A comparison of active management and expectant management of the third stage of labour: a Swedish randomised controlled trial

Abstract

Objective: to compare blood loss in women actively and expectantly managed in the third stage of labour.

Design: randomised controlled trial (RCT).

Setting: two delivery units at a Swedish university hospital.

Population: healthy women with normal pregnancies, at gestational age 34-43 weeks, with singleton cephalic presentation and expected vaginal delivery.

Methods: the women were randomly allocated to either active (n = 903) or expectant (n = 899) management of the third stage of labour.

Main outcome measures: the primary outcome was blood loss > 1000 ml, and secondary outcomes were mean blood loss, duration of third stage, retained placenta, haemoglobin level and blood transfusion.

Results: blood loss > 1000 ml occurred in 10% of the actively managed group and 16.8% of the expectantly managed group (P < 0.001). Mean blood loss was 535 ml in the actively managed group and 680 ml in the expectantly managed group (P < 0.001). A prolonged duration of the third stage was associated with increased blood loss. Increased placenta weight was associated with increased blood loss. The haemoglobin level was 118 g/dl in actively managed women and 115/dl in expectantly managed women (P < 0.001) the day after childbirth. The occurrence of retained placenta and the number of blood transfusions did not differ between the groups.

Conclusions: active management of the third stage of labour was associated with less blood loss compared with expectant management. It is reasonable to advocate this regime, especially in primiparous women.