Active versus expectant management of third stage of labour: the Hinchingbrooke randomised controlled trial

• Published in: The Lancet (British edition) 1998-03, Vol.351 (9104), p.693-699
• Main Authors: Rogers, Jane, Wood, Juliet, McCandlish, Rona, Ayers, Sarah, Truesdale, Ann, Elbourne, Diana
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Births; Blood; Clinical trials; Constriction; Delivery. Postpartum. Lactation; Drug therapy; Ergonovine; Female; Gynecology. Andrology. Obstetrics; Hemorrhage; Humans; Labor Stage, Third; Maternal, fetal and perinatal monitoring; Medical sciences; Midwifery; Oxytocics; Oxytocin; Postpartum Hemorrhage - prevention & control; Posture; Pregnancy; Pregnancy Outcome; Risk reduction; Umbilical Cord
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(97)09409-9

This study tested the hypotheses that active management of the third stage of labour lowers the rates of primary postpartum haemorrhage (PPH) and longer-term consequences compared with expectant management, in a setting where both managements are commonly practised, and that this effect is not mediated by maternal posture. 1512 women judged to be at low risk of PPH (blood loss >500 mL) were randomly assigned active management of the third stage (prophylactic oxytocic within 2 min of baby's birth, immediate cutting and clamping of the cord, delivery of placenta by controlled cord traction or maternal effort) or expectant management (no prophylactic oxytocic, no cord clamping until pulsation ceased, delivery of placenta by maternal effort). Women were also randomly assigned upright or supine posture. Analyses were by intention to treat. The rate of PPH was significantly lower with active than with expectant management (51 [6·8%] of 748 vs 126 [16·5%] of 764; relative risk 2·42 [95% CI 1·78–3·30], p