OB Hemorrhage: Third Stage Labor
Active Management
Andrew Hull, MD, David Lagrew, MD
University of California, San Diego; Saddleback Memorial Medical Center
Summary
Active management of the third stage of labor describes techniques of expediting placental delivery rather than awaiting spontaneous completion. The most common protocol involves routine administration of oxytocin as the fetal shoulders are delivering, cord clamping and cutting, controlled cord traction and uterine massage after delivery of the placenta.
The Cochrane Review (2000) of four randomized controlled trials examining expectant versus active management concluded that active management reduced risks of the following: 1) maternal blood loss; 2) post partum hemorrhage exceeding 500 mL; and 3) prolonged third stage labor. Compared with expectant management, however, actively managed patients experienced increased risk of unpleasant side effects like nausea and vomiting, and in studies where ergometrine was utilized an increased incidence of hypertension. Given the benefits, the review recommends active management as the routine management of choice for women delivering a baby by vaginal delivery.
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