scholarly journals Duration of third stage labour and postpartum blood loss: a secondary analysis of the WHO CHAMPION trial data

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Sumangala B. Chikkamath ◽  
Geetanjali M. Katageri ◽  
Ashalata A. Mallapur ◽  
Sunil S. Vernekar ◽  
Manjunath S. Somannavar ◽  
...  
Keyword(s):  
Blood Loss ◽  
Secondary Analysis ◽  
Positive Association ◽  
Trial Data ◽  
Active Management ◽  
P Value ◽  
Clinical Trial Registry ◽  
Main Trial ◽  
Postpartum Blood Loss ◽  
Third Stage

Abstract Background Obstetric haemorrhage continues to be a leading cause of maternal mortality, contributing to more than a quarter of the 2,443,000 maternal deaths reported between 2003 and 2009. During this period, about 70% of the haemorrhagic deaths occurred postpartum. In addition to other identifiable risk factors for greater postpartum blood loss, the duration of the third stage of labour (TSL) seems to be important, as literature shows that a longer TSL can be associated with more blood loss. To better describe the association between the duration of TSL and postpartum blood loss in women receiving active management of third stage of labour (AMTSL), this secondary analysis of the WHO CHAMPION trial data has been conducted. Methods This was a secondary analysis of the WHO CHAMPION trial conducted in twenty-three sites in ten countries. We studied the association between the TSL duration and blood loss in the sub cohort of women from the CHAMPION trial (all of whom received AMTSL), with TSL upto 60 min and no interventions for postpartum haemorrhage. We used a general linear model to fit blood loss as a function of TSL duration on the log scale, arm and center, using a normal distribution and the log link function. We showed this association separately for oxytocin and for Heat stable (HS) carbetocin. Results For the 10,040 women analysed, blood loss rose steeply with third stage duration in the first 10 min, but more slowly after 10 min. This trend was observed for both Oxytocin and HS carbetocin and the difference in the trends for both drugs was not statistically significant (p-value = 0.2070). Conclusions There was a positive association between postpartum blood loss and TSL duration with either uterotonic. Blood loss rose steeply with TSL duration until 10 min, and more slowly after 10 min. Study registration The main trial was registered with Australian New Zealand Clinical Trials Registry ACTRN12614000870651 and Clinical Trial Registry of India CTRI/2016/05/006969

scholarly journals Duration of Third Stage Labour and Postpartum Blood Loss: a Secondary Analysis of the WHO CHAMPION Trial Data

2021 ◽  
Author(s):  
Sumangala B Chikkamath ◽  
Geetanjali M Katageri ◽  
Ashalata A Mallapur ◽  
Sunil S Vernekar ◽  
Manjunath S Somannavar ◽  
...  
Keyword(s):  
Blood Loss ◽  
Secondary Analysis ◽  
Positive Association ◽  
Trial Data ◽  
Active Management ◽  
P Value ◽  
Clinical Trial Registry ◽  
Main Trial ◽  
Postpartum Blood Loss ◽  
Third Stage

Abstract Background: Obstetric haemorrhage continues to be a leading cause of maternal mortality, contributing to more than a quarter of the 2,443,000 maternal deaths reported between 2003 and 2009. During this period, about 70% of the haemorrhagic deaths occurred postpartum. In addition to other identifiable risk factors for greater postpartum blood loss, the duration of the third stage of labour (TSL) seems to be important, as literature shows that a longer TSL can be associated with more blood loss. To better describe the association between the duration of TSL and postpartum blood loss in women receiving active management of third stage of labour (AMTSL), this secondary analysis of the WHO CHAMPION trial data has been conducted.Methods: This was a secondary analysis of the WHO CHAMPION trial conducted in twenty-three sites in ten countries. We studied the association between the TSL duration and blood loss in the sub cohort of women from the CHAMPION trial defined above. We used a general linear model to fit blood loss as a function of TSL duration on the log scale, arm and center, using a normal distribution and the log link function. We showed this association separately for oxytocin and for Heat stable (HS) carbetocin.Results: For the 10,040 women analysed, blood loss rose steeply with third stage duration in the first 10 minutes, but more slowly after 10 minutes. This trend was observed for both Oxytocin and HS carbetocin and the difference in the trends for both drugs was not statistically significant (p-value=0.2070). Conclusions: There was a positive association between postpartum blood loss and TSL duration with either uterotonic. Blood loss rose steeply with TSL duration until 10 minutes, and more slowly after 10 minutes. Study registration: The main trial was registered with Australian New Zealand Clinical Trials Registry ACTRN12614000870651 and Clinical Trial Registry of India CTRI/2016/05/006969.

scholarly journals A Comparative Study of Active Management of the Third Stage of Labor IV Methergine and IM Oxytocin

