Active management of the third stage of labor with and without controlled cord traction: a systematic review and meta‐analysis of randomized controlled trials

Du, Yongming; Ye, Man; Zheng, Fangfang

doi:10.1111/aogs.12424

Cited by 20 publications

(18 citation statements)

References 14 publications

(27 reference statements)

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“…Thus, the difference in the AMTSL practices of the groups may have affected the results. However, because the procedures, including cord traction and uterine massage, are considered to have little or no effect [3, 4, 6], we believe that RUPO reduced the maternal blood loss.…”

Section: Discussionmentioning

confidence: 99%

The Routine Use of Prophylactic Oxytocin in the Third Stage of Labor to Reduce Maternal Blood Loss

Kuzume

Sugimi

Suga

et al. 2017

Journal of Pregnancy

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Objective To demonstrate whether or not the routine use of prophylactic oxytocin (RUPO) reduces the blood loss and incidence of postpartum hemorrhaging (PPH). Methods We used a prospective cohort and a historical control in a tertiary perinatal care center in Japan. In the prospective cohort, we introduced RUPO in April 2012 by infusing 10 units of oxytocin per 500 mL of normal saline into a venous line after anterior shoulder delivery (RUPO group). In the historical control, oxytocin was administered via a case-selective approach (historical control group). We included completed singleton vaginal deliveries and compared the volume of blood loss and the incidence of PPH between the groups. Results We found a significantly lower volume of blood loss (520 ± 327 versus 641 ± 375 mL, p < 0.001) and a lower incidence of PPH (6.1% versus 14.0%, p < 0.001) in the RUPO group (n = 392) than in the control group (n = 407). Although the oxytocin dose was significantly higher in the RUPO group (12.8 ± 6.7 versus 10.1 ± 8.0 IU, p < 0.001), no adverse outcomes were observed to be associated with RUPO. Conclusions The introduction of RUPO significantly reduced blood loss and the incidence of PPH during completed singleton vaginal deliveries without an increase in adverse effects.

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Section: Discussionmentioning

confidence: 99%

The Routine Use of Prophylactic Oxytocin in the Third Stage of Labor to Reduce Maternal Blood Loss

Kuzume

Sugimi

Suga

et al. 2017

Journal of Pregnancy

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“…Du et al [14], in a recent meta-analysis of 5 randomized controlled trials, similarly reported that umbilical cord traction decreased postpartum blood loss. However, it fell short of preventing severe postpartum hemorrhage (> 1000 cc), a need for additional uterotonics, or transfusions.…”

Section: Discussionmentioning

confidence: 99%

Comparison of active vs. expectant management of the third stage of labor in women with low risk of postpartum hemorrhage: a randomized controlled trial

Yildirim

Ozyurek²,

Ekiz³

et al. 2016

Ginekol Pol

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Objectives: To compare the 'strictly' active management protocol in women with low risk of postpartum hemorrhage using the expectant management protocol with respect to changes in hematologic parameters, uterotonics, blood transfusions, or additional interventions. Material and methods:A randomized controlled prospective trial in which 934 singleton parturients enrolled; 654 were randomly assigned to the active and mixed management groups. The primary outcome parameter was the reduction in hemoglobin concentrations due to delivery, and the secondary outcome parameters were changes in hemoglobin of more than 3 g/dL (∆Hb ≥ 3 g/dL), durations of the third stage of labor, need for additional uterotonic agents, blood transfusions, manual removal of the placenta, and surgical evacuation of retained products of conception. Results:The mean postpartum hemoglobin concentration was significantly higher (P = 0.04) in the active management group with a significantly lower reduction (P = 0.03). Falls of hemoglobin levels of more than 3 g/dL (∆Hb ≥ 3g/dL) were less common in the active management group though not significantly (P = 0.32). The mean duration of the third stage of labor was significantly (P < 0.001) shorter in the active management group. There was no significant difference between the two groups with regard to the need for additional uterotonic agents, uterine atony, blood transfusion, manual removal of the placenta, surgical evacuation of retained products of conception, and prolonged third stage of labor. Conclusions:Although active management of the third stage of labor was associated with higher postpartum hemoglobin levels, it did not influence the risk of 'severe postpartum hemorrhage' in women with low risk of postpartum hemorrhage.

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“…The 3 rd stage prolongation is considered the first cause of PPH. Preventive measures to reduce 3 rd stage complications are suggested for all women undergoing childbirth [8].…”

Section: Introductionmentioning

confidence: 99%

Effect of Placental Cord Drainage on the Third Stage of Labour Progress and Incidence of Postpartum Hemorrhage: Randomized Controlled Clinical Trial

Elgzar¹,

Ibrahim²,

Elkhateeb³

2020

SARJNHC

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Background: Postpartum hemorrhage (PPH) is accountable for around 25% of maternal mortality in the developing countries. Management of 3 rd stage of labour is the cornerstone in PPH prevention. The effect of Placenta Cord Drainage (PCD) on the 3 rd progress and PPH prevention is still controversy. Aim of the study: This study aims to investigate the effect of placental drainage on the third stage of labour progress and incidence of postpartum hemorrhage. Research design: randomized controlled clinical trial. Setting: This study is conducted at normal labour unit at Damanhour educational institution affiliated to ministry of health at Elbehira governorate/Egypt. Sampling: A purposive sample of 120 women undergoing normal easy vaginal delivery. Tools: two tools were used for data collection. Tool I: sociodemographic characteristics and obstetric history interview schedule. Tool II: Labour assessment sheet it consists of three main parts. Part I: Summary of the first and second stage of labor. Part II: third stage assessment sheet. Part III: 3. Early postpartum assessment sheet. Results: The present study results shows no statistical significant differences between PCD and control group regarding vital signs during the 3rd stage, uterus condition after placenta delivery, type, dose and route of uterotonic drugs given during 3rd stage. On the contrary, a statistical significant reduction in the time elapsed until appearance of placenta separation signs (3.5583±0.83915), 3rd stage duration(5.1417±1.03138), amount of blood loss during 3rd stage (195.45±13.994), placenta weight (580.333±64.97631) and incidence of retained placenta ((0%) in the PCD group than control. In the early postpartum assessment, the mean pulse (88.2.7667±3.11022) is higher among control group compared to PCD (83.4667±2.78292) group. Control group needs higher dose of uterotonic (8.6780±2.62902) drugs than PCD (5.0566±1.41985) group. In addition, maternal hemoglobin (9.5234±0.6087) is slightly higher in PCD group compared to control (8.458±0.873). Conclusion: PCD is safe, effective noninvasive intervention that may help in improving 3 rd stage progress. Recommendation: PCD should be added to third stage of labour intervention protocol.

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Active management of the third stage of labor with and without controlled cord traction: a systematic review and meta‐analysis of randomized controlled trials

Cited by 20 publications

References 14 publications

The Routine Use of Prophylactic Oxytocin in the Third Stage of Labor to Reduce Maternal Blood Loss

The Routine Use of Prophylactic Oxytocin in the Third Stage of Labor to Reduce Maternal Blood Loss

Comparison of active vs. expectant management of the third stage of labor in women with low risk of postpartum hemorrhage: a randomized controlled trial

Effect of Placental Cord Drainage on the Third Stage of Labour Progress and Incidence of Postpartum Hemorrhage: Randomized Controlled Clinical Trial

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