Active versus expectant management for women in the third stage of labour

Begley, Cecily; Gyte, Gillian ML; Devane, Declan; McGuire, William; Weeks, Andrew

doi:10.1002/14651858.cd007412.pub4

Cited by 204 publications

(100 citation statements)

References 69 publications

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“…It consisted of the following: the administration of a prophylactic uterotonic after the delivery of the baby, early cord clamping and cutting, and controlled traction of the umbilical cord. In addition, uterine massage has been frequently included as part of this active management of the third stage of labor [10].…”

Section: Introductionmentioning

confidence: 99%

A New Maneuver for Prevention of Postpartum Haemorrhage

Hamdy¹

2014

J Obstet Gynecol India

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Background Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide. Many methods have been developed to decrease its rate. The aim of this study was to evaluate the applicability of a new nonpharmacologic maneuver in decreasing its rate. Methods This case series study was conducted in one center in Cairo, Egypt, from January-2010 to June-2013. 400 pregnant women, aged 18 years or more and candidate for normal labor, were enrolled to this study. High risk subjects for PPH were excluded. After placental delivery, the new maneuver was done by sustained traction of the anterior and posterior lips of the cervix by two ovum forceps for duration of 90 s. The amount of blood loss was estimated by standardized visual estimation after removal of the forceps. All subjects were followed up for 6 h. Results The rate of PPH, defined as more than 500 ml, was eight cases (2 %) with 95 % CI (0.63-3.37 %). The rate of PPH was not affected by parity, gestational age, episiotomy, or the presence of tears. PPH is more in cases with anemia (p 0.032). It occurred in all cases with uterine atony (p \ 0.001). The range of estimated blood loss was 550-600 ml in cases with PPH and 150-450 ml in cases without PPH. Severe PPH more than 1,000 ml did not occur. Conclusion This pilot study introduced a novel maneuver that can be helpful in decreasing the rate of PPH and reducing the amount of postpartum blood loss. Further RCT is recommended to investigate it.

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Section: Introductionmentioning

confidence: 99%

A New Maneuver for Prevention of Postpartum Haemorrhage

Hamdy¹

2014

J Obstet Gynecol India

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“…Begley et al [3], compared the active and expectant management of the third stage of labor in a Cochrane database meta-analysis. This meta-analysis showed that although active management reduced mean blood loss and postpartum hemorrhage (> 500 cc), there was no statistically significant reduction in severe postpartum hemorrhage (> 1000 cc) for women at low risk for bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…Active management consists in early umbilical cord clamping, the use of uterotonic agents after birth, controlled cord traction, and uterine massage. In contrast, in physiologic management clinicians await the signs of placental separation and allow for the placenta to fall by maternal effort or spontaneously, with gravity, and do not use uterotonic agents or clamp the cord until placental expulsion [3]. The choice of the optimal method remains controversial.…”

Section: Introductionmentioning

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 primary purpose of active management of the third stage of labour is to reduce the risk of postpartum haemorrhage (PPH) (Begley et al, 2010;Begley et al, 2011). Active management of the third stage of labour is associated with a lower incidence of postpartum haemorrhage greater than 1000 mL (Begley et al, 2010;Begley et al, 2011). Prophylactic oxytocin in women with a risk of PPH is administered routinely in all government hospital in Jeddah.…”

Section: Discussionmentioning

confidence: 99%