2021 ◽  
pp. 267-272
Author(s):  
K. Sharmila
Keyword(s):  
Blood Loss ◽  
The United States ◽  
Active Management ◽  
P Value ◽  
Negative Effects ◽  
The Third ◽  
Third Stage Of Labor ◽  
Group I ◽  
Third Stage ◽  
The Mean

Postpartum haemorrhage (PPH) has been more common over the last three decades, accounting for 11% of all pregnancy-related deaths in the United States. In the third stage of labour, risk classification and active management are crucial preventative techniques. To avoid negative effects, a multidisciplinary approach to PPH patient care is required. To treat uterine atony, uterotonic medicines like oxytocin are used in combination with manipulative procedures like uterine massage and balloon tamponade. The amount of blood loss, duration of the third stage, need for MRP, incidence of PPH, need for repeated oxytocics, and its side effects were measured in Group I 100 women who were administered injection oxytocin 10 IU injection methergin 0.2 mg IV within one minute of the baby's delivery. The mean blood loss at vaginal delivery in Group I was 100-150 ml and in group I P value 0.027, which was statistically significant .In  Group II was 160-200 ml with P value 0.036, which was statistically significant. The mean duration of third stag labour in Group 1 was 124.6 min and Group 2 was 144.8 min intravenous methergin is a better uterotonic when compared to intramuscular oxytocin to reduce the amount of blood loss at delivery and prevent complications like atonic PPH.

scholarly journals Efficacy of tranexamic acid in preventing postpartum haemorrhage in vaginal delivery

2019 ◽  
Vol 8 (9) ◽  
pp. 3485
Author(s):  
G. Anantha Lakshmi Satyavathi ◽  
Chandrika K.
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Postpartum Haemorrhage ◽  
Acid Group ◽  
Active Management ◽  
Singleton Pregnancy ◽  
Total Blood ◽  
Postpartum Blood Loss ◽  
Third Stage ◽  
History Of

Background: Postpartum blood loss is difficult to evaluate especially in developing countries like India where most of the women are anaemic with poor reserve and these conditions are further aggravated by increased demand during pregnancy and blood loss during third stage of labour. The present study was planned to compare the efficacy of prophylactic 10 IU intramuscular oxytocin and 10 IU intramuscular oxytocin +1g Tranexamic acid in reducing blood loss in the third stage of labour.Methods: The present study was carried out on full term pregnancies primigravida/ multiparas with singleton pregnancy being delivered vaginally at GSL Hospital, Rajahmundry between 2016-2017 were included. For this comparative study, 200 women in labor were included after obtaining informed consent. A detailed obstetric history, history of previous medical illnesses, history of the treatment received earlier, cardiovascular and respiratory system and other systems including thyroid and breast were noted.Results: The average total blood loss in IIIrd stage of labour with IM oxytocin was 210 ml and with IM oxytocin + Tranexamic acid was130 ml, which was statistically significant (p<0.001). Oxytocin + Tranexamic acid group had less blood loss when compared to oxytocin group alone. Side effects like, nausea vomiting, headache were slightly more with oxytocin + Tranexamic acid group when compared to oxytocin group alone.Conclusions: In the active management of IIIrd stage of labour 10 IU intramuscular Oxytocin + one gram of tranexamic acid IV is a better combination in reducing the blood loss at delivery when compared to 10 IU intramuscular oxytocin alone.

scholarly journals Study of effect of intra-umbilical oxytocin along with active management in third stage of labor

2021 ◽  
Vol 10 (9) ◽  
pp. 3486
Author(s):  
Neetu Verma ◽  
Monica Soni ◽  
Priyanka Singh
Keyword(s):  
Blood Loss ◽  
Normal Saline ◽  
Demographic Data ◽  
Active Management ◽  
P Value ◽  
Study Group ◽  
Third Stage Of Labor ◽  
Third Stage ◽  
Group A ◽  
Group B

Background: The aim of the study was to determine effect of intra-umbilical oxytocin along with active management on duration and amount of blood loss in 3rd of stage of labor.Methods: This was a hospital based prospective, randomized, case-control study conducted in the department of OBG between 1st September 2019 to 31st December 2020. After obtaining permission from ethical committee, screening of inclusion and exclusion criteria and informed consent of participants, 300 cases were enrolled. In group A (control) 20 ml normal saline and in group B (case) 20 IU oxytocin diluted in normal saline to make a 20 ml solution was given intra-umbilically along with standard active management of third stage labor. The data was systematically recorded and analysed.Results: Both the groups were comparable in terms of demographic data.  A statistically significant reduction in the duration of third stage of  labor (1.83±0.64  min in group B vs 2.92±0.79 min in group A), amount of blood loss (203.73±62.11 ml in group B vs 328.83±87.18 ml  group A) and fall in haemoglobin (9.28±1.03 g/dl in the study group A vs 9.97±1.28 g/dl in group B) and haematocrit (31.20±3.05% in  study group A vs 33.60±3.31%  in study group B)  were noted, taking p value  significant <0.05.Conclusions: Intra-umbilical oxytocin was associated with a significant reduction in duration and amount blood loss in third stage of labor.

