How Do Physicians and Midwives Manage the Third Stage of Labor?

Tan, Weiping M.; Kleín, Michael C.; Saxell, Lee; Shirkoohy, Sahba Eftekhary; Asrat, Getnet

doi:10.1111/j.1523-536x.2008.00243.x

Cited by 33 publications

(74 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our survey suggests this policy is followed for vaginal births conducted by obstetricians, but midwives were more likely to give the uterotonic later. Similar practice for obstetricians and midwives has been reported elsewhere [14]. This may be because if the midwife is alone she will not be able to give the uterotonic drug until after the baby is born, whilst obstetricians are less likely to attend a delivery alone.…”

Section: Discussionmentioning

confidence: 53%

Care during the third stage of labour: A postal survey of UK midwives and obstetricians

Farrar

Tuffnell

Airey

et al. 2010

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

BackgroundThere are two approaches to care during the third stage of labour: Active management includes three components: administration of a prophylactic uterotonic drug, cord clamping and controlled cord traction. For physiological care, intervention occurs only if there is clinical need. Evidence to guide care during the third stage is limited and there is variation in recommendations which may contribute to differences in practice. This paper describes current UK practice during the third stage of labour.MethodsA postal survey of 2230 fellows and members of the Royal College of Obstetricians and Gynaecologists (RCOG) and 2400 members of the Royal College of Midwives was undertaken. Respondents were asked about care during the third stage of labour, for vaginal and caesarean births and their views on the need for more evidence to guide care in the third stage. The data were analysed in Excel and presented as descriptive statistics.Results1189 (53%) fellows and members of the RCOG and 1702 (71%) midwives responded, of whom 926 (78%) and 1297 (76%) respectively had conducted or supervised births in the last year. 93% (863/926) of obstetricians and 73% (942/1297) of midwives report 'always or usually' using active management. 66% (611/926) of obstetricians and 33% (430/1297) of midwives give the uterotonic drug with delivery of the anterior shoulder; this was intramuscular Syntometrine® for 79% (728/926) and 86% (1118/1293) respectively. For term births, 74% (682/926) of obstetricians and 41% (526/1297) of midwives clamp the cord within 20 seconds, as do 57% (523/926) and 55% (707/1297) for preterm births. Controlled cord traction was used by 94% of both obstetricians and midwives. For caesarean births, intravenous oxytocin was the uterotonic used by 90% (837/926) of obstetricians; 79% (726/926) clamp the cord within 20 seconds for term births as do 63% (576/926) for preterm births.Physiological management was used 'always or usually' by 2% (21/926) of obstetricians and 9% (121/1297) of midwives. 81% (747/926) of obstetricians and 89% (1151/1297) of midwives thought more evidence from randomised trials was needed; the most popular question was when is best to clamp the cord.ConclusionsActive management of the third stage of labour is widely used by both obstetricians and midwives in the UK. Syntometrine® is usually used for vaginal births and oxytocin for caesarean births; when this is given and when the cord is clamped varies.

show abstract

Section: Discussionmentioning

confidence: 53%

Care during the third stage of labour: A postal survey of UK midwives and obstetricians

Farrar

Tuffnell

Airey

et al. 2010

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

show abstract

“…22 Although active management is practised in both high-and low-income countries, the relative timing of each component varies. [23][24][25] In Sweden it is recommended that all women giving birth vaginally be given an intravenous injection of 10 iu of oxytocin as soon as the baby is born. 26 However, the entire AMTSL procedure has not been adopted, and has been questioned by care providers.…”

Section: Introductionmentioning

confidence: 99%

A comparison of active management and expectant management of the third stage of labour: a Swedish randomised controlled trial

