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Birth 2020 Jul 29. Epub 2020 Jul 29.

Department of Anthropology, Oregon State University, Portland, OR, USA.

Background: Postpartum hemorrhage (PPH) is a potential childbirth complication. Little is known about how third-stage labor is managed by midwives in the United States, including use of uterotonic medication during community birth. Access to uterotonic medication may vary based on credentials of the midwife or state regulations governing midwifery. Read More

Curr Drug Res Rev 2020 Jun 27. Epub 2020 Jun 27.

Department of Gynecology & Obstetrics, Zagazig General Hospital, Zagazig, El-Sharkia. Egypt.

Background: Postpartum hemorrhage (PPH) is one of the primary causes of maternal mortality and morbidity during the third stage of labor. Oxytocin is the gold standard uterotonic agent for the prevention of PPH.

Objective: We aimed to compare the efficacy of oxytocin administered intramuscularly (IM) or intravenously (IV) for the preventive management of PPH. Read More

Prehosp Emerg Care 2020 Jul 13:1-6. Epub 2020 Jul 13.

Received February 12, 2020 from Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Australia (BVS, SH, LP, SR, EB); School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia (SH, SR, EB) Revision received June 14, 2020; accepted for publication June 19, 2020.

Aim: Primary postpartum hemorrhage (PPH) is a life-threatening obstetric emergency that can be mitigated through the administration of a uterotonic to actively manage the third stage of labor. This study describes the prehospital administration of oxytocin by paramedics following attendance of out-of-hospital (OOH) births.

Methods: A retrospective analysis was undertaken of all OOH births between the 1 January 2018 and 31 December 2018 attended by the Queensland Ambulance Service. Read More

J BUON 2020 Mar-Apr;25(2):597-604

University of Novi Sad, School of Medicine, Novi Sad, Serbia.

Cervical cancer is the third most common malignancy in pregnancy. Pregnancy does not have a detrimental effect on the survival of patients with cervical carcinoma. Management of cervical carcinoma in pregnancy depends on the stage of the disease, tumor size, nodal status, pathohistological characteristics of the tumor, the gestation of pregnancy, age and parity of patient and her motivation to preserve the pregnancy. Read More

Nurse Educ Pract 2020 May 30;46:102808. Epub 2020 May 30.

Department of Midwifery, Faculty of Health Sciences, Manisa Celal Bayar University, Manisa, Turkey. Electronic address:

This study examined the effects of simulation training on student midwives' management skills for normal childbirth and their satisfaction. This study utilized a quantitative, quasi-experimental, comparison group research design. Students were placed into two groups according to the last digit of their school identity number (odd versus even), given by The Directorate of Student Affairs. Read More

J Midwifery Womens Health 2020 May 19;65(3):410-416. Epub 2020 May 19.

Eisner Pediatric and Family Medical Center, Los Angeles, California.

Tranexamic acid (TXA) is an antifibrinolytic pharmacologic agent with demonstrated effectiveness for reducing the incidence of death from blood loss following trauma and major surgery. In intrapartum care, TXA is being used in in conjunction with uterotonic agents to treat postpartum hemorrhage (PPH). Based on the findings of the WOMAN trial that found TXA reduced maternal death due to PPH, the World Health Organization recommends that TXA be part of the standard comprehensive PPH treatment package, and US professional organizations recognize its use as adjunctive treatment for PPH. Read More

J Midwifery Womens Health 2020 May 18;65(3):301-305. Epub 2020 May 18.

School of Nursing, Vanderbilt University, Nashville, Tennessee.

Arch Gynecol Obstet 2020 03 2;301(3):643-653. Epub 2020 Mar 2.

Department of obstetrics and gynecology, The First Hospital of Lanzhou University, Key Laboratory of Gynecologic Oncology Gansu Province, Lanzhou, 730000, Gansu, People's Republic of China.

