Effects of Syntocinon use in active management of third stage labour
Following the publication of guidance from the National Institute for Health and Clinical Excellence (NICE) (2007), Syntometrine was withdrawn in practice for routine use as part of the active management of the third stage and replaced with Syntocinon 10 international units(iu). While it was recognized that these guidelines related to the care of low-risk women, from the evidence reviewed there did not appear to be any reason not to recommend the use of Syntocinon for the majority of women. Concern about perceived increase in major postpartum haemorrhage (>100 ml) resulted in a retrospective comparative study of primary postpartum haemorrhage (PPH) rates and blood transfusion rates. This study found a statistically significant increase in estimated blood loss (EBL) above 1000 ml from 2008 to 2010 (0.59% vs. 1.74%). Nevertheless, there was no statistically significant increase in blood transfusion rates. Possible reasons for this increase are suggested, including: the limitations of the present study compared to previous studies; the experience of staff using Syntocinon 10iu; as well as the attitude of staff toward this practice change. In view of these issues, the researchers do not believe that these results provide robust evidence to revert to using Syntometrine, contrary to the recommendations of the Centre for Maternal and Child Enquiries (CMACE) (2011).