Abstract

ACTIVE VERSUS EXPECTANT MANAGEMENT OF THIRD STAGE OF LABOUR

Dr. Wazera Raoof Rasheed* and Dr. Selda Bakr Hasan

ABSTRACT

Background: Expectant management of the third stage of labour involves allowing the placenta to deliver spontaneously or ided by gravity or nipple stimulation while, active management involves administration of prophylactic oxytocin with the delivery of the anterior shoulder of the fetus, early cord clamping and cutting with controlled traction of the umbilical cord. Objectives: To compare the effects of active versus expectant management of the third stage of labour on the maternal blood loss, postpartum haemorrhage, and the duration of the third stage of labour. Setting: Sulaimani Maternity Teaching Hospital. Design: Prospective case control study. Patients and Methods: Randomized trial involving the study of 200 women including primiparous and multiparous were selected randomly with low risk of haemorrhage, in 100 women, the third stage of labour were expectantly managed with no prophylactic oxytocin, delay cord clamping and cutting and deliver)' of placenta by maternal effort, in the other 100 women, the third stage of labour were actively managed by using prophylactic 10 unit oxytocin with the delivery of the anterior shoulder of the fetus, early cord clamping and cutting and delivery of the placenta by controlled cord traction, then comparison between the two groups in the amount of blood loss, duration of the third stage of labour, the incidence of postpartum haemorrhage and blood transfusion. Results: We found that the incidence of bleeding of more than 500 ml was 4% in actively managed group, while in expectantly managed group was 26%. The duration of the third stage of labour in the group allocated active management was shorter with mean of 3.75 minutes in comparison to other group which had more prolong duration of third stage of labour with mean of 5.4 minutes. The active management was associated with reduce the incidence of retained placenta (2% versus 4%). Four percent of women in the actively managed group versus 7% in the expectantly managed group need blood transfusion. Conclusion: Policy of active management that had been practiced in this trial reduces the incidence of postpartum haemorrhage, shortens the third stage and facilitates % the delivery of the placenta; that is to say active management reduces the blood loss without causing retained placenta.

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