Article type
Year
Abstract
Objective: To determine whether or not active management is superior to expectant management in the prevention of postpartum haemorrhage (blood loss > 500 ml) during the third stage of labour.
Methods: A structured review of all randomised controlled trials (RCTs) of active management versus expectant management in the third stage of labour, where active management included administration of a prophylactic oxytocic, early cord clamping, and usually controlled cord traction.
Results: Five RCTs carried out in Bristol, Dublin, Brighton, Hinchingbrooke and the Netherlands between 1986 and 1997 were identified. The data consistently showed that active management reduced the risk of PPH, and all other indices of blood loss. When the oxytocic used was an ergot alkaloid, active management was associated with an increased risk of nausea, vomiting and raised blood pressure. There was no evidence of any differential effects of the policies on the mother in the longer term nor on the newbom baby, in the few trials in which these outcomes were considered.
Discussion: Routine active management is superior to expectant management in terms of maternal blood loss in labour and its short term consequences. The greatest potential value of this policy, however, would be in the developing world where the consequences of PPH are more likely to lead to long term morbidity or even death. Further trials in such settings are therefore urgently required.
Methods: A structured review of all randomised controlled trials (RCTs) of active management versus expectant management in the third stage of labour, where active management included administration of a prophylactic oxytocic, early cord clamping, and usually controlled cord traction.
Results: Five RCTs carried out in Bristol, Dublin, Brighton, Hinchingbrooke and the Netherlands between 1986 and 1997 were identified. The data consistently showed that active management reduced the risk of PPH, and all other indices of blood loss. When the oxytocic used was an ergot alkaloid, active management was associated with an increased risk of nausea, vomiting and raised blood pressure. There was no evidence of any differential effects of the policies on the mother in the longer term nor on the newbom baby, in the few trials in which these outcomes were considered.
Discussion: Routine active management is superior to expectant management in terms of maternal blood loss in labour and its short term consequences. The greatest potential value of this policy, however, would be in the developing world where the consequences of PPH are more likely to lead to long term morbidity or even death. Further trials in such settings are therefore urgently required.