title: Afterpains: a comparison between active and expectant management of the third stage of labor.
abstract: BACKGROUND
  Management of the third stage of labor, the period following the birth of the infant until delivery of the placenta, is crucial. Active management using synthetic oxytocin has been advocated to decrease blood loss. It has been suggested, but not studied, that oxytocin may increase afterpains. The aim of this study was to compare women's experience of pain intensity when the third stage of labor was managed actively and expectantly and their experience of afterpains.
  
  
  METHODS
  A single-blind, randomized, controlled trial was performed at two delivery units in Sweden in a population of healthy women with normal, singleton pregnancies, gestational age of 34 to 43 weeks, cephalic presentation, and expected vaginal delivery. Women (n=1,802) were randomly allocated to either active management or expectant management of the third stage of labor. Afterpains were assessed by Visual Analog Scale (VAS) and the Pain-o-Meter (POM-WDS) 2 hours after delivery of the placenta and the day after childbirth.
  
  
  RESULTS
  At 2 hours after childbirth, women in the actively managed group had lower VAS pain scores than expectantly managed women (p=0.014). Afterpains were scored as more intense the day after, compared with 2 hours after, childbirth in both groups. Multiparas scored more intense afterpains, compared with primiparas, irrespective of management (p<0.001).
  
  
  CONCLUSIONS
  Active management of the third stage of labor does not provoke more intense afterpains than expectant management.
authors: Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors: Elisabeth
authors: E
authors: Jangsten
authors: Ingrid
authors: I
authors: Bergh
authors: Lars-Åke
authors: LÅ
authors: Mattsson
authors: Anna-Lena
authors: AL
authors: Hellström
authors: Marie
authors: M
authors: Berg
mesh_terms: D000293:Adolescent; D000328:Adult; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D048949:Labor Pain / Q000139:chemically induced*; D007749:Labor Stage, Third; D008875:Middle Aged; D010120:Oxytocics / Q000008:administration & dosage / Q000009:adverse effects*; D010121:Oxytocin / Q000008:administration & dosage / Q000009:adverse effects*; D010147:Pain Measurement; D011247:Pregnancy; D016037:Single-Blind Method; D055815:Young Adult
chemical_list: D010120:Oxytocics; D010121:Oxytocin