Management of third stage of labour.

Does active management of the third stage of labour confer any benefits over expectant management? A Cochrane review of 7 studies in 8247 women (Begley, 2011) found “The evidence suggested that for women at mixed levels of risk of bleeding, active management showed a reduction in the average risk of maternal primary haemorrhage at time of birth (more than 1000 mL) (average risk ratio (RR) 0.34, 95% CI 0.14 to 0.87, three studies, 4636 women) and of maternal haemoglobin (Hb) less than 9 g/dL following birth (average RR 0.50, 95% CI 0.30 to 0.83, two studies, 1572 women). We also found no difference in the incidence in admission of infants to neonatal units (average RR 0.81, 95% CI 0.60 to 1.11, two studies, 3207 women) nor in the incidence of infant jaundice requiring treatment (0.96, 95% CI 0.55 to 1.68, two studies, 3142 women).” A randomised trial in 200 Iranian women (Kashanian, 2010) compared an intervention group (n=100) given 10IU of oxytocin intramuscularly following birth of the anterior shoulder of the baby to a control group (n=100), in whom the placenta was expelled by maternal force. Mean blood loss during the third stage of labour was 216.93+/-165.16 ml and 232.12+/-150.35 ml in the intervention and control groups, respectively; the difference was not significant (p=0.49). In contrast, mean blood loss during the fourth stage of labour differed significantly (422.62+/324.7 ml and 327.27+/-255.99 ml in the intervention and control groups, respectively; p=0.02). The mean duration of the third stage of labour was less in the intervention group than in the control group (4.69+/-5.51 mins and 6.34+/-5.03 mins; p=0.028). The authors concluded that active management did not decrease blood loss during the third stage of labour, but did decrease the duration of this stage. Active management was associated with increased blood loss during the fourth stage of labour. Further research was called for in order to determine the optimal method by which to manage the third stage of labour.