Letters

Managing the third stage of labour: Nausea is a fair price for preventing haemorrhage

BMJ 1994; 308 doi: http://dx.doi.org/10.1136/bmj.308.6920.59 (Published 01 January 1994) Cite this as: BMJ 1994;308:59
  1. N Dwyer
  1. St Bartholomew's Hospital,London ECIA 7BE

    EDITOR, - Susan J McDonald and colleagues conclude that there are “few advantages but several disadvantages for the routine use of oxytocinergometrine when prophylactic active managemant of the third stage of labour is pracyised.” 2 The disadvantages were significantly higher rates of nausea, vomiting and high blood pressure measured in a labour ward. The results suggested, however, if women received oxytocin alone an additional 8-11 women per 1000 would experience a severe postpartum haemorrhage. This is roughly one patient a week in an average hospital with 5000 deliveries a year. Although this increased incidence did not reach significance, it might have done had more women been recruited to the trail, as suggested by the results of meta-analysis2

    As the authors point out, postpartum haemorrhage is an important cause of death both in Britain and, more particularly, in the Third World. As it is far more important than the transient side effects that did reach significance, I believe …

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