scholarly journals A comparative study between intramuscular oxytocin and intramuscular methyl ergometrine in the active management of third stage of labour

2018 ◽  
Vol 7 (5) ◽  
pp. 1943 ◽  
Author(s):  
Devi Reddy Hema Swapnika ◽  
Prema Priya G. ◽  
S. Senthil Priya ◽  
A. S. Allirathinam
Keyword(s):  
Side Effects ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Active Management ◽  
P Value ◽  
Singleton Pregnancy ◽  
The Third ◽  
Third Stage ◽  
The Difference ◽  
Vertex Presentation

Background: To compare the efficacy of prophylactic IM oxytocin 10U and IM methyl ergometrine 0.2mg on duration of third stage of labour, amount of blood loss during the third stage of labour and associated side effects.Methods: 50 low risk antenatal women with singleton pregnancy at term gestation in vertex presentation admitted for vaginal delivery, were randomly allocated into 2groups of 25 each and managed actively in the third stage of labour either with 10 U oxytocin IM or with 0.2mg methyl ergometrine IM immediately after the birth of the baby. The main outcome measures were the difference between the 2groups with regard to: duration of third stage of labour, blood loss by volume, difference in haemoglobin and haematocrit, need for blood transfusion, additional uterotonics and side effects of drugs.Results: The mean duration of third stage of labour in the oxytocin group was 6.68±2.17min and in methergine group was 6.4±1.93 min. Mean blood loss was 302±75.6ml and 282.8±58.27ml. Mean fall in Hb was 0.92gm% and 0.812gm%. Mean fall in PCV was 2.36% and 1.88%. 2women in oxytocin group and 1woman in methergine group received additional 0.2mg methergine. 3women in both groups received 1unit of blood transfusion. 8women who received methergine had side effects while only one in the oxytocin group, with a p value 0.004 which is statistically significant.Conclusions: This study has shown that both oxytocin and methylergometrine were equally efficacious. However, oxytocin had significantly better safety profile and lesser contraindications for usage.

scholarly journals Cervical traction: a simple step ahead in the prevention of postpartum hemorrhage

2019 ◽  
Vol 8 (8) ◽  
pp. 3174
Author(s):  
Harshita Naidu ◽  
Sujatha B. S. ◽  
Muralidhar V. Pai
Keyword(s):  
Blood Loss ◽  
Postpartum Hemorrhage ◽  
Active Management ◽  
Control Group ◽  
Case Group ◽  
Postpartum Blood Loss ◽  
The Third ◽  
Third Stage Of Labor ◽  
Third Stage ◽  
Cervical Traction

Background: Postpartum hemorrhage is the most common preventable cause of maternal mortality in developing countries. The present study aimed to examine the impact of cervical traction technique in reducing the amount of postpartum blood loss and rate of PPH.Methods: This was a case-control, pilot study conducted in a tertiary hospital between June 2017 to June 2018. A total of 200 singletons, low-risk pregnant females, undergoing normal vaginal delivery, were enrolled in this study. Subjects showing a high risk for PPH were excluded. Patients were randomized as case group (n=100) and control group (n=100). The case group received sustained traction for 90 seconds to anterior and posterior lip of the cervix with active management of the third stage of labor, whereas the control group received routine active management of the third stage of labor. All subjects were followed up for 6 hours post-delivery. The amount of blood loss, hematocrit and hemoglobin post-delivery were compared between both groups.Results: The mean blood loss (ml), decrease in hemoglobin (g/L) and decrease in hematocrit post-delivery in cases were significantly low compared to controls (207±37.6 versus 340±49, P<0.01), (0.78±0.2 versus 1.4±0.3, P=0.03) and (1.7±0.2 versus 3.5±0.2, P<0.01). PPH occurred in 7 of 200 (3.5%) patients. The difference in the number of PPH was not significant (5/100; 5% versus 2/100; 2% P=0.2). There were no complications reported due to cervical traction.Conclusions: Cervical traction is a simple and safe maneuver to reduce the amount of postpartum blood loss. Larger RCT is recommended to investigate the reduction in PPH rate.

scholarly journals Use of Oral Misoprostol, Intramuscular Oxytocin and Intravenous Methergin in Prevention of Postpartum Haemorrhage

2013 ◽  
Vol 8 (1) ◽  
pp. 34-36
Author(s):  
Banwari Lal Meena
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Post Partum ◽  
Active Management ◽  
P Value ◽  
Multi Centre Study ◽  
Oral Misoprostol ◽  
Third Stage ◽  
Group B ◽  
A Prospective Study

