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DELIVRANCE DIRIGEE
SYSTEMATIQUE
Delphine HEQUET
DES gynécologie-obstétrique
QU’EST CE QU’UNE DELIVRANCE
DIRIGEE ?
DELIVRANCE DIRIGEE = tout ce qui s’oppose à une délivrance naturelle ou physiologique, à savoir, l’expectative.
ENJEUX DE LA DELIVRANCE
DIRIGEE
HEMORRAGIE DE LA DELIVRANCE :
500 000 déces par an dans le mondedont 99% dans les PVD
Premières études dès 1932 : Moir rapporte son étude concernant l’utilisation de l’ergotamine
Dans les années 50 aux Etats-Unis, utilisation quasi-systématique de l’ergotamine
FAUT-IL REALISER UNE
DELIVRANCE DIRIGEE SYSTEMATIQUE ?
META-ANALYSE PRENDIVILLE, 19889 ETUDES
34 ANS
4494 PATIENTES
Taille des études : de 26 à 1459 patientes
Médicaments utilisés : ergotamine, oxytocine, association ergotamine-ocytocine, prostaglandines
Mode d’administration : intra-vasculaire, intramusculaire, intra-myométrial
Moment d’administration : tête, épaule antérieure, après naissance
RESULTATS
Survenue d’hémorragie de la délivrance
Oxytocic Control Odds ratio 95% CI
Howard (1964) 24/963 25/470 0.43 0.23-0.78
McGinty (1951) 1/150 5/50 0.04 0.01-0.27
Daley (1951) 45/490 80/510 0.55 0.38-0.80
Rooney (1985) 34/346 42/278 0.61 0.38-0.99
Friedman (1957) 24/717 2/177 2.19 0.82-5.83
0.57
Recours aux ocytociques en post-partum
Oxytocic Control Odds ratio 95% CI Howard (1964) 46/984 58/475 0.32 0.21-0.49 Newton (1961) 1/50 11/50 0.15 0.05-0.51Friedman (1957) 100/717 36/177 0.61 0.39-0.96 0.40
Hypertension en post-partum (PAS 17O ou PAS 140 et PAD 90)
Oxytocic Control Odds ratio 95% CI
Howard (1964) 153/983 50/475 1.57 1.15-2.15Mc Ginty ( &ç(-) 43/150 6/50 2.45 1.17-5.15Hacker (1979) 9/20 0/6 6.77 1.03-44.38Friedman (1975) 14/717 1/177 2.32 0.64-8.33 1.76
AU TOTAL : HEMORRAGIES DE LA DELIVRANCE DIMINUEES DE 40%
RESULTATS CONTRADICOIRES
DRIFE, 1997 : Rétention placentaire 3 fois plus fréquentes en cas de délivrance dirigée
GIACALONE, 2000
MAC DONALD, 2000 Pas de différence significative de survenue d’hémorragie de la délivrance entre le
BEGLEY, 1990 groupe délivrance dirigée et le groupe délivrance physiologique.
AUTRES ETUDES EN FAVEUR D’UNE DELIVRANCE DIRIGEE
SYSTEMATIQUE
PRENDIVILLE, 1988 : essai randomisé management actif versus management passif de la délivrance
1695 patientes
OXYTOCIN 5 UI + ERGOMETRINE 0.5 mg, IV, épaule antérieure, traction sur le
cordon clampé à moins de 30 sec de la naissance
RESULTATS : 5.9% HD versus 17.9% , odd ratio 3.3
PIERRE, 1991
THILAGANATHAN, 1993 Management actif diminue la durée de la troisième phase du travail
POESCHMANN, 1991
ROGER, 1998 Management actif diminue le risque d’hémorragie de la délivrance
COMMENT REALISER UNE DELIVRANCE
DIRIGEE
DELIVRANCE DIRIGEE MECANIQUE
DRAINAGE DU CORDON
THOMAS, 1990 : Etude randomisée, 1908 femmes, administration prophylactique d’oxytocines à
l’épaule antérieure. Pas de bénéfice supplémentaire du drainage.
