title: Policies for manual removal of placenta at vaginal delivery: variations in timing within Europe.
abstract: The length of the third stage of labour is a potential modifiable risk factor for postpartum haemorrhage at vaginal delivery, but there is no definitive evidence that early intervention to remove the placenta manually will prevent postpartum haemorrhage. We report a wide variation between countries in Europe in policies about the timing of manual removal of placenta. Two groups of countries with clearly divergent policies were identified. A randomised controlled trial is needed to provide definitive evidence on the risks and benefits of manual removal of placenta at different timings after vaginal delivery.
authors.affiliation: INSERM, UMR S149, IFR 69, UPMC, Epidemiological Research Unit on Perinatal Health and Women's health, Hopital Tenon, Paris, France. cdeneux.u149@chusa.jussieu.fr
authors.forename: C
authors.initials: C
authors.lastname: Deneux-Tharaux
authors.forename: A
authors.initials: A
authors.lastname: Macfarlane
authors.forename: C
authors.initials: C
authors.lastname: Winter
authors.forename: W-H
authors.initials: WH
authors.lastname: Zhang
authors.forename: S
authors.initials: S
authors.lastname: Alexander
authors.forename: M-H
authors.initials: MH
authors.lastname: Bouvier-Colle
mesh_terms: D036861:Delivery, Obstetric / Q000379:methods*; D005060:Europe; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007749:Labor Stage, Third; D018457:Placenta, Retained / Q000517:prevention & control*; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D017410:Practice Guidelines as Topic / Q000592:standards; D011247:Pregnancy; D013997:Time Factors