Management of the third stage of labour in women at low risk of postpartum haemorrhage

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

“…Two approaches, active and expectant, have been proposed for the management of the third stage of labor. Active management involves administration of prophylactic oxytocin before delivery of the placenta, early cord clamping and cutting, and gentle cord traction with uterine countertraction when the uterus is well contracted (Brandt-Andrews maneuver) (1,2,(4)(5)(6)(7)(8)(9)(10)(11). Expectant management involves waiting for signs of placental separation and allowing the placenta to deliver spontaneously or aided by gravity or nipple stimulation (4).…”

“…Several large randomized controlled trials (5,6,(9)(10)(11) and key reviews (7,8) have addressed the question of whether expectant or active management is preferable. These five trials, which have been the subject of a meta-analysis in the Cochrane Library (1), are commonly named according to their geographic sites, namely, Abu Dhabi (5), Brighton (10), Bristol (6), Dublin (11), and Hinchingbrooke (9).…”

“…These five trials, which have been the subject of a meta-analysis in the Cochrane Library (1), are commonly named according to their geographic sites, namely, Abu Dhabi (5), Brighton (10), Bristol (6), Dublin (11), and Hinchingbrooke (9). These trials have consistently shown that active management leads to several benefits compared with expectant management, with an approximately 60 percent reduction in the occurrence of postpartum hemorrhage and severe postpartum hemorrhage, reduction in anemia, and reduction in the need for blood transfusion; the need for therapeutic uterotonic agents was also reduced by 80 percent.…”

Survey of the management of third stage of labour in the Netherlands

“…Also other studies in Ireland [4] and the United Kingdom [5] suggest that there still exists a need for a trial of oxytocin vs. placebo in women at low risk for postpartum haemorrhage. To elucidate standard prac tice during the third stage of labour in the Netherlands, we mailed a questionnaire to all Dutch midwives and obstetricians.…”

Timing of placental delivery to prevent post‐partum haemorrhage: Lessons learned from an abandoned randomised clinical trial

“…Trials comparing the active management of labour with expectant management have clearly shown a reduction in the rate of post-partum haemorrhage and a shortening of the third stage of labour. [8][9][10][11][12] The shortening of the third stage of labour is very important, as we now have to re-evaluate the appropriate interval time to minimise post-partum haemorrhage and maternal morbidity. In a prior observational study, the risk of a post-partum haemorrhage was significant at 10 min, with an OR of 2.1 increasing to 4.3 by 20 min and to 6.2 by 30 min.…”