DELAI DE SECTION DU CORDON
OXFORD MIDWIVES RESEARCH GROUP, 1991 : Etude randomisée, 554 femmes, section rapide ou
différée. Pas de différence.
TRACTION CONTROLLEE DU CORDON
KHAN, 1997 : Etude randomisée, 1648 femmes.
Groupe « actif » : oxytocique 10 UI IM et traction du cordon
Groupe « passif » : efforts expulsifs maternels
Diminution des hémorragies de la délivrance et des rétentions placentaires dans le
groupe actif.
DELIVRANCE DIRIGEE PHARMACOLOGIQUE
OCYTOCINE + ERGOMETRINE : SYNTOMETRINE
ELBOURNE, 1988 : Méta-analyse, 17 essais randomisés
Efficacité supérieure aux dérivés de l’ergot de
seigle seuls, non concluant versus oxytocine seul
Combine la rapidité d’action de l’ocytocine et la durée prolongée de l’action de l’ergotamine.
Nombreux EI : HTA, angor, arrêt cardiaque
Quasi-totalité des études « management actif-management passif de la délivrance », implique syntométrine.
Largement utilisée aux Etats-Unis, non disponible en France.
OCYTOCINE : SYNTOCINON
MC DONALD, 1993 : Etude randomisée en double aveugle, oxytocine versus oxytocine+ergométrine 3497 patientes 1730 oxytocine(5 UI) + ergométrine(0,5 mg) dont 664 à bas risque d’hémorragie ( grossesse unique, parité inf 5, pas d’ATCD d’HD, travail spontané inf à 12 h, accouchement voie basse normal) 1753 oxytocine(10 UI) dont 658 à bas risque d’hémorragie
Au total :
ocytocine est aussi efficace que l’association ocytocine-ergométrine et entraine moins d’EI.
AUTRES ETUDES COMPARANT SYNTOCINON-SYNTOMETRINE
ATHAVALE, 1991 KHAN, 1994 Même efficacité, EI moindresSORIANO, 1996
YUEN, 1995ELBOURNE, 1998 Même efficacité, EI moindres mais plus de rétention placentaires
MC DONALD, 2006 : méta-analyse incluant 6 essais, 9332 femmes HD 500-1000 ml : supériorité de syntométrine HD >1000 ml : même efficacité EI ( vomissements, HTA) : supérieurs avec syntométrine
SORIANO, 1996 : administration d’oxytocine à l’expulsion de la tête versus à l’expulsion du placenta meilleure prévention lors d’une administration précoce.
ZAMORA, 1999 : tendance à une diminution d’HD (pas de résultats significatif) lors d’une administration précoce (avant délivrance placentaire) des oxytociques.
COCHRANE, 2006 : Étude en cours
VOIE D’ADMINISTRATION
ETUDE DE LA VOIE OMBILICALE
REDDY, 1989 Réduction des pertes sanguines et de la troisième phase du travailDAHIYA, 1995
CHESNUT, 1987YOUNG, 1988 Pas d’effet statistiquement prouvé
« TIMING » D’ADMINISTRATION
MISOPROSTOL : CYTOTEC
EL-REFAEY, 1997 : Etude prospective descriptive. 600 µg misoprostol per os; efficacité
dans le traitement des HD. Intérêt dans les PVD.
