***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: A r and omised , controlled trial of 1429 women was carried out to compare ' active ' management of the third stage of labour , using i.v . Ergometrine 0.5 mg , with a method of ' physiological ' management , in women at ' low risk ' to haemorrhage . In the " active " management group a higher incidence of the following complications was found:- manual removal of placenta ( p less than 0.0005 ) , problems such as nausea ( p less than 0.0005 ) , vomiting ( p less than 0.0005 ) , and severe after-birth pains ( p less than 0.02 ) , hypertension ( p less than 0.0001 ) and secondary postpartum haemorrhage ( p less than 0.02 ) . The incidence of postpartum haemorrhage ( blood loss greater than 500 ml ) and postnatal haemoglobins less than 10 gm/100 were higher in the ' physiological ' group ( p less than 0.0005 , p less than 0.002 ) . No difference was found in the need for blood transfusion in either group . The routine use of i.v . Ergometrine 0.5 mg during the third stage of labour in women at ' low risk ' to haemorrhage does not appear to be necessary and has many adverse effects . Further studies comparing different methods of ' physiological ' management are recommended in order to reduce to a minimum the incidence of postpartum haemorrhage and anaemia Objective To compare intravenous oxytocin administration ( Partocon ® 10 IU ) with saline solution in the management of postpartum haemorrhage in the third stage of labour BACKGROUND Postpartum haemorrhage is a leading cause of maternal morbidity and mortality . Active management of the third stage of labour , including use of a uterotonic agent , has been shown to reduce blood loss . Misoprostol ( a prostagl and in E1 analogue ) has been suggested for this purpose because it has strong uterotonic effects , can be given orally , is inexpensive , and does not need refrigeration for storage . We did a multicentre , double-blind , r and omised controlled trial to determine whether oral misoprostol is as effective as oxytocin during the third stage of labour . METHODS In hospitals in Argentina , China , Egypt , Irel and , Nigeria , South Africa , Switzerl and , Thail and , and Vietnam , we r and omly assigned women about to deliver vaginally to receive 600 microg misoprostol orally or 10 IU oxytocin intravenously or intramuscularly , according to routine practice , plus corresponding identical placebos . The medications were administered immediately after delivery as part of the active management of the third stage of labour . The primary outcomes were measured postpartum blood loss of 1000 mL or more , and the use of additional uterotonics without an unacceptable level of side-effects . We chose an upper limit of a 35 % increase in the risk of blood loss of 1000 mL or more as the margin of clinical equivalence , which was assessed by the confidence interval of the relative risk . Analysis was by intention to treat . FINDINGS 9264 women were assigned misoprostol and 9266 oxytocin . 37 women in the misoprostol  group and 34 in the  oxytocin  group had emergency caesarean sections and were excluded . 366 ( 4 % ) of women on misoprostol had a measured blood loss of 1000 mL or more , compared with 263 ( 3 % ) of those on oxytocin ( relative risk 1.39 [ 95 % CI 1.19 - 1.63 ] , p<0.0001 ) . 1398 ( 15 % ) women in the misoprostol group and 1002 ( 11 % ) in the oxytocin group required additional uterotonics ( 1.40 [ 1.29 - 1.51 ] , p<0.0001 ) . Misoprostol use was also associated with a significantly higher incidence of shivering ( 3.48 [ 3.15 - 3.84 ] ) and raised body temperature ( 7.17 [ 5.67 - 9.07 ] ) in the first hour after delivery . INTERPRETATION 10 IU oxytocin ( intravenous or intramuscular ) is preferable to 600 microg oral misoprostol in the active management of the third stage of labour in hospital setting s where active management is the norm It has been recognised that , if the length of the third stage of labour exceeds 30 min , then there is an increased risk of a post‐partum haemorrhage . Recent information has suggested that 18 min is the optimal time for removal of the undelivered placenta to prevent a post‐partum haemorrhage . A r and omised trial comparing 20 vs. 30 min was stopped after an interim analysis because only eight of 1607 patients ’ placentas had not delivered by 20 min . A third stage of labour that exceeded 10 min was