***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Oxytocin was administered in a r and omized fashion via either the umbilical or maternal intravenous route . Women who received intraumbilical oxytocin had significantly greater calculated blood loss compared with those who received peripheral administration ( P = .01 ) . This greater blood loss was confirmed by a decrease in hematocrit and hemoglobin concentrations after delivery . There was no difference between the groups in the length of the third stage of labor . The incidence of fetomaternal transfusion was higher in the intraumbilical group ( P = .07 ) . We conclude that intraumbilical oxytocin is no more beneficial than peripheral administration Objective To compare intravenous oxytocin administration ( Partocon ® 10 IU ) with saline solution in the management of postpartum haemorrhage in the third stage of labour OBJECTIVE --To compare the effects on fetal and maternal morbidity of routine active management of third stage of labour and expectant ( physiological ) management , in particular to determine whether active management reduced incidence of postpartum haemorrhage . DESIGN --R and omised trial of active versus physiological management . Women entered trial on admission to labour ward with allocation revealed just before vaginal delivery . Five months into trial high rate of postpartum haemorrhage in physiological group ( 16.5 % v 3.8 % ) prompted modification of protocol to exclude more women and allow those allocated to physiological group who needed some active management to be switched to fully active management . Sample size of 3900 was planned , but even after protocol modification a planned interim analysis after first 1500 deliveries showed continuing high postpartum haemorrhage rate in physiological group and study was stopped . SETTING --Maternity hospital . PARTICIPANTS --Of 4709 women delivered from 1 January 1986 to 31 January 1987 , 1695 were admitted to trial and allocated r and omly to physiological ( 849 ) or active ( 846 ) management . Reasons for exclusion were : refusal , antepartum haemorrhage , cardiac disease , breech presentation , multiple pregnancy , intrauterine death , and , after May 1986 , ritodrine given two hours before delivery , anticoagulant treatment , and any condition needing a particular management of third stage . INTERVENTIONS --All but six women allocated to active management actually received it , having prophylactic oxytocic , cord clamping before placental delivery , and cord traction ; whereas just under half those allocated to physiological management achieved it . A fifth of physiological group received prophylactic oxytocic , two fifths underwent cord traction and just over half clamping of the cord before placental delivery . ENDPOINT -- Reduction in incidence of postpartum haemorrhage from 7.5 % under physiological management to 5.0 % under active management . MEASUREMENTS AND MAIN RESULTS --Incidence of postpartum haemorrhage was 5.9 % in active management group and 17.9 % in physiological group ( odds ratio 3.13 ; 95 % confidence interval 2.3 to 4.2 ) , a contrast reflected in other indices of blood loss . In physiological group third stage was longer ( median 15 min v 5 min ) and more women needed therapeutic oxytocics ( 29.7 % v 6.4 % ) . Apgar scores at one and five minutes and incidence of neonatal respiratory problems were not significantly different between groups . Babies in physiological group weighed mean of 85 g more than those in active group . When women allocated to and receiving active management ( 840 ) were compared with those who actually received physiological management ( 403 ) active management still produced lower rate of postpartum haemorrhage ( odds ratio 2.4;95 % CI1.6 to 3.7 ) . CONCLUSIONS --Policy of active management practised in this trial reduces incidence of postpartum haemorrhage , shortens third stage , and results in reduced neonatal packed cell volume The authors analysed the effect of the i.v . oxytocin induced third stage of labour in a controlled trial concerning 1000 patients . The appliance of such an policy in a unit that already had a fairly active management of delivery was very encouraging . The incidence of post-partum haemorrhage ( greater than 500 ml ) is significantly ( P less than 0.001 ) less than in the control group ; and the same for severe haemorrhage . The third stage is significantly ( P less than 0.001 ) shorter in the oxytocin-injected group than in the control group . Moreover , there is no significant difference between the two groups for retained placenta . The economy of blood transfusion , which