Active Management of Third Stage Labor Is Associated with a Lower Cord Blood Unit Volume.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5282-5282
Author(s):  
Valerie Lapierre ◽  
Stephane Maddens ◽  
Stephanie Vuillemin ◽  
Chrystelle Vidal ◽  
Michelle Menetrier ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Cord Blood ◽  
Post Partum ◽  
Univariate Analysis ◽  
Active Management ◽  
Cell Content ◽  
Second Stage ◽  
Cd34 Cells ◽  
Third Stage ◽  
Post Partum Haemorrhage

Abstract Aim: It has been demonstrated that active management of third stage of labour (AMTSL) (prophylactic administration of a uterotonic agent, early cord blood clamping and controlled cord blood traction) reduces the risk of primary post partum haemorrhage compared with expectant (or physiological) management. However this strategy might decrease the cord blood unit (CBU) volume which is collected in order to be banked for therapeutic use. Knowing that efficacy of CBU transplantation correlates with CD34+ progenitor cells content (which is correlated with the collected volume of CBU), we conducted a retrospective study to analyse the impact of AMTSL on volume and CD34 progenitor’s content of CBU. Material and Method: From Jan 1st 2001 to Oct 2nd, 2004 the maternity affiliated to the Besançon CBB performed 3838 CBU collections after normal deliveries. Different factors that might impact on CBU volume and CD34+ cell content were analysed: age, parity, and smoking habit of the mother, gestational age, type of initiation and duration of first labour stage, duration (from the beginning of labour to initiation of the pushing phase), time of the second stage of labour (from the initiation of pushing time to the birth of the baby), foetal cardiac rhythm (FCR) alterations during labour, type of delivery (assisted or not) and variables of the third stage of labour (AMTSL, uterine revision, primary post partum haemorrhage occurrence, placenta weight). Moreover, variables in relation with the baby were studied: sex, weight, Apgar score at 1 and 5 minutes. Each factor were submitted to a univariate analysis. Multivariate analysis was carried only onto factors significant after univariate analysis. Analysis concerning volume was performed on all 3838 CBU while analysis for CD34+ cells content was performed only on CBU with a volume > 80 ml (minimum volume required for banking in our CBB) Results: In univariate analysis, assisted initiation of first stage of labour (p=0.04), FCR modification during labour (p=0.01), uterine revision (p=0.01), primary post partum haemorrhage (p=0.01), gestational stage (p=0.0001), duration of second stage labour (P=0.0001), placenta and baby weight (both p=0.0001) instrumental expulsion (p= 0.0001) and male baby (p=0.01) were associated with higher CBU volume. Conversely, AMSTL (p= 0.01) and Apgar sore at 1 and 5 minutes (p=0.0007 and 0.004 respectively) were associated with lower CBU volume. In multivariate analysis, only assisted initiation of first stage of labour (p=0.02), primary post partum haemorrhage (p=0.0001), duration of second stage labour (P=0.003), placenta and baby weight (both p=0.0001) were associated with higher CBU volume. However, AMSTL (p= 0.03) and Apgar sore at 1 (p=0.003) were associated with lower CBU volume. Concerning CD34+ cells, in multivariate analysis, only maternal age (p=0.02), gestational stage (p=0.0001), FCR modification during labour (p=0.001), duration of second stage labour (p=0.0001), placenta and baby weight (respectively p= 0.001 and p=0.0001) were associated with higher CD34+ cells content in CBU. Conversely, only Apgar sore at 1 (p=0.0001) was associated with lower CD34+ cells content in CBU. Conclusion: AMSTL is associated with a low CBU volume but not with a low CD34+ cell count. In view of the know generalized use of AMSTL, such findings could have on impact on the determination of volume and CD34+ cell content threshold required for CBU banking.

scholarly journals Active management of third stage of labour, post–partum haemorrhage and maternal death rate in the Vanga Health Zone, Province of Bandundu, Democratic Republic of the Congo

