How has Active Management of the Third Stage of Labor Reduced Postpartum Hemorrhage Occurrence?

Background: Postpartum hemorrhage is the leading cause of maternal mortality and is preventable. Its prevalence is still high even with guidelines in effect. Postpartum hemorrhage occurs mainly during the third stage of labor up to 24 hours after birth. Active Management of Third Stage of Labor consists of interventions to prevent or control postpartum hemorrhage which include the use of uterotonics, uterine massage, controlled cord traction, cord clamping, placental blood drainage and uterine assessment. The purpose of this review was to identify effectiveness of current interventions used during third stage of labor to decrease postpartum hemorrhage occurrences.

Methods: A literature review was conducted of the online database – EBSCO – with the following inclusion criteria: peer reviewed, published from 2008 to 2018, written in English, and vaginal deliveries. Fifty records were retrieved with 23 meeting inclusion criteria and included in final evaluation.

Findings: There were inconsistent results with all interventions proposed. Early cord clamping was shown to have no effect on the amount of blood loss. Similarly, delayed cord clamping was shown to not increase risk of maternal blood loss. Uterine massage was shown to be beneficial in postpartum hemorrhage and was also shown to be a potential cause for increased bleeding. Placental blood drainage results shown decreased blood loss, shorter duration and decreased complications during the third stage. Similarly, placental blood drainage was found to have no effect on maternal blood loss. The use of uterotonics are beneficial, however; results vary on which drug is more effective. Controlled cord traction was shown to have a non-significant effect on maternal blood loss.

Conclusion: Active management of third stage of labor is still recommended for the prevention and treatment of postpartum hemorrhage. Further research needed on all intervention to assess effectiveness due to differing results and lack of literature. Possible research using single interventions to measure if one intervention alone decreases postpartum hemorrhage versus multiple interventions used in combination.