Background: Clinical studies and trials have shown that oxytocin can effectively reduce postpartum bleeding, whether by intramuscular (IM) injection or intravenous (IV) injection. These two methods are widely used in the prevention and treatment for the third stage of childbirth. However, it is unclear whether the subtle differences between the mode of these routes have any effect on maternal outcomes. Read More

J Environ Public Health 2020 5;2020:4717520. Epub 2020 Feb 5.

Health Service Management Specialists, Department of Public Health, Wachemo University, Hosanna, Ethiopia.

Pregnancy-related death is a cause for maternal and newborn mortality and morbidity as well as an obstacle for economic growth. Three-quarters of mothers' lives can be saved if women have access to a skilled health worker at delivery and emergency obstetric care. This evaluation was conducted to assess skilled delivery service implementation level by using three dimensions (availability, compliance, and acceptability) and identify major contributing issues for underutilization of the service. Read More

J Matern Fetal Neonatal Med 2020 Feb 23:1-5. Epub 2020 Feb 23.

IVF Unit, Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.

Pregnancies conceived by fertilization (IVF) are associated with a higher prevalence of perinatal complications than pregnancies conceived spontaneously, even after correction of confounding factors. Little is known about the prevalence of complications of the third stage of labor in IVF pregnancies. To compare the prevalence and types of complications of the third stage of labor following vaginal delivery of singleton infants born to matched groups of women who conceived through IVF or spontaneously. Read More

BMC Health Serv Res 2020 Jan 6;20(1):16. Epub 2020 Jan 6.

Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Suite W5009C, Baltimore, MD, 21205, USA.

Background: Increased coverage of antenatal care and facility births might not improve maternal and newborn health outcomes if quality of care is sub-optimal. Our study aimed to assess the facility readiness and health worker knowledge required to provide quality maternal and newborn care.

Methods: Using an audit tool and interviews, respectively, facility readiness and health providers' knowledge of maternal and immediate newborn care were assessed at all 23 birthing centers (BCs) and the District hospital in the rural southern Nepal district of Sarlahi. Read More

J Pak Med Assoc 2019 Dec;69(12):1790-1793

King Edward Medical University, Lahore.

Objective: To compare the duration of 3rd stage of labour and blood-loss in patients with and without placental cord blood drainage following normal vaginal delivery.

Methods: The quasi-experimental study was conducted at the Services Hospital, Lahore, Pakistan, from October4, 2015, to April 4, 2016, and comprised pregnant women aged 18-40 years with any parity having gestation >36 weeks and haemoglobin >7.0gm. Read More

Int J Womens Health 2019 5;11:577-588. Epub 2019 Nov 5.

Research Institute of Health Sciences (IRSS), Ouagadougou, Burkina Faso.

Background And Aim: The quality of maternity care in low-income countries has often been questioned. The objective of this study was to describe the trend of the percentage of staff trained on selected obstetric care topics and their level of knowledge of maternal care over a 5-year period in Burkina Faso.

Methods: We conducted a secondary analysis of data from two national emergency obstetric and newborn care (EmONC) needs assessments. Read More

BMC Health Serv Res 2019 Nov 29;19(1):915. Epub 2019 Nov 29.

Averting Maternal Death and Disability, Columbia University, NY and FHI 360, Columbia, North Carolina, USA.

Background: Improving maternal and newborn health indicators are key if Ethiopia is to achieve the Sustainable Development Goals. To do so, women need access to skilled attendance at birth and emergency obstetric and newborn care. To maximize their impact, understanding gaps in workers' knowledge is required to remedy the weakness. Read More

Int J Gynaecol Obstet 2020 Feb 2;148(2):238-242. Epub 2019 Dec 2.

Obstetrics and Gynecology Department, Kasr Al Aini Hospital, Cairo University, Cairo, Egypt.

Objective: To compare effectiveness and safety of carbetocin and misoprostol for prevention of postpartum hemorrhage (PPH) among low-risk women.

Methods: Randomized controlled trial among 150 pregnant women with low risk of PPH admitted for vaginal delivery at Kasr Al Ainy Hospital, Cairo, Egypt, between July 2018 and May 2019. Participants were assigned to two groups by a web-based randomization system ensuring allocation concealment. Read More

Acta Obstet Gynecol Scand 2020 03 18;99(3):374-380. Epub 2019 Nov 18.

