Participants were recruited from an urban primary and secondary hospital in Ilam city, Iran. All pregnant women who were admitted to labour room for delivery during the study period were invited to participate in this study. Participants were eligible if they were in the third phase of vaginal delivery, singleton pregnancies, aged 18-35 years-old, and fetus weight of 2500-4500 grams. Participants were excluded if they had hypertension, placenta previa, placental abruption, anemia (haemoglobin <12 g/mL), the first stages of delivery lasted more than 15 hours, polyhydramnios, multiple pregnancy, past or present history of vaginal bleeding during pregnancy and delivery, curettage, cesarean section, operative vaginal delivery and history of anticoagulant therapy.

Sample size was estimated at the desired significance level of 5%, two-sided alpha of 0.05 and 90% power to detect a 3 mL difference in blood loss. Primary outcome was amount of PPH. The sample was calculated based on the amount of blood loss differences between two groups. Hence, sample size calculations show that at least 60 subjects in each group were needed to detect a statistical difference.

The recruitment process was conducted in two stages. At the first stage, to achieve adequate participant enrolment, advertising flyers were placed on the notice boards of the hospital. In the second stage, all participants went through a screening process conducted by the researchers. Based on the inclusion and exclusion criteria 120 patients were screened for eligibility by the study researchers. The screening process was standardised with a comprehensive case report form, on which each respondent’s results were recorded. The information collected included socio-demographic profiles, medical and drug history and amount of bleeding. Prior to enrolment, eligible participants were provided with a detailed description of the study. Following examination and enrolment, eligible respondents were sequentially numbered and randomly allocated into two groups using a computer generated random number. The person (the first author) conducting the randomisation, received only participants IDs and was hence completely blind to the respondent’s information and identities [Table/Fig-1].

[Table/Fig-1]:

CONSORT flow chart.

Immediately after the delivery, routine haemorrhage control was performed with intravenous infusion of oxytocin (20 units of oxytocin in 1000 mL ringer lactate solution) in control group. Participants in the intervention group received 200 mL of 10% dextrose solution intravenously to prevent any potential PPH. For each patient, systolic and diastolic blood pressure, body temperature, pulse and respiratory rate were continuously measured and recorded each quarter during the first 48 hours after delivery. The volume of blood loss was calculated by subtracting the weight of gauzes placed under the patient’s buttocks before delivery from the weight of the Shawn after all visible blood were wiped away. Gauze samples were weighed and recorded at first and second hour after delivery. One-gram increase in the weight of the gauzes is equal to one millilitre of blood loss. Gauze samples were weighted by a digital sensitive weighing balance (Scoute, Ohaus, 0.1 g accuracy) [6,12-15].

The Ilam University of Medical Science approved this study. All eligible participants were provided with oral and written informed consent prior to initiation of the study and were asked to sign consent form.

This trial was registered in the world health organisation approved Committee of the Iranian Clinical Trial Registry with registration number IRCT201304146790N6.

Descriptive statistics were presented using frequencies for categorical data and means and Standard Deviation (SD) for continuous variables. The normality of the data was assessed using Shapiro-Wilk tests. Baseline characteristics of the two groups (Homogeneity of sample) were assessed using analysis of variance for continuous variables and chi-square statistics for categorical variables. Chi-square and independent t-test were used to determine the effect of the intervention within the groups during the study period (one and two hours after delivery). All data were analysed using SPSS, (version 16, SPSS Inc, Chicago, IL, USA).

As shown in [Table/Fig-2], the two groups had similar characteristics at baseline. Further, the mean differences for each covariate between two groups were not statistically significant. Two independent sample t-tests were conducted to compare the effect of administering oxytocin and Dextrose 10% on the amount of PPH after delivery. The first sample t-test indicated that there was a significant difference in the scores of dextrose 10% (142.17±61.15) and oxytocin (196.27±56.24) on the amount of PPH one hour after delivery (p=0.001). The second sample t-test indicated that there was a significant difference in the score of dextrose 10% (81.65±15.45) and oxytocin (102.65±13.32) on the amount of PPH two hours after delivery (p=0.002) [Table/Fig-3]. As shown in this study, dextrose 10% was more effective in controlling PPH as compared to oxytocin during the first and second hours after delivery.

PPH is considered as one of the most important factor contributed to maternal mortality and life-threatening situation in developing countries [16]. Uterine atony is the most common cause of PPH, accounting for 80% of PPH cases. To prevent PPH due to ineffective uterine contractions, effective strategies to prevent and manage bleeding, need be applied. The present study indicated that the intravenous administration of dextrose 10% is an appropriate strategy for controlling PPH. Dextrose is more effective than oxytocin in controlling blood loss during the two hours after delivery. This result is in line with the findings of the previous study by Rafiee MS et al., [9]. Previous studies have compared the effectiveness of date fruit consumption and oxytocin on the amount of bleeding following normal delivery. Results of these studies suggested that blood loss during the first two hours after delivery were lower in those participants who received date fruit when compared to those who received oxytocin (p<0.005) [8,9]. Hatami Rad R NS and Hekmat KH, compared the effectiveness of Normal saline and Dextrose saline on Labour period and delivery outcomes in nulliparous women. The finding from this study indicated that duration of labour can be decreased by the administration of intravenous dextrose [11]. Rahmani Bilandi R MA et al., conducted a clinical study to examine the effectiveness of food intake during labour on obstetric outcomes. Participants were divided into two groups: consumption of a light diet or water during labour. This study indicates that the duration of labour was shorter in those who consume a light diet [17]. With regard to the effect of dextrose 10% on postpartum haemorrhage, it was hypothesised that activation of voltage-gated calcium (Ca²⁺) channels initiate contraction of myometer directly by increasing cytosolic Ca²⁺ concentration. In particular, the role of potassium channels must not be ignored. Potassium channels have inhibitory effect on calcium L-type channels [9].

There is some evidence that shows that acute hyperglycaemia cause vasodilatation by increasing opening of potassium channels and Protein Kinase C (PKC) [9,18-20].

Because of ethical consideration, we could not deprive one group from intervention and compare intervention groups with control (no intervention) group.

Administering of dextrose 10% to pregnant women at the third stage of labour is associated with lower postpartum haemorrhage compared to Oxytocin.