Slide 1
This presentation will:
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Briefly review the two methods of third stage management, and present the advantages/disadvantages for each method.
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Briefly review the procedure of active management
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Present the evidence comparing Active vs. Physiologic Management.
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Present available evidence comparing Controlled Cord Traction vs Minimal
Intervention.
Present available evidence regarding specific Oxytocic Drugs.
Discuss the available evidence evaluating Nipple Stimulation and effect on PPH.
The latest evidence on new oxytocics.
Slide 6
Active management reduces the duration of the third stage and reduces postpartum hemorrhage.
Slide 7
WHO recommends giving oxytocin within 2 minutes to give provider time to give injection
Continuous gentle traction
Uterine massage every 15 minutes for 2 hours
Slide 12
The rate of postpartum hemorrhage was significantly lower with active management than with physiological management in both trials (5.9% vs. 17.9% [Bristol] and 6.8% vs. 16.5% [Hinchingbrooke]).
Slide 13
The duration of third stage was reduced, as well as the need for blood transfusion and therapeutic oxytocics in the active management groups compared to the physiological management group.
Slide 15
Misoprostol holds promise for use as an oxytocic. It is effective, practical and inexpensive. In contrast to the other three oxytocics, misoprostol is stable (heat, light) and does not have to be given by injection. It can be given orally or rectally.
Slide 21
Because syntometrine has more side effects: nausea, vomiting and increased blood pressure, it is less safe. Therefore, since oxytocin is equally effective and safer, it should be the first choice.
Slide 25
Oxytocics are not heat stable, but oxytocin is better than ergometrine/
methyl-ergometrine.
Slide 26
Need oxytocics; efforts should be made to make it available at all levels of care.
Getting the uterus to contract probably requires some “surge” of oxytocin, such as that delivered by an injection of oxytocin. When oxytocics are not available, CCT and fundal massage should be performed.
Natural oxytocin produced by suckling of baby at breast may be useful for helping to maintain the tone of an already contracted uterus.
