title: Uterine massage to reduce postpartum hemorrhage after vaginal delivery.
abstract: OBJECTIVE
  To determine the effectiveness of sustained uterine massage started before delivery of the placenta in reducing postpartum hemorrhage.
  
  
  METHODS
  A randomized controlled trial conducted in Egypt and South Africa between September 2006 and February 2009. A total of 1964 pregnant women were randomly allocated to 1 of 3 treatment groups: intramuscular oxytocin, sustained uterine massage, or both treatments. Blood loss within 30 minutes of delivery was recorded.
  
  
  RESULTS
  The incidence of blood loss of 300 mL or more within 30 minutes of delivery was significantly higher in the massage group than in the massage plus oxytocin (RR 1.88; 95% CI, 1.29-2.74 in Assiut, and RR 1.3; 95% CI, 1.00-1.68 in SA) and the oxytocin only group (RR 1.7; 95% CI, 1.11-2.61 in Assiut, and RR 2.24; 95% CI, 1.54-3.27 in SA). In both centers, use of additional uterotonics was significantly higher in the uterine massage group compared with the other 2 groups.
  
  
  CONCLUSIONS
  Uterine massage was less effective than oxytocin for reducing blood loss after delivery. When oxytocin was used, there was no additional benefit from uterine massage. The effectiveness of uterine massage in the absence of oxytocin was not studied. ACTRN: 12609000372280.
authors.affiliation: Department of Obstetrics and Gynecology, Women's Health Centre, Assiut University Hospital, Assiut, Egypt. aleemh@yahoo.com
authors.forename: Hany
authors.initials: H
authors.lastname: Abdel-Aleem
authors.forename: Mandisa
authors.initials: M
authors.lastname: Singata
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Abdel-Aleem
authors.forename: Nolundi
authors.initials: N
authors.lastname: Mshweshwe
authors.forename: Xoliswa
authors.initials: X
authors.lastname: Williams
authors.forename: G Justus
authors.initials: GJ
authors.lastname: Hofmeyr
mesh_terms: D000328:Adult; D004534:Egypt; D005260:Female; D006801:Humans; D008405:Massage / Q000379:methods*; D010121:Oxytocin / Q000627:therapeutic use*; D036801:Parturition; D006473:Postpartum Hemorrhage / Q000188:drug therapy / Q000517:prevention & control*; D011247:Pregnancy; D013019:South Africa; D014599:Uterus / Q000502:physiology*; D014621:Vagina / Q000187:drug effects; D055815:Young Adult
chemical_list: D010121:Oxytocin