Jangsten

Lå

Lyckestam

et al. 2010

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

View full text Add to dashboard Cite

Objective To compare blood loss in women actively and expectantly managed in the third stage of labour. Design Randomised controlled trial (RCT).Setting Two delivery units at a Swedish university hospital.Population Healthy women with normal pregnancies, at gestational age 34-43 weeks, with singleton cephalic presentation and expected vaginal delivery.Methods The women were randomly allocated to either active (n = 903) or expectant (n = 899) management of the third stage of labour.Main outcome measures The primary outcome was blood loss > 1000 ml, and secondary outcomes were mean blood loss, duration of third stage, retained placenta, haemoglobin level and blood transfusion.Results Blood loss > 1000 ml occurred in 10% of the actively managed group and 16.8% of the expectantly managed group (P < 0.001). Mean blood loss was 535 ml in the actively managed group and 680 ml in the expectantly managed group (P < 0.001). A prolonged duration of the third stage was associated with increased blood loss. Increased placenta weight was associated with increased blood loss. The haemoglobin level was 118 g/dl in actively managed women and 115 g/dl in expectantly managed women (P < 0.001) the day after childbirth. The occurrence of retained placenta and the number of blood transfusions did not differ between the groups.Conclusions Active management of the third stage of labour was associated with less blood loss compared with expectant management. It is reasonable to advocate this regime, especially in primiparous women.Keywords Active management, active management of the third stage of labour, expectant management, oxytocin, postpartum haemorrhage, third stage of labour.

show abstract

“…In fact, a number of maternal circumstances warrant ICC to the benefit of the mother-infant dyad, including placental previa, placental abruption, and velamentous cord insertion [2,3]. While a recent Cochrane review showed that DCC does not increase the risk of postpartum hemorrhage in more mature infants [44], this concern continues to be one of the primary reasons obstetricians cite for performing ICC [12,22].…”

Section: Reasons To Perform Iccmentioning

confidence: 99%

“…The practice of increasing placental-fetal transfusion at birth was considered standard of care until the 1960 s when practice shifted to immediate clamping of the cord and handing off the infant to the pediatric team for resuscitation and as active management of the third stage of labor [2,3]. At that time, increased placental-fetal transfusion was associated with hyperbilirubinemia and polycythemia, with additional evidence that delays in resuscitation may worsen neonatal outcomes [4][5][6].…”

Section: Introduction and Historical Perspectivementioning

confidence: 99%

Placental transfusion strategies in extremely preterm infants: The next piece of the puzzle

Backes

Rivera

Haque

et al. 2014

Journal of Neonatal-Perinatal Medicine

View full text Add to dashboard Cite

Evidence is growing on the potential value of enhancing placental-fetal transfusion at birth, with recent endorsement of the practice by the World Health Organization and American College of Gynecologists. However, these recommendations provide clinicians with little guidance on the optimal practice among infants born extremely premature (<28 weeks gestation) and those requiring immediate resuscitation. The goals of this review are to: 1) provide rationale for better outcomes among extremely preterm infants following delayed cord clamping or umbilical cord "milking" than with immediate cord clamping; 2) describe clinical situations that warrant immediate cord clamping following delivery and explore the controversy regarding optimal cord clamping practice among extremely premature infants, including those requiring immediate resuscitation; 3) discuss the quality of evidence in this subgroup of infants; 4) consider areas for future research, with a focus on characterizing if placental-fetal transfusion affects the magnitude or timing of variables associated with physiological transition. The review provided herein suggests that delayed cord clamping or umbilical cord milking can be applied safely to infants born prior to 28 weeks gestation, but the lack of evidence on the best practice among infants born severely depressed and requiring immediate resuscitation, who comprise a greater proportion of infant deliveries at the lowest gestational ages, is recognized. Future studies using well-defined physiologic outcome measures are needed to understand the role of placental transfusion in premature infants' adaptations to extrauterine life. C.H. Backes et al. / Placental transfusion in preterm infants"Another thing very injurious to the child, is the tying and cutting of the navel string too soon; which should always be left till the child has not only repeatedly breathed but till all pulsation in the cord ceases. As otherwise the child is much weaker than it ought to be; a part of the blood being left in the placenta, which ought to have been in the child; and at the same time the placenta does not so naturally collapse, and withdraw itself from the sides of the uterus, and is not therefore removed with so much safety and certainty." -Erasmus Darwin, Zoonomia, Volume II [1]

show abstract

How Do Physicians and Midwives Manage the Third Stage of Labor?

Cited by 33 publications

References 18 publications

Care during the third stage of labour: A postal survey of UK midwives and obstetricians

Care during the third stage of labour: A postal survey of UK midwives and obstetricians

A comparison of active management and expectant management of the third stage of labour: a Swedish randomised controlled trial

Placental transfusion strategies in extremely preterm infants: The next piece of the puzzle

Contact Info

Product

Resources

About