Aims: The purpose of the study was to compare the efficacy of misoporstol 600mg orally (Group A), injection oxytocin 10 IU intramuscularly (Group B) and injection methylergometrine 0.2 mg intravenously (Group C) on reducing blood loss in third stage of labour, duration of third stage of labour, effect on haemoglobin of the patient, need of additional oxytocics or blood transfusion and associated side effects and complications. Methods: A prospective study enrolling 510 women and randomising them into three groups was done in S P Medical College, Bikaner, Rajasthan, India. Active management of third stage of labour was done using one of the three uterotonics as per the group of the patient. Results: Methylergometrine was superior to rest of the drugs with lowest duration of third stage of labour (p = 0.02), lowest amount of blood loss (p = 0.0001) and lowest rate of post partum hemorrhage (p = 0.08). The need of additional oxytocics and blood transfusion was highest with oral misoprostol as compared to all other drugs used in the study with p value of 0.08 and 0.009 respectively. Conclusions: Methylergometrine has the best uterotonic drug profile amongst the drugs used, strongly favouring its routine use as oxytocic for active management of third stage of labour. Oral misoprostol resulted in a higher blood loss compared to other drugs and hence it should be used only in low-resource settings where other drugs are not available. However, a large multi-centre study is needed for the confirmation of the finding. Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 1 / Issue 15 / Jan- June, 2013 / 34-36 DOI: http://dx.doi.org/10.3126/njog.v8i1.8859

scholarly journals PRIMARY POSTPARTUM HEMORRHAGE

2016 ◽  
Vol 23 (10) ◽  
pp. 1178-1182
Author(s):  
Rozina Yasir ◽  
Mumtu Bai Lakhwani ◽  
Shaista Naz ◽  
Zain Ali
Keyword(s):  
Blood Loss ◽  
Tertiary Care ◽  
Active Management ◽  
Control Group ◽  
P Value ◽  
Care Hospital ◽  
Group I ◽  
Third Stage ◽  
Uterine Massage ◽  
Group Ii

Objectives: The aim of our study is to determine the effectiveness of uterinemassage with active management and compare it with active management alone, in primarypostpartum hemorrhage prevention. Study Design: Randomized control trial. Period: 8months from September 2014 to April 2015. Setting: Tertiary Care Hospital in Karachi, Pakistan.Method: The study population consists of n=118 patients, both emergency and elected cases,who came to the gynecology and obstetrics ward at our hospital. The patient population wasdivided into two groups, group I received active management of labor ( third stage ) while groupII received active management of labor (third stage) in addition to the uterine massage (for a 2hrduration), the outcome was measured by measuring the amount of blood loss and the need foruterotonic agents. A p value of less than 0.05 was considered significant. Results: The studypopulation consisted of n=118 patients, undergoing spontaneous labor, and divided into twogroups, the mean blood loss in group I (control group) was 211.4mls and in group II (massagegroup) was 167.8mls (p value= 0.015). In group I n=15 patients required additional uterotonicsupport, while in group II only n=3 patients required it (p value= 0.00058). Conclusion:According to the results of our study, uterine massage in addition to the active managementof labor reduces post-partum hemorrhage, and it also reduces the requirement for additionaluterotonic agents for the control of hemorrhage.

Use of Cholera Beds in the Delivery Room: A Simple and Appropriate Method for Direct Measurement of Postpartum Bleeding

2003 ◽  
Vol 33 (4) ◽  
pp. 215-216 ◽  
Author(s):  
Roland T Strand ◽  
Florinda da Silva ◽  
Staffan Bergström
Keyword(s):  
Blood Loss ◽  
Vaginal Bleeding ◽  
Postpartum Haemorrhage ◽  
Critical Time ◽  
Good Alternative ◽  
Active Management ◽  
Limited Resources ◽  
Visual Estimation ◽  
Postpartum Blood Loss ◽  
Third Stage

Abundant obstetric bleeding is a predominant cause of maternal death, with the immediate postpartum period being the most critical time. Visual estimation of postpartum haemorrhage (PPH) often leads to severe underestimation and delay in treatment. Various methods have been developed in order to measure blood loss accurately, but none has proved appropriate in poor settings. The aim of this study was to present a method which is appropriate for measuring postpartum blood loss in a setting with limited resources. Parturient women ( n=814) with active management of third stage of labour in Luanda, Angola were studied. Vaginal bleeding immediately after birth and during the first 2 hours postpartum was collected using a combination of a plastic sheet and a bucket below a cholera bed, in which the women rested during postpartum observation. Monitoring postpartum blood loss in the same way as cholera patients are monitored for loss of stool fluid was found to be a useful and practical way of measuring haemorrhage of parturient women after childbirth. The method described here is simple and appropriate, which makes it a good alternative to more costly methods in detecting and quantifying PPH.

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

Sign in / Sign up

Export Citation Format

Share Document