Efficacy of skin-to-skin contact between mother and newborn during the third stage of labour in reducing postpartum haemorrhage risk

Abstract

Objective: To evaluate the efficacy of skin-to-skin contact (SSC) in reducing the risk of postpartum haemorrhage and blood loss after childbirth.

Background: Postpartum haemorrhage is a leading cause of preventable mortality, particularly in developing countries. Although various strategies exist for its prevention, the effect of SSC remains unclear.

Design: Systematic review with meta-analysis.

Data sources: Searches were conducted in PubMed, Scopus, Cochrane Library, CINAHL, Google Scholar, and Web of Science up to May 2024.

Review methods: The PRISMA guidelines were followed. Prospective clinical trials were included and assessed using the revised Cochrane RoB 2 tool for randomized controlled trials and ROBINS-I for non-randomized studies. The meta-analysis was performed using STATA 18.

Results: The analysis of 18 prospective clinical trials showed that SSC during the third stage of labour was associated with a reduction in the incidence of uterine atony and a lower likelihood of blood loss greater than or equal to 500 mL. Additionally, SSC was linked to a decrease in mean blood loss during the third stage of labour, the first two hours postpartum, and at 24 h postpartum. No significant differences were found in the incidence of severe postpartum haemorrhage.

Conclusions: SSC during the third stage of labour appears to be effective in reducing the risk of uterine atony, blood loss of 500 mL or more, and mean postpartum blood loss. This suggests significant potential for improving obstetric outcomes. However, given the high risk of bias in the studies analysed, caution is required in interpreting these results. Further high-quality research is needed to confirm these benefits, particularly in caesarean sections.

Impact: Postpartum haemorrhage is one of the leading causes of maternal mortality, particularly in developing countries. This meta-analysis suggests that SSC during the third stage of labour could be a key intervention in reducing the risk of uterine atony, blood loss of 500 mL or more, and mean postpartum blood loss. These findings are especially relevant in countries where access to uterotonic drugs is limited, highlighting the need for cost-effective, evidence-based alternatives to improve maternal health.

Patient or public contribution: No patient or public contribution. TRIAL REGISTRATION : PROSPERO registration number CRD 42024543192.

Keywords: Kangaroo-Mother Care Method; Labor Stage, Third; Obstetrical complications; Postpartum Hemorrhage; Skin-to-skin contact; Uterine Atony.

Fig. 1

Flow diagram illustrating the search and selection process

Fig. 2

Bias Risk Assessment in the Studies Included in the Meta-Analysis: a Randomized Controlled Trials according to RoB2. b Non-Randomized Studies according to ROBINS-I

Fig. 3

Meta-analysis of the effect of SSC on uterine atony: a Overall effect; b Effect according to country income level

Fig. 4

Meta-analysis of the effect of SSC on blood loss ≥ 500 mL: a Overall effect; b Effect according to study type

Fig. 5

Meta-analysis of the effect of SSC on mean blood loss: a Overall effect; b Effect according to type of study