Timing of manual placenta removal to prevent postpartum hemorrhage: is it time to act? |
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| Authors: | Kelly Cummings Dorota A Doherty Paul J Wendel John C Morrison |
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| Institution: | 1. Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA,;2. School of Women’s and Infants’ Health, University of Western Australia, Perth, Australia, and;3. Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, MS, USA |
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| Abstract: | Objective: The length of the third stage of labor is an important risk factor for postpartum hemorrhage (PPH). Current practice recommends manual placenta removal, if not delivered spontaneously, within 30?min. The review reexamines the evidence to determine the optimal length of the third stage of labor.Methods: A MEDLINE search that associated the length of the third stage of labor with the risk of PPH was undertaken.Results: A retrospective cohort study revealed the risk of a PPH became significant at 10?min (odds ratio?=?2.1, 95% confidence interval: 1.6–2.6), and had doubled by 20?min (odds ratio?=?4.3, 95% confidence interval: 3.3–5.5). A receiver operator curve determined the optimal length of the third stage of labor to prevent PPH was 18?min. A follow up randomized controlled trial showed that hemodynamic compromise secondary to a PPH can be reduced with manual placenta removal at 10 compared to 15?min (6.4 versus 19.2%, p?=?0.001).Conclusion: The time interval of 15?min may be a more appropriate time interval to recommend placental removal to prevent PPH. |
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| Keywords: | Maternal morbidity maternal mortality placental removal time interval postpartum hemorrhage third stage of labor |
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