Comparison of the Effect of Cooling the Lower Abdomen and Oxytocin on Postpartum Blood Loss in Vaginal Delivery

Abstract

Postpartum hemorrhage (PPH) refers to the blood loss of more than 500 cc after completing the third stage of labor (1,2). Nonetheless, this estimation is generally only half of the actual blood loss based on the evidence (3). In addition, PPH is known as one of the major reasons for maternal mortality (4). In other words, 28% and 10% of maternal deaths in developing and developed countries are related to PPH, respectively (2,5,6). Further, PPH is characterized by a 10% drop in hematocrit levels and the need for postpartum blood transfusions (7). It could lead to hypovolemic shock, disseminated intravascular coagulation, and acute renal failure (8, 9). Treatments should address the causes of PPH. The possible causes of uterine postpartum bleeding are trauma, retained placenta, and uterine atony (10-12). Uterotonic drugs such as oxytocin, ergo derivatives, and misoprostol are used as the first line of treatments for PPH in Iran (7). Except for uterine massage, the other treatments of PPH have disadvantages on the mother (e.g., headache, vomiting, the elevation of blood pressure, and the like) or breastfeeding (1,13). Consequently, preventing PPH is highly important. Reducing hemorrhage is usually implemented by the routine active management of placenta delivery by drug using to contract the uterus such as oxytocin (11). Today, ice therapy is used as one of the new methods for the treatment of many diseases, even cancer by lessening pain, inflammation, and vasoconstriction (14). It can be one of the useful methods for preventing uterine atony and PPH (15). Based on the evidence, placing an icebag on the lower abdomen for cooling the uterus is one of the standard non-pharmacological prophylactic strategies to prevent PPH in low-risk women in Japan (15), and its argument is that cold compresses would contract the myometrium and decreases the amount of blood flow (16). In contrast, some studies have reported conflicting results about the effectiveness of icebag in preventing uterine atony in normal delivery (16,17). This study was designed to reduce maternal deaths as an important factor for children’s growth, specifically in poor countries (18) by using available methods such Abstract Objectives: Using uterotonic drugs to prevent postpartum hemorrhage is recommended in the health centers. However, the related studies are contradictory, thus the evaluation of non-invasive methods with minimal side-effects such as icepack would be useful. Traditionally, icepack has been applied, along with drugs in most deliveries in postpartum hemorrhage (PPH) in Iran although it has not evidenced yet. Therefore, the present study aimed to evaluate the effect of the icepack on blood loss. Materials and Methods: This study was a randomized controlled trial. The sample size included 58 women including 29 intervention and 29 control groups. The intervention group benefited from an icepack placed on the lower abdomen 2 hours after placental delivery while the control group received 20 units of oxytocin. Subsequently, the amount of lost blood after placental delivery was measured via weighting the sheets and pads. The mean difference between the two groups was detected with 80% power at the two tails of a 5% significance level. Results: Based on the results, there was no significant difference between the groups in parity, neonatal weight, and hemoglobin levels before and after delivery in the second and third stage of delivery and breastfeeding. Moreover, excessive PPH was 12.1% (17.2% vs. 6.9%). Thus, no significant difference (P > 0.05) was observed between the groups in terms of blood loss (254 ± 68 mL vs. 245 ± 53 mL, respectively) although the only complication in the intervention group was an unpleasant cold feeling in the abdominal area. Conclusions: The application of the icepack in low-risk women is a non-pharmacological and affordable method that can be a good alternative to oxytocin in order to decrease blood loss after delivery.