Skip to main content

How effective are the components of active management of the third stage of labor?

Author(s): Sheldon, Wendy R.; Durocher, J.; Winikoff, B.; Blum, J.; Trussell, James

Download
To refer to this page use: http://arks.princeton.edu/ark:/88435/pr1nx7d
Full metadata record
DC FieldValueLanguage
dc.contributor.authorSheldon, Wendy R.-
dc.contributor.authorDurocher, J.-
dc.contributor.authorWinikoff, B.-
dc.contributor.authorBlum, J.-
dc.contributor.authorTrussell, James-
dc.date.accessioned2019-11-26T15:53:55Z-
dc.date.available2019-11-26T15:53:55Z-
dc.date.issued2013en_US
dc.identifier.citationSheldon, WR, Durocher, J, Winikoff, B, Blum, J, Trussell, J. (2013). How effective are the components of active management of the third stage of labor? BMC Pregnancy and Childbirth, 13 (1-8). doi:10.1186/1471-2393-13-46en_US
dc.identifier.issn1471-2393-
dc.identifier.urihttp://arks.princeton.edu/ark:/88435/pr1nx7d-
dc.description.abstractBackground: Active management of the third stage of labor is recommended for the prevention of post-partum hemorrhage and commonly entails prophylactic administration of a uterotonic agent, controlled cord traction, and uterine massage. While oxytocin is the first-choice uterotonic, it is not known whether its effectiveness varies by route of administration. There is also insufficient evidence regarding the value of controlled cord traction or uterine massage. This analysis assessed the independent and combined effectiveness of all three interventions, and the effect of route of oxytocin administration on post-partum blood loss. Methods: Secondary data were analyzed from 39202 hospital-based births in four countries and two clinical regimens: one in which oxytocin was administered following delivery of the baby; the other in which it was not. We used logistic regression to examine associations between clinical and demographic variables and post-partum blood loss >= 700 mL. Results: Among those with no oxytocin prophylaxis, provision of controlled cord traction reduced hemorrhage risk by nearly 50% as compared with expectant management (P < 0.001). Among those with oxytocin prophylaxis, provision of controlled cord traction reduced hemorrhage risk by 66% when oxytocin was intramuscular (P < 0.001), but conferred no benefit when oxytocin was intravenous. Route of administration was important when oxytocin was the only intervention provided: intravenous administration reduced hemorrhage risk by 76% as compared with intramuscular administration (P < 0.001); when combined with other interventions, route of administration had no effect. In both clinical regimens, uterine massage was associated with increased hemorrhage risk. Conclusions: Recommendations for active management of the third stage of labor should account for setting-related differences such as the availability of oxytocin and its route of administration. The optimal combination of interventions will vary accordingly.en_US
dc.format.extent1 - 8en_US
dc.language.isoen_USen_US
dc.relation.ispartofBMC Pregnancy and Childbirthen_US
dc.rightsFinal published version. This is an open access article.en_US
dc.titleHow effective are the components of active management of the third stage of labor?en_US
dc.typeJournal Articleen_US
dc.identifier.doidoi:10.1186/1471-2393-13-46-
pu.type.symplectichttp://www.symplectic.co.uk/publications/atom-terms/1.0/journal-articleen_US

Files in This Item:
File Description SizeFormat 
1471-2393-13-46.pdf193.07 kBAdobe PDFView/Download


Items in OAR@Princeton are protected by copyright, with all rights reserved, unless otherwise indicated.