title: Comparison of active and expectant management on the duration of the third stage of labour and the amount of blood loss during the third and fourth stages of labour: a randomised controlled trial.
abstract: BACKGROUND
  Postpartum haemorrhage is one of the most important causes of maternal death.
  
  
  OBJECTIVE
  To evaluate the effect of active management of the third stage of labour on the amount of blood loss in the third and fourth stages of labour, and the duration of the third stage of labour.
  
  
  METHODS
  A randomised controlled trial was completed on 200 women who gave birth at a maternity unit in Iran. In the intervention group (n=100), 10IU of oxytocin was injected intramuscularly into the mother following birth of the anterior shoulder of the baby. After clamping and cutting the umbilical cord, the uterus was pushed upwards and posterior, while the cord was pulled down with constant and intermittent traction until the placenta was delivered. In the control group (n=100), on observing signs of placental separation, the placenta was expulsed by maternal force. In both groups of women, blood loss was measured at birth using collecting devices, and drapes and sheets were weighed to estimate blood loss.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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. Due to conflicting results between studies, further research should be undertaken to determine the optimal method by which to manage the third stage of labour.
authors.affiliation: Department of Obstetrics and Gynaecology, Iran University of Medical Sciences, Akbarabadi Teaching Hospital, Tehran, Iran. maryamkashanian@yahoo.com
authors.forename: Maryam
authors.initials: M
authors.lastname: Kashanian
authors.forename: Mohsen
authors.initials: M
authors.lastname: Fekrat
authors.forename: Zahra
authors.initials: Z
authors.lastname: Masoomi
authors.forename: Narges
authors.initials: N
authors.lastname: Sheikh Ansari
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007492:Iran; D007749:Labor Stage, Third / Q000097:blood*; D007744:Obstetric Labor Complications / Q000097:blood* / Q000188:drug therapy*; D010120:Oxytocics / Q000008:administration & dosage*; D018743:Perinatal Care / Q000379:methods*; D018457:Placenta, Retained / Q000517:prevention & control; D006473:Postpartum Hemorrhage / Q000097:blood / Q000517:prevention & control*; D011247:Pregnancy; D011256:Pregnancy Outcome; D014470:Umbilical Cord; D055815:Young Adult
chemical_list: D010120:Oxytocics