A review of third stage of labour care guidance

2021 ◽  
Vol 29 (10) ◽  
pp. 557-563
Author(s):  
Karen Baker ◽  
John Stephenson ◽  
Dawn Leeming ◽  
Hora Soltani
Keyword(s):  
Royal College ◽  
Management Practices ◽  
Postpartum Haemorrhage ◽  
Expectant Management ◽  
Home Birth ◽  
Low Risk ◽  
Active Management ◽  
Stage Management ◽  
Third Stage ◽  
Labour Practice

Introduction Concerns exist regarding the suitability of national and international guidance informing third stage of labour care for women at low risk of postpartum haemorrhage. Methods The robustness and appropriateness of the research evidence underpinning third stage of labour care guidance by institutions such as the National Institution for Health and Care Excellence, the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives was assessed and areas for further research to address any gaps in knowledge were identified. Results National and international third stage of labour practice guidance recommend active management for all women. This may not be suitable for women at low risk of postpartum haemorrhage giving birth in a midwife-led unit or a home birth setting. This is because of the reduced reliability, validity and generalisability of the evidence informing this guidance to this group of women. Conclusions Expectant management may be more appropriate for women at low risk of postpartum haemorrhage who choose to birth in a midwife-led unit or home birth setting and want to experience a birth with minimal intervention. However, more research into third stage management practices in these settings is needed.

scholarly journals Retrospective cohort study comparing current third stage management to expedient squatting third stage management

2021 ◽  
Author(s):  
Judy Cohain ◽  
Rina E. Buxbaum
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Expectant Management ◽  
Positive Outcome ◽  
Low Risk ◽  
Active Management ◽  
Stage Management ◽  
The Third ◽  
Third Stage

Abstract Objective: To compare current the third stage management to expedient squatting at 3 minutes postpartum. Design, Setting, Sample and Methods: A retrospective cohort study of 1,098 planned, attended low risk vaginal births in Israel using Judy’s 3,4,5 minute third stage protocol compared to 2,691 attended low risk vaginal births in British Columbia using various forms of active or expectant management of the third stage of labor. Main Outcome measures: PPH>1000, PPH>500 and manual removal of placenta Results: Among similar groups of low risk births, active management, or expectant management resulted in 4.1% PPH over 1000 cc, whereas Judy’s 3,4,5 minute protocol resulted in 0% PPH over 500 cc. Conclusion: Evidence supports less postpartum bleeding and postpartum hemorrhage when women deliver the placenta in squatting 3 minutes after birth. The risks are minimal and the data suggests the likelihood of a very positive outcome, making it recommended for practitioners in all settings to try it.

The LENTE Study: The Effectiveness of Prophylactic Intramuscular Oxytocin in the Third Stage of Labor Among Low-Risk Women in Primary Care Midwifery Practice: A Randomized Controlled Trial

2016 ◽  
Vol 6 (3) ◽  
pp. 173-182 ◽  
Author(s):  
Suze M. P. J. Jans ◽  
Kathy C. Herschderfer ◽  
Mariet Th. van Diem ◽  
Mieke Aitink ◽  
Marlies Rijnders ◽  
...  
Keyword(s):  
Primary Care ◽  
Expectant Management ◽  
Hemoglobin Level ◽  
Low Risk ◽  
Stage Management ◽  
Randomized Controlled ◽  
Management Group ◽  
Third Stage ◽  
Breastfeeding Rates ◽  
Low Risk Women

PURPOSE:To test third stage management of labor for low-risk women comparing routine prophylactic intramuscular oxytocin management versus modified expectant management.STUDY DESIGN:Randomized controlled multicenter trial in primary care midwifery practice.MAJOR FINDINGS:32.4% of women in the prophylactic intramuscular oxytocin management group had blood loss of 500 mL or more versus 44.2% in the modified expectant management group, relative risk (RR) 0.61, 95% confidence interval (CI) [0.50, 0.74]. The percentage of women experiencing postpartum hemorrhage (PPH) defined as more than 1,000 mL blood loss was 6.3% in the prophylactic intramuscular oxytocin management group versus 11.9% in the modified expectant management group (RR 0.50, 95% CI [0.36, 0.71]). The type of management showed no significant differences between the two groups in clinically relevant indicators of women’s short-term health such as the number of referrals, treatment given, hemoglobin level 36 hours postpartum, and breastfeeding rates after 1 week. Medium-term health such as hemoglobin level at 6 weeks postpartum, women’s perceptions of tiredness, and breastfeeding rates at 3 months after birth also showed no differences between the two groups.CONCLUSION:Third stage management by means of routine prophylactic intramuscular oxytocin reduced the risk of postpartum hemorrhage in a group of childbearing women at low risk of complications in primary midwifery care compared to modified expectant third stage management, but there was no evidence this was associated with a reduction in clinically relevant adverse health outcomes.

Holistic physiological care compared with active management of the third stage of labour for women at low risk of postpartum haemorrhage: A cohort study

2010 ◽  
Vol 23 (4) ◽  
pp. 146-152 ◽  
Author(s):  
Kathleen Fahy ◽  
Carolyn Hastie ◽  
Andrew Bisits ◽  
Christine Marsh ◽  
Lurena Smith ◽  
...  
Keyword(s):  
Cohort Study ◽  
Postpartum Haemorrhage ◽  
Low Risk ◽  
Active Management ◽  
The Third ◽  
Third Stage

scholarly journals Frequency of retained placenta in patients presenting with postpartum haemorrhage after active management of third stage of labour

2020 ◽  
Vol 7 (11) ◽  
pp. 4256
Author(s):  
Nabila Shams ◽  
Haleema Yasmin ◽  
Shaista Bashir Anwer ◽  
Kalavanti Bai ◽  
Bushra Rubab
Keyword(s):  
Postpartum Haemorrhage ◽  
Expectant Management ◽  
Cross Sectional Study ◽  
Active Management ◽  
Vaginal Examination ◽  
Sectional Study ◽  
Cross Sectional ◽  
Retained Placenta ◽  
Third Stage ◽  
Life Threatening

Background: Postpartum haemorrhage (PPH) is a potentially life-threatening complication. PPH is defined as blood loss of more than 500 ml in vaginal delivery or 1000 ml in caesarean delivery. The most frequent causes are uterine atony, genital tract trauma followed by retained placenta. Active management of third stage of labour reduces the risk of postpartum haemorrhage and should be offered and recommended to all women.Methods: It was a descriptive (cross sectional study) conducted to determine the frequency of retained placenta in patients presenting with postpartum haemorrhage after active management of third stage of labour, conducted in ward 8, Jinnah Post Graduate Medical Centre, Karachi from October, 2013 to April, 2014. A total of 189 patients with postpartum haemorrhage after receiving active management of third stage labour were included in this study. All patients were subjected to detailed history and vaginal examination to confirm retained placenta. Data was recorded in a pre-designed proforma.Results: Frequency of retained placenta presenting with postpartum haemorrhage after active management of third stage of labour was observed in 20.11%.Conclusion: It is concluded that active management of the third stage of labour has proved beneficial compared with expectant management based on the decrease in the PPH rate, use of additional uterotonic medication and cost of the care. 

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.

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.

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

1993 ◽  
Vol 48 (1) ◽  
pp. 19-22 ◽  
Author(s):  
Baskaran Thilaganathan ◽  
Alfred Cutner ◽  
John Latimer ◽  
Robert Beard
Keyword(s):  
Postpartum Haemorrhage ◽  
Low Risk ◽  
The Third ◽  
Third Stage
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