2010 ◽  
Vol 2 (1) ◽  
Author(s):  
Jean-Pierre Fina Lubaki ◽  
Jean-Robert Musiti Ngolo ◽  
Lucie Zikudieka Maniati
Keyword(s):  
Maternal Death ◽  
Democratic Republic ◽  
Post Partum ◽  
Active Management ◽  
Maternal Deaths ◽  
Third Stage ◽  
Post Test ◽  
Republic Of The Congo ◽  
Health Zone ◽  
Post Partum Haemorrhage

Background: Post-partum haemorrhage (PPH) is the single largest cause of maternal death worldwide and a particular burden for developing countries. In Africa, about 33.9 % of maternal deaths are due to PPH. In the Democratic Republic of the Congo (DRC), the prevalence of PPH is unknown. PPH can be prevented with active management of the third stage of labour (AMTSL). Objectives: To describe the practice of AMTSL in Vanga Health Zone and to calculate the incidence of PPH in Vanga Health Zone.Method: An intervention study with post-test-only design was conducted among health maternity wards using a data collection sheet to obtain information. All pregnant women attending Vanga Health maternity wards constituted the study population. Frequencies were determined for variables of interest.Results: From April 2007 to March 2008, 6339 deliveries took place at Vanga Health maternity wards, representing 71% of the institutional delivery rate. The number of deliveries realised with the practice of (AMTSL) were 5562; 366 cases of PPH were reported, making an incidence of 5.77%. Three cases of maternal deaths – two of which were related to PPH – were reported during the study period, which means there was a decline of 70% compared with the previous two years.Conclusion: The prevalence of PPH has been estimated to be 5.77%; PPH represents the cause of 67% of all maternal deaths. The extension of AMTSL practice, combined with the assurance of better supplies of oxytocin to enhance drug management, is strongly advised/suggested. As a number of births still take place outside the health maternity wards, the introduction of oral misoprostol could be considered a part of AMTSL for use by patients being treated by traditional midwives.

scholarly journals A prospective randomized controlled trial for comparison of oral misoprostol with methyl ergometrine in the third stage of labour for prevention of post-partum haemorrhage

2017 ◽  
Vol 6 (7) ◽  
pp. 2825 ◽  
Author(s):  
Sushma Gore ◽  
Atul Padmawar ◽  
Sabir Khan Pathan
Keyword(s):  
Post Partum ◽  
Tertiary Care ◽  
Active Management ◽  
Oral Misoprostol ◽  
Vaginal Deliveries ◽  
Third Stage ◽  
Group A ◽  
Post Partum Haemorrhage ◽  
Group B ◽  
Study Participants

Background: Near about 11% of women having live births have severe PPH (Globally 14 million women per year). About 3.9% of vaginal deliveries and 6.4% of cesarean section get PPH. Near about 1.4 million women die of PPH every year. Frequency of PPH is related to management of third stage of labour. Objective of the study was to compare the efficacy of misoprostol with conventional oxytocics for active management of third stage of labour.Methods: The present study was carried out in tertiary care teaching hospital for a period of three years from June 2007-May 2010. A total of 364 study participants who reported to labour ward with labour pains in latent phase and subsequently went in spontaneous labour were enrolled and randomly distributed to two groups and given oral misoprostol and i.v. ergometrine.Results: The mean age in Group A was 23.17±2.55 and 24.31±3.28 respectively. It was observed that most the study participants in both the groups had the duration of third stage of labour in between 10-14 minutes i.e. 29% in Group A and 36.3% in Group B respectively. The duration of third stage of labour was significantly more in Group B compared to Group A.Conclusions: Misoprostol is a promising drug in the management of third stage of labour for the prevention of post- partum haemorrhage.

scholarly journals A comparative study of efficacy of oxytocin, methylergometrine and misoprostol in prevention of post-partum haemorrhage

