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Active versus expectant management for women in the third stage of labour

Evidence Summaries

Level of Evidence = C

Active management of the third stage of labour may reduce the mother´s risk of haemorrhage greater than 1000 ml compared to expectant management.

A Cochrane review 1 included 7 studies with a total of 8247 subjects. The evidence suggested that for women at mixed levels of risk of bleeding, active management showed a reduction in the average risk of maternal primary haemorrhage at time of birth (more than 1000 ml) (RR 0.34, 95% CI 0.14 to 0.87; 3 trials, n=4636) and of maternal haemoglobin (Hb) less than 9 g/dl following birth (RR 0.50, 95% CI 0.30 to 0.83; 2 trials, n=1572). No difference in the incidence in admission of infants to neonatal units was found (average RR 0.81, 95% CI 0.60 to 1.11; 2 trials, n=3207) nor in the incidence of infant jaundice requiring treatment (0.96, 95% CI 0.55 to 1.68; 2 trials, n=3142). There were no data on our other primary outcomes of very severe postpartum haemorrhage (PPH) at the time of birth (more than 2500 ml), maternal mortality, or neonatal polycythaemia needing treatment. Active management showed a significant decrease in primary blood loss greater than 500 ml, and mean maternal blood loss at birth, maternal blood transfusion and therapeutic uterotonics during the third stage or within the first 24 hours, or both and significant increases in maternal diastolic blood pressure, vomiting after birth, after-pains, use of analgesia from birth up to discharge from the labour ward and more women returning to hospital with bleeding (outcome not pre-specified).

References

1. Begley CM, Gyte GM, Devane D et al. Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev 2011;(11):CD007412 [Assessed as up-to-date: 30 September 2014].  [PMID:22071837]


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Citation

"Active Versus Expectant Management for Women in the Third Stage of Labour." Evidence-Based Medicine Guidelines, Duodecim Medical Publications Limited, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/EBMG/457509/all/Active_versus_expectant_management_for_women_in_the_third_stage_of_labour.
Active versus expectant management for women in the third stage of labour. Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. https://evidence.unboundmedicine.com/evidence/view/EBMG/457509/all/Active_versus_expectant_management_for_women_in_the_third_stage_of_labour. Accessed March 24, 2019.
Active versus expectant management for women in the third stage of labour. (2019). In Evidence-Based Medicine Guidelines. Available from https://evidence.unboundmedicine.com/evidence/view/EBMG/457509/all/Active_versus_expectant_management_for_women_in_the_third_stage_of_labour
Active Versus Expectant Management for Women in the Third Stage of Labour [Internet]. In: Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. [cited 2019 March 24]. Available from: https://evidence.unboundmedicine.com/evidence/view/EBMG/457509/all/Active_versus_expectant_management_for_women_in_the_third_stage_of_labour.
* Article titles in AMA citation format should be in sentence-case
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