Nombreuses études randomisées
Etudes randomisées MisoprostolEtudes randomisées Misoprostol HD (>1 000) Recours Ocytociques Effets Indésirables
HOFMEYR, 1998 6%-9% RR=0,65 NS 2,8 %-8,4% RR=0,33 Tremblements 19%-5%RR=3,69 250 Misoprotol 400 µg PoVs. 250 Placebo
DANIEL, 1999 7%-15% NS 16%-38% RR=0,47 31 Misoprostol 600 µg PoVs. 34 Placebo
WHO, 2001 4%-3% RR=1,39 15%-11% RR=1,40 Tremblements RR=3,48 9264 Misoprostol 600 µg Po Hyperthermie RR=7,17Vs. 9266 Oxytocine 10 UI IV
NG, 2001 5%-4% RR=1,26 NS 22,6%-14% RR=1,62 1026 Misoprostol 600 µg Po Vs. 1032 Syntométrine IM 1mL
VILLAR, 2002 (Revue) RR=1,36 RR=1,80 Tremblements RR=3,27 10 539 Misoprostol 600 µg Po Hyperthermie RR=6,96Vs. 10 558 Oxytocine IV
O BORO, 2003 1%-0% RR=3,02 NS Tremblements 57%-14% RR=4,06 966 Patientes Misoprostol 600 µg PoVs. Oxytocine IV 10 UI
HOFMEYR, 2004 5,1%-9,2% RR=0,56 NS 57%-56% RR=1,01 NS Mortalité maternelle 2,6%-0% 117 Misoprostol 1 000 µg Po,IR,S Fièvre 9,6%-1,7% RR=5,69Vs. 121 Placebo
LAEGER, 2006 11%-17% RR=0,66 Misoprostol 600 µg SL Vs. Oxytociques
Au total :
Efficacité Moindre
Effets secondaires plus nombreux
Pas d’indication dans les centres équipés
VOIE D’ADMINISTRATION
ETUDE DE LA VOIE INTRA-RECTALE
O’BRIEN, 1998 : 14 présentant une hémorragie de la délivrance, traitées avec succès par 1000 µg de
cytotec intra-rectal seul
DIAB, 1999 : Etude comparant 200 µg misoprostol IR (25 patientes)
400µg misoprostol IR (45 patientes)
syntométrine IM (75 patientes)
Diminution significative des pertes sanguines avec le misoprostol IR quelque soit la dose
BAMIGBOYE, 1996 : 271 patientes 400 µg cytotec IR – 275 patientes placebo
1997 : 241 patientes 400 µg cytotec IR – 250 patientes syntométrine
pas de réduction significative d’hémorragie de la délivrance avec le cytotec
pas d’EI supplémentaire avec cette voie d’administration à ces doses
ANALOGUE PGE2 : NALADOR
POESCHMANN, 1991 : Efficacité équivalente à l’ocytocine mais EI nombreux
ANALOGUE PGF2α
CHUA, 1995 : CARBOPROST versus syntométrine : même efficacité mais EI fréquents (diarrhée) et prix
20 fois supérieur
LAMONT, 2001 : HEMABATE versus syntométrine : même conclusion
Au total : pas d’avantage des prostaglandines dans la prévention des hémorragies de la délivrance
AUTRES PROSTAGLANDINES
DE GROOT, 1996 : Etude randomisée comparant ergométrine – oxytocine
Diminution des pertes sanguines : 5% pour ergométrine versus 9% pour oxytocine
METHYLERGOMETRINE : METHERGIN
CONCLUSION
AVANTAGES A UNE DELIVRANCE DIRIGEE SYSTEMATIQUE
SYNTOCINON ASSOCIE L’EFFICACITE ET PEU D’EFFETS SECONDAIRES
L’UTILISATION DU CYTOTEC EST PEU CONCLUANTE MALGRE LES AVANTAGES QU’IL PRESENTE NOTAMMENT POUR LES PVD
DERNIERES ETUDES PORTENT SUR L’APPLICATION ET LA FAISABILITE D’UNE DELIVRANCE DIRIGEE SYSTEMATIQUE DANS LES PVD :
2003 : Indonésie2004 : Uruguay2005 : Gambie, Angola2006 : Egypte, Tibet, Vietnam