Department of Clinical Science, University of Bergen, Bergen, Norway.

Introduction: Isolated single umbilical artery (iSUA) refers to single umbilical artery cords with no other fetal malformations. The association of iSUA to adverse outcome of pregnancy has not been consistently reported, and whether iSUA carries increased risk of third stage of labor complications has not been studied. We aimed to investigate the risk of adverse perinatal outcome, third stage of labor complications, and associated placental and cord characteristics in pregnancies with iSUA. Read More

PLoS One 2019 10;14(10):e0208367. Epub 2019 Oct 10.

Promoting the Quality of Medicines Program, U.S. Pharmacopeial Convention, Rockville, Maryland, United States of America.

Background: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality in Nigeria and in most low- and middle-income countries. The World Health Organization (WHO) strongly recommends oxytocin as effective, affordable, and the safest drug of first choice in the prevention and treatment of PPH in the third stage of labor. However, there are concerns about its quality. Read More

PLoS One 2019 3;14(10):e0222843. Epub 2019 Oct 3.

Department of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Background: Active management of third stage of labor is the most indispensable intervention to avert post-partum hemorrhage which is one of the typical causes of maternal morbidity and mortality. Therefore, the aim of the study was to assess practice and factors associated with active management of third stage of labor among obstetric care providers in referral hospitals.

Methods: Institution based cross-sectional study design was conducted from April 1-30, 2018. Read More

BMC Pregnancy Childbirth 2019 Sep 4;19(1):325. Epub 2019 Sep 4.

Department of Cardiology, University Hospitals Birmingham NHS Trust, Edgbaston, Birmingham, B15 2TH, UK.

Background: Women with cardiac disease are thought to be at increased risk of post-partum haemorrhage. We sought to assess the estimated blood loss (EBL) in our cohort of women with and without cardiac disease (CD) in a quaternary hospital in the UK. Our population consisted of both congenital and acquired CD; and low risk women who delivered in our unit between 01/01/2012-30/09/2016. Read More

Rev Lat Am Enfermagem 2019 Aug 19;27:e3165. Epub 2019 Aug 19.

Queens University, School of Nursing, Belfast, Irlanda del Norte.

Objective: to identify evidence concerning the contribution of health technologies used to prevent and control hemorrhaging in the third stage of labor.

Method: systematic review with database searches. First, two researchers independently selected the papers and, at a second point in time, held a reconciliation meeting. Read More

J Matern Fetal Neonatal Med 2019 Aug 30:1-7. Epub 2019 Aug 30.

Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev , Be'er Sheva , Israel.

To examine whether prior cesarean delivery (CD) in the first stage of labor (non-progressive labor in the first stage - NPL1), when compared with CD in the second stage of labor (non-progressive labor in the second stage - NPL2), is associated with different rates of third stage placental complications in the subsequent delivery. A retrospective cohort study, of all deliveries following a CD due to NLP1 or NLP2 that occurred between the years 1988 and 2013, was undertaken. Multiple gestation pregnancies, known uterine malformations or uterine fibroids were excluded. Read More

Sex Reprod Healthc 2019 Oct 9;21:21-25. Epub 2019 May 9.

Department of Community Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt.

Introduction: Retained placenta can be defined as lack of expulsion of the placenta within 30 min of delivery of the infant. It is a significant cause of maternal mortality and morbidity throughout the developing world.

Aim Of The Work: The aim of this study was to compare the efficacy of intra-umbilical vein injection of carbetocin versus oxytocin in the management of retained placenta. Read More

Am J Obstet Gynecol 2020 01 20;222(1):71.e1-71.e6. Epub 2019 Jul 20.

Department of Obstetrics and Gynecology University of Texas Southwestern Medical Center, Dallas, TX.

