Active Management Third Stage of Labor Used by Family
Abstract
Objective
To review the clinical aspects of postpartum hemorrhage (PPH) and provide guidelines to assist clinicians in the prevention and management of PPH. These guidelines are an update from the previous Social club of Obstetricians and Gynaecologists of Canada (SOGC) clinical practice guideline on PPH, published in Apr 2000.
Show
Medline, PubMed, the Cochrane Database of Systematic Reviews, ACP Journal Club, and BMJ Clinical Evidence were searched for relevant articles, with concentration on randomized controlled trials (RCTs), systematic reviews, and clinical practice guidelines published between 1995 and 2007. Each article was screened for relevance and the total text caused if determined to be relevant. Each full-text article was critically appraised with use of the Jadad Calibration and the levels of evidence definitions of the Canadian Task Forcefulness on Preventive Wellness Care.
Values
The quality of evidence was rated with apply of the criteria described past the Canadian Task Strength on Preventive Health Care.
Sponsor
The Society of Obstetricians and Gynaecologists of Canada.
Recommendations
Prevention of Postpartum Hemorrhage
- 1
Active management of the tertiary stage of labour (AMTSL) reduces the risk of PPH and should be offered and recommended to all women (I-A).
- ii
Oxytocin (10 IU), administered intramuscularly, is the preferred medication and route for the prevention of PPH in low-risk vaginal deliveries. Care providers should administer this medication afterward delivery of the anterior shoulder (I-A).
- 3
Intravenous infusion of oxytocin (xx to 40 IU in 1000 mL, 150 mL per hour) is an acceptable culling for AMTSL (I-B).
- 4
An Iv bolus of oxytocin, v to 10 IU (given over 1 to 2 minutes), tin be used for PPH prevention after vaginal birth but is not recommended at this time with elective Caesarean section (Ii-B).
- 5
Ergonovine can be used for prevention of PPH simply may be considered second option to oxytocin owing to the greater risk of maternal adverse furnishings and of the need for manual removal of a retained placenta. Ergonovine is contraindicated in patients with hypertension (I-A).
- 6
Carbetocin, 100 µg given as an IV bolus over ane minute, should exist used instead of continuous oxytocin infusion in elective Caesarean section for the prevention of PPH and to decrease the need for therapeutic uterotonics. (I-B)
- vii
For women delivering vaginally with i risk gene for PPH, carbetocin 100 µg IM decreases the need for uterine massage to forestall PPH when compared with continuous infusion of oxytocin (I-B).
- 8
Ergonovine, 0.2 mg IM, and misoprostol, 600 to 800 µg given by the oral, sublingual, or rectal route, may be offered as alternatives in vaginal deliveries when oxytocin is not available (II-1B).
- 9
Whenever possible, delaying cord clamping by at least 60 seconds is preferred to clamping earlier in premature newborns (< 37 weeks gestation) since at that place is less intraventricular hemorrhage and less need for transfusion in those with late clamping (I-A).
- 10
For term newborns, the possible increased risk of neonatal jaundice requiring phototherapy must be weighed confronting the physiological benefit of greater hemoglobin and iron levels up to 6 months of age conferred past delayed cord clamping (I-C).
- 11
There is no show that, in an uncomplicated delivery without bleeding, interventions to accelerate delivery of the placenta before the traditional 30 to 45 minutes will reduce the risk of PPH (II-2C).
- 12
Placental cord drainage cannot exist recommended as a routine practice since the evidence for a reduction in the duration of the tertiary stage of labour is limited to women who did not receive oxytocin as part of the management of the 3rd stage. There is no prove that this intervention prevents PPH (Two-1C).
- 13
Intraumbilical cord injection of misoprostol (800 µg) or oxytocin (10 to 30 IU) can be considered as an alternative intervention earlier transmission removal of the placenta (Ii-2C).
Treatment of PPH
- 14
For blood loss estimation, clinicians should utilize clinical markers (signs and symptoms) rather than a visual interpretation (3-B).
