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Bibliographical entry (without author) :

Active versus expectant management of third stage of labour - The Lancet - Vol. 351, 9116 - ISBN: 01406736 - p.1659

Author(s) :

Odent, Michel

Year of publication :


URL(s) :…

Résumé (français)  :

Abstract (English)  :

(Correspondence. Full text of the letter)

Jane Rogers and colleagues (March 7, p 693)1 excluded from their trial women with haemoglobin concentrations below 10 g/dL. The results of large studies,2, 3 however, indicate that haemoglobin concentrations of 9–9·5 g/dL are associated with optimum perinatal outcomes (they reflect good plasma volume expansion). In the Hinchingbrooke trial, 4934 women were judged ineligible and among the 1512 women randomly assigned active or expectant management, the mean concentration of haemoglobin was 11·1 g/dL.

My second comment concerns the short definition of full expectant management. Rogers and colleagues do not mention the main factors that facilitate the delivery of the placenta, for example, a perfectly adjusted thermoenvironment. Concentrations of catecholamines affect the risk of postpartum haemorrhage. In practice, it is almost always necessary to overheat during the third stage. Another factor is an undisturbed eye-to-eye and skin-to-skin contact between mother and baby. Any distraction can interfere with the spontaneous release of oxytocin. Cutting the cord when it stops pulsating or suggesting positions represent unnecessary distractions. Ideally, during an expectant management of third stage there would be nobody else in the birthing room apart from an experienced and low-profile midwife.

In Pithiviers, France, where the active management of third stage is unknown,4 a rate of postpartum haemorrhage of 88% would have been deemed unacceptable.

Rogers, J, Wood, J, McCandlish, R, Ayers, S, Truesdale, A, and Elbourne, D. Active versus expectant management of third stage of labour: the Hinchingbrooke randomised controlled trial. Lancet. 1998; 351: 693–699
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Steer, P, Alan, MA, Wadsworth, J, and Welch, A. Relation between maternal haemoglobin concentration and birth weight in different ethnic groups. BMJ. 1995; 310: 489–491
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La, TT and Pung, TC. Anaemia in pregnancy– is the current definition meaningful?. Eur J Obstet Gynecol Reprod Biol. 1996; 68: 53–58
View in Article | Summary | Full Text PDF | PubMed | Scopus (31)
Gillett, J. Childbirth in Pithiviers, France. Lancet. 1979; ii: 894–896
View in Article | Abstract | Scopus (6)

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Keywords :

➡ physiology ; postpartum hemorrhage ; oxytocin ; oxytocin-3rd stage of labour

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