Management of the third stage of labor: a survey of practice among Texas obstetricians.

Available evidence shows that the benefits of routine oxytocic administration in the third stage of labor far outweigh the potential risks. In 1990, T.F. Baskett, MD, reviewed the routine use of oxytocic drugs by Canadian obstetricians in the management of the third stage of labor. With Dr Baskett's permission, we sent a similar questionnaire to 1500 obstetricians in Texas: 1000 practiced in urban areas and 500 practiced in rural areas of the state. Ninety-four percent of Texas obstetricians answering the survey used oxytocics routinely in managing the third stage of labor. However, only 14.9% administered the oxytocics before delivery of the placenta, in contrast to 92.1% who gave oxytocics after the delivery of the placenta. Oxytocin was the chosen oxytocic drug for routine third-stage management (95%) as well as for postpartum hemorrhage (73.3%). Of the physicians surveyed, 55.9% used 15-methyl prostaglandin F2a (Hemabate) to treat postpartum hemorrhage refractory to other drugs within the past year. Of the respondents, 14.3% had managed acute uterine inversion during the past year. Thus, Texas obstetricians use Oxytocin routinely in the management of the third stage of labor, but few are converted to active management.