwifery; 1992; Reading, UK. 1992.
    1. McDonald S, Prendiville WJ. A randomized controlled trial of Syntocinon vs Syntometrine as part of the active management of the third stage of labour. Journal of Perinatal Medicine 1992;20(1):97.
    1. McDonald S, Prendiville WJ, Blair E. A randomised controlled trial of Syntocinon vs Syntometrine as part of the active management of the third stage of labour. Proceedings of 26th British Congress of Obstetrics and Gynaecology; 1992 July 7‐10; Manchester, UK. 1992.
    1. McDonald SJ. Management in the third stage of labour [dissertation]. Western Australia: University of Western Australia, 1996.
    1. McDonald SJ, Prendiville W, Blair E. Randomised controlled trial of oxytocin alone versus oxytocin and ergometrine in active management of the third stage of labour. BMJ 1993;307:1167‐71. - PMC - PubMed
Mitchell 1993 {published data only}
    1. Mitchell GG, Elbourne DR. The Salford third stage trial: oxytocin plus ergometrine versus oxytocin alone in the active management of the third stage of labour. Online Journal of Current Clinical Trials 1993;2:Doc 83. - PubMed
Nieminen 1963 {published data only}
    1. Nieminen U, Jarvinen PA. A comparative study of different medical treatments of the third stage of labour. Annales Chirurgiae et Gynaecologiae Fenniae 1963;53:424‐9. - PubMed
Yuen 1995 {published data only}
    1. Yuen PM. Personal communication August 15, 2002.
    1. Yuen PM, Chan NST, Yim SF, Chang AMZ. A randomised double blind comparison of syntometrine and syntocinon in the management of the third stage of labour. British Journal of Obstetrics and Gynaecology 1995;102:377‐80. - PubMed

References to studies excluded from this review

Abu‐Omar 2001 {published data only}
    1. Abu‐Omar AA. Prevention of postpartum hemorrhage, safety and efficacy. Saudi Medical Journal 2001;22(12):1118‐21. - PubMed
Docherty 1981 {published data only}
    1. Docherty PW, Hooper M. Choice of an oxytocic agent for routine use at delivery. Journal of Obstetrics and Gynaecology 1981;2:60.
Dumoulin 1981 {published data only}
    1. Dumoulin JG. A reappraisal of the use of ergometrine. Journal of Obstetrics and Gynaecology 1981;1:178‐81.
Soriano 1996 {published data only}
    1. Soriano D, Dulitzki M, Schiff E, Barkai G, Mashiach S, Seidman, DS. A prospective cohort study of oxytocin plus ergometrine with oxytocin alone for prevention of postpartum haemorrhage. British Journal of Obstetrics and Gynaecology 1996;103:1068‐73. - PubMed
Symes 1984 {published data only}
    1. Symes JB. A study on the effect of ergometrine on serum prolactin levels following delivery. Journal of Obstetrics and Gynaecology 1984;5:36‐8.
Vaughan 1974 {published data only}
    1. Vaughan Williams C, Johnson A, Ledward R. A comparison of central venous pressure changes in the third stage of labour following oxytocic drugs and diazepam. Journal of Obstetrics and Gynaecology of the British Commonwealth 1974;81:596‐9. - PubMed

