Active vs expectant management in the third stage of labor Prendivlille WJ, Elbourne D, McDonald S

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Active vs expectant management in the third stage
of laborPrendivlille WJ, Elbourne D, McDonald S

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Active vs expectant management in the third stage
of labor

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Active vs expectant management in the third stage
of labor

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Active vs expectant management in the third stage
of labor

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Active vs expectant management in the third stage
of labor

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Active vs expectant management in the third stage
of labor

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• Hinchingbrooke 1998 (Cambridgeshire, UK) (Lancet
  1988351693-699)
• Low Risk - Vaginal delivery, Singleton, vertex.
• Exclusion criteria - Placenta previa, previous
  PPH, antepatrtum hemorrhage, anemia lt 10g,
  epidural, oxytocin infusion, pregnancy lt 32 wks,
  intended operative delivery.
• Oxytocic of choice - Syntometrine IM
• 6446 women gave birth during trial period. 1512
  were eligible, 748 active, 764 passive.

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Active vs expectant management in the third stage
of labor

• Brighton 1993 (Eur J Obstet Gynecol Reprod Biol
  19934819-22)
• Low risk - Singleton, vertex, term, para lt 5.
• Exclusion criteria - Hx of C/S, antepartum
  hemorrhage, PPH, PIH, IUFD, augmentation of
  labor, operative delivery, 3rd degree perineal
  tears or cervical lacerations.
• 103 active , 90 physiological.

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Active vs expectant management in the third stage
of labor

• Bristol 1988 (Br J Med 19882971295-1300)
• Exclusion criteria - Patient refusal, antepartum
  hemorrhage, cardiac disease, breech, multiple
  pregnancy.
• Oxytocic of choice - Syntometrine IM.
• 1695 women, 846 active, 849 physiological.

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Active vs expectant management in the third stage
of labor

• Dublin 1990 (Midwifery 199063-17)
• Low risk - singleton, vertex, gestation gt 35 wks.
• Exclusion criteria - Cardiac disease, heparin
  therapy, HTN, age gt 35, Hx of PPH, anemia lt 11g,
  Epidural, antepartum hemorrhage, operative
  delivery, prolonged labor gt 15hrs.
• Oxytocic of choice - Ergometrine.
• 1429 women - 705 active, 724 physiological.

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Active vs expectant management in the third stage
of labor

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• Active management was associated with the
  following reduced risks of bleeding
• Maternal blood loss (weighted mean difference
  -79.33ml, 95 confidence interval -94.29 to
  -64.37) Post partum hemorrhage of more than
  500ml (odds ratio 0.34 95 CI 0.28 to 0.41)
  prolonged 3rd stage of labor (weighted mean
  difference - 3.40 min, 95 CI -4.66 to -2.13)

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Active vs expectant management in the third stage
of labor

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• Active management was associated with increased
  risks of maternal nausea (odds ratio 1.95, 95 CI
  1.58 to 2.42) vomiting and raised blood pressure
  (probably due to the use of ergometrine).

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Active vs expectant management in the third stage
of labor

• Active management reduces clinical outcomes such
  as PPH, Severe PPH, post partum anemia, need for
  blood transfusion. It reduces risk for prolonged
  3rd stage and the use of oxytocic drugs.
• Active management increases nausea, vomiting,
  headache and HTN when Ergometrine is used as an
  oxytocic.
• No clinical difference in neonatal outcomes.