1: Tsu VD, Mai TT, Nguyen YH, Luu HT.Related Articles, Links Reducing postpartum hemorrhage in Vietnam: assessing the effectiveness of active management of third-stage labor.Obstet Gynaecol Res. 2006 Oct;32(5):489-96. 2: Mercer SW, Sevar K, Sadutshan TD.Related Articles, Links Using clinical audit to improve the quality of obstetric care at the Tibetan Delek Hospital in North India: a longitudinal study.Reprod Health. 2006 Jun 7;3:4. 3: Lagro MG, Stekelenburg J.Related Articles, Links [The Millennium project of the United Nations, focusing on adequate postpartum care to reduce maternal and neonatal mortality world-wide]Ned Tijdschr Geneeskd. 2006 May 20;150(20):1143-7. Review. Dutch. 4: Maughan KL, Heim SW, Galazka SS.Related Articles, Links Preventing postpartum hemorrhage: managing the third stage of labor.Am Fam Physician. 2006 Mar 15;73(6):1025-8. Review. 5: Walraven G, Blum J, Dampha Y, Sowe M, Morison L, Winikoff B, Sloan N.Related Articles, Links Misoprostol in the management of the third stage of labour in the home delivery setting in rural Gambia: a randomised controlled trial.BJOG. 2005 Sep;112(9):1277-83. 6: Fenton JJ, Baumeister LM, Fogarty J.Related Articles, Links Active management of the third stage of labor among American Indian women.am Med. 2005 Jun;37(6):410-4. 7: Magann EF, Lanneau GS.Related Articles, Links Third stage of labor.Obstet Gynecol Clin North Am. 2005 Jun;32(2):323-32, x-xi. Review. 8: Clarke J, Butt M.Related Articles, Links Maternal collapse.Curr Opin Obstet Gynecol. 2005 Apr;17(2):157-60. Review. 9: Hofmeyr GJ.Related Articles, Links Evidence-based intrapartum care.Best Pract Res Clin Obstet Gynaecol. 2005 Feb;19(1):103-15. Epub 2004 Dec 13. Review. 10: Strand RT, Da Silva F, Jangsten E, Bergstrom S.Related Articles, Links Postpartum hemorrhage: a prospective, comparative study in Angola using a new disposable device for oxytocin administration.Acta Obstet Gynecol Scand. 2005 Mar;84(3):260-5. 11: Lazarus JV, Lalonde A.Related Articles, Links Reducing postpartum hemorrhage in Africa.Int J Gynaecol Obstet. 2005 Jan;88(1):89-90. 12: Colomar M, Belizan M, Cafferata ML, Labandera A, Tomasso G, Althabe F, Belizan JM; Grupo de Estudio de Practicas Perinatales.Related Articles, Links [Practices of maternal and perinatal care performed in public hospitals of Uruguay]Ginecol Obstet Mex. 2004 Sep;72:455-65. Spanish.
BIBLIOGRAPHIE
13: Cherine M, Khalil K, Hassanein N, Sholkamy H, Breebaart M, Elnoury A.Related Articles, Links Management of the third stage of labor in an Egyptian teaching hospital.Int J Gynaecol Obstet. 2004 Oct;87(1):54-8. 14: Vimala N, Mittal S, Kumar S, Dadhwal V, Mehta S.Related Articles, Links Sublingual misoprostol versus methylergometrine for active management of the third stage of labor.Int J Gynaecol Obstet. 2004 Oct;87(1):1-5. 15: Hofmeyr GJ, Ferreira S, Nikodem VC, Mangesi L, Singata M, Jafta Z, Maholwana B, Mlokoti Z, Walraven G, Gulmezoglu AM.Related Articles, Links Misoprostol for treating postpartum haemorrhage: a randomized controlled trial [ISRCTN72263357].BMC Pregnancy Childbirth. 2004 Aug 6;4(1):16. 16: Chong YS, Su LL, Arulkumaran S.Related Articles, Links Current strategies for the prevention of postpartum haemorrhage in the third stage of labour.Curr Opin Obstet Gynecol. 2004 Apr;16(2):143-50. Review. 17: Gulmezoglu AM, Forna F, Villar J, Hofmeyr GJ.Related Articles, Links Prostaglandins for prevention of postpartum haemorrhage.Cochrane Database Syst Rev. 2004;(1):CD000494. Review. 18: McDonald S, Abbott JM, Higgins SP.Related Articles, Links Prophylactic ergometrine-oxytocin versus oxytocin for the third stage of labour.Cochrane Database Syst Rev. 2004;(1):CD000201. Review. 