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

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 Evaluation of complications during third stage of labour among women delivering at tertiary care center

2018 ◽  
Vol 7 (7) ◽  
pp. 2706
Author(s):  
Tanya Agrawal ◽  
Ruchi Kalra ◽  
Aabha Suryavanshi
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Active Management ◽  
Perineal Tear ◽  
Retained Placenta ◽  
Uterine Inversion ◽  
Perineal Tears ◽  
Third Stage Of Labor ◽  
Third Stage ◽  
Maternal Morbidity And Mortality

Background: The common complications occurring during third stage of labor are PPH Retained Placenta, Morbid adherent placenta- placenta accreta, placenta increta, percreta, perineal tears, uterine inversion increasing the maternal morbidity and mortality. The objective of the present study was to evaluate percentage and spectrum of obstetrics complication occurring during third stage of labor.Methods: An observational study was done at Department of Obstetrics and Gynecology, People’s College of Medical Sciences and Research Center, Bhopal from January 2016 to December 2017. All women delivering vaginally including instrumental deliveries were included. The medio-lateral episiotomy was given to all primigravida and for multigravida decision was case based as big size babies, instrumental deliveries, rigid perineum. Active management of third stage of labor was practiced.Results: 899 women delivered vaginally during the study period of 2 years (Jan -Dec 2016 Jan -Dec 2017). Among these 6.45% (58 women) had various complications during third stage of labor . 55% were primigravida. Complications which were observed to occur during third stage of labor were perineal tear 4% (37/899 deliveries). Atonic PPH occurred in 0.5% (9/899 deliveries) Traumatic PPH was in 1.44% (13/899 deliveries and 0.3% cases had retained placenta. Associated condition in perineal tear cases were 92% had big size babies 5% cases were preterm labor and in 3% cases ventouse application was done.Conclusions: Common complications were 1st and 2nd degree perineal tears occurred in 4% deliveries and traumatic PPH were in 1.44% of cases.

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 A Comparative Study of Oxytocin & Misoprostol in Active Management of Third Stage of Labour

2015 ◽  
Vol 12 (1) ◽  
pp. 22-24
Author(s):  
N Ansari ◽  
CR Das
Keyword(s):  
Blood Loss ◽  
College Teaching ◽  
Cross Sectional Study ◽  
Active Management ◽  
Cross Sectional ◽  
Medical College ◽  
Significant Difference ◽  
Third Stage ◽  
Group A ◽  
Group B

Introduction: The third stage of labour is the period which follows the completed delivery of the foetus and consists of delivery of the placenta and its attached membranes.Aims and objectives: Comparison of oxytocin & misoprostol in active management of third stage of labour.Material and Methods: This is a comparative cross-sectional study was conducted in Nepalgunj Medical College Teaching Hospital, Kohalpur from March 2013 to March 2014. Group A - Oxytocin 10 IU IV bolus in 100 patients and Group B - Misoprostol 600 micro gram rectally. The collected were subjected to statistical analysis using SPSS 15.Results: After active management with bolus oxytocin, the blood loss was grossly reduced being 40-100ml in 84% cases and only 7% had blood loss more than 100ml. blood loss between 200-300ml were only 6% and only 3% had PPH, after misoprostol 80% of cases had blood loss within 40 – 100 ml., 6% cases had blood loss within 100 – 200 ml. and larger amount of blood loss i.e. between 200 – 300 ml. was observed in 7% cases, in 3% cases blood loss was between 300 – 400 ml. and 4% of women in this group had PPH.Conclusion: There was no statistically significant difference in the efficacy of oxytocin and misoprostol in reducing amount of blood loss and duration of labour rd in 3 stage of labour.Journal of Nepalgunj Medical College Vol.12(1) 2014: 22-24

scholarly journals Factors associated with increased blood loss during delivery

2020 ◽  
Vol 9 (3) ◽  
pp. 1213
Author(s):  
Paridhi Jain ◽  
Nisha Thakur ◽  
Ashu Jain ◽  
Sunita Agarwal ◽  
Sangeeta Kamra ◽  
...  
Keyword(s):  
High Risk ◽  
Blood Loss ◽  
Gestational Hypertension ◽  
Placenta Previa ◽  
Active Management ◽  
Chronic Hypertension ◽  
Third Stage Of Labor ◽  
Management Protocol ◽  
Third Stage ◽  
Scarred Uterus

