open access

Vol 87, No 5 (2016)
Research paper
Published online: 2016-06-02
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Comparison of active vs. expectant management of the third stage of labor in women with low risk of postpartum hemorrhage: a randomized controlled trial

Dogukan Yildirim, Sefik E. Ozyurek, Ali Ekiz, Elif C. Eren, Derya Uyan Hendem, Olgu Bafali, Kerem D. Seckin
DOI: 10.5603/GP.2016.0015
·
Pubmed: 27304659
·
Ginekol Pol 2016;87(5):399-404.

open access

Vol 87, No 5 (2016)
ORIGINAL PAPERS Obstetrics
Published online: 2016-06-02

Abstract

Objectives: To compare the ‘strictly’ active management protocol in women with low risk of postpartum hemorrhage using the expectant management protocol with respect to changes in hematologic parameters, uterotonics, blood transfusions, or additional interventions.

Material and methods: A randomized controlled prospective trial in which 934 singleton parturients enrolled; 654 were randomly assigned to the active and mixed management groups. The primary outcome parameter was the reduction in hemoglobin concentrations due to delivery, and the secondary outcome parameters were changes in hemoglobin of more than 3 g/dL (ΔHb ≥ 3 g/dL), durations of the third stage of labor, need for additional uterotonic agents, blood transfusions, manual removal of the placenta, and surgical evacuation of retained products of conception.

Results: The mean postpartum hemoglobin concentration was significantly higher (P = 0.04) in the active management group with a significantly lower reduction (P = 0.03). Falls of hemoglobin levels of more than 3 g/dL (ΔHb ≥ 3g/dL) were less common in the active management group though not significantly (P = 0.32). The mean duration of the third stage of labor was significantly (P < 0.001) shorter in the active management group. There was no significant difference between the two groups with regard to the need for additional uterotonic agents, uterine atony, blood transfusion, manual removal of the placenta, surgical evacuation of retained products of conception, and prolonged third stage of labor.

Conclusions: Although active management of the third stage of labor was associated with higher postpartum hemoglobin levels, it did not influence the risk of ‘severe postpartum hemorrhage’ in women with low risk of postpartum hemorrhage.

Abstract

Objectives: To compare the ‘strictly’ active management protocol in women with low risk of postpartum hemorrhage using the expectant management protocol with respect to changes in hematologic parameters, uterotonics, blood transfusions, or additional interventions.

Material and methods: A randomized controlled prospective trial in which 934 singleton parturients enrolled; 654 were randomly assigned to the active and mixed management groups. The primary outcome parameter was the reduction in hemoglobin concentrations due to delivery, and the secondary outcome parameters were changes in hemoglobin of more than 3 g/dL (ΔHb ≥ 3 g/dL), durations of the third stage of labor, need for additional uterotonic agents, blood transfusions, manual removal of the placenta, and surgical evacuation of retained products of conception.

Results: The mean postpartum hemoglobin concentration was significantly higher (P = 0.04) in the active management group with a significantly lower reduction (P = 0.03). Falls of hemoglobin levels of more than 3 g/dL (ΔHb ≥ 3g/dL) were less common in the active management group though not significantly (P = 0.32). The mean duration of the third stage of labor was significantly (P < 0.001) shorter in the active management group. There was no significant difference between the two groups with regard to the need for additional uterotonic agents, uterine atony, blood transfusion, manual removal of the placenta, surgical evacuation of retained products of conception, and prolonged third stage of labor.

Conclusions: Although active management of the third stage of labor was associated with higher postpartum hemoglobin levels, it did not influence the risk of ‘severe postpartum hemorrhage’ in women with low risk of postpartum hemorrhage.

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Keywords

postpartum hemorrhage, active management, expectant management, controlled cord traction, third stage of labor

About this article
Title

Comparison of active vs. expectant management of the third stage of labor in women with low risk of postpartum hemorrhage: a randomized controlled trial

Journal

Ginekologia Polska

Issue

Vol 87, No 5 (2016)

Article type

Research paper

Pages

399-404

Published online

2016-06-02

DOI

10.5603/GP.2016.0015

Pubmed

27304659

Bibliographic record

Ginekol Pol 2016;87(5):399-404.

Keywords

postpartum hemorrhage
active management
expectant management
controlled cord traction
third stage of labor

Authors

Dogukan Yildirim
Sefik E. Ozyurek
Ali Ekiz
Elif C. Eren
Derya Uyan Hendem
Olgu Bafali
Kerem D. Seckin

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