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2013, Number 3

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Rev Cub Med Mil 2013; 42 (3)

Influence of active management of the third stage of labor upon maternal morbidity due to postpartum hemorrhage

Segura FA, Guerra PV, León CI, Rodríguez IG, Arpa GÁM

Language: Spanish
References: 26
Page: 258-367
PDF size: 188.61 Kb.


ABSTRACT

Introduction: postpartum haemorrhage is the main cause of maternal death worldwide. Active management of the third stage of labor may reduce the incidence of this fatal complication.
Objective: determine the usefulness of active management of third stage of labor with respect to maternal morbidity due to postpartum hemorrhage.
Methods: analytical cross-sectional observational study of 2 523 women who had eutocic deliveries at Dr. Luis Díaz Soto Hospital from January 2003 to December 2007. A comparison was made of the effects of active and expectant management in terms of blood loss and other maternal complications. Active management included the administration of oxytocine upon emergence of the fetus's anterior shoulder, controlled traction of the cord, and counter traction above the pubic bone. The chi-square test was used for analysis, with a significance level of 0.05.
Results: of the total eutocic deliveries, active management of the third stage of labor was used in 1 364 (54.1 %) whereas expectant management was used in 1 159 (45.9 %). Active management was associated with a lesser need of blood transfusions (0.8 % vs. 1.8 %) (p= 0.025) [RR = 2.25; LI= 1.09; LS 4.64], a shorter duration of the third stage of labor (0.3 % vs. 1.2 %) (p= 0.04) [RR= 3.53; LI 1.14; LS 10.92], a need for puerperal hysterectomy and admission to intensive care units (0 vs. 0.35 %) (p= 0.03). Postpartum stay was longer in expectant management cases (0.7 % vs. 0.4 %) (p= 0.04).
Conclusions: results show the protective value of the use of active management of the third stage of labor for the variables studied, as well as the advisability of its systematic use after singleton pregnancy eutocic deliveries.


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