title: [Evaluation and efficacy of preventive measures in intrapartum bleeding].
abstract: OBJECTIVE
  To evaluate the efficacy, applicability and safety of two recently introduced preventive-restrictive measures on the use of episiotomy and active management of the third stage of labour, in order to reduce puerperal bleeding results.
  
  
  METHODS
  Cohort study of a prospective series of 1098 women who gave birth in the Obstetrics and Gynaecology Department of the La Mancha General Hospital. Data were collected in two phases (1st phase, before applying the measures: 591; 2nd phase, after: 507). The main objective was to assess intrapartum blood loss. The independent variables analysed were active management of the third stage of labour and episiotomy rate. Age, parity, prematurity, weight of the newborn child, analgesia, duration and type of childbirth (spontaneous or induced), tears, retained placenta and neonatal results were included as control variables. Caesarean deliveries and those cases with increased bleeding risk factors were excluded.
  
  
  RESULTS
  Both postpartum anaemia and excessive hemorrhagic loss were significantly lowered (8.7% and 50% respectively). Likewise, episiotomy rate was also significantly reduced (8.6%) and active management of the third stage of labour increased to 86.6%. Neonatal outcome results did not change throughout the study.
  
  
  CONCLUSIONS
  The restrictive use of episiotomy and active management during the third stage of labour were effective, and with no side effects, in reducing intrapartum blood loss and improving puerperal quality of life.
authors.affiliation: Servicio de Ginecología y Obstetricia, Hospital Infanta Sofía, Madrid, España. jasmiclasmi@yahoo.es
authors.forename: Y
authors.initials: Y
authors.lastname: Cabrera-Guerra
authors.forename: A
authors.initials: A
authors.lastname: Pascual-Pedreño
authors.forename: A
authors.initials: A
authors.lastname: Hernández-Martínez
authors.forename: M
authors.initials: M
authors.lastname: Mayorga-Campo
authors.forename: M T
authors.initials: MT
authors.lastname: Martínez-Bermejo
authors.forename: G
authors.initials: G
authors.lastname: Bueno-Pacheco
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000379:methods / Q000592:standards; D004841:Episiotomy / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D007744:Obstetric Labor Complications / Q000517:prevention & control*; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D011446:Prospective Studies