原创力文档how effective are the components of active management of the third stage of labor如何有效的组件是积极管理的第三阶段的劳动.pdfVIP
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Sheldon et al. BMC Pregnancy and Childbirth 2013, 13:46
/1471-2393/13/46
RESEARCH ARTICLE Open Access
How effective are the components of active
management of the third stage of labor?
1,2* 2 2 2 1,3
Wendy R Sheldon , Jill Durocher , Beverly Winikoff , Jennifer Blum and James Trussell
Abstract
Background: Active management of the third stage of labor is recommended for the prevention of post-partum
hemorrhage and commonly entails prophylactic administration of a uterotonic agent, controlled cord traction, and
uterine massage. While oxytocin is the first-choice uterotonic, it is not known whether its effectiveness varies by
route of administration. There is also insufficient evidence regarding the value of controlled cord traction or uterine
massage. This analysis assessed the independent and combined effectiveness of all three interventions, and the
effect of route of oxytocin administration on post-partum blood loss.
Methods: Secondary data were analyzed from 39202 hospital-based births in four countries and two clinical
regimens: one in which oxytocin was administered following delivery of the baby; the other in which it was not.
We used logistic regression to examine associations between clinical and demographic variables and post-partum
blood loss ≥ 700 mL.
Results: Among those with no oxytocin prophylaxis, provision of controlled cord traction reduced hemorrhage risk
by nearly 50% as compared with expectant management (P 0.001). Among those with oxytocin prophylaxis,
provision of controlled cord traction reduced hemorrhage risk by 66% when oxytocin was intramuscular (P 0.001),
but conferred no benefit when oxytocin was intravenous. Route of administration was important when oxytocin
wa
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