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    WITHDRAWN: Active versus expectant management in the third stage of labour.

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    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.
    Issue Date
    2012-02-01T10:57:43Z
    MeSH
    Delivery, Obstetric/*methods
    Female
    Humans
    *Labor Stage, Third
    Postpartum Hemorrhage/*prevention & control
    Pregnancy
    
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    Citation
    Cochrane Database Syst Rev. 2009 Jul 8;(3):CD000007.
    Journal
    Cochrane database of systematic reviews (Online)
    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
    ISSN
    1469-493X (Electronic)
    1361-6137 (Linking)
    ae974a485f413a2113503eed53cd6c53
    10.1002/14651858.CD000007.pub2
    Scopus Count
    Collections
    Coombe Women & Infants University Hospital

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