Intra-Umbilical Vein Oxytocin Injection as an Adjunct to Active Management of the Third Stage of Labour

Postpartum haemorrhage remains one of the leading causes of maternal morbidity and mortality worldwide, particularly in low-resource settings. A large proportion of these deaths occur during the third stage of labour, the period between delivery of the baby and expulsion of the placenta. Failure of effective uterine contraction and delayed placental separation during this stage can lead to excessive blood loss and significant reduction in maternal haemoglobin levels. Although active management of the third stage of labour with uterotonic agents and controlled cord traction is widely practiced and has been shown to reduce blood loss, additional low-cost and practical interventions that can further improve outcomes are still needed.

Oxytocin is a uterotonic drug that promotes uterine contraction and facilitates placental separation. Administering oxytocin through the umbilical vein allows the drug to reach the placental bed directly, which may enhance localized uterine contraction at the site of placental attachment. This targeted approach has the potential to shorten the duration of the third stage of labour, reduce the volume of postpartum blood loss, and help preserve maternal haemoglobin. Such an intervention may be particularly valuable in environments where access to blood transfusion and advanced obstetric care is limited, and where even moderate blood loss can result in serious complications.

This study was conducted to examine whether the addition of intra-umbilical oxytocin to standard active management provides measurable clinical benefit. By comparing outcomes between women who received oxytocin through the umbilical vein and those who received a placebo alongside routine care, the study seeks to contribute evidence on the effectiveness of this simple and inexpensive technique in improving maternal outcomes during the immediate postpartum period. The findings are intended to inform clinical practice and support strategies aimed at reducing preventable maternal complications associated with childbirth.

Inclusion criteria

Pregnant women aged 18 to 35 years Singleton live pregnancy Gestational age between 37 and 42 weeks Vaginal delivery Parity between 1 and 4 Haemoglobin concentration of 10 g/dl or higher before delivery No identifiable risk factors for postpartum haemorrhage Willing and able to provide written informed consent

Exclusion criteria

Blood pressure ≥140/90 mmHg Placenta previa Placental abruption History of vaginal bleeding in the index pregnancy Previous caesarean section or any uterine scar Coagulation disorders Instrumental delivery Haemoglobin concentration below 10 g/dl Multiple gestation Fibroids coexisting with pregnancy Genital tract lacerations or bleeding episiotomy