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Abstract
INTRODUCTION
Loss of more than 500 mL of blood following childbirth is usually caused by failure of the uterus to contract fully after
delivery of the placenta, and occurs in over 10% of deliveries, with a 1% mortality rate worldwide. Other causes of postpartum
haemorrhage include retained placental tissue, lacerations to the genital tract, and coagulation disorders. Uterine atony
is more likely in women who have had a general anaesthetic or oxytocin, an over-distended uterus, a prolonged or precipitous
labour, or who are of high parity. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following
clinical questions: What are the effects of non-drug interventions and of drug interventions to prevent primary postpartum
haemorrhage? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2010 (Clinical
Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included
harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare
products Regulatory Agency (MHRA).
RESULTS
We found 40 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation
of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions:
active management of the third stage of labour, carboprost injection, controlled cord traction, ergot compounds (ergometrine/methylergotamine),
immediate breastfeeding, misoprostol (oral, rectal, sublingual, or vaginal), oxytocin, oxytocin plus ergometrine combinations,
prostaglandin E2 compounds, and uterine massage.
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Authors
Institution
Virginia Common Wealth University Medical Centre, Richmond, USA.
Source
Clinical evidence 2011: 2011 pgPub Type(s)
Journal ArticleLanguage
eng
PubMed ID
21463537