- 15
Management of ongoing PPH requires a multidisciplinary approach that involves maintaining hemodynamic stability while simultaneously identifying and treating the cause of blood loss (3-C).
- 16
All obstetric units should accept a regularly checked PPH emergency equipment tray containing appropriate equipment (Ii-2B).
- 17
Evidence for the benefit of recombinant activated factor VII has been gathered from very few cases of massive PPH. Therefore this agent cannot exist recommended as role of routine practice (Two-3L).
- 18
Uterine tamponade can be an efficient and effective intervention to temporarily control active PPH due to uterine atony that has not responded to medical therapy (Three-L).
- 19
Surgical techniques such as ligation of the internal iliac artery, compression sutures, and hysterectomy should be used for the management of intractable PPH unresponsive to medical therapy (III-B).
Recommendations were quantified using the evaluation of show guidelines developed past the Canadian Task Force on Preventive Wellness Care (Table 1).
Tabular array 1 Key to testify statements and grading of recommendations, using the ranking of the Canadian Job Force on Preventive Wellness Care
| Quality of Show Assessment * The quality of evidence reported in these guidelines has been adapted from The Evaluation of Testify criteria described in the Canadian Task Force on Preventive Health Care. | Classification of Recommendations † Recommendations included in these guidelines have been adapted from the Classification of Recommendations criteria described in the The Canadian Job Force on Preventive Wellness Intendance. |
|---|---|
| I: Prove obtained from at to the lowest degree one properly randomized controlled trial | A. In that location is adept evidence to recommend the clinical preventive action |
| II-1: Evidence from well-designed controlled trials without randomization | B. There is off-white prove to recommend the clinical preventive action |
| Two-two: Evidence from well-designed cohort (prospective or retrospective) or case-control studies, preferably from more than ane eye or research group | C. The existing evidence is alien and does not permit to make a recommendation for or against use of the clinical preventive action; yet, other factors may influence controlling |
| II-3: Evidence obtained from comparisons between times or places with or without the intervention. Dramatic results in uncontrolled experiments (such equally the results of treatment with penicillin in the 1940s) could also be included in this category | D. At that place is off-white bear witness to recommend confronting the clinical preventive action |
| 3: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees | E. At that place is practiced evidence to recommend against the clinical preventive action |
| L. At that place is insufficient evidence (in quantity or quality) to make a recommendation; however, other factors may influence decision-making |
Adapted from: Woolf SH, et al. Canadian Task Force on Preventive Health Care. New grades for recommendations from the Canadian Task Force on Preventive Wellness Care. CMAJ 2003;169(3):207–8.
The quality of evidence reported in these guidelines has been adjusted from The Evaluation of Evidence criteria described in the Canadian Task Force on Preventive Health Care.
† Recommendations included in these guidelines take been adjusted from the Nomenclature of Recommendations criteria described in the The Canadian Task Strength on Preventive Wellness Care.
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Central Words
- Prevention
- hemorrhage
- obstetrics
- obstetric hemorrhage
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REFERENCES
-
Global burden of maternal death and inability.
Br Med Bull. 2003; 67 : 1-11 -
Postpartum hemorrhage: practical approach to a life-threatening complication.
Clin Exp Obstet Gynecol. 2006; 33 : 81-84 -
Postpartum hemorrhage: frequency, consequences in terms of health status, and gamble factors before delivery].
J Gynecol Obstet Biol Reprod (Paris). 2004; 33 () -
Postpartum haemorrhage.
Curr Obstet Gynaecol. 2006; sixteen : half dozen-thirteen -
Maternal bloodshed in Giza, Arab republic of egypt: magnitude, causes, and prevention.
Stud Fam Plann. 1992; 23 : 45-57 -
Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions.
BJOG. 2006; 113 : 919-924 -
Approach to the patient with shock.
()in: Kasper DL Braunwald Eastward Fauci AS Hauser SL Longo DL Jameson JL Harrison's principles of internal medicine. 16th ed. McGraw-Hill, New York 2004 () -
Agile versus expectant management in the tertiary stage of labour.
Cochrane Database Syst Rev. 2000; () -
Joint argument: management of the third stage of labour to forbid post-partum haemorrhage.
J Midwifery Womens Health. 2004; 49 : 76-77 -
Recommendations for the Prevention of Postpartum Haemorrhage.
WHO, Geneva 2007 -
Controlled cord traction versus minimal intervention techniques in delivery of the placenta: a randomized controlled trial.
Am J Obstet Gynecol. 1997; 177 : 770-774 -
Safe ergometrine–oxytocin versus oxytocin for the 3rd stage of labour.
Cochrane Database Syst Rev. 2004; () -
Prophylactic oxytocin for the third phase of labour.
Cochrane Database Syst Rev. 2001; () -
Routine oxytocin in the third stage of labour: a placebo controlled randomised trial.
Br J Obstet Gynaecol. 1997; 104 : 781-786 -
A randomized controlled trial comparing oxytocin administration earlier and after placental delivery in the prevention of postpartum hemorrhage.
Am J Obstet Gynecol. 2001 October; 185 : 873-877 -
A comparing of 'active' and 'physiological' direction of the third stage of labour.
Midwifery. 1990; 6 : 3-17 -
Maternal hemodynamics subsequently oxytocin bolus compared with infusion in the third stage of labor: a randomized controlled trial.
Obstet Gynecol. 2005; 105 : 294-299 -
Hemodynamic effects of oxytocin given as IV bolus or infusion on women undergoing caesarean section.
Br J Anaesth. 2007; 98 : 116-119 -
Signs of myocardial ischemia after injection of oxytocin: a randomized double-bullheaded comparison of oxytocin and methylergometrine during caesarean department.
Br J Anaesth. 2008; 100 : 683-689 -
Double-blind comparison of carbetocin versus oxytocin in prevention of uterine atony later on cesarean section.
Am J Obstet Gynecol. 1999; 180 : 670-676 -
Pharmacokinetics of a long-acting oxytocin analogue, in non-pregnant women.
Curr Ther Res. 1990; 47 : 528-540 -
Comparing of carbetocin and oxytocin for the prevention of postpartum hemorrhage following vaginal delivery: a double-blind randomized trial.
J Obstet Gynaecol Can. 2004; 26 : 481-488 -
Oxytocin agonists for preventing postpartum hemorrhage.
Cochrane Database Syst Rev. 2007; () -
A randomized trial of carbetocin versus Syntometrine in the direction of the tertiary stage of labour.
BJOG. 2006; 113 : 1459-1464 -
Misoprostol for third stage of labour [letter of the alphabet].
Lancet. 1996; 347 : 1257 -
Misoprostol to treat postpartum haemorrhage: a systematic review.
BJOG. 2005; 112 : 547-553 -
Prostaglandins for prevention of postpartum bleeding.
Cochrane Database Syst Rev. 2004; () -
Systematic review of randomized controlled trials of misoprostol to prevent postpartum hemorrhage.
Obstet Gynecol. 2002; 100 : 1301-1312 -
Misoprostol utilise during the 3rd phase of labor.
Int J Gynaecol Obstet. 2003; 82 : 143-152 -
WHO multicentre randomised trial of misoprostol in the management of the third stage of labour.
Lancet. 2001; 358 : 689-695 -
Rectal misoprostol versus oxytocin in the direction of the 3rd phase of labour.
J Obstet Gynaecol Can. 2007; 29 : 711-718 -
Cord closure: Can hasty clamping hurt the newborn?.
OBG Manage. 1998; (): 29-36 -
The complete claret count: physiologic basis and clinical usage.
J Perinat Neonatal Nurs. 1997; eleven : 1-18 -
Distribution of blood between infant and placenta after birth.
