Uterotonics and Postpartum Haemorrhage
Postpartum hemorrhage is an important cause of maternal mortality in developing countries, especially Africa and Asia. Active management of the third stage of labor consists of the use of oxytocin soon after delivery of the baby, controlled cord traction, and delayed clamping and cutting of the cord until the deliverer is ready to apply traction.
In a study published recently in The Lancet, Gulmezoglu et al showed that controlled cord traction may be omitted from the management of the third stage of labor without a significant increase in the risk for severe hemorrhage. Thus, the main component of active management is the uterotonic and it is the key intervention that will prevent excessive bleeding after childbirth.
Despite this, controlled cord traction is safe and its use can be continued in settings in which it is routinely practiced.
22 March 2012
Active management of the third stage of labour with and without controlled cord traction: a randomised, controlled, non-inferiority trial. Gulmezoglu AM, Lumbiganon P, Landoulsi S et al. The Lancet - 6 March 2012 DOI: 10.1016/S0140-6736(12)60206-2.