Background: The present study was done to assess the blood loss during delivery even after active management of third stage of labor with oxytocin and the maternal outcomes of PPH.Methods: We studied 100 pregnant women were either in spontaneous labor or admitted for induction of labor, underwent vaginal delivery or caesarean section in our institute. Active management of third stage of labor in all 100 cases included 10 IU intramuscular oxytocin or 10 to 20 IU intravenous in 500 ml of Ringer’s Lactate. Blood loss in all cases was noted.Results: Of the included cases, 27 had to be given extra-uterotonics for atonic uterus, of which 12 parturient still had PPH. Atonic uterus was the cause of PPH in 11 of the 12 cases, while one case was of atonic uterus plus trauma. Half of all PPH cases responded to medical management alone, five cases had to undergo tamponade/stepwise devascularization and one case had to undergo obstetric hysterectomy. Blood loss was significantly higher in women aged more than 35 years, primigravida, not in labor, oligohydramnios or post-datism, elective LSCS, scarred uterus in and had more than 1 high risk factor. Among various high-risk conditions, significantly higher blood loss was observed in patients with chronic hypertension, gestational hypertension, pre-gestational diabetes mellitus, multipara with prior PPH, placenta previa, preeclampsia and sickle cell trait.Conclusions: Fifteen women avoided PPH by using a reliable method of blood loss measurement and initiating interventions early. Organized PPH management protocol morbidity and mortality of the mother and neonate can be prevented.

scholarly journals Post partum haemorrhage: Prevalence, morbidity and management pattern in Dhulikhel Hospital

1970 ◽  
Vol 8 (2) ◽  
pp. 212-215 ◽  
Author(s):  
AS Dongol ◽  
A Shrestha ◽  
CD Chawla
Keyword(s):  
Blood Loss ◽  
Genital Tract ◽  
Post Partum ◽  
Medical Science ◽  
Active Management ◽  
Management Pattern ◽  
Standard Format ◽  
Retained Placenta ◽  
Manual Removal ◽  
Post Partum Haemorrhage

Background: Post partum haemorrhage (PPH) is the leading cause of maternal death worldwide. PPH occurs in up to 18% of total births. Among different factors, PPH due to uterine atony is the primary and direct cause of maternal mortality comprising about 90%. Objective: The objective of the present study was to assess the prevalence, morbidity and management pattern of PPH in Dhulikhel Hospital. Materials and methods: Hospital based retrospective study was carried out at Kathmandu University School of Medical Science, Dhulikhel Hospital from the period of January 2007 till October 2009. The study group included total of 60 patients. All women who had PPH both primary and secondary were studied. Information regarding total number of deliveries obtained from Obstetrics ward. The cases with PPH were identified and detail records were reviewed using standard format. The main outcome measures used for the analysis were amount of blood loss, cause of PPH and treatment methods. Results: In Dhulikhel hospital, from January 2007 till October 2009 a total of 3805 deliveries took place. Out of which 60 women had PPH. The prevalence was 16/1000 deliveries. There are 41 (68.3%) cases of primary PPH and 19 (31.7%) cases of secondary PPH. PPH was found more in home deliveries, unbooked case and in multiparas. The mean blood loss was 1055ml. As an aetiology, retained placenta and retained placental bits of tissue was found in 37(61.7%) cases, atonic uterus in 10 (16.7%) cases, genital tract trauma in 8(13.3%), sepsis of genital tract in 3(5%), case of ruptured uterus in one case and a case of angle bleeding from previous uterine scar following caesarean section. Among all 15 (25%) cases underwent manual removal of placenta, 5(8.3%) underwent controlled cord traction, 3 (5%) underwent manual removal of placenta followed by check curettage in cases of retained placenta, 16 (26.7%) cases were managed by check curettage for retained bits of placental tissue and membrane. Trauma in genital tract was managed by repair of trauma in 6 (10%) cases. Hysterectomy was required in 3 (5%) cases. Conservative management with uterotonics only required in 12 (20%) cases. Conclusion: Active management of third stage of labour can prevent PPH so delivery by skilled hand in hospital should be promoted. Secondary PPH besides primary can result in significant maternal morbidity. It also deserves similar attention. Key words: Atonic uterus; Postpartum haemorrhage DOI: 10.3126/kumj.v8i2.3561 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 212-215

scholarly journals Comparison between oxytocin, ergometrine and misoprostol in active management of the third stage of labour: a randomized controlled trial

