-VISIT OUR OTHER FORUMS- OB-GYN-L Ultrasound Ultrasound History Fibroid Forum Physicians-in-Training Tech Talk OBSTET-L (portuguese) OBGIN-L (spanish) Nursing

Re: Active management - third stage From: Barbara Nicol MD (blnicol@ix.netcom.com) Tue Oct 11 19:38:57 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Betsy Hyde: "Re: Active management - third stage" Previous message: Jane Wines: "Re: Active management - third stage" In reply to: RModugno@aol.com: "Active management - third stage" Next in thread: Betsy Hyde: "Re: Active management - third stage" At our hospital, we routinely use oxytocin (20 U/1000 cc) wide open after cord clamping or alternately 10 U IM if no IV is present. The exceptions are patient refusal (usually because she desires as natural an experience as possible) or no antepartum ultrasound (in other words, if the pregnancy is not known to be singleton). We did this after reviewing the literature you mention at the departmental level. It seems odd to me that there are actually 3 well-conducted RCTs of oxytocics in 3rd stage showing benefit and few do it. However, I understand that UCSF and SF General have also adopted similar practices recently. The usual "reasons" given by US authorities for avoiding oxytocics in 3rd stage are (1) undiagnosed 2nd twin - not likely now with nearly 100% ultrasound - and (2) retained placenta - which has been disproven by the RCTs - except perhaps for ergot alkaloids which may cause retained placenta. We chose IV because many of our patients do have an IV and why stick another needle into the patient at such a moment? - Barb At Tue, 11 Oct 2005, RModugno@aol.com wrote: > >In training in South Africa in the early 70's active management of the third >stage was routine - the administration of an oxytocic agent with delivery of >the anterior shoulder and controlled cord traction. > >I have worked in the U.S. since 1978 and have never seen active management >of the third stage used.On questioning British-trained nurse midwives at our >hospital, they have never seen it used either. > >The Cochrane reviews claim that active management of the third stage reduces >PPH by 60%. > >British literature on PPH often mentions this as prophylaxis for PPH. > >American literature on PPH never mentions this. > >Why is active management of the third stage not used in the U.S.? Or is it? > >Thoughts! > >Robert Modugno MD MBA FACOG >Marietta, GA -- Barbara Nicol MD St. Luke's Health Care Center San Francisco CA USA Next message: Betsy Hyde: "Re: Active management - third stage" Previous message: Jane Wines: "Re: Active management - third stage" In reply to: RModugno@aol.com: "Active management - third stage" Next in thread: Betsy Hyde: "Re: Active management - third stage"

Return to

Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Thu Oct 2 04:50:21 2008

The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.