PREVENTION OF AFTERBIRTH AND EARLY POSTPARTUM HEMORRHAGE: ACTIVE OR WAIT-AND-SEE POLICY?


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Abstract

Ministry of Health and Social Development of Russia, Moscow The author has examined the data currently available in the literature on labor management tactics for the prevention of afterbirth and early postpartum hemorrhage. Wait-to-see policy envisages the natural process of labor and early postpartum. Active policy is distinguished by the use of uterotonic agents and umbilical ligation and crossing within 1 minute after childbirth and by the implementation of measures for rapid birth of the placenta with further uterine massage. The results of systematic reviews of randomized clinical trials have strongly demonstrated that the active management tactic, primarily the use of uterotonic drugs, assists in reducing blood loss, the rate of postpartum hemorrhages, and the duration of the third stage of labor. In the literature there is now no agreement regarding the benefits of administration of an uterotonic agent before or after birth of the placenta and the optimal time for umbilical ligation to prevent hemorrhage. The active management tactic may be accompanied by a number of side effects and complications. However, the frequency of complications is low and the degree of side effects is generally of no significant clinical value. The active management tactic is an effective method for reducing afterbirth and early postpartum blood loss.

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About the authors

O. R BAYEV

Academician V. I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health and Social Development of Russia

Email: o_baev@oparina4.ru

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