is a major concern nowadays , could be the real interest of this active management of the third stage of labour Cynthia Stanton and colleagues conducted a cluster-r and omized controlled trial in rural Ghana to assess whether oxytocin given by injection by community health officers at home births was a feasible and safe option in preventing postpartum hemorrhage . Please see later in the article for the Editors ' Background Hemorrhage is the leading direct cause of maternal death globally . While oxytocin is the drug of choice for postpartum hemorrhage prevention , its use has generally been limited to health facilities . This trial assesses the effectiveness , safety , and feasibility of exp and ing the use of prophylactic intramuscular oxytocin to peripheral health care providers at home births in four predominantly rural districts in central Ghana . Methods This study is design ed as a community-based cluster-r and omized trial in which Community Health Officers are r and omized to provide ( or not provide ) an injection of oxytocin 10 IU via the UnijectTM injection system within one minute of delivery of the baby to women who request their presence at home at the onset of labor . The primary aim is to determine if administration of prophylactic oxytocin via Uniject ™ by this cadre will reduce the risk of postpartum hemorrhage by 50 % relative to deliveries which do not receive the prophylactic intervention . Postpartum hemorrhage is examined under three sequential definitions : 1 ) blood loss ≥500 ml ( BL ) ; 2 ) treatment for bleeding ( TX ) and /or BL ; 3 ) hospital referral for bleeding and /or TX and /or BL . Secondary outcomes address safety and feasibility of the intervention and include adverse maternal and fetal outcomes and logistical concerns regarding assistance at home births and the storage and h and ling of oxytocin , respectively . Discussion Results from this trial will build evidence for the effectiveness of exp and ing the delivery of this established prophylactic intervention to peripheral setting s. Complementary data on safety and logistical issues related to this intervention will assist policymakers in low-income countries in selecting both the best uterotonic and service delivery strategy for postpartum hemorrhage prevention . Results of this trial are expected in mid-2013 . The trial is registered at Clinical Trials.gov : NCT01108289 Background There are two approaches to care during the third stage of labour : Active management includes three components : administration of a prophylactic uterotonic drug , cord clamping and controlled cord traction . For physiological care , intervention occurs only if there is clinical need . Evidence to guide care during the third stage is limited and there is variation in recommendations which may contribute to differences in practice . This paper describes current UK practice during the third stage of labour . Methods A postal survey of 2230 fellows and members of the Royal College of Obstetricians and Gynaecologists ( RCOG ) and 2400 members of the Royal College of Midwives was undertaken . Respondents were asked about care during the third stage of labour , for vaginal and caesarean births and their views on the need for more evidence to guide care in the third stage . The data were analysed in Excel and presented as descriptive statistics . Results 1189 ( 53 % ) fellows and members of the RCOG and 1702 ( 71 % ) midwives responded , of whom 926 ( 78 % ) and 1297 ( 76 % ) respectively had conducted or supervised births in the last year . 93 % ( 863/926 ) of obstetricians and 73 % ( 942/1297 ) of midwives report ' always or usually ' using active management . 66 % ( 611/926 ) of obstetricians and 33 % ( 430/1297 ) of midwives give the uterotonic drug with delivery of the anterior shoulder ; this was intramuscular Syntometrine ® for 79 % ( 728/926 ) and 86 % ( 1118/1293 ) respectively . For term births , 74 % ( 682/926 ) of obstetricians and 41 % ( 526/1297 ) of midwives clamp the cord within 20 seconds , as do 57 % ( 523/926 ) and 55 % ( 707/1297 ) for preterm births . Controlled cord traction was used by 94 % of both obstetricians and midwives . For caesarean births ,  intravenous oxytocin  was the uterotonic used by 90 % ( 837/926 ) of obstetricians ; 79 % ( 726/926 ) clamp the cord within 20 seconds for term births as do 63 % ( 576/926 ) for preterm births . Physiological management was used ' always or usually ' by 2 % ( 21/926 ) of obstetricians and 9 % ( 121/1297 ) of midwives . 