الفهرس 
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Abstract
The third stage is the interval between delivery of the infant and delivery of the placenta. This stage averages 10 minutes and is considered prolonged if it lasts longer than 30 minutes. Placental separation occurs along Nitabuch’s layer and is the result of continued uterine contractions. Continued contractions control blood loss by compression of spiral arteries and also result in migration of the placenta into the lower uterine segment and then through the cervix.
Although the third stage of labor remains a time of anxiety for obstetricians, actively managing its third stage is now a rule. Because a prolonged third stage has been associated with postpartum hemorrhage and the need for manual removal of placenta.
Oxytocin injected into the umbilical vein reaches the placental bed in relatively high concentrations. This stimulates uterine contractions, thus decreasing the area of the placental attachment site. The resulting tension causes the decidua spongiosa to give way with the formation of a hematoma. This accelerates the process of placental separation and expulsion, thus resulting in a shorter duration of the third stage of labor and a smaller amount of blood loss.
The purpose of this study is to evaluate the effect of intra-umbilical vein injection of oxytocin with active management of third stage of labor on the amount of blood loss during third and fourth stages of labor and duration of third stage. And its effect on incidence of postpartum hemorrhage and retained placenta.
Four hundred pregnant women admitted to the labor ward fulfilled the inclusion criteria and agreed to participate in this study.
Patients under study were divided into two groups:
Control group:
In this group (n=200), after clamping and cutting of the cord at the maternal side 30 ml normal saline was injected in the umbilical vein and after signs of placental separation the placenta was delivered by controlled cord traction.
Study group:
In this group (n=200), after clamping and cutting of the
cord at the maternal side 30 iu of oxytocin diluted in 2۷ ml
normal saline was injected in the umbilical vein and after signs
of placental separation the placenta was delivered by controlled
cord traction.
Results:
There was no statistically significant difference between both groups concerning age, gestational age, and parity, hemoglobin level, blood pressure and fetal weight.
Comparison between both study and placebo groups regarding amount of blood loss in the third and fourth stages of labor and the duration of the third stage of labor There were high statistically significant differences between both groups, with less amount of blood loss and shorter duration of the third stage of labor among study group.