Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

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

16.11.2010
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
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: elisabeth.jangsten@gu.se

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

Helena Aaberg | idw
Further information:
http://hdl.handle.net/2077/23833

More articles from Studies and Analyses:

nachricht Real-time feedback helps save energy and water
08.02.2017 | Otto-Friedrich-Universität Bamberg

nachricht The Great Unknown: Risk-Taking Behavior in Adolescents
19.01.2017 | Max-Planck-Institut für Bildungsforschung

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: Breakthrough with a chain of gold atoms

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

Im Focus: DNA repair: a new letter in the cell alphabet

Results reveal how discoveries may be hidden in scientific “blind spots”

Cells need to repair damaged DNA in our genes to prevent the development of cancer and other diseases. Our cells therefore activate and send “repair-proteins”...

Im Focus: Dresdner scientists print tomorrow’s world

The Fraunhofer IWS Dresden and Technische Universität Dresden inaugurated their jointly operated Center for Additive Manufacturing Dresden (AMCD) with a festive ceremony on February 7, 2017. Scientists from various disciplines perform research on materials, additive manufacturing processes and innovative technologies, which build up components in a layer by layer process. This technology opens up new horizons for component design and combinations of functions. For example during fabrication, electrical conductors and sensors are already able to be additively manufactured into components. They provide information about stress conditions of a product during operation.

The 3D-printing technology, or additive manufacturing as it is often called, has long made the step out of scientific research laboratories into industrial...

Im Focus: Mimicking nature's cellular architectures via 3-D printing

Research offers new level of control over the structure of 3-D printed materials

Nature does amazing things with limited design materials. Grass, for example, can support its own weight, resist strong wind loads, and recover after being...

Im Focus: Three Magnetic States for Each Hole

Nanometer-scale magnetic perforated grids could create new possibilities for computing. Together with international colleagues, scientists from the Helmholtz Zentrum Dresden-Rossendorf (HZDR) have shown how a cobalt grid can be reliably programmed at room temperature. In addition they discovered that for every hole ("antidot") three magnetic states can be configured. The results have been published in the journal "Scientific Reports".

Physicist Dr. Rantej Bali from the HZDR, together with scientists from Singapore and Australia, designed a special grid structure in a thin layer of cobalt in...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Booth and panel discussion – The Lindau Nobel Laureate Meetings at the AAAS 2017 Annual Meeting

13.02.2017 | Event News

Complex Loading versus Hidden Reserves

10.02.2017 | Event News

International Conference on Crystal Growth in Freiburg

09.02.2017 | Event News

 
Latest News

Switched-on DNA

20.02.2017 | Materials Sciences

Second cause of hidden hearing loss identified

20.02.2017 | Health and Medicine

Prospect for more effective treatment of nerve pain

20.02.2017 | Health and Medicine

VideoLinks
B2B-VideoLinks
More VideoLinks >>>