Choose your font:
 Mukta Malar
 Open Sans Condensed
 Source Sans Pro


[Valid RSS] RSS

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

Description of this bibliographical database (AFAR website)
Currently 3053 records
YouTube channel (tutorial)

Created on : 11 Apr 2016
Modified on : 11 Apr 2016

 Modify this record
Do not follow this link unless you know an editor’s password!

Share: Facebook logo   Tweeter logo   Easy

Bibliographical entry (without author) :

Active versus expectant management for women in the third stage of labour - Cochrane Database of Systematic Reviews

Author(s) :

Begley, Cecily M; Gyte, Gillian ML; Devane, Declan; McGuire, William; Weeks, Andrew

Year of publication :


URL(s) :…

Résumé (français)  :

Abstract (English)  :

Active management of the third stage of labour involves giving a prophylactic uterotonic, early cord clamping and controlled cord traction to deliver the placenta. With expectant management, signs of placental separation are awaited and the placenta is delivered spontaneously. Active management was introduced to try to reduce haemorrhage, a major contributor to maternal mortality in low-income countries.
To compare the effectiveness of active versus expectant management of the third stage of labour.
Search strategy:
We searched the Cochrane Pregnancy and Childbirth Group Trials Register (30 September 2014) and reference lists of retrieved studies.
Selection criteria:
Randomised and quasi-randomised controlled trials comparing active versus expectant management of the third stage of labour.
Data collection and analysis:
Two review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction.
Main results:
We included seven studies (involving 8247 women), all undertaken in hospitals, six in high-income countries and one in a low-income country. Four studies compared active versus expectant management, and three compared active versus a mixture of managements. We used random-effects in the analyses because of clinical heterogeneity. There was an absence of high-quality evidence according to GRADE assessments for our primary outcomes. The evidence suggested that for women at mixed levels of risk of bleeding, active management showed a reduction in the average risk of maternal primary haemorrhage at time of birth (more than 1000 mL) (average risk ratio (RR) 0.34, 95% confidence interval (CI) 0.14 to 0.87, three studies, 4636 women, GRADE: very low quality) and of maternal haemoglobin (Hb) less than 9 g/dL following birth (average RR 0.50, 95% CI 0.30 to 0.83, two studies, 1572 women, GRADE: low quality). We also found no difference in the incidence in admission of infants to neonatal units (average RR 0.81, 95% CI 0.60 to 1.11, two studies, 3207 infants, GRADE: low quality) nor in the incidence of infant jaundice requiring treatment (0.96, 95% CI 0.55 to 1.68, two studies, 3142 infants, GRADE: very low quality). There were no data on our other primary outcomes of very severe postpartum haemorrhage (PPH) at the time of birth (more than 2500 mL), maternal mortality, or neonatal polycythaemia needing treatment.
Active management also showed a significant decrease in primary blood loss greater than 500 mL, and mean maternal blood loss at birth, maternal blood transfusion and therapeutic uterotonics during the third stage or within the first 24 hours, or both, and significant increases in maternal diastolic blood pressure, vomiting after birth, after-pains, use of analgesia from birth up to discharge from the labour ward and more women returning to hospital with bleeding (outcome not pre-specified). There was also a decrease in the baby’s birthweight with active management, reflecting the lower blood volume from interference with placental transfusion.
In the subgroup of women at low risk of excessive bleeding, there were similar findings, except there was no significant difference identified between groups for severe haemorrhage or maternal Hb less than 9 g/dL (at 24 to 72 hours).
Hypertension and interference with placental transfusion might be avoided by using modifications to the active management package, e.g. omitting ergot and deferring cord clamping, but we have no direct evidence of this here.

Sumário (português)  :

Full text (private) :

 ➡ Access requires authorization

Comments :

Argument (français) :

Argument (English):

Argumento (português):

Keywords :

➡ oxytocin-3rd stage of labour

Author of this record :

Import 11/04/2016 — 11 Apr 2016

Discussion (display only in English)
➡ Only identified users

 I have read the guidelines of discussions and I accept all terms (read guidelines)


New expert query --- New simple query

Creating new record --- Importing records

User management --- Dump database --- Contact


This database is managed by Alliance francophone pour l'accouchement respecté (AFAR,
affiliated with Collectif interassociatif autour de la naissance (CIANE,
It is fed by the voluntary contributions of persons interested in the sharing of scientific data.
If you agree with this project, you can support us in several ways:
(1) contributing to this database if you have a minimum training in documentation
(2) or financially supporting AFAR (see below)
(3) or joining the AFAR (or another society affiliated with CIANE).
Sign in or create an account to follow changes or become an editor.
Contact afar.association(arobase) for more information.

Valid CSS! Valid HTML!
Donating to AFAR (click “Faire un don”) will help us to maintain and develop sites and public
databases towards the support of parents and caregivers’ informed decisions with respect to childbirth