Thilaganathan B, Cutner A, Latimer J, Beard R
Department of Obstetrics and Gynaecology, Royal Sussex County Hospital, Brighton, UK.
Eur J Obstet Gynecol Reprod Biol. 1993 Jan;48(1):19-22. doi: 10.1016/0028-2243(93)90048-h.
To compare active management with physiological management of the third stage of labour in women at low risk of postpartum haemorrhage.
Randomised allocation of women in labour at low risk of postpartum haemorrhage to either physiological or active management of the third stage.
Labour ward in a district general hospital.
193 Women with spontaneous vaginal delivery at term completed the study. Exclusion criteria were induction or augmentation of labour, antepartum or previous postpartum haemorrhage, premature rupture of membranes, previous caesarean section, raised blood pressure, cervical lacerations and third degree tears.
Active management with syntometrine and controlled cord traction; or physiological management, where the cord was not clamped and the placenta was delivered by maternal effort.
Blood loss was measured subjectively at delivery and estimated objectively by comparing the haemoglobin in labour with that on the third postpartum day. The duration of the third stage was also measured as was the incidence of retained placenta and blood transfusion.
There was no significant difference in the estimated blood loss or haemoglobin drop between the two groups (P > 0.5). In addition the duration of the third stage was significantly longer in the physiological group (P < 0.001). Out of 90 women having physiological management, 7 received oxytocics for presumed postpartum haemorrhage. Only one case in the active group required further oxytocics and one other case in this group required a manual removal of placenta.
This preliminary study confirms that active management results in a reduction in the length of the third stage of labour. However, it suggests that active management does not reduce blood loss when compared to physiological management in the woman at low risk of postpartum haemorrhage.
比较产后出血低风险女性第三产程的积极处理与生理性处理。
将产后出血低风险的分娩女性随机分配至第三产程的生理性处理组或积极处理组。
地区综合医院的产房。
193例足月自然阴道分娩的女性完成了本研究。排除标准包括引产或催产、产前或既往产后出血、胎膜早破、既往剖宫产史、血压升高、宫颈裂伤和三度会阴裂伤。
用合成缩宫素和控制脐带牵引进行积极处理；或生理性处理，即不夹紧脐带，由产妇自行娩出胎盘。
分娩时主观测量失血量，并通过比较产时血红蛋白与产后第三天血红蛋白客观估计失血量。同时测量第三产程的持续时间以及胎盘残留和输血的发生率。
两组间估计失血量或血红蛋白下降无显著差异（P>0.5）。此外，生理性处理组的第三产程持续时间显著更长（P<0.001）。在90例接受生理性处理的女性中，7例因疑似产后出血接受了催产素治疗。积极处理组仅1例需要进一步使用催产素，该组另有1例需要人工剥离胎盘。
这项初步研究证实，积极处理可缩短第三产程的时长。然而，研究表明，与产后出血低风险女性的生理性处理相比，积极处理并不能减少失血量。