19: Vivio D, Williams D.Related Articles, Links Active management of the third stage of labor: why is it controversial?J Midwifery Womens Health. 2004 Jan-Feb;49(1):2-3. No abstract available. 20: Strand RT, da Silva F, Bergstrom S.Related Articles, Links Use of cholera beds in the delivery room: a simple and appropriate method for direct measurement of postpartum bleeding.Trop Doct. 2003 Oct;33(4):215-6. 21: Tsu VD, Sutanto A, Vaidya K, Coffey P, Widjaya A.Related Articles, Links Oxytocin in prefilled Uniject injection devices for managing third-stage labor in Indonesia.Int J Gynaecol Obstet. 2003 Oct;83(1):103-11. 22: Nothnagle M, Taylor JS.Related Articles, Links Should active management of the third stage of labor be routine?Am Fam Physician. 2003 May 15;67(10):2119-20. Review. No abstract available. 23: Festin MR, Lumbiganon P, Tolosa JE, Finney KA, Ba-Thike K, Chipato T, Gaitan H, Xu L, Limpongsanurak S, Mittal S, Peedicayil A, Pramono N, Purwar M, Shenoy S, Daly S.Related Articles, Links International survey on variations in practice of the management of the third stage of labour.Bull World Health Organ. 2003;81(4):286-91. Epub 2003 May 16. 24: Oboro VO, Tabowei TO.Related Articles, Links A randomised controlled trial of misoprostol versus oxytocin in the active management of the third stage of labour.J Obstet Gynaecol. 2003 Jan;23(1):13-6. 25: Krapp M, Katalinic A, Smrcek J, Geipel A, Berg C, Germer U, Gembruch U.Related Articles, Links Study of the third stage of labor by color Doppler sonography.Arch Gynecol Obstet. 2003 Feb;267(4):202-4. Epub 2002 Aug 21. 26: Villar J, Gulmezoglu AM, Hofmeyr GJ, Forna F.Related Articles, Links Systematic review of randomized controlled trials of misoprostol to prevent postpartum hemorrhage.Obstet Gynecol. 2002 Dec;100(6):1301-12. Review.
27: Baskett TF.Related Articles, Links Acute uterine inversion: a review of 40 cases.J Obstet Gynaecol Can. 2002 Dec;24(12):953-6. Review. 28: Gulmezoglu AM, Forna F, Villar J, Hofmeyr GJ.Related Articles, Links Prostaglandins for prevention of postpartum haemorrhage.Cochrane Database Syst Rev. 2002;(3):CD000494. Review. Update in: Cochrane Database Syst Rev. 2004;(1):CD000494. 29: Magill-Cuerden J.Related Articles, Links Clinicalfile. Active management of third stage labor. Uterine inversion.Pract Midwife. 2001 Jan;4(1):29. No abstract available. 30: Geelhoed D, Visser L, Agordzo P, Asare K, van Leeuwen JS, van Roosmalen J.Related Articles, Links Active versus expectant management of the third stage of labor in rural Ghana.Acta Obstet Gynecol Scand. 2002 Feb;81(2):172-3. No abstract available. 31: Lokugamage AU, Paine M, Bassaw-Balroop K, Sullivan KR, Refaey HE, Rodeck CH.Related Articles, Links Active management of the third stage at caesarean section: a randomised controlled trial of misoprostol versus syntocinon.Aust N Z J Obstet Gynaecol. 2001 Nov;41(4):411-4. 32: Brucker MC.Related Articles, Links Management of the third stage of labor: an evidence-based approach.J Midwifery Womens Health. 2001 Nov-Dec;46(6):381-92. Review. 33: Elbourne DR, Prendiville WJ, Carroli G, Wood J, McDonald S.Related Articles, Links Prophylactic use of oxytocin in the third stage of labour.Cochrane Database Syst Rev. 2001;(4):CD001808. Review. 34: Gulmezoglu AM, Forna F, Villar J, Hofmeyr GJ.Related Articles, Links Prostaