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

Abstract

Although there is a lack of high quality evidence, active management of the third stage reduced the risk of haemorrhage greater than 1000 mL at the time of birth in a population of women at mixed risk of excessive bleeding, but adverse effects were identified. Women should be given information on the benefits and harms of both methods to support informed choice. Given the concerns about early cord clamping and the potential adverse effects of some uterotonics, it is critical now to look at the individual components of third-stage management. Data are also required from low-income countries.

Intervention or interference? The need for expectant care throughout normal labour

“…11 Results of meta-analyses show that AMTSL reduces rates of severe blood loss, blood transfusions and anaemia in the 6 postnatal period but causes a number of harms including vomiting, increased diastolic blood pressure, increased after-birth pains and a decrease in baby's birthweight. This decrease is likely due to the reduction in transfer of approximately 80 mls of fetal blood into the baby's circulation as a result of early cord clamping.…”

“…The authors conclude that all women should be given information on the benefits and harms of both methods, to support their informed choice. 11 One additional harm of AMTSL, as currently practised, is due to early cord clamping and cutting, to aid controlled cord traction. The reduction of 80 mls of blood in the baby's circulation, caused by immediate cord clamping, leads to lower Hb concentrations in term neonates in the first 24 to 48 hours and twice the level of anaemia at 3-6 months.…”

“…11 The first is that a high percentage of women participating had received an oxytocic for induction or acceleration of labour, which may predispose them to PPH. Secondly, expectant management was not the norm for the midwives involved, so the blood loss seen in these trials may be greater than would be obtained by midwives experienced in using expectant management of the third stage of labour (EMTSL).…”

Odgovornosti babice glede pregleda posteljice: raziskava o pristopih v slovenskih porodnišnicah

“…Sestavljen je bil na podlagi pregleda literature (Walsh, 2007;McDonald, 2009;Burke, 2010;Harris, 2011;Begley, 2011;ICM, 2011). Vprašanja so se nanašala na kritične točke vodenja tretje porodne dobe, saj domnevno prihaja do razhajanja med na dokazih temelječimi raziskavami in izvajanjem tretje porodne dobe v praksi slovenskih porodnišnic.…”

“…Upoštevati moramo torej tudi način vodenja prve in druge porodne dobe, saj morata tudi prva in druga porodna doba potekati fiziološko, če želimo, da tako poteka tudi tretja (Walsh, 2007). Raziskave (Begley, et al, 2011;Westhoff, et al, 2013) sicer navajajo, da aktivno vodenje tretje porodne dobe zmanjša izgubo krvi in krvavitve, večje od 500 ml. Vendar pa Walsh (2007) (Zakon, 2008).…”