Lancet. 1969; 2 : 871-873 -
Early versus delayed umbilical cord clamping in preterm infants.
Cochrane Database Syst Rev. 2004; () -
Placental transfusion: umbilical cord clamping and preterm infants.
J Perinatol. 2000; xx : 351-354 -
Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials.
JAMA. 2007; 297 : 1241-1252 -
Result of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes.
Cochrane Database Syst Rev. 2008; () -
Tertiary phase of labor: assay of duration and clinical practise.
Am J Obstet Gynecol. 1995; 172 : 1279-1284 -
Prolonged third phase of labor; morbidity and risk factors.
Obstet Gynecol. 1991; 77 : 863-867 -
Timing of placental delivery to prevent post-partum haemorrhage: lessons learned from an abandoned randomised clinical trial.
AustNZJ Obstet Gynaecol. 2006; 46 : 549-551 -
Placental string drainage afterwards spontaneous vaginal delivery as office of the management of the third stage of labour.
Cochrane Database Syst Rev. 2005; () -
Evaluation of placental drainage as a method of placental delivery in vaginal deliveries.
Arch Gynecol Obstet. 2005; 271 : 343-345 -
Umbilical vein injection for direction of retained placenta.
Cochrane Database Syst Rev. 2001; () -
Umbilical vein injection for the routine management of third stage of labour [Protocol].
Cochrane Database Syst Rev. 2006; () -
Fugitive transmission removal of placenta: evaluation of intra-umbilical injection of uterotonics using the Pipingas technique for direction of adherent placenta.
Acta Obstet Gynecol. 2007; 86 : 48-54 -
Surgical management of severe obstetrical hemorrhage: experience with an obstetrical hemorrhage equipment tray.
J Obstet Gynaecol Can. 2004; 26 : 805-808 -
The use of recombinant activated gene Vii in obstetric and gynaecological bleeding.
BJOG. 2007; 114 : 8-15 -
Uterine artery embolization: an underused method of controlling pelvic hemorrhage.
Am J Obstet Gynecol. 1997; 176 () -
Ligation of both internal iliac arteries for hemorrhage in hysterectomy for carcinoma uteri.
Bull Johns Hopkins Hosp. 1984; five : 53 -
Internal iliac artery ligation for arresting postpartum bleeding.
BJOG. 2007; 114 : 356-361 -
The B-Lynch surgical technique for the control of massive postpartum haemorrhage: An alternative to hysterectomy? Five cases reported.
Br J Obstet Gynaecol. 1997; 104 : 372-375 -
Hemostatic suturing technique for uterine bleeding during cesarean delivery.
Obstet Gynecol. 2000; 96 : 129-131
Article Info
Publication History
No. 235 Oct 2009 (Replaces No. 88, April 2000, Reaffirmed December 2018)
Footnotes
This document reflects emerging clinical and scientific advances on the date issued and is subject area to change. The data should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions tin can dictate amendments to these opinions. They should exist well documented if modified at the local level. None of these contents may be reproduced in any course without prior written permission of the publisher.
All people have the right and responsibleness to brand informed decisions about their care in partnership with their health care providers. In social club to facilitate informed choice, patients should exist provided with information and back up that is prove-based, culturally appropriate and tailored to their needs.
This guideline was written using linguistic communication that places women at the middle of care. That said, the SOGC is committed to respecting the rights of all people – including transgender, gender not-binary, and intersex people – for whom the guideline may apply. Nosotros encourage healthcare providers to engage in respectful chat with patients regarding their gender identity as a critical part of providing safe and appropriate care. The values, beliefs and private needs of each patient and their family should exist sought and the final decision about the care and treatment options chosen by the patient should be respected.
Identification
DOI: https://doi.org/x.1016/j.jogc.2018.09.024
Copyright
© 2018 Published by Elsevier Inc. on behalf of Social club of Obstetricians and Gynaecologists of Canada.
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