observed to be significantly correlated with an increased risk of post‐partum haemorrhage Abstract The distribution of the circulatingblood volume in the infant-placental circuit at birth and in the first minutes after birth was studied in 111 normal full-term deliveries . The blood-volume of the infants , divided in groups where umbilical cords were clamped at various times , was measured by the 125 I-serum-albumin dilution method , and the placental residual blood-volume was measured by drainage both when the placenta was still in utero and after its delivery . The distribution of the blood between the infant 's and placental circuits was about 67%/33 % at birth , 80%/20 % at 1 minute , and 87%/13 % at the termination of placental transfusion Methods We describe a prospect i ve study , done over a 2-year period in which a total of 958 women having a vaginal delivery were r and omised to the drainage method ( 478 women ) or controlled cord traction method ( 480 women ) for placental delivery . Results The mean age , parity , gestation and birth weight were similar in the two groups . The mean duration of third stage of labor was 3.24 min and 3.2 min in the placental drainage group in contrast to 8.57 min and 6.20 min in controlled cord traction method in primigravida and multigravida respectively . Conclusion Placental drainage significantly reduces the duration of third stage of labour in vaginal deliveries BACKGROUND The cardiovascular effects of oxytocin in animal models and women undergoing Caesarean section include tachycardia , hypotension and decrease in cardiac output . These can be sufficient to cause significant compromise in high-risk patients . We aim ed to find a simple way to decrease these risks whilst retaining the benefits of oxytocin in decreasing bleeding after delivery . Method . We recruited 30 women undergoing elective Caesarean section . They were r and omly allocated to receive 5 u of oxytocin either as a bolus injection ( bolus group ) or an infusion over 5 min ( infusion group ) . These women had their heart rate and intra-arterial blood pressure recorded every 5 s throughout the procedure . The haemodynamic data , along with the estimated blood loss , were compared between the groups . RESULTS Marked cardiovascular changes occurred in the bolus group ; the heart rate increased by 17 ( 10.7 ) beats min(-1 ) [ mean ( sd ) ] compared with 10 ( 9.7 ) beats min(-1 ) in the infusion group . The mean arterial pressure decreased by 27 ( 7.6 ) mm Hg in the bolus group compared with 8 ( 8.7 ) mm Hg in the infusion group . There were no differences in the estimated blood loss between the two groups . CONCLUSION We recommend that bolus doses should be used with caution , and further studies should ascertain if oxytocin is equally effective in reducing blood loss when given at a slower rate OBJECTIVE : To assess the effects of oxytocin bolus or infusion on maternal hemodynamics in the third stage of labor . METHODS : In a r and omized , double-blind , double-dummy fashion , 99 women received an intravenous oxytocin bolus ( 10 IU push ) and 102 women received an infusion ( 10 IU in 500 mL saline  at 125 mL/h ) at delivery of the anterior shoulder . Mean arterial pressure and heart rate were measured every minute for 10 minutes , then every 5 minutes for the next 20 minutes . These serial measurements were analyzed using a 2-factor analysis of variance for repeated measures . RESULTS : Serial mean arterial pressure measures varied significantly between groups ( interaction effect , P = .002 ) . Mean arterial pressure ( ± st and ard deviation ) nadirs were reached after 10 minutes , 80.9 ( ± 11.0 ) mm Hg in the bolus group compared with 77.0 ( ± 12.1 ) mm Hg in the dilute infusion group . The mean difference ( 95 % confidence interval ) between groups was 4.0 ( 0.7–7.2 ) mm Hg . Serial heart rate measures also varied between groups ( interaction effect , P < .001 ) . Mean heart rate ( ± st and ard deviation ) peaked 1 minute after the oxytocin infusion , 115 ( ± 27 ) beats per minute ( bpm ) in the bolus group compared with 109 ( ± 21 ) bpm in the dilute infusion group . The mean difference ( 95 % confidence interval ) between groups was 6.6 bpm ( −0.1 to 13.3 ) . The dilute oxytocin infusion group experienced a greater mean estimated blood loss ( 423.7 mL compared with 358.1 mL , P = .029 , t test ) , increased use of additional