Timing of manual placenta removal to prevent postpartum hemorrhage: is it time to act?

Kelly Cummings, Dorota A. Doherty, Everett F. Magann, Paul J. Wendel, John C. Morrison

    Research output: Contribution to journalReview article

    7 Citations (Scopus)

    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.

    Original languageEnglish
    Pages (from-to)3930-3933
    Number of pages4
    JournalJournal of Maternal-Fetal and Neonatal Medicine
    Volume29
    Issue number24
    DOIs
    Publication statusPublished - 16 Dec 2016

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