Third Stage Of Labor Research Paper

Abstract

OBJECTIVE--To compare the effects on fetal and maternal morbidity of routine active management of third stage of labour and expectant (physiological) management, in particular to determine whether active management reduced incidence of postpartum haemorrhage. DESIGN--Randomised trial of active versus physiological management. Women entered trial on admission to labour ward with allocation revealed just before vaginal delivery. Five months into trial high rate of postpartum haemorrhage in physiological group (16.5% v 3.8%) prompted modification of protocol to exclude more women and allow those allocated to physiological group who needed some active management to be switched to fully active management. Sample size of 3900 was planned, but even after protocol modification a planned interim analysis after first 1500 deliveries showed continuing high postpartum haemorrhage rate in physiological group and study was stopped. SETTING--Maternity hospital. PARTICIPANTS--Of 4709 women delivered from 1 January 1986 to 31 January 1987, 1695 were admitted to trial and allocated randomly to physiological (849) or active (846) management. Reasons for exclusion were: refusal, antepartum haemorrhage, cardiac disease, breech presentation, multiple pregnancy, intrauterine death, and, after May 1986, ritodrine given two hours before delivery, anticoagulant treatment, and any condition needing a particular management of third stage. INTERVENTIONS--All but six women allocated to active management actually received it, having prophylactic oxytocic, cord clamping before placental delivery, and cord traction; whereas just under half those allocated to physiological management achieved it. A fifth of physiological group received prophylactic oxytocic, two fifths underwent cord traction and just over half clamping of the cord before placental delivery. ENDPOINT--Reduction in incidence of postpartum haemorrhage from 7.5% under physiological management to 5.0% under active management. MEASUREMENTS AND MAIN RESULTS--Incidence of postpartum haemorrhage was 5.9% in active management group and 17.9% in physiological group (odds ratio 3.13; 95% confidence interval 2.3 to 4.2), a contrast reflected in other indices of blood loss. In physiological group third stage was longer (median 15 min v 5 min) and more women needed therapeutic oxytocics (29.7% v 6.4%). Apgar scores at one and five minutes and incidence of neonatal respiratory problems were not significantly different between groups. Babies in physiological group weighed mean of 85 g more than those in active group. When women allocated to and receiving active management (840) were compared with those who actually received physiological management (403) active management still produced lower rate of postpartum haemorrhage (odds ratio 2.4;95% CI1.6 to 3.7). CONCLUSIONS--Policy of active management practised in this trial reduces incidence of postpartum haemorrhage, shortens third stage, and results in reduced neonatal packed cell volume.

1. Maughan KL, Heim SW, Galazka SS. Preventing postpartum hemorrhage: managing the third stage of labor. Am Fam Physician. 2006;73(6):1025–8.[PubMed]

2. Zainur RZ, Loh KY. Postpartum morbidity-what we can do. Med J Malaysia. 2006;61(5):651–6.[PubMed]

3. McDonald S. Management of the third stage of labor. J Midwifery Womens Health. 2007;52(3):254–61.[PubMed]

4. Nahar S, Nargis SF, Khannam M. Simple technique of uterine compression sutures for prevention of primary postpartum hemorrhage during caesarian section. Pak J Med Sci. 2010;26(2):319–23.

5. Combs CA, Laros RK. Prolonged third stage of labor: morbidity and risk factors. Obstet Gynecol. 1991;77(6):863–7.[PubMed]

6. Magann EF, Evans S, Chauhan SP, Lanneau G, Fisk AD, Morrison JC. The length of the third stage of labor and the risk of postpartum hemorrhage. Obstet Gynecol. 2005;105(2):290–3.[PubMed]

7. Soltan MH, Khashoggi T. Retained placenta and associated risk factors. J Obstet Gynaecol. 1997;17(3):245–7.[PubMed]

8. Zhou W, Nielsen GL, Larsen H, Olsen J. Induced abortion and placenta complications in the subsequent pregnancy. Acta Obstet Gynecol Scand. 2001;80(12):1115–20.[PubMed]

9. Panpaprai P, Boriboonhirunsarn D. Risk factors of retained placenta in Siriraj Hospital. J Med Assoc Thai. 2007;90(2 Suppl1):1293–7.[PubMed]

10. Kamyabi Z, Naderi T, Ramazani A. A randomized, placebo-controlled trial of the effects of pethidine on labor pain, uterine contractions and infant Apgar score. Ann Saudi Med. 2003;23(5):318–20.[PubMed]

11. Jerbi M, Hidar S, Elmoueddeb S, Chaieb A, Khairi H. Oxytocin in the third stage of labor. Int J Gynaecol Obstet. 2007;96(3):198–9.[PubMed]

12. Jackson KW, Jr, Allbert JR, Schemmer GK, Elliot M, Humphrey A, Taylor J. A randomized controlled trial comparing oxytocin administration before and after placental delivery in the prevention of postpartum hemorrhage. Am J Obstet Gynecol. 2001;185(4):873–7.[PubMed]

13. Giacalone PL, Vignal J, Daures JP, Boulot P, Hedon B, Laffargue F. A randomised evaluation of two techniques of management of the third stage of labour in women at low risk of postpartum haemorrhage. BJOG. 2000;107(3):396–400.[PubMed]

14. Sharma JB, Pundir P, Malhotra M, Arora R. Evaluation of placental drainage as a method of placental delivery in vaginal deliveries. Arch Gynecol Obstet. 2005;271(4):343–5.[PubMed]

15. Armbruster D, Fullerton J. Cord clamping and active management of the third stage. J Midwifery Womens Health. 2007;52(5):526.[PubMed]

16. Soltani H, Poulose TA, Hutchon DR. Placental cord drainage after vaginal delivery as part of the management of the third stage of labour. Cochrane Database Syst Rev. 2011;9:CD004665.[PubMed]

17. Soltani H, Dickinson F, Symonds I. Placental cord drainage after spontaneous vaginal delivery as part of the management of the third stage of labour. Cochrane Database Syst Rev. 2005;4:CD004665.[PubMed]

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