Background: Because nearly one-third of births in the United States are now achieved by cesarean delivery, comprising more than 1.27 million women each year, national organizations have recently published revised guidelines for the management of labor. These new guidelines stipulate that labor arrest should not be diagnosed unless ≥6 cm cervical dilatation has been reached or labor has been stimulated for at ≥6 hours. Read More

Ci Ji Yi Xue Za Zhi 2019 Jul-Sep;31(3):158-162

Department of Urology, S. P. Medical College, Bikaner, Rajasthan, India.

Objective: Active management of the third stage of labor (AMTSL) is a critical intervention for the prevention of postpartum hemorrhage (PPH), which is still the most common cause of maternal morbidity and mortality worldwide. The objective of the study is to compare the effect of intramuscular methylergometrine, rectal misoprostol, and low-dose intravenous oxytocin in the AMTSL in terms of amount of blood loss and duration of the third stage of labor, cost-effectiveness, and side effect profile.

Materials And Methods: Seventy-five pregnant patients admitted in the maternity ward for vaginal delivery from February 2017 to February 2018 received either intramuscular methylergometrine (0. Read More

Afr Health Sci 2019 Mar;19(1):1517-1524

University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria, Obstetrics and Gynaecology.

Background: Adjunctive uterotonic in patients at risk of primary post-partum haemorrhage may reduce its incidence.

Objective: To compare the effectiveness and safety of adjunctive rectal misoprostol with adjunctive intravenous oxytocin for the prevention of primary post-partum haemorrhage in at risk patients.

Materials And Methods: A total of 122 patients with risk factors for uterine atony were allocated to receive either 600µg of rectal misoprostol (n= 61) or 20IU of oxytocin infusion (n=61) after routine management of third stage of labour. Read More

Midwifery 2019 Aug 3;75:110-116. Epub 2019 May 3.

Women and Families Service Group, Sunshine Coast Hospital and Health Service, Australia.

Objective: This study aimed to describe practices used during the third stage of labour in a cohort of Australian women and explore clinical outcomes such as postpartum hemorrhage and clinical decision making associated with these practices.

Design: This study employed a prospective cohort design and reports a secondary analysis of a primary study that examined factors associated with PPH; specifically relating to third stage management practices.

Setting: It was conducted in three linked sites, in Queensland, Australia: a regional hospital, rural hospital and a private-practising midwifery service. Read More

Cochrane Database Syst Rev 2019 04 29;4:CD001808. Epub 2019 Apr 29.

Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon, USA, 97239.

Background: Active management of the third stage of labour reduces the risk of postpartum blood loss (postpartum haemorrhage (PPH)), and is defined as administration of a prophylactic uterotonic, early umbilical cord clamping and controlled cord traction to facilitate placental delivery. The choice of uterotonic varies across the globe and may have an impact on maternal outcomes. This is an update of a review first published in 2001 and last updated in 2013. Read More

Eur J Obstet Gynecol Reprod Biol 2019 May 26;236:160-165. Epub 2019 Mar 26.

Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Hadassah School of Medicine Jerusalem, Israel. Electronic address:

Objectives: To identify risk factors and complications associated with 3 stage of labor removal of placental fragments (3 SRPF) by manual uterine revision under a strict protocol.

Study Design: Ten years retrospective register-based cohort study of vaginal deliveries. Women with 3 SRPF n = 3297 (exposed) and those without n = 97,888 (non exposed) were compared. Read More

Am J Obstet Gynecol 2019 07 13;221(1):65.e1-65.e18. Epub 2019 Mar 13.

Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom. Electronic address:

Background: Third-trimester studies in selected high-risk pregnancies have reported that low cerebroplacental ratio, due to high pulsatility index in the umbilical artery, and or decreased pulsatility index in the fetal middle cerebral artery, is associated with increased risk of adverse perinatal outcomes.

Objective: To investigate the predictive performance of screening for adverse perinatal outcome by the cerebroplacental ratio measured routinely at 35-37 weeks' gestation.