oxytocics ( 35.3 % compared with 22.2 % , P = .044 , Fisher exact test ) and a greater drop in hemoglobin ( admission minus postpartum ) ( 17.4g/L compared with 11.4g/L , P = .002 , t test ) compared with the oxytocin bolus group . CONCLUSION : Bolus oxytocin of 10 IU is not associated with adverse hemodynamic responses and can safely be administered to women with intravenous access in the third stage of labor for postpartum hemorrhage prophylaxis . LEVEL OF EVIDENCE : OBJECTIVES Our purpose was to compare the controlled cord traction technique with the minimal intervention technique for delivery of the placenta . The primary outcome was the incidence of postpartum hemorrhage . Secondary outcomes included duration of third stage of labor , frequency of retained placenta , hemorrhagic shock , the need for blood transfusion , and the need for uterotonic agents to control postpartum hemorrhage . STUDY DESIGN A total of 1648 women who were delivered vaginally were r and omly allocated during labor to the  controlled cord traction group ( n = 827 ) or the minimal intervention group ( n = 821 ) . In the controlled cord traction group women received oxytocin , 10 units intramuscularly , with delivery of the baby 's anterior shoulder , after which the placenta was delivered actively by controlled cord traction ( Br and t- And rews method ) . In the minimal intervention group the placenta was delivered by maternal pushing . Continuous intravenous oxytocin was given after delivery of the placenta . Odds ratios with 95 % confidence intervals were calculated for each variable . RESULTS The overall incidence of postpartum hemorrhage was significantly lower in the controlled cord traction group ( 5.8 % vs 11 % ; odds ratio 0.50 , 95 % confidence interval 0.34 to 0.73 ) . The incidence of retained placenta ( > or = 30 minutes ) was 1.6 % in the controlled cord traction group and 4.5 % in the minimal intervention group ( odds ratio 0.31 , 95 % confidence interval 0.15 to 0.63 ) . Significantly more patients in the minimal intervention group required additional uterotonic agents to control hemorrhage ( 5.1 % vs 2.3 % ; odds ratio 0.44 , 95 % confidence interval 0.24 to 0.78 ) . CONCLUSION The controlled cord traction technique for delivery of the placenta results in a significantly lower incidence of postpartum hemorrhage and retained placenta , as well as less need for uterotonic agents , compared with the minimal intervention technique OBJECTIVE The goal of this study was to compare carbetocin , a long-acting oxytocin analog , with oxytocin in the prevention of uterine atony after cesarean section . STUDY DESIGN We enrolled 694 patients undergoing elective cesarean section in a Canadian multicenter , double-blind , r and omized clinical trial . We compared the effect of a single 100 microg dose of carbetocin with that of a st and ard 8-hour infusion of oxytocin . The primary outcome was the proportion of patients requiring additional oxytocic intervention for uterine atony . A variable sample size , sequential design was used . RESULTS The overall oxytocic intervention rate was 7.4 % . The odds of treatment failure requiring oxytocic intervention was 2.03 ( 95 % confidence interval 1.1 to 2.8 ) times higher in the oxytocin group compared with the carbetocin group , respectively , 32 of 318 ( 10.1 % ) versus 15 of 317 ( 4.7 % ) , P < .05 . CONCLUSIONS Carbetocin , a new drug for the prevention 
    Output:
    
Oxytocin ( 10 IU ) , administered intramuscularly , is the preferred medication and route for the prevention of PPH in low-risk vaginal deliveries .
For women delivering vaginally with 1 risk factor for PPH , carbetocin 100 microg IM decreases the need for uterine massage to prevent PPH when compared with continuous infusion of oxytocin .
There is no evidence that , in an uncomplicated delivery without bleeding , interventions to accelerate delivery of the placenta before the traditional 30 to 45 minutes will reduce the risk of PPH .
( II-2C ) 12 .
Placental cord drainage can not be recommended as a routine practice since the evidence for a reduction in the duration of the third stage of labour is limited to women who did not receive oxytocin as part of the management of the third stage .
There is no evidence that this intervention prevents PPH .
Evidence for the benefit of recombinant activated factor VII has been gathered from very few cases of massive PPH .