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A comparative study of posterior pituitary extract administered at the onset of and after the completion of the third stage of labor

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      Summary

      The optimum time for the administration of pituitary extract in controlling postpartum bleeding is an unsettled question. A comparative study of the prophylactic administration in the third stage and administration after completion of the third stage is presented. The study involved 1,100 cases in each series and the results obtained are as follows:
      • 1.
        The general average blood loss and the group percentage distribution are too nearly alike to concede an advantage to either method.
      • 2.
        Investigation of induced and stimulated labors yielded inconsistent results.
      • 3.
        There is a 5.5 per cent reduction of the blood loss in normal cases and a 6 per cent reduction of the average loss in operative cases when pituitary extract is administered prophylactically. The maximum saving is less than an ounce.
      • 4.
        Prophylactic administration reduced the incidence of postpartum hemorrhage by 2.7 cases per thousand. It had no effect on the cause of hemorrhage, but did reduce the blood loss in hemorrhages due to atony by as much as 16.5 per cent. And inasmuch as the average postpartum hemorrhage with an atonic uterus amounted to 1,060 c.c., the saving was considerable.
      • 5.
        The earlier administration of pituitary extract shortened the third stage of labor causing 11 per cent more patients to terminate this stage within four minutes. This helped to increase the number of cases in the group having the lowest blood loss.
      • 6.
        If the placenta is delivered within five minutes, prophylactic injection does not lessen appreciably the blood loss. However where the third stage lasts between six and ten minutes, the blood loss is reduced 14 per cent, and where the placental stage requires more than ten minutes, the blood loss is reduced 7.5 per cent. But the average blood loss in these two groups is 250 and 380 c.c., respectively, and inasmuch as the percentage saved is inversely related to the amount of blood loss, the maximum saving does not amount to an ounce and a half.
      • 7.
        The complications of the third stage are about equally distributed in both series.
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