2018 ◽  
Vol 7 (6) ◽  
pp. 2076
Author(s):  
Abubaker Y. H. Abdel Rahim ◽  
Mohamed A. A. Gadir E. Ounsa ◽  
Rayan G. Albarakati ◽  
Elsadig Y. Mohamed ◽  
Sawsan M. Abdalla
Keyword(s):  
Blood Loss ◽  
Intravenous Infusion ◽  
Controlled Trial ◽  
University Hospital ◽  
Active Management ◽  
Singleton Pregnancy ◽  
The Third ◽  
Third Stage Of Labor ◽  
Third Stage ◽  
Sublingual Misoprostol

Background: The aim of the present study was to compare the effectiveness of sublingual misoprostol, intravenous infusion of oxytocin, and intravenous infusion of Ergometrine in reducing blood loss during the third stage of labor.Methods: This is a no-random trial study conducted in in Ribat University Hospital, Khartoum among 150 laboring ladies with a healthy singleton pregnancy. After obtaining their written informed consent to participate in the study, they were randomly assigned to one of three possible treatment groups: 400 μg of sublingual misoprostol; 10 IU of intravenous infusion oxytocin; and 0.5 mg of intravenous infusion of Ergometrine. Blood loss was estimated by weighing the collected blood and converting the weight to milliliters.Results: The shortest mean duration of the third stage of labor was seen in patients who received misoprostol (3.89±0.37 min), followed by oxytocin (4.6±0.9 min), and Ergometrine (5.45±0.9 min). The lowest mean blood loss was seen in the patients who received 400 µg misoprostol (168.36±24.83 ml), followed by those who received 10 IU oxytocin (205.56±34.82 ml), and 0.5 mg Ergometrine (214.49±35.97 ml).Conclusions: Present study showed that 400 µg sublingual misoprostol was more effective than the conventional parenteral uterotonics in reducing the amount of the blood loss during the third stage of labor and has comparable effect to that of 10 IU intravenous oxytocin in shortening the duration of third stage of labor. It also showed that the use of misoprostol reduces the need for extra-uterotonics and blood transfusion.

scholarly journals Manual Removal of the Placenta after Vaginal Delivery: An Unsolved Problem in Obstetrics

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Fiona Urner ◽  
Roland Zimmermann ◽  
Alexander Krafft
Keyword(s):  
Maternal Morbidity ◽  
Placenta Previa ◽  
Morbidity And Mortality ◽  
Active Management ◽  
Retained Placenta ◽  
Manual Removal ◽  
The Third ◽  
Third Stage Of Labor ◽  
Third Stage ◽  
Maternal Morbidity And Mortality

The third stage of labor is associated with considerable maternal morbidity and mortality. The major complication is postpartum hemorrhage (PPH), which is the leading cause of maternal morbidity and mortality worldwide. Whereas in the event of PPH due to atony of the uterus there exist numerous treatment guidelines; for the management of retained placenta the general consensus is more difficult to establish. Active management of the third stage of labour is generally accepted as standard of care as already its duration is contributing to the risk of PPH. Despite scant evidence it is commonly advised that if the placenta has not been expelled 30 minutes after delivery, manual removal of the placenta should be carried out under anaesthesia. Pathologic adhesion of the placenta in the low risk situation usually is diagnosed at the time of delivery; therefore a pre- or intrapartum screening opportunity for placenta accreta would be desirable. But diagnosis of abnormalities of placentation other than placenta previa remains a challenge. Nevertheless the use of ultrasound and doppler sonography might be helpful in the third stage of labor. An improvement might be the implementation of standardized operating procedures for retained placenta which could contribute to a reduction of maternal morbidity.

scholarly journals COMPARISON OF MISOPROSTOL WITH OXYTOCIN IN THIRD STAGE OF LABOUR