Additional references

Begley 1990
    1. Begley CM. Comparison of "active" and "physiological" management of the third stage of labour. Midwifery 1990;6:3‐17. - PubMed
Beischer 1986
    1. Beischer NA, Mackay EV. Obstetrics and the newborn. Eastbourne: Bailliere Tindall, 1986.
Burchell 1980
    1. Burchell RC. Postpartum haemorrhage. In: Quilligan ES editor(s). Current therapy in obstetrics and gynecology. Philadelphia: WB Saunders, 1980.
Cotter 2001
    1. Cotter A, Ness A, Tolosa J. Prophylactic oxytocin for the third stage of labour. Cochrane Database of Systematic Reviews 2001, Issue 4. [Art. No.: CD001808. DOI: 10.1002/14651858.CD001808] - PubMed
Elbourne 1988
    1. Elbourne D, Prendiville W, Chalmers I. Choice of oxytocic preparation for the routine use in the management of the third stage of labour: an overview of evidence from controlled trials. British Journal of Obstetrics and Gynaecology 1988;295:17‐30. - PubMed
Gülmezoglu 2004
    1. Gülmezoglu AM, Forna F, Villar J, Hofmeyr GJ. Prostaglandins for prevention of postpartum haemorrhage. Cochrane Database of Systematic Reviews 2004, Issue 1. [Art. No.: CD000494. DOI: 10.1002/14651858.CD000494.pub2] - PubMed
Khan 1997
    1. Khan GQ, John IS, Wani S, Doherty T, Sibari BM. Controlled cord traction versus minimal intervention techniques in delivery of the placenta: a randomized controlled trial. American Journal of Obstetrics and Gynecology 1997;177:770‐4. - PubMed
Kwast 1991
    1. Kwast BE. Postpartum haemorrhage: its contribution to maternal mortality. Midwifery 1991;7:64‐70. - PubMed
McDonald 2003a
    1. McDonald S. Physiology and management of the third stage of labour. In: Fraser D, Cooper M editor(s). Myles textbook for midwives. 14th Edition. Edinburgh: Churchill Livingstone, 2003.
McDonald 2003b
    1. McDonald SJ, Abbott JM. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database of Systematic Reviews 2003, Issue 1. [Art. No.: CD004074. DOI: 10.1002/14651858.CD004074] - PubMed
McDonald 2007
    1. McDonald S. Management of the third stage of labour. Journal of Midwifery & Women's Health 2007;52:254‐61. - PubMed
Murray 2003
    1. Murray I. Physiology and management of the third stage of labour. In: Fraser D, Cooper M editor(s). Myles textbook for midwives. 14th Edition. Edinburgh: Churchill Livingstone, 2003.
Prendiville 1988
    1. Prendiville W, Harding JE, Elbourne DR, Stirrat GM. The Bristol Third Stage Trial: "active" vs "physiological" management of the third stage of labour. BMJ 1988;297:1295‐300. - PMC - PubMed
Prendiville 2000
    1. Prendiville WJ, Elbourne D, McDonald S. Active versus expectant management in the third stage of labour. Cochrane Database of Systematic Reviews 2000, Issue 3. [Art. No.: CD000007. DOI: 10.1002/14651858.CD000007] - PubMed
Rabe 2004
    1. Rabe H, Reynolds G, Diaz‐Rossello J. Early versus delayed umbilical cord clamping in preterm infants. Cochrane Database of Systematic Reviews 2004, Issue 4. [Art. No.: CD003248. DOI: 10.1002/14651858.CD003248.pub2] - PubMed
Rogers 1998
    1. Rogers J, Wood J, McCandlish R, Ayers S, Truesdale A, Elbourne D. Active versus expectant management of third stage of labour: the Hinchingbrook randomised controlled trial. Lancet 1998;351:593‐9. - PubMed
Thilaganathan 1993
    1. Thilaganathan B, Cutner A, Latimer J, Beard R. Management of the third stage of labour in women at low risk of postpartum haemorrhage. European Journal of Obstetrics & Gynecology and Reproductive Biology 1993;48:19‐22. - PubMed
UNICEF 1996
    1. Adamson P. A failure of imagination. Progress of Nations. UNICEF, 1996:2‐9.
WHO 1990
    1. World Health Organization. The prevention and management of postpartum haemorrhage. Report of Technical Working Group. Geneva: World Health Organisation, 1990:Report no.: WHO/MCH/90.7.
WHO 1996
    1. World Health Organization. Care in normal birth. Geneva: WHO, 1996.
WHO 1998
    1. World Health Organization. Postpartum care of the mother and newborn: a practical guide. Geneva: WHO, 1998. - PubMed
WHO 2000
    1. World Health Organization. Managing complications in pregnancy and childbirth: a guide for midwives and doctors. Geneva: WHO, 2000.
WHO 2002
    1. World Health Organization. Making pregnancy safer (MPR). http://www.who.int/reproductive‐health/mps/index.htm (accessed 24 October 2002).
Yuen 2002
    1. Yuen PM. Personal communication August 15, 2002.

References to other published versions of this review

CDSR 2003
    1. McDonald S, Prendiville WJ, Elbourne D. Prophylactic syntometrine versus oxytocin for delivery of the placenta. Cochrane Database of Systematic Reviews 2003, Issue 4. [Art. No.: CD000201. DOI: 10.1002/14651858.CD000201] - PubMed

LinkOut - more resources