Active management of the third stage of labor (AMTSL) without controlled cord traction at Nongkai Hospital

Abstract

Objective : To compare simplified active management of the third stage of labor (AMTSL) package with the full AMTSL package in the active management of the third stage of labor with respect to the amount of bleeding.

Design : Randomized controlled trial.

Setting : Nongkai Hospital.

Materials and Methods : Two hundred women with imminent vaginal delivery were randomized into two groups, namely: the study and control groups in the study group, simplified package of the third-stagelabor management [oxytocin injection, cord clamping, uterine message, without controlled cord traction (CCT)] were performed. In the control group, full package of the third-stage-management (oxytocin injection, cord clamping, controlled cord traction and uterine message) were performed. The primary outcome measure was blood loss during the third stage of labor. The duration of the third stage of labor, blood transfusion, the use of additional oxytocin to treat PPH, blood loss of 500 ml or more, incidence of retained placenta, manual removal of the placenta, additional surgical procedures (e.g. hysterectomy, ligation of blood vessels), incidence of uterine inversion were compared.

Results : In 200 cases with vaginal delivery, 100 cases were assigned to the study group, and the rest 100 cases were assigned to the control group. The mean blood loss in the study group [without controlled cord traction (CCT)] and the control group (full AMTSL package) were 354.12 ml and 335.25 ml, respectively. The mean blood loss was 18.87 ml lower in the control group (full AMTSL package) than in the study group (without CCT): however, this difference was not statistically significant (P = 0.12). The duration of the third stage of labor in the control group (full AMTSL package) was statistically significantly less than the study group (without CCT) (6.85 ± 5.91 vs. 9.21 ± 3.64: P = 0.001). The incidence of postpartum hemorrhage, blood transfusion, the use of additional oxytocin to treat postpartum hemorrhage (PPH), retained placenta, manual removal of the placenta were lower in the control group (full AMTSL package) but there was not statistical difference. There was no additional surgical procedures (e.g. hysterectomy, ligation of vessels), incidence of uterine inversion in both groups.

Conclusions : Blood loss in third stage of labor in the simplified AMTSL package was higher than in the full AMTSL package, but without statistically significance. The present findings support a larger clinical trial to determine whether the simplified AMTSL package may not increase the risk of PPH and it may, therefore, be recommended for the peripheral levels of the health care system.