Placental cord drainage during third stage of labour: a randomized control trial at a tertiary care centre

Background: Labour is a physiological process, but it is often associated with morbidity and mortality, with the most common cause being blood loss. Primary postpartum hemorrhage is commonly defined as a blood loss of 500 ml or more within 24 hours after normal vaginal birth. A prolonged third stage of labour (more than 20 min) is associated with postpartum hemorrhage. The present study was undertaken with the objective of assessing efficacy of placental cord drainage (PCD) during active management of third stage of labour.Methods: This is a randomized control trial in which full term primi gravida who were expected to have normal vaginal delivery, admitted in labour room of a tertiary care centre were evaluated for inclusion in the study. Total 126 participants were enrolled after having normal vaginal delivery. In study group (n = 63), placental cord drainage was used for management of third stage of labour while in control group (n = 63), third stage was managed without PCD.Results: The mean difference in duration of third stage of labour in study and control group was 1.79 minute and the mean difference in blood loss during third stage of labour in both groups was 57.86 ml which was statistically significant.Conclusions: The results of this study show small positive effects from cord drainage in reducing the length of the third stage of labour and in reducing the amount of blood loss when compared with those without cord drainage. The observed changes may be of clinical significance in reducing third stage related complications.

Intramuscular oxytocin 10 units versus intravenous methylergometrine 0.2 mg in active management of third stage of labour for prevention of postpartum haemorrhage: a comparative study

Background: To compare the effectiveness of 10 IU of oxytocin IM with 0.2 mg methyl ergometrine IV in the prevention of post-partum hemorrhage when used as a part of active management of third stage of labour. This study aims to compare their influence on duration of the third stage of labour, the amount of blood loss during the third stage of labour and the immediate post-partum period and side effects of the drugs if any.Methods: The study was conducted in a tertiary care teaching hospital. 200 women, who underwent normal delivery with or without episiotomy, were enrolled and were randomly distributed into two groups. 100 women received 10 IU of intramuscular Oxytocin and 100 women received intravenous 0.2 mg of methyl ergometrine. Women of both the groups were given the medication after delivery of anterior shoulder of the baby. Comparison done between percentages fall in Hb from before delivery to 24 hours after delivery, need for additional uterotonic agents, need for blood transfusion, duration of third stage of labour and any side effects including retained placenta and need for manual removal of placenta.Results: Intravenous methylergometrine was observed to be equally effective as intramuscular oxytocin in prevention of post-partum hemorrhage. There was no difference in the duration of third stage of labour, amount of blood loss, need for additional uterotonic agents, and need for blood transfusion in both the groups. There was no significant side effect in both the groups.Conclusions: Intramuscular oxytocin is as efficacious as Intravenous methylergometrine in the prevention of postpartum hemorrhage with no side effects.

Study of blood component therapy in obstetrics

Background: Blood transfusion is a life saving measure. Various pregnancy complications and disorders of labor present as risk factors for extra blood loss during pregnancy and cause severe hemodynamic instability. This along with complications due to abortion (spontaneous or induced) and ruptured ectopic pregnancy show up as conditions needing transfusion in the day-to-day practice of obstetrics. In a country like India, limited and fixed resources of blood, forces us to titrate the use of blood and its components. Normally, blood loss during birth is well-tolerated because of changes during pregnancy.Methods: This is a retrospective observational study done at tertiary care hospital. This study is based on study of indoor patients admitted during one year duration. Detailed history and all necessary investigations were carried out. Details regarding blood transfusion were taken indication of blood transfusion, number and type of unit transfused, number of patients given blood components, indications where single unit was transfused. Analysis of the data was done.Results: Anemia followed by antepartum hemorrhage followed by postpartum hemorrhage was the major cause for blood and blood product transfusion. Approximately 60% patients required two units of PCV (Packed Cell Volume) transfusion. Anemia in pregnancy was the major cause of single unit PCV transfusion.Conclusions: A proper knowledge for blood and blood product transfusion is needed to make it available for people who are actually in need and also to decrease the economic burden. Measures to prevent anemia should be implemented. Active management of third stage of labour (AMTSL) should be done to avoid postpartum hemorrhage. Single unit transfusion should be avoided.

The effect and safety of placental blood drainage as a part of active management of third stage of labour in spontaneous vaginal delivery

Background: In placental cord drainage facilitates placental delivery in both vaginal and caesarean section deliveries. The present study was done to evaluate the effect and safety of placental blood drainage as a part of active management of third stage of labour to reduce the duration and blood loss during third stage of labour.Methods: The study was conducted in department of Obstetrics and, SN Medical College, Agra, Uttar Pradesh, India on 400 term pregnant women, with single live intrauterine fetus in cephalic presentation, without any complication. They were randomly divided into to study and control group. Study group: It comprised of 200 Gynaecology cases, underwent active management of third stage of labour with placental blood drainage. Control group: It comprised of 200 cases, underwent active management of third stage of labour (AMTSL) alone. Duration and blood loss during third stage were noted.Results: The mean duration of third stage of labour was 3.61±0.972mins in study group and 8.15±1.711mins in control group. The mean blood loss during third stage of labour was 168.14±76.703ml and 287.40±85.808ml in study and control group respectively.Conclusions: Duration of third stage, blood loss during third stage, and hemoglobin deference between pre and post-delivery were reduced significantly in study group than control group.

