WITHDRAWN: Active versus expectant management in the third stage of labour.

Hdl Handle:
http://hdl.handle.net/10147/208014
Title:
WITHDRAWN: Active versus expectant management in the third stage of labour.
Authors:
Prendiville, Walter J P; Elbourne, Diana; McDonald, Susan J
Affiliation:
Department of Obstetrics and Gynaecology, Coombe Lying-In Hospital, Dolphin's, Barn, Dublin 8, Ireland.
Citation:
Cochrane Database Syst Rev. 2009 Jul 8;(3):CD000007.
Journal:
Cochrane database of systematic reviews (Online)
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/208014
DOI:
10.1002/14651858.CD000007.pub2
PubMed ID:
19588315
Abstract:
BACKGROUND: Expectant management of the third stage of labour involves allowing the placenta to deliver spontaneously or aiding by gravity or nipple stimulation. Active management involves administration of a prophylactic oxytocic before delivery of the placenta, and usually early cord clamping and cutting, and controlled cord traction of the umbilical cord. OBJECTIVES: The objective of this review was to assess the effects of active versus expectant management on blood loss, post partum haemorrhage and other maternal and perinatal complications of the third stage of labour. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: Randomised trials comparing active and expectant management of the third stage of labour in women who were expecting a vaginal delivery. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted independently by the reviewers. MAIN RESULTS: Five studies were included. Four of the trials were of good quality. Compared to expectant management, active management (in the setting of a maternity hospital) was associated with the following reduced risks: maternal blood loss (weighted mean difference -79.33 millilitres, 95% confidence interval -94.29 to -64.37); post partum haemorrhage of more than 500 millilitres (relative risk 0.38, 95% confidence interval 0.32 to 0.46); prolonged third stage of labour (weighted mean difference -9.77 minutes, 95% confidence interval -10.00 to -9.53). Active management was associated with an increased risk of maternal nausea (relative risk 1.83, 95% confidence interval 1.51 to 2.23), vomiting and raised blood pressure (probably due to the use of ergometrine). No advantages or disadvantages were apparent for the baby. AUTHORS' CONCLUSIONS: Routine 'active management' is superior to 'expectant management' in terms of blood loss, post partum haemorrhage and other serious complications of the third stage of labour. Active management is, however, associated with an increased risk of unpleasant side effects (eg nausea and vomiting), and hypertension, where ergometrine is used. Active management should be the routine management of choice for women expecting to deliver a baby by vaginal delivery in a maternity hospital. The implications are less clear for other settings including domiciliary practice (in developing and industrialised countries).
Language:
eng
MeSH:
Delivery, Obstetric/*methods; Female; Humans; *Labor Stage, Third; Postpartum Hemorrhage/*prevention & control; Pregnancy
ISSN:
1469-493X (Electronic); 1361-6137 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorPrendiville, Walter J Pen_GB
dc.contributor.authorElbourne, Dianaen_GB
dc.contributor.authorMcDonald, Susan Jen_GB
dc.date.accessioned2012-02-01T10:57:43Z-
dc.date.available2012-02-01T10:57:43Z-
dc.date.issued2012-02-01T10:57:43Z-
dc.identifier.citationCochrane Database Syst Rev. 2009 Jul 8;(3):CD000007.en_GB
dc.identifier.issn1469-493X (Electronic)en_GB
dc.identifier.issn1361-6137 (Linking)en_GB
dc.identifier.pmid19588315en_GB
dc.identifier.doi10.1002/14651858.CD000007.pub2en_GB
dc.identifier.urihttp://hdl.handle.net/10147/208014-
dc.description.abstractBACKGROUND: Expectant management of the third stage of labour involves allowing the placenta to deliver spontaneously or aiding by gravity or nipple stimulation. Active management involves administration of a prophylactic oxytocic before delivery of the placenta, and usually early cord clamping and cutting, and controlled cord traction of the umbilical cord. OBJECTIVES: The objective of this review was to assess the effects of active versus expectant management on blood loss, post partum haemorrhage and other maternal and perinatal complications of the third stage of labour. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register. SELECTION CRITERIA: Randomised trials comparing active and expectant management of the third stage of labour in women who were expecting a vaginal delivery. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted independently by the reviewers. MAIN RESULTS: Five studies were included. Four of the trials were of good quality. Compared to expectant management, active management (in the setting of a maternity hospital) was associated with the following reduced risks: maternal blood loss (weighted mean difference -79.33 millilitres, 95% confidence interval -94.29 to -64.37); post partum haemorrhage of more than 500 millilitres (relative risk 0.38, 95% confidence interval 0.32 to 0.46); prolonged third stage of labour (weighted mean difference -9.77 minutes, 95% confidence interval -10.00 to -9.53). Active management was associated with an increased risk of maternal nausea (relative risk 1.83, 95% confidence interval 1.51 to 2.23), vomiting and raised blood pressure (probably due to the use of ergometrine). No advantages or disadvantages were apparent for the baby. AUTHORS' CONCLUSIONS: Routine 'active management' is superior to 'expectant management' in terms of blood loss, post partum haemorrhage and other serious complications of the third stage of labour. Active management is, however, associated with an increased risk of unpleasant side effects (eg nausea and vomiting), and hypertension, where ergometrine is used. Active management should be the routine management of choice for women expecting to deliver a baby by vaginal delivery in a maternity hospital. The implications are less clear for other settings including domiciliary practice (in developing and industrialised countries).en_GB
dc.language.isoengen_GB
dc.subject.meshDelivery, Obstetric/*methodsen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.mesh*Labor Stage, Thirden_GB
dc.subject.meshPostpartum Hemorrhage/*prevention & controlen_GB
dc.subject.meshPregnancyen_GB
dc.titleWITHDRAWN: Active versus expectant management in the third stage of labour.en_GB
dc.contributor.departmentDepartment of Obstetrics and Gynaecology, Coombe Lying-In Hospital, Dolphin's, Barn, Dublin 8, Ireland.en_GB
dc.identifier.journalCochrane database of systematic reviews (Online)en_GB
dc.description.provinceLeinster-

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