Management of the third stage of labour in women at low risk of postpartum haemorrhage

Abstract

Objective: To compare active management with physiological management of the third stage of labour in women at low risk of postpartum haemorrhage. Design: Randomised allocation of women in labour at low risk of postpartum haemorrhage to either physiological or active management of the third stage. Setting: Labour ward in a district general hospital. Patients: 193 Women with spontaneous vaginal delivery at term completed the study. Exclusion criteria were induction or augmentation of labour, antepartum or previous postpartum haemorrhage, premature rupture of membranes, previous caesarean section, raised blood pressure, cervical lacerations and third degree tears. Interventions: Active management with syntometrine and controlled cord traction; or physiological management, where the cord was not clamped and the placenta was delivered by maternal effort. Measurements: Blood loss was measured subjectively at delivery and estimated objectively by comparing the haemoglobin in labour with that on the third postpartum day. The duration of the third stage was also measured as was the incidence of retained placenta and blood transfusion. Results: There was no significant difference in the estimated blood loss or haemoglobin drop between the two groups ( P > 0.5). In addition the duration of the third stage was significantly longer in the physiological group ( P < 0.001). Out of 90 women having physiological management, 7 received oxytocics for presumed postpartum haemorrhage. Only one case in the active group required further oxytocics and one other case in this group required a manual removal of placenta. Conclusions: This preliminary study confirms that active management results in a reduction in the length of the third stage of labour. However, it suggests that active management does not reduce blood loss when compared to physiological management in the woman at low risk of postpartum haemorrhage.