Training of maternal health care providers in newer modalities of management of post-partum haemorrhage

Background: Postpartum haemorrhage (PPH) is a life-threatening complication, that occurs suddenly and unexpectedly. Institutional delivery by skilled birth attendant who are trained in active management of third stage of labour and those who can use of Uterine Balloon Tamponade and Non-pneumatic anti shock garment can reduce incidence and morbidity related to PPH. The objective of the paper was to share the experiences of the training programmes held for maternal health care workers in the newer modalities of PPH management.Methods: During one and a half year period, 32 Continuation of Medical Education (CME) programmes, with the theme of “Managing Obstetric Emergencies and Obstetric Trauma”, covering important topics related to high risk pregnancies like Hypertension, Eclampsia ,Anaemia and Haemorrhage at 32 health institutions, spread over 11 states and 2 union territories in India, were conducted .In addition,42 hands on workshops  at various health facilities were conducted with training of more than 2575 maternal health care providers.Results: The pre and post test scores revealed that 95 percent of the maternal health care providers were unaware about the use of Uterine Balloon Tamponade (Bakri balloon) in PPH and Non-pneumatic anti shock garment (NASG). Seventy percent were unaware about the proper sequence of steps of active management of third stage of labour. Training programmes helped to improve the knowledge, whereas hands on workshop, helped in skill development of the health care providers. The participants expressed great satisfaction regarding the knowledge and skills they acquired through training programme on management of post-partum haemorrhage. They gave positive feedback about the quality, contents and conduct of training programme.Conclusions: There is need for refresher training of maternal health care providers in newer modalities like AMTSL, NASG and Bakri balloon, which have potential to save lives.

Third stage of labour: expectant versus active management-a comparative study in local low risk population

Background: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality, accounting for about 35% of all maternal deaths. These deaths have a major impact on the lives and health of the families affected. Thus, anticipation as well as proper management of 3rd stage of labour is mandatory. The objective of this study was to compare expectant and active management of third stage of labour in preventing post-partum blood loss and having impact on prevention of maternal mortality in local population. Advantages and disadvantages of both techniques might be over estimated.Methods: Prospective comparative study carried out in Obstetrics and Gynecology department of SBKSMIRC (Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre), Dhiraj general hospital, comprising of 200 laboring women admitted directly or from OPD to labour room for expected vaginal delivery. They were randomly allocated to group A (expectant management) and group B (active management). Labour progress was charted on partograph and interventions recorded. Statistical analysis of data was done after compiling and tabulation of data. Mean±SD for descriptive variables were calculated and appropriate statistical tests applied to determine significance.Results: Average PPBL (post-partum blood loss) was 360.5ml in group A as compared to 290.6ml in group B. 12 patients in group A had blood loss more than 500ml while none in group B. 66% cases in group B had duration of third stage of labour less than 5 min as compared to only 22% in group A. the mean duration of third stage was 13.46±8.3 in group A while 5.32±3.05 in group B. these differences were statistically significant.Conclusions: Active management of the third stage of labour is associated with less blood loss as well as a shorter duration of third stage compared with expectant management. It is reasonable to advocate this regime.

A prospective randomized comparative study of Misoprostol and balloon tamponade using condom catheter to prevent postpartum hemorrhage at M. Y. H., Indore, India in vaginal delivered patients

Background: PPH is responsible for quarter of maternal deaths occurring worldwide and its incidence is increasing in developed world. According to Confidential Enquiries into Maternal and Child Health (CEMACH) report obstetric hemorrhage occurs in around3.7 per 1000 births. The objective of the study is that it was a prospective randomized comparative study of misoprostol and balloon tamponade via condom catheter to prevent postpartum hemorrhage in normal delivered patients at MYH.Methods: A sample size of 200 normal delivered patients between age group 18 and 45 years is chosen with excessive bleeding after third stage of labour and after administration of oxytocics. These 200 patients are divided into two groups: First group receiving Misoprostol and applying condom catheter in other group. Both groups are evaluated for PPH.Results: It was found that CG balloon condom catheter was a much better and more effective alternative in controlling PPH than Misoprostol as the failure rate with CG balloon condom catheter were  much less than that  with misoprostol. Due to its cost effectiveness and being easily available at primary health center and due to absence of any drug reactions and easy technique of formation makes it a better modality in controlling PPH even at PHC.Conclusions: Patients with condom catheter in situ must show better result than patients receiving misoprostol.

