A randomized trial of active versus expectant management of the third stage of labor

Abstract

STAGE OF LABOR MATTHEW HOFFMAN, FATIMA NAQVI, ANTHONY SCISCIONE, Christiana Hospital, Newark, Delaware, Christiana Care Health Services, Obstetrics and Gynecology, Newark, Delaware, Drexel University College of Medicine, Obstetrics and Gynecology, Philadelphia, Pennsylvania OBJECTIVE: We sought to compare active management of the third stage of labor to the more traditional expectant management. STUDY DESIGN: We conducted a randomized controlled trial of women who had an uncomplicated term vaginal delivery. Women were randomized to either expectant or active management of the third stage of labor before delivery. Active management consisted of a standardized oxytocin infusion immediately following delivery of the fetus coupled with cord traction and fundal massage. The expectant group had cord traction and fundal massage upon signs of placental separation coupled with a standardized oxytocin infusion following placental delivery. Our primary outcome variable was the mean change in hematocrit pre and post delivery. Univariate analysis was performed using Student’s t test with unequal variance, Wilcoxon rank sum, c and Fisher exact test when appropriate. A P value of ! .05 was statistically significant. RESULTS: One hundred and fifty women were randomized between August 2002 and November 2003 (72 active management and 78 expectant management). Active management of the third stage of labor was associated with a shorter duration of the third stage of labor (7.3 minutes vs. 9.8 minutes; P value ! .0001). Although there was no difference in incidence of postpartum hemorrhage (EBL >500 mL) in the expectant versus the actively managed groups (17.39% vs. 11.11%; P = .302), the mean change in hct was significantly less in women who were in the actively managed group (2.5 vs. 3.35 P = .0475). There was no significant difference in the need for placental extraction or retained placentas between the groups. CONCLUSION: Active management of the third stage of labor was associated with faster delivery of the placenta and a smaller decrease in the mean pre and post-delivery hematocrit. S82 SMFM Abstracts