Uterine massage to reduce postpartum hemorrhage after vaginal delivery

Abstract

Uterine massage was less effective than oxytocin for reducing blood loss after delivery. When oxytocin was used, there was no additional benefit from uterine massage. The effectiveness of uterine massage in the absence of oxytocin was not studied. ACTRN: 12609000372280.

How effective are the components of active management of the third stage of labor?

“…In fact, our findings uniformly suggest that uterine massage either increases post-partum blood loss or confers no added benefits. This was true in both clinical regimens and is consistent with findings from prior research [17]. These findings likely reflect some selection bias, however, since uterine massage is often provided in response to heavy post-partum bleeding.…”

“…The first was a pilot study (N = 200) in which provision of all three AMTSL interventions was associated with a non-significant decrease in the risk of post-partum hemorrhage (> 500 mL), as compared with oxytocin plus controlled cord traction [16]. In the second trial uterine massage was associated with increased blood loss, although treatment was initiated before placental delivery rather than after, as per current AMTSL guidelines [17]. …”

Uterine massage as part of active management of the third stage of labour for preventing postpartum haemorrhage during vaginal delivery: a systematic review and meta‐analysis of randomised trials

“…Statistical heterogeneity within the studies was high with I 2 = 73% for the primary outcome. Additional unpublished data from two trials were kindly obtained by the original authors …”

“…Hofmeyr et al in a previous Cochrane review analysed the efficacy of uterine massage to prevent PPH. They included only two trials evaluating the efficacy of uterine massage in the third stage of labour after vaginal delivery. Indeed, there are no trials on uterine massage at the time of caesarean delivery.…”

Pharmacotherapy of Massive Obstetric Bleedings as Alternative to Hysterectomy

“…First aid in obstetric hemorrhage in most countries traditionally employs the use of uterotonics and prostaglandins, manual examination of uterus and birth canals and uterine massage (Abdel-Aleem et al, 2010;Henrich et al, 2008;Price & Lynch, 2005). If uterotonics and manual examination of the uterus prove to be ineffective, more complex surgical technics are traditionally employeduterine artery ligation, internal iliac artery ligation and hysterectomy.…”