Study Design: This was a prospective observational study in 47,211 women with singleton pregnancies undergoing routine ultrasound examination at 35 to 37 weeks' gestation, including measurement of umbilical artery-pulsatility index and middle cerebral artery-pulsatility index. Read More

Gynecol Obstet Fertil Senol 2019 05 11;47(5):465-470. Epub 2019 Mar 11.

Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.

Objective: The aim of the study was to assess the impact of the introduction of training workshops on the quality of prevention and management of Post-Partum Hemorrhage (PPH) in a type III university center.

Methods: A clinical audit was carried out in our type III university center before and after the introduction of training workshops on the prevention and management of PPH, in two periods between January 1st to December 31st 2011 and March 1st and August 1st, 2015. Training workshops were according to the recommendations for clinical practice of the National College of Gynecologists-Obstetricians French published in 2014, and included a theoretical portion and a simulation of low fidelity manikin. Read More

Am J Obstet Gynecol 2019 07 23;221(1):59.e1-59.e15. Epub 2019 Feb 23.

Inserm CIC 1413, Nantes University Hospital, Nantes, France.

Background: To assess both severe maternal and neonatal mortality and morbidity after attempted operative vaginal deliveries by residents under supervision and by attending obstetricians.

Study Design: Secondary analysis of a 5-year prospective study with cross-sectional analysis including 2192 women with live singleton term fetuses in vertex presentation who underwent an attempted operative vaginal delivery in a tertiary care university hospital. Obstetricians who attempted or performed an operative vaginal delivery were classified into 2 groups according to their level of experience: attending obstetricians (who had 5 years or more of experience) and obstetric residents (who had less than 5 years of experience) under the supervision of an attending obstetrician. Read More

Obstet Gynecol 2019 03;133(3):e208-e225

Labor causes severe pain for many women. There is no other circumstance in which it is considered acceptable for an individual to experience untreated severe pain that is amenable to safe intervention while the individual is under a physician's care. Many women desire pain management during labor and delivery, and there are many medical indications for analgesia and anesthesia during labor and delivery. Read More

Obstet Gynecol 2019 03;133(3):595-597

Labor causes severe pain for many women. There is no other circumstance in which it is considered acceptable for an individual to experience untreated severe pain that is amenable to safe intervention while the individual is under a physician's care. Many women desire pain management during labor and delivery, and there are many medical indications for analgesia and anesthesia during labor and delivery. Read More

Cochrane Database Syst Rev 2019 02 13;2:CD007412. Epub 2019 Feb 13.

School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, Ireland.

Background: Active management of the third stage of labour involves giving a prophylactic uterotonic, early cord clamping and controlled cord traction to deliver the placenta. With expectant management, signs of placental separation are awaited and the placenta is delivered spontaneously. Active management was introduced to try to reduce haemorrhage, a major contributor to maternal mortality in low-income countries. Read More

Hepatology 2019 12 12;70(6):2035-2046. Epub 2019 Apr 12.

Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan.

In Japan, bezafibrate (BF) is a second-line agent for primary biliary cholangitis (PBC) that is refractory to ursodeoxycholic acid (UDCA) treatment. From a retrospective cohort (n = 873) from the Japan PBC Study Group, we enrolled 118 patients who had received UDCA monotherapy for at least 1 year followed by combination therapy with UDCA+BF for at least 1 year. GLOBE and UK-PBC scores after UDCA monotherapy (i. Read More

J Obstet Gynaecol Res 2019 Apr 20;45(4):841-848. Epub 2019 Jan 20.

Department of Obstetrics & Gynaecology, Govt Medical College, Ambikapur, India.

Aim: To evaluate the effect of low dose (1 g) of intravenous tranexamic acid (TXA) before caesarean delivery upon the mean blood loss during and after surgery as well side effects of the drug and to compare these effects with those who did not receive this medication in a referral hospital situated at the tribal terrain of Chhattisgarh.

Methods: Total 100 women fulfilling inclusion criteria and shifted for caesarean section were studied. Fifty women comprising the study group were given one gram TXA (10 mL) intravenously over 10-20 min before skin incision whereas the other 50 women did not receive the drug (control group). Read More

Am J Obstet Gynecol 2019 02 25;220(2):191.e1-191.e7. Epub 2018 Oct 25.

Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. Electronic address:

Background: A low rate of primary cesarean delivery is expected to reduce some of the major complications that are associated with a repeat cesarean delivery, such as uterine rupture, adhesive placental disorders, hysterectomy, and even maternal death. Since 2014, and in alignment with the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, we changed our approach to labor dystocia, defined as abnormal progression of labor, by allowing a longer duration of the second stage of labor.

Objective: To examine the effect of prolonging the second stage of labor on the rate of cesarean delivery, and maternal and neonatal outcomes. Read More

Obstet Gynecol Surv 2018 Dec;73(12):695-702

Consultant in Maternal-Fetal Medicine, Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Importance: Obstetric anal sphincter injuries (OASISs) complicate approximately 1 in 10 deliveries.

Objective: The aims of this study were to review and compare recommendations from recently published national guidelines regarding OASISs at vaginal delivery.

Evidence Acquisition: Three national guidelines on OASISs at vaginal delivery are presented through a descriptive review: Royal College of Obstetricians and Gynaecologists on "The Management of Third- and Fourth-Degree Perineal Tears," American College of Obstetricians and Gynecologists on "Prevention and Management of Obstetric Lacerations at Vaginal Delivery," and Society of Obstetricians and Gynaecologists of Canada on "Obstetrical Anal Sphincter Injuries (OASIS): Prevention, Recognition, and Repair. Read More

Int J Environ Res Public Health 2018 12 9;15(12). Epub 2018 Dec 9.

Department of Pregnancy Pathology, Department of Woman's Health, School of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.

: To evaluate the effectiveness of pharmacological and non-pharmacological pain relief methods and to compare them. : 258 women were included in the study and interviewed using a questionnaire and the visual analogue scale for pain. They were divided into six groups depending on chosen method of labour pain relief: epidural anaesthesia (EA; = 42), water immersion and water birth (WB; = 40), nitrous oxide gas for pain control (G; = 40), transcutaneous electrical nerve stimulation (TENS) ( = 50), multiple management (MM; = 42), none (N; = 44). Read More

J Obstet Gynaecol Can 2018 12;40(12):e841-e855

Ottawa, ON.

Objective: To review the clinical aspects of postpartum hemorrhage (PPH) and provide guidelines to assist clinicians in the prevention and management of PPH. These guidelines are an update from the previous Society of Obstetricians and Gynaecologists of Canada (SOGC) clinical practice guideline on PPH, published in April 2000.

Evidence: Medline, PubMed, the Cochrane Database of Systematic Reviews, ACP Journal Club, and BMJ Clinical Evidence were searched for relevant articles, with concentration on randomized controlled trials (RCTs), systematic reviews, and clinical practice guidelines published between 1995 and 2007. Read More

Mymensingh Med J 2018 Oct;27(4):793-797

Dr Parul Akhter, Assistant Professor, Department of Gynae & Obs, Sir Salimullah Medical College, Mitford, Dhaka, Bangladesh.

The third stage of labour is considered to be the most critical part of child birth due to the risk of post partum haemorrhage (PPH). To compare the effectiveness of carbetocin and oxytocin in the management of 3rd stage of labour in preventing post partum hemorrhage, this experimental clinical trial was conducted in the Department of Obstetrics and Gynecology, Sir Salimulla Medical College Hospital, Dhaka, Bangladesh from January 2015 to June 2016. Three hundred women undergoing normal vaginal delivery were consecutively enrolled. Read More

Eur J Obstet Gynecol Reprod Biol 2019 Jan 28;232:22-29. Epub 2018 Oct 28.

Aurora Health Care, Department of Obstetrics and Gynecology, Aurora Sinai Medical Center, Milwaukee, WI, United States.

Background: Retained placenta is the most common second-trimester delivery complication. As the optimal third stage of labor duration remains undefined, complications associated with retained placentas are difficult to study.