81 % ( 747/926 ) of obstetricians and 89 % ( 1151/1297 ) of midwives thought more evidence from r and omised trials was needed ; the most popular question was when is best to clamp the cord . Conclusions Active management of the third stage of labour is widely used by both obstetricians and midwives in the UK . Syntometrine ® is usually used for vaginal births and oxytocin for caesarean births ; when this is given and when the cord is clamped varies OBJECTIVE Comparison of 3 regimens for third-stage management after second-trimester intravaginal misoprostol termination . STUDY DESIGN Prospect i ve r and omized trial . Three third-stage management strategies were compared : 10 units of intramuscular oxytocin ( group 1 ) , 600 microg oral misoprostol ( group 2 ) , or no additional medication ( group 3 ) after fetal expulsion . Primary study outcome was the incidence of placental retention . RESULTS Two hundred fifty-one women were r and omly assigned to the groups . There was a significant difference in placental retention rates : group 1 , 8 of 83 ( 10 % ) vs group 2 , 24 of 83 ( 29 % ) vs group 3 , 26 of 85 ( 31 % ) ; P = .002 . Blood loss was significantly lower in group 1 , 100 mL ( interquartile ranges , 50 - 200 ) vs group 2 , 200 mL ( interquartile ranges , 100 - 370 ) vs group 3 , 200 mL ( interquartile ranges , 100 - 375 ) ; P < .001 . Requirement for blood transfusion : group 1 , 1 of 83 ( 1 % ) vs group 2 , 1 of 83 ( 1 % ) vs group 3 , 5 of 85 ( 6 % ) ; P = .103 . CONCLUSION Intramuscular oxytocin administered after fetal delivery after second-trimester medical termination significantly increases placental expulsion rates and decreases short-term postpartum blood loss Background . The single most common direct obstetric disorder accounting for 25 % of all maternal deaths globally is severe hemorrhage , generally occurring postpartum . Nearly all these deaths occur in the developing world . The role of oxytocic drugs in the management of the third stage of labor as a strategy to reduce maternal mortality has been emphasized . However , the adverse effects of these oxytocic agents , in particular ergometrine , have not been properly evaluated in our environment . Objectives . To evaluate the effect of ergometrine and oxytocin on the cardiovascular system when used for active management of the third stage of labor . Study design . A double-blind , r and omized controlled study was carried out at the Federal Medical Centre , Makurdi over 24 months . Five hundred and ten patients were r and omized to treatment with either 0.5 mg of intramuscular ergometrine or 10 IU of intravenous oxytocin , respectively , as single injections . Their effects on the cardiovascular system were observed using blood pressure as a marker . Results . Ergometrine unlike oxytocin was observed to cause a significant rise in blood pressure , and this effect was most marked in the first 24 hours of the puerperium . Conclusions . These results suggest that ergometrine may be safe in normotensive parturients but hazardous in hypertensive parturients in whom oxytocin would be a safer option The incidences of postpartum haemorrhage and retained placenta have decreased with the use of synthetic oxytocin and controlled cord traction . Whether such treatment is valuable is open to question because of the lack of clinical and physiological studies . The physiological effects of synthetic oxytocin on plasma concentrations of oxytocin and events during delivery were assessed . Plasma oxytocin concentration was determined in serial sample s during the late second stage and throughout the third stage of labour in 25 women . Ten women received combined ergotamine and synthetic oxytocin intramuscularly and 15 were not treated . The geometric mean plasma oxytocin concentration 
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AUTHORS ' CONCLUSIONS Prophylactic oxytocin at any dose decreases both PPH greater than 500 mL and the need for therapeutic uterotonics compared to placebo alone .
If IV delivery is not possible , IM delivery may be used as this route of delivery did show a benefit to prevent PPH greater than 500 mL and there was a trend to decrease the need for therapeutic uterotonics , albeit not statistically significant .
Prophylactic oxytocin was superior to ergot alkaloids in preventing PPH greater than 500 mL ; however , in subgroup analysis this benefit did not persist when only r and omised trials with low risk of method ologic bias were analysed .
Based on this , there is limited high- quality evidence supporting a benefit of prophylactic oxytocin over ergot alkaloids .
Importantly , there is no evidence to suggest that prophylactic oxytocin  increases the risk of retained placenta when compared to placebo or ergot alkaloids .