Different management for women in the third stage of labour / 中国实用护理杂志

Active management of the third stage of labour involves giving a prophylactic uterotonic, early cord clamping, controlled cord traction and uterine massage. Active management of the third stage, as the main package of procedure to prevent postpartum hemorrhage, can effectively shorten the third stage of labor and reduce the incidence of severe postpartum hemorrhage, this is a major cause of women dying in developing countries. In developed countries, severe bleeding occurs much less often, yet active management has become standard practice in many countries for several decades. The most common complications of active management of the third stage of labor are pain and side effects of oxytocin, in addition to serious complications such as inversion of uterus and retained placental. Therefore, in recent years, a variety of interventions have been adopted in the third stage of labour, especially for low-risk pregnant women, which have been questioned and the evidence for using active management for all women is insufficient. The purpose of this article is to compare the effectiveness and variations of different management of the third stage of labour, and provide the basis for reasonable and individualized management of the third stage of labour, ultimately promote the natural labour.

Different management for women in the third stage of labour / 中国实用护理杂志

Active management of the third stage of labour involves giving a prophylactic uterotonic, early cord clamping, controlled cord traction and uterine massage. Active management of the third stage, as the main package of procedure to prevent postpartum hemorrhage, can effectively shorten the third stage of labor and reduce the incidence of severe postpartum hemorrhage, this is a major cause of women dying in developing countries . In developed countries, severe bleeding occurs much less often, yet active management has become standard practice in many countries for several decades. The most common complications of active management of the third stage of labor are pain and side effects of oxytocin, in addition to serious complications such as inversion of uterus and retained placental. Therefore, in recent years, a variety of interventions have been adopted in the third stage of labour, especially for low-risk pregnant women, which have been questioned and the evidence for using active management for all women is insufficient. The purpose of this article is to compare the effectiveness and variations of different management of the third stage of labour, and provide the basis for reasonable and individualized management of the third stage of labour, ultimately promote the natural labour.

Role of oral misoprostol 600 mcg in active management of third stage of labour: a comparative study with carboprost 125 mcg, intramuscular.

Background: Objectives: To compare misoprostol 600 mcg, oral with carboprost 125 mcg, i.m., in the active management of third stage of labour. Methods: A total of 200 pregnant women of 38-42 weeks of gestation delivering vaginally in the Shivamogga institute of medical sciences, Shivamogga, Karnataka, India were selected for study. 100 women received misoprostol 600 mcg, orally and 100 women received carboprost 125 mcg, i.m. immediately after delivery of baby and cord clamping by the method of randomisation. Results: In the misoprostol group, mean blood loss is 134.9 ml, mean duration of the third stage of labour is 4.07 min and mean fall in hemoglobin is 0.34 g/dl. In the carboprost group, mean blood loss is 123.7 ml, mean duration of the third stage of labour is 3.73 min and mean fall in hemoglobin is 0.28 g/dl. There was no significant difference between the two groups with regard to the above mentioned factors. There were 5 cases of PPH in the misoprostol group and 3 cases in the carboprost group. 21 cases in the misoprostol group and 14 cases in the carboprost group required additional oxytocics. Unpleasant side effects like diarrhoea and vomiting were more in carboprost group. Conclusion: Oral misoprostol is as effective as carboprost in AMTSL and can be used safely in vaginal deliveries for prevention of PPH, especially in non-institutional deliveries and in places of low resource settings.

Comparative Study of Prostaglandin F2 α Versus Ergometrine in the Management of Post Partum Haemorrhage

The present study was done to compare Prostaglandin F2 α (250μg) and methylergometrine (0.25mg) in the management of postpartum haemorrhage. 100 women of postpartum haemorrhage were studied in the tertiary care teaching hospital of Govt. Medical College Srinagar. at LDH in year 2001 to 2003. They were divided in two groups. Group A women were given intravenous methylgometrine (0.25mg) and group B received intramuscular injection of prostaglandin F2 α (250 μg). Main outcome measures were duration of third stage of labor, amount of blood loss and the side effects of drugs. Two groups were comparable with regard to parity in group A, 54% were primipara and 46% multipara; in group B 66% were primipare and 34% multipara. Mean duration of third stage of labour was shortened in group B. Blood loss was comparably less in group B (p < .001). Side effects were noted in both the groups but more in group A. Prostaglandin F2 ∝ (250μg) is a life saving drug in atonic postpartum haemorrhage, It shortens the duration of third stage of labour, and minimizes blood loss. Prostaglandin F2 ∝ offers an advantage over methylergometrine in case of hypertension.