Objective(s): To determine the optimal third stage of labor duration in second-trimester deliveries based on estimates of time-specific probabilities of placental delivery, placental intervention, and postpartum complication. Read More

Arch Gynecol Obstet 2019 01 1;299(1):129-134. Epub 2018 Nov 1.

Meir Medical Center, Sackler School of Medicine, Tel Aviv University, 59 Tchernichovsky St., 4428164, Kfar Saba, Israel.

Purpose: Normal labor curves have not been assessed for women undergoing a trial of labor after cesarean delivery (TOLAC). This study examined labor patterns during TOLAC in relation to epidural analgesia use.

Methods: Retrospective cohort study of deliveries of women undergoing TOLAC at a single, academic, tertiary medical center. Read More

Women Birth 2019 Aug 19;32(4):327-335. Epub 2018 Oct 19.

Center for Evidence-Based Health Care, Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, Zhonghe District, New Taipei City, Taiwan; Shared Decision Making Resource Center, Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, Zhonghe District, New Taipei City, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address:

Background: Aromatherapy is a treatment method that applies fragrant extracts from herbal plants, existed long ago in medical history as a major treatment approach and now used as an auxiliary treatment and sometimes a major treatment for pain and stress management, including those that occur in labour.

Aim: We aimed to conduct a meta-analysis of randomised controlled trials of the effectiveness of aromatherapy on labour pain and duration reduction.

Methods: We searched the Pubmed, EMBASE, Cochrane Central Register of Controlled Trials, Google Scholar and Clinicaltrials. Read More

Syst Rev 2018 10 20;7(1):170. Epub 2018 Oct 20.

School of Health Sciences, Health Professions 2239, Central Michigan University, Mount Pleasant, MI, USA.

Background: Postpartum hemorrhage (PPH) and the amount of blood loss are directly related to management of the third stage of labor. No previous report has compared the effects of carbetocin to those of misoprostol. The aim of this systematic review was to compare the effects of carbetocin to those of misoprostol for management of the third stage of labor and for the prevention of PPH. Read More

Int J Gynaecol Obstet 2019 Jan 22;144(1):56-61. Epub 2018 Oct 22.

ClinAmygate, Cairo, Egypt.

Objective: To assess the impact of a cervical traction maneuver (Amr's maneuver) used in conjunction with active management of the third stage of labor (AMTSL) on the incidence of postpartum hemorrhage (PPH).

Method: The present multicenter randomized controlled trial was conducted in Cairo between March 1, 2016, and June 30, 2017. Women aged at least 18 years who had singleton pregnancies and were candidates for vaginal delivery were enrolled. Read More

Cochrane Database Syst Rev 2018 09 22;9:CD009332. Epub 2018 Sep 22.

UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, Geneva, Switzerland, CH-1211.

Background: There is general agreement that oxytocin given either through the intramuscular or intravenous route is effective in reducing postpartum blood loss. However, it is unclear whether the subtle differences between the mode of action of these routes have any effect on maternal and infant outcomes. This is an update of a review first published in 2012. Read More

Turk J Obstet Gynecol 2018 Sep 3;15(3):188-192. Epub 2018 Sep 3.

University of Health Sciences, İzmir Tepecik Training and Research Hospital, Department of Obstetrics and Gynecology, İzmir, Turkey.

Postpartum hemorrhage is a potentially life-threatening, albeit preventable, condition that persists as a leading cause of maternal death. It occurs mostly during the third stage of labor, and active management of the third stage of labor (AMTSL) can prevent its occurrence. AMTSL is a recommended series of steps, including the provision of uterotonic drugs immediately upon fetal delivery, controlled cord traction, and massage of the uterine fundus, as developed by the World Health Organization. Read More

Pregnancy Hypertens 2018 Jul 9;13:166-170. Epub 2018 Jun 9.

Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel. Electronic address:

Objective: To examine the association between hypertensive disorders of pregnancy and third stage placental complications.

Methods: A retrospective cohort study based on Soroka Medical Center institutional computerized database. All vaginal deliveries of women between the years 1998-2013 were included. Read More