Abstract
Primary postpartum haemorrhage is the loss of ≥ 500ml of blood from the genital tract within 24 hours of childbirth. It remains a leading cause of maternal morbidity and mortality world-wide(1). The risk of postpartum haemorrhage (PPH) can be reduced by administration of a prophylactic uterotonic drug straight after birth. In the United Kingdom, the drug recommended for this purpose after vaginal birth is oxytocin. A telephone survey of 185 hospitals in England, Scotland and Wales which I conducted in 2013 concluded that 70% of all obstetric units were not adhering to this guidance. Syntometrine was the most used prophylactic uterotonic drug after vaginal birth in low-risk women, even though its use is associated with increased maternal side effects(2).The IMox Study, presented within this thesis, was the first randomised control trial to directly compare intramuscular oxytocin, Syntometrine and carbetocin for prevention of PPH after vaginal birth. 5929 women were randomised in 6 hospitals from February 2015 – August 2018. The primary outcome measure was the use of additional uterotonic drugs. Secondary outcomes included weighed blood loss, blood transfusion, and side effects. Health-related quality of life was measured antenatally and on postnatal days 1 & 14. Participants receiving Syntometrine were significantly less likely to receive additional uterotonics than those receiving oxytocin or carbetocin. Rates of PPH and blood transfusion were not different between arms. Prophylactic uterotonic drug allocation did not affect maternal quality of life at any timepoint. Syntometrine use was associated with increased maternal side effects, and a negative impact on the mother’s ability to bond with and care for her baby in the first two postnatal hours. Within this thesis I present the methods and result of the The IMox Study, as well as a critique of the trial and an exploration of the impact of my work.
| Date of Award | 22 Mar 2022 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Elsa M R Marques (Supervisor) & Christy Burden (Supervisor) |
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