2018 ◽  
Vol 6 (1) ◽  
pp. 19-21
Author(s):  
Nilam Subedi ◽  
Deepanjali Sharma ◽  
Rubby Das
Keyword(s):  
Blood Loss ◽  
Active Management ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Medical Sciences ◽  
Third Stage Of Labor ◽  
Third Stage ◽  
Misoprostol Group ◽  
Group 2 ◽  
To Receive

Introduction: Postpartum Haemorrhage (PPH) is one of the leading causes of maternal mortality worldwide. A simple measure to prevent PPH is active management of third stage of labour (AMTSL). This prospective study was conducted in Universal College of Medical Sciences and Teaching Hospital, Tribhuvan University,  Bhairahawa where misoprostol  600  mcg  orally was compared with the standard  oxytocin regime in active management of third stage of labour.Materials and Methods: A total of 100 women were selected to receive either 600 mcg misoprostol orally or 10 IU oxytocin intramuscularly. The incidences of postpartum hemorrhage and side effects were examined.Results: Both groups were comparable in age, parity, gestational age, pre-delivery hemoglobin, and duration of labor. There was no significant differences between the misoprostol and oxytocin groups in terms of blood loss  96% vs 100% had blood loss of < 500 ml, p=0.475). And incidence of PPH  (4% vs 0%). None of the group had severe PPH i.e. blood loss> 1000 ml. The duration of the third stage of labor, a secondary outcome measure was shorter in the misoprostol group than in the oxytocin group (7.02±2.26 SD vs 8.44±4.08 SD, p=0.034). Two women of oxytocin group received a blood transfusion. The adverse effects of shivering and pyrexia were encountered more frequently in the misoprostol than in the oxytocin group (2% vs 38%, p<0.001, P<0.001; and 2% vs 10%, p=0.207). No major surgical intervention for atonic PPH was needed and no maternal deaths occurred in either group.Conclusion: Misoprostol 600 mcg orally is equally as effective as standard oxytocin regime in AMTSL to prevent PPH and can be safely used in the peripheral institutions or by midwives where there is lack of trained personnel and storage facility.Journal of Universal College of Medical SciencesVol. 6, No. 1, 2018, Page: 19-21

Active management of third stage of labour by oxytocin: Umbilical vein versus intramuscular use

1970 ◽  
Vol 2 (1) ◽  
pp. 13-16 ◽  
Author(s):  
Neebha Ojha ◽  
Dibya S Malla
Keyword(s):  
Blood Loss ◽  
Umbilical Vein ◽  
Maternity Hospital ◽  
Active Management ◽  
Cord Clamping ◽  
Group I ◽  
Third Stage ◽  
Umbilical Cord Clamping ◽  
Prospective Comparative Study ◽  
Added Benefit

Aim: To compare oxytocin used via intraumbilical or intramuscular route in the active management of third stage of labour with respect to duration and amount of bleeding. Methods: Prospective comparative study conducted in Maternity Hospital, Thapathali, Kathmandu for three months 29th April - July 28th 2004 (061/1/16 to 061/4/12 BS ). After immediate umbilical cord clamping following vaginal delivery, 120 women were divided into 2 groups administering 10 units of oxytocin; in Group I: which was diluted mixing with 10 ml of normal saline before it was infused intraumbilical and Group II: injected intramuscularly. Results: There was no difference in the duration of third stage of labour (3.6 vs. 3.7min) between the two groups. There was significant blood loss in the intraumblical group as compared to intramuscular group (242ml vs.168ml, p. 0.004). The need for additional oxytocic to control the uterine bleeding was more in intraumbilical group as compared to intramuscular group (28.3% vs 6.7%, p 0.005). There was more postpartum haemorrhage (PPH) in intraumbilical group (8.3% vs 3.3%, p 0.439). The injection delivery interval was significantly longer in the intraumbilical group as compared to intramuscular group (46.9 vs. 30.7 sec). Conclusion: Intraumbilical oxytocin is technically more difficult to administer without having any added benefit either in decreasing the duration of third stage of labour or reducing the blood loss. Key words: Intraumbilical oxytocin, intramuscular oxytocin, third stage of labour. doi:10.3126/njog.v2i1.1469 N. J. Obstet. Gynaecol Vol. 2, No. 1, p. 13 - 16 May -June 2007

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