2017 ◽  
Vol 6 (5) ◽  
pp. 1960 ◽  
Author(s):  
Anjuman Alam ◽  
Paresh Shyam ◽  
Swapnil Goswami
Keyword(s):  
Blood Loss ◽  
Post Partum ◽  
Active Management ◽  
Singleton Pregnancy ◽  
Primary Parameter ◽  
Third Stage ◽  
Drug Storage ◽  
Trained Personnel ◽  
Post Partum Haemorrhage ◽  
Spontaneous Onset

Background: To compare the efficacy of oxytocin, methylergometrine and misoprostol in active management of third stage of labour (AMTSL).Methods: A clinical study was conducted on 330 low risk pregnant women with a healthy singleton pregnancy and spontaneous onset of labour at term; allocated into three groups where active management of third stage of labour was done with either Oxytocin 10 IU intramuscular, or Methylergometrine 0.2 mg intramuscular, or tab Misoprostol 600µg sublingual on 110 women each group. Primary parameter was blood loss during labour. Secondary parameters were the duration of third stage of labour and changes in haemoglobin level.Results: Blood loss during labour in Oxytocin group was 145.86±11.53 ml, which was significantly less than that in Methylergometrine (164.02±9.36 ml) and Misoprostol groups (183.18±9.70 ml), but no patient in any of the groups had blood loss more than 200ml. Duration of third stage of labour was significantly less in Oxytocin group (5.13±1.91 mins) than in. Methylergometrine (6.16±1.85 mins), and Misoprostol groups (6.47±1.51 mins). No patient had prolonged third stage in any of the groups. There was no significant change in pre-and post-delivery haemoglobin levels in all the groups.Conclusions: Though injectable uterotonics are effective for active management of third stage of labour (AMTSL), misoprostol can also be effectively used, especially in settings where there is no adequate trained personnel and drug storage facility.

scholarly journals Active management of third stage of labor

1970 ◽  
Vol 1 (2) ◽  
pp. 25-27
Author(s):  
Meena Thapa ◽  
Rachana Saha ◽  
Sumita Pradhan ◽  
Sushil Thakur ◽  
Archan Shamsher Rana
Keyword(s):  
Blood Loss ◽  
Post Partum ◽  
College Teaching ◽  
Uterine Atony ◽  
Active Management ◽  
Retained Placenta ◽  
Average Blood Loss ◽  
Cord Clamping ◽  
Third Stage Of Labor ◽  
Third Stage

Objective: Overall objective of the study was to see effects of active management of third stage of labour (AMSTL) with oxytocin. Specific objective of the study was to look for incidence of Post-Partum Haemorrhage (PPH), length of 3rd stage, incidence of retained placenta and average blood loss. Methodology: A hospital based prospective, descriptive, observational study was carried out from 1st July 2005 to 30th June 2006 at department of Obstetrics and Gynaecology, Kathmandu Medical College Teaching Hospital (KMCTH). All patients undergoing vaginal delivery excluding twins, polyhydraminios and instrumental deliveries were included in the study. The active management of 3rd stage included administration of 10 units IU of oxytocin, early cord clamping, controlled cord traction and uterine massage. Blood loss was estimated by visual inspection and measured by jar pressed against perineum. Result: Total number of deliveries during the study period was 530. There were 13 cases of PPH. Incidence of PPH was 2.4%. There were six cases each of uterine atony and genital tract trauma. One case was of retained placenta requiring Manual Removal (MRP). Average third stage duration was less than 5 minutes. Average blood loss was 90 ml. In 2 cases the third stage lasted more than 30 mins. Conclusion: Active management of 3rd stage of labour reduces the incidence of PPH from uterine atony, reduces the duration as well as average blood loss during third stage.condition. Key words: Labor analgesia; epidural, combined spinal epidural; complications, dural puncture, postdural puncture headache (PDPH); prevention.   doi:10.3126/njog.v1i2.1490 N. J. Obstet. Gynaecol Vol. 1, No. 2, p. 25 - 27 Nov-Dec 2006

Optimizing donor selection in order to establish a cord blood banking facility: maternal and obstetric factors impact

Open Medicine ◽  
2007 ◽  
Vol 2 (2) ◽  
pp. 180-189 ◽  
Author(s):  
Mihaela Chivu ◽  
Serban Nastasia ◽  
Camelia Sultana ◽  
Coralia Bleotu ◽  
Irina Alexiu ◽  
...  
Keyword(s):  
Cord Blood ◽  
Blood Volume ◽  
Donor Selection ◽  
Gestation Length ◽  
Gestational Length ◽  
Cell Content ◽  
Cd34 Cells ◽  
Newborn Weight ◽  
The Mean ◽  
Obstetric Factors

AbstractIn this study, we analyzed the obstetric factors affecting total nucleated cells (TNC) content of cord blood units to establish the criteria for umbilical cord blood (UCB) donor selection in our geographic area.UCB was collected from normal uncomplicated pregnancies. In every case, following data were recorded: (1) gestation length; (2) type of delivery (cesarean or vaginal); and (3) newborn characteristics: weight and sex. For each sample, TNC content, percentage and number of CD34+ cells, and viability were analyzed.The results showed that TNC content increases with cord blood volume, gestational length and newborn weight. The mean blood volume and the mean TNC per unit were 42.37 ± 13.5 ml and 55.49 ± 19.4 × 107, respectively. Stepwise regression analysis revealed a positive and significant correlation (r= 0.89) between these two variables. Meanwhile the CD34+ cell content remains unchanged in deliveries at 32–40 weeks of gestation. The mean CD34+ percentage obtained was 0.37 ± 0.06, and the total number of CD34+ cells was 4.827 ± 0.8204 × 104 / mL UCB.Concluding, the maternal and obstetric factors have a significant impact on UCB cell quantity and quality. The main criteria for UCB collection and storage resulted to be: a gestational age higher than 36–40 weeks and newborn weight > 3200g; gestation number ≤ 2 and placental weight > 700g can be added to the standard criteria to improve the bank efficiency. Our results have also become helpful in evaluating stored UCB units to establish the adequacy for clinical transplant utilization.

scholarly journals Third stage of labour: expectant versus active management-a comparative study in local low risk population

2019 ◽  
Vol 8 (2) ◽  
pp. 641
Author(s):  
Kavita A. Chandnani ◽  
Deepti D. Sharma
Keyword(s):  
Blood Loss ◽  
Comparative Study ◽  
Maternal Mortality ◽  
Post Partum ◽  
Expectant Management ◽  
Active Management ◽  
Research Centre ◽  
Third Stage ◽  
Group A ◽  
Group B

Background: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality, accounting for about 35% of all maternal deaths. These deaths have a major impact on the lives and health of the families affected. Thus, anticipation as well as proper management of 3rd stage of labour is mandatory. The objective of this study was to compare expectant and active management of third stage of labour in preventing post-partum blood loss and having impact on prevention of maternal mortality in local population. Advantages and disadvantages of both techniques might be over estimated.Methods: Prospective comparative study carried out in Obstetrics and Gynecology department of SBKSMIRC (Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre), Dhiraj general hospital, comprising of 200 laboring women admitted directly or from OPD to labour room for expected vaginal delivery. They were randomly allocated to group A (expectant management) and group B (active management). Labour progress was charted on partograph and interventions recorded. Statistical analysis of data was done after compiling and tabulation of data. Mean±SD for descriptive variables were calculated and appropriate statistical tests applied to determine significance.Results: Average PPBL (post-partum blood loss) was 360.5ml in group A as compared to 290.6ml in group B. 12 patients in group A had blood loss more than 500ml while none in group B. 66% cases in group B had duration of third stage of labour less than 5 min as compared to only 22% in group A. the mean duration of third stage was 13.46±8.3 in group A while 5.32±3.05 in group B. these differences were statistically significant.Conclusions: Active management of the third stage of labour is associated with less blood loss as well as a shorter duration of third stage compared with expectant management. It is reasonable to advocate this regime.

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