Active Versus Expectant Management for Women in the Third Stage of Labor

Abstract

Background: The third stage of labor is a normal physiological progression of birth that may be compounded by serious complications. The most common complication is postpartum hemorrhage. Clinical guidelines to prevent postpartum haemorrhage widely recommend the provision of package intervention known collectively as active management of the third stage of labor. Although there is some variation across AMTSL guideline, the intervention commonly includes prophylactic administration of a uterotonic agent, cord clumping & controlled cord traction. Aim of the study: This study is designed to evaluate the effectiveness of active versus expectant management of the third stage of labor in minimizing the amount of blood loss, the incidence of post-platinum hemorrhage, postpaitum Hemoglobin reduction & sh01tening the duration of this stage. Study setting and design: This study was conducted in Baghdad Teaching Hospital at the Department of Obstetrics and Gynecology. It is a prospective study applied on a randomized sample of women who expected a vaginal birth at 24 weeks gestation or later. Patient & Method: Two hundred women in the 3rd stage of labor after vaginal delivery were grouped into two groups the physiological management II group & active management group, where the amount of blood loss &the incidence of PPH, HP: S9g/dl 24to72hours postpartum& duration of 3rd stage was compared as the study outcome.Results: In 200 cases, 100 cases were assigned to active management Group & 100 were assigned to the physiological management group. The average blood loss in the third stage of labor in the active management group was 157.7 ± 100.1 ml Vs396.82 ± 169.6 ml in the physiological management   group, so there was a significant reduction in postpartum blood loos in the active management group. The incidence of post-partum hemorrhage was 2.2% in the active management group vs 10.0% in the physiological management group, so there was a significant reduction in the incidence of PPH in the active management group. The active management group was   unlikely to   have Hb: S9gm/dl24to48hr Postpartum as it occurs in 2.0%, while in the physiological management group 9.0%. The duration of 3rd stage of labor was significantly shorter in the active management group. It was3.8± 0.98min. vs7.46± 1.74 min. in the physiological management group. Conclusion: Active management of the third stage of labor decreases the amount of blood loss, decreases the incidence of postpa1tum Hb: S9gm/dl & shmten the duration of 3rd stage of labor, so reduces postpartum hemorrhage & its complications.