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

Magann, Everett F.; Doherty, Dorota; Briery, Christian; Niederhauser, Amy; Morrison, John C.

doi:10.1111/j.1479-828x.2006.00658.x

Cited by 25 publications

(18 citation statements)

References 10 publications

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“…More recent studies show that the incidence of PPH rises earlier during the third stage. Based on these findings, it has been suggested that interventions to prevent PPH should be undertaken earlier …”

Section: Introductionmentioning

confidence: 99%

The duration of the third stage in relation to postpartum hemorrhage

Ast

Goedhart

Luttmer

et al. 2019

Birth

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Introduction In this study, we describe the distribution of placenta delivery and the incidence of postpartum hemorrhage in both spontaneous placental delivery and manual removal of the placenta. Methods A retrospective study was performed of 7603 singleton vaginal deliveries of a gestational age over 32 weeks, registered between September 2011 and 2016. We calculated the incidence of postpartum hemorrhage (≥1000 mL blood loss) per 10‐minute duration of the third stage. The odds ratio for developing postpartum hemorrhage was assessed, adjusted for risk factors. The incidence of postpartum hemorrhage was compared between women that did and did not receive manual removal of placenta. Results The median duration of the third stage was 10 minutes (interquartile range 7‐16 minutes). The median amount of blood loss was 300 mL (200‐400 mL). The overall incidence of postpartum hemorrhage was 8.5%. With every additional 10 minutes of third‐stage duration, the risk of developing postpartum hemorrhage significantly increased. In a third stage longer than 60 minutes, the incidence of postpartum hemorrhage was 21.2% without manual removal of the placenta and 70.3% with manual removal. Conclusions The incidence of postpartum hemorrhage increases significantly from 10 to 19 minutes into the third stage. Women with the removal of the placenta had a significantly higher percentage of postpartum hemorrhage. The optimal timing for manual removal of the placenta should be investigated in a carefully designed randomized controlled trial to examine whether earlier manual removal of placenta lowers the incidence and limits the severity of postpartum hemorrhage.

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Section: Introductionmentioning

confidence: 99%

The duration of the third stage in relation to postpartum hemorrhage

Ast

Goedhart

Luttmer

et al. 2019

Birth

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“…5,6 Shorter median durations of the third stage, down to 4 minutes, have been reported in the most recent studies. 16 These could be explained by an increased use of active management.…”

Section: Discussionmentioning

confidence: 99%

Policies for manual removal of placenta at vaginal delivery: variations in timing within Europe

Deneux‐Tharaux

Macfarlane

Winter

et al. 2008

BJOG

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The length of the third stage of labour is a potential modifiable risk factor for postpartum haemorrhage at vaginal delivery, but there is no definitive evidence that early intervention to remove the placenta manually will prevent postpartum haemorrhage. We report a wide variation between countries in Europe in policies about the timing of manual removal of placenta. Two groups of countries with clearly divergent policies were identified. A randomised controlled trial is needed to provide definitive evidence on the risks and benefits of manual removal of placenta at different timings after vaginal delivery.Keywords Manual removal of placenta, prevention policies, postpartum haemorrhage, third stage of labour.

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“…The degree of blood loss associated with placental separation and delivery depends on how quickly the placenta separates from the uterine wall and how effectively the uterine muscle contracts around the placental bed and the uterine blood vessels (3). If the placenta is not delivered within 10 minutes, the risk of PPH increases (18). Therefore, any intervention for shortening the duration of the TSL and preventing complications becomes important.…”

Section: Discussionmentioning

confidence: 99%

“…Placental retention is defined as the failure of placental delivery within 30 to 45 minutes and it usually requires intervention to assist delivery (18). Failure of the retro-placental myometrium contraction is the usual cause of a retained placenta.…”

Section: Data Presented As Mean ± Standard Deviation or Median With Mmentioning

confidence: 99%

Placental Blood Drainage Shortens Duration of the Third Stage of Labor in Women Slowly Administered 20 IU Oxytocin

Kaba

Üstün

Eyı

et al. 2017

Gynecol Obstet Reprod Med

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OBJECTIVE: Prolongation of the third stage of labor may cause serious postpartum complications. Thus, timely expulsion of the placenta is essential for preventing complications of the third stage of labor. We conducted a prospective cohort study to determine the effect of placental cord drainage on the duration of the TSL in women administered intravenous oxytocin during this stage. STUDY DESIGN:This was a prospective cohort study in which 112 low risk pregnant women were allocated to the study. There were 53 women in the placental cord drainage group, and 59 women in the cord clamping group without drainage. Immediately after fetal delivery, intravenous infusion of 20 IU oxytocin in 500 mL Ringers' Lactate was started and infused within 2 hours in women in both groups. Outcome measures were the third stage duration and hemoglobin differences between admission and the postpartum sixth hour. RESULTS:There were no significant differences between the two groups with regard to duration of stages 1 and 2 of labor, hemoglobin level on admission, and at the postpartum sixth hour, and hemoglobin differences between admission and the postpartum sixth hour. The median third stage duration in the study group was 3.40 (range: 0.35-16.20) minutes, and 5.10 (range: 2.30-11.00) minutes in the control group. This difference between the groups was statistically significant (p<0.01). CONCLUSION:Placental cord drainage reduces the third stage duration following vaginal deliveries in patients receiving intravenous oxytocin. Placental cord drainage is simple, does not require additional cost, and is applicable for every delivery.Keywords: Third stage of labor, Active management of the third stage, Placental cord drainage,

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

Cited by 25 publications

References 10 publications

The duration of the third stage in relation to postpartum hemorrhage

The duration of the third stage in relation to postpartum hemorrhage

Policies for manual removal of placenta at vaginal delivery: variations in timing within Europe

Placental Blood Drainage Shortens Duration of the Third Stage of Labor in Women Slowly Administered 20 IU Oxytocin

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