Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:


Active management of the third stage of labour reduces risk of bleeding

Active management of the third stage of labour means that women lose less blood than with a more expectant approach, reveals a thesis from the University of Gothenburg, Sweden, in conjunction with Sahlgrenska University Hospital.

A number of studies in the West have shown that heavy bleeding following childbirth has become more common in recent years. In her thesis, midwife and researcher Elisabeth Jangsten decided to look at how heavily women bleed after giving birth in Angola and Sweden following active and expectant management.

The study in Angola covered 1,590 women, while the Swedish study included 1,802. The Swedish study was conducted at two of the delivery units at Sahlgrenska University Hospital, which make use of both active and expectant management.

Active management means that the umbilical cord is clamped straight after the baby is delivered, the midwife gives the mother medication to stimulate uterine contractions, presses a hand on the lower part of the uterus, and pulls gently on the umbilical cord while the mother pushes, so delivering the placenta. With an expectant approach, the umbilical cord is also clamped straight after the baby is delivered, but the midwife then waits for signals that the placenta has separated from the wall of the uterus before encouraging the mother to bear down and push out the placenta. Uterine stimulants are always given if the need arises.

“In Angola, 7.5% of women lost more than a litre of blood in the expectantly managed group, and only 1% in the actively managed group,” says Jangsten, a midwife at Sahlgrenska University Hospital/Östra Hospital and researcher at the Institute of Health and Care Sciences at the Sahlgrenska Academy. “In Sweden, the difference was bigger: almost 17% of women lost more than a litre in the expectantly managed group, and only 10% in the actively managed group.”

The researchers did not find any difference between the two methods in terms of perceived afterpains in either Sweden or Angola. However, afterpains were more common the more children the women had had. They also found that first-time mothers in Sweden lost more blood and were more likely to require a blood transfusion than those who had given birth before. More women bled heavily in the Swedish study, which can be explained partly by all blood being measured carefully during the course of the study, but may also be down to other factors, such as excess weight, big babies and greater intervention during childbirth.

The recommendation in Sweden has been to give mothers uterine stimulants immediately after delivery.

“But not every element of the active management approach is always included, although the World Health Organisation, the International Confederation of Midwives and the International Federation of Gynaecology and Obstetrics have been recommending active management for a number of years, albeit with slightly later clamping of the umbilical cord,” says Jangsten.
However, administering uterine stimulants routinely following all types of delivery has been questioned by those who believe that there should be as little medical intervention in childbirth as possible in order not to disrupt the natural process. They believe instead that treatment should be given only if the situation requires it.

“In the light of our results in this thesis, I think that active management should be the first choice for hospital deliveries. However, women should be informed about the different methods available so that they can be involved in decisions about the management of the third stage of labour if they so wish.”

Postpartum haemorrhage is the medical term for bleeding following childbirth, both before and after the placenta is delivered. Total blood loss is normally around 600 ml, but sometimes the bleeding is heavier because the placenta does not separate properly from the uterus, or because the muscles in the walls of the uterus do not contract strongly enough. If this happens, the mother is given medication to stimulate uterine contractions, and sometimes the placenta may need to be removed manually.
For more information, please contact:
Elisabeth Jangsten, midwife at the delivery unit at Sahlgrenska University Hospital/Östra Hospital and researcher at the Institute of Health and Care Sciences at the Sahlgrenska Academy, tel. +46 31 786 6063, mobile: +46 762 26 39 73, e-mail:

Title of thesis: Third stage of labour – studies on management, blood loss and pain in Angola and Sweden.

Helena Aaberg | idw
Further information:

More articles from Studies and Analyses:

nachricht Diagnoses: When Are Several Opinions Better Than One?
19.07.2016 | Max-Planck-Institut für Bildungsforschung

nachricht High in calories and low in nutrients when adolescents share pictures of food online
07.04.2016 | University of Gothenburg

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: New 3-D wiring technique brings scalable quantum computers closer to reality

Researchers from the Institute for Quantum Computing (IQC) at the University of Waterloo led the development of a new extensible wiring technique capable of controlling superconducting quantum bits, representing a significant step towards to the realization of a scalable quantum computer.

"The quantum socket is a wiring method that uses three-dimensional wires based on spring-loaded pins to address individual qubits," said Jeremy Béjanin, a PhD...

Im Focus: Scientists develop a semiconductor nanocomposite material that moves in response to light

In a paper in Scientific Reports, a research team at Worcester Polytechnic Institute describes a novel light-activated phenomenon that could become the basis for applications as diverse as microscopic robotic grippers and more efficient solar cells.

A research team at Worcester Polytechnic Institute (WPI) has developed a revolutionary, light-activated semiconductor nanocomposite material that can be used...

Im Focus: Diamonds aren't forever: Sandia, Harvard team create first quantum computer bridge

By forcefully embedding two silicon atoms in a diamond matrix, Sandia researchers have demonstrated for the first time on a single chip all the components needed to create a quantum bridge to link quantum computers together.

"People have already built small quantum computers," says Sandia researcher Ryan Camacho. "Maybe the first useful one won't be a single giant quantum computer...

Im Focus: New Products - Highlights of COMPAMED 2016

COMPAMED has become the leading international marketplace for suppliers of medical manufacturing. The trade fair, which takes place every November and is co-located to MEDICA in Dusseldorf, has been steadily growing over the past years and shows that medical technology remains a rapidly growing market.

In 2016, the joint pavilion by the IVAM Microtechnology Network, the Product Market “High-tech for Medical Devices”, will be located in Hall 8a again and will...

Im Focus: Ultra-thin ferroelectric material for next-generation electronics

'Ferroelectric' materials can switch between different states of electrical polarization in response to an external electric field. This flexibility means they show promise for many applications, for example in electronic devices and computer memory. Current ferroelectric materials are highly valued for their thermal and chemical stability and rapid electro-mechanical responses, but creating a material that is scalable down to the tiny sizes needed for technologies like silicon-based semiconductors (Si-based CMOS) has proven challenging.

Now, Hiroshi Funakubo and co-workers at the Tokyo Institute of Technology, in collaboration with researchers across Japan, have conducted experiments to...

All Focus news of the innovation-report >>>



Event News

#IC2S2: When Social Science meets Computer Science - GESIS will host the IC2S2 conference 2017

14.10.2016 | Event News

Agricultural Trade Developments and Potentials in Central Asia and the South Caucasus

14.10.2016 | Event News

World Health Summit – Day Three: A Call to Action

12.10.2016 | Event News

Latest News

Resolving the mystery of preeclampsia

21.10.2016 | Health and Medicine

Stanford researchers create new special-purpose computer that may someday save us billions

21.10.2016 | Information Technology

From ancient fossils to future cars

21.10.2016 | Materials Sciences

More VideoLinks >>>