Database - Alliance francophone pour l'accouchement respecté (AFAR)

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Created on : 19 Nov 2004
Modified on : 01 Dec 2007

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Bibliographical entry (without author) :

Should active management of the third stage of labor be routine? AMERICAN FAMILY PHYSICIAN. 67 (10): 2119-2120 MAY 15

Author(s) :

Nothnagle M, Taylor JS

Year of publication :

2003

URL(s) :

Résumé (français)  :

Abstract (English)  :

Background. Expectant management of the third stage of labor involves allowing the placenta to deliver spontaneously or aided by gravity or nipple stimulation. Active management involves administration of a prophylactic oxytocic before delivery of the placenta and, usually, early cord clamping and cutting, and controlled cord traction on the umbilical cord.

Objectives. The objective of this review(1) was to assess the effects of active versus expectant management on blood loss, postpartum hemorrhage, and other maternal and perinatal complications of the third stage of labor.

Search Strategy. The authors searched the Cochrane Pregnancy and Childbirth Group trials register.

Selection Criteria. Randomized trials comparing active and expectant management of the third stage of labor in women who were expecting a vaginal delivery were included.

Data Collection and Analysis. Trial quality was assessed, and data were extracted independently by the reviewers.

Primary Results. Five studies were included. Four of the trials were of good quality. Compared with expectant management, active management (in the setting of a maternity hospital) was associated with the following reduced risks: maternal blood loss (weighted mean difference [WMD], -79.33 mL, 95 percent confidence interval [CI], -94.29 to -64.37); postpartum hemorrhage greater than 500 mL (relative risk [RR], 0.38, 95 percent CI, 0.32 to 0.46); and prolonged third stage of labor (WMD, -9.77 minutes, 95 percent CI, -10.00 to -9.53). Active management was associated with an increased risk of maternal nausea (RR, 1.83, 95 percent CI, 1.51 to 2.23), vomiting, and raised blood pressure (probably due to the use of ergometrine). No advantages or disadvantages were apparent for the infant.

Reviewers’ Conclusions. Routine active management is superior to expectant management in terms of blood loss, postpartum hemorrhage, and other serious complications of the third stage of labor. Active management is, however, associated with an increased risk of unpleasant side effects (e.g., nausea and vomiting) and hypertension when ergometrine is used. Active management should be the routine management of choice for women expecting to deliver a baby by vaginal delivery in a maternity hospital. The implications are less clear in other settings, including home birth in developing and industrialized countries.

Sumário (português)  :

Resumen (español)  :

Comments :

Il s’agit d’une "review" de 5 études. Cependant, la bibliographie de cet article contient seulement 3 références (COMBS,CA 1991; MCDONALD S,2003; PRENDIVILLE WJ, 2003).
Cela me parrait quand même relativement peu pour un article qui se qualifie de "review"!

Argument (français) :

Review: La gestion active du travail devrait être la gestion de routine pour les accouchements par voie vaginale

Argument (English):

Review: Active management should be the routine management of choice for women expecting to deliver a baby by vaginal delivery in a maternity hospital

Argumento (português):

Argumento (español):

Keywords :

➡ duration of labour ; postpartum hemorrhage ; active management of labor

Author of this record :

Sandrine Péneau — 19 Nov 2004