Active management of the third stage of labor among American Indian women.

OBJECTIVE This study's objective was to judge whether active management of the third stage of labor is as effective in reducing maternal blood loss among rural American Indian women as in randomized trials. METHODS We collected retrospective data on a cohort of largely multiparous American Indian women having singleton vaginal births at a rural hospital in 2000-2001, comparing measures of blood loss among women receiving active (n=62) versus routine (n=113) management of the third stage of labor. Outcomes included both objective (postpartum hemoglobin decline) and subjective (estimated blood loss) measures of maternal blood loss. RESULTS Active management was associated with reduced maternal blood loss on several measures when compared to routine management, including incidence of a 3 g/dl or greater postpartum hemoglobin decline (5% versus 27%), mean postpartum hemoglobin decline (1.7 versus 2.2 g/dl), and mean estimated blood loss (355 versus 430 ml). Compared to women who received routine management, women who received active management had 87% reduced odds of a 3 g/dl or greater postpartum hemoglobin decline after adjusting for preeclampsia, manual placental extraction, laceration repair, and maternal age. CONCLUSIONS Our findings suggest that active management of the third stage is as effective in reducing maternal blood loss among rural American Indian women as in randomized trials in maternity hospitals.