Active versus expectant management in the third stage of labour
(Cochrane Review)
Prendiville WJ, Elbourne D, McDonald S
What's new in this issue
Search abstracts
Browse alphabetical list of titles
Browse by Review Group
--------------------------------------------------------------------------------
A substantive amendment to this systematic review was last made on 09
--------------------------------------------------------------------------------
March 2000. Cochrane reviews are regularly checked and updated if
--
--------------------------------------------------------------------------------
necessary.
Background: Expectant management of the third stage of labour involves
allowing the placenta to deliver spontaneously or aiding by gravity or
nipple stimulation. Active management involves administration of a
prophylactic oxytocic before delivery of the placenta, and usually early
cord clamping and cutting, and controlled cord traction of the umbilical
cord.
Objectives: The objective of this review was to assess the effects of
active versus expectant management on blood loss, post partum
haemorrhage and other maternal and perinatal complications of the third
stage of labour.
Search strategy: We searched the Cochrane Pregnancy and Childbirth Group
trials register.
Selection criteria: Randomised trials comparing active and expectant
management of the third stage of labour in women who were expecting a
vaginal delivery.
Data collection and analysis: Trial quality was assessed and data were
extracted independently by the reviewers.
Main results: Five studies were included. Four of the trials were of
good quality. Compared to expectant management, active management (in
the setting of a maternity hospital) was associated with the following
reduced risks: maternal blood loss (weighted mean difference -79.33
millilitres, 95% confidence interval -94.29 to -64.37); post partum
haemorrhage of more than 500 millilitres (relative risk 0.38, 95%
confidence interval 0.32 to 0.46); prolonged third stage of labour
(weighted mean difference -9.77 minutes, 95% confidence interval -10.00
to -9.53). Active management was associated with an increased risk of
maternal nausea (relative risk 1.83, 95% confidence interval 1.51 to
2.23), vomiting and raised blood pressure (probably due to the use of
ergometrine). No advantages or disadvantages were apparent for the
baby.
Authors' conclusions: Routine 'active management' is superior to
'expectant management' in terms of blood loss, post partum haemorrhage
and other serious complications of the third stage of labour. Active
management is, however, associated with an increased risk of unpleasant
side effects (eg nausea and vomiting), and hypertension, where
ergometrine is used. Active management should be the routine management
of choice for women expecting to deliver a baby by vaginal delivery in a
maternity hospital. The implications are less clear for other settings
including domiciliary practice (in developing and industrialised
countries).
Citation: Prendiville WJ, Elbourne D, McDonald S. Active versus
expectant management in the third stage of labour. The Cochrane
Database of Systematic Reviews 2000, Issue 3. Art. No.: CD000007. DOI:
10.1002/14651858.CD000007.
At Thu, 22 Jun 2006, Gail Graham wrote:
>
>Darryl.elrod@LAKENHEATH.AF.MIL wrote:
>> If you call gentle downward traction physiologic, then sure. I don't
>> have the patience to wait much longer than that.
>>
>No, that's definitely not physiological. If you don't give an oxytocic
>then you must NOT clamp and cut the cord and you must NOT use any
>traction on the cord. You wait until the cord stops pulsating (for
>obvious reasons) then you apply the baby's clamp and cut leaving the
>cord unclamped. Then you use gravity and maternal effort to deliver the
>placenta. If you are deviating from this you are not doing either
>active or physiological 3rd stage. And I know you're going to tell me
>that you've never had a PPH either...
>
>Gail
--
“ The greatest obstacle to knowledge is not ignorance,
it is the illusion of knowledge.” Daniel J. Boorstin - Historian
