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Administration of uterotonic drugs before and after placental delivery as part of the management of the third stage of labour following vaginal birth

Soltani H, Hutchon DR, Poulose TA
Published Online: 
8 August 2010

Active management of the third stage of labour has been shown to reduce the risk of postpartum haemorrhage. It usually involves clamping and cutting the cord, administration of uterotonic drugs and controlled cord traction (inserting pressure on the uterus and pulling the cord mainly with the sign of placental separation). Although active management has been shown to reduce the risk of postpartum haemorrhage, it may have an impact on the well-being of the mother and baby in terms of the amount of blood that has been transfused to the baby before the separation of the placenta. The optimum timing of uterotonic administration (before or after placental expulsion) can have a major role in this process and it has not been systematically investigated previously. This review of three trials (1671 participants) found that routine administration of oxytocin with the anterior shoulder compared with use of oxytocin after delivery of the placenta did not have any influence on the amount of bleeding postpartum or retained placenta. The route of administration of oxytocin in two of the three included studies was through intravenous infusion. Cord management at delivery was consistent with double clamping and immediate cutting after delivery of the baby. Application of controlled cord traction was slightly different among the included studies. In two of the studies, the placenta was delivered with controlled cord traction when signs of placental separation were present. Fundal pressure on the uterus was used in one study from the beginning to ensure continued uterine contraction. Oxytocin was the only uterotonic assessed. There were no assessments of any impact on neonatal health. More well designed studies using consistent approaches in this area of the management of the third stage of labour are required.

This record should be cited as: 
Soltani H, Hutchon DR, Poulose TA. Timing of prophylactic uterotonics for the third stage of labour after vaginal birth. Cochrane Database of Systematic Reviews 2010, Issue 8. Art. No.: CD006173. DOI: 10.1002/14651858.CD006173.pub2
Assessed as up to date: 
30 March 2010