Uterine massage to reduce postpartum hemorrhage after vaginal delivery.
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.
Abdel-Aleem
Hany
H
Department of Obstetrics and Gynecology, Women's Health Centre, Assiut University Hospital, Assiut, Egypt. aleemh@yahoo.com
Singata
Mandisa
M
Abdel-Aleem
Mahmoud
M
Mshweshwe
Nolundi
N
Williams
Xoliswa
X
Hofmeyr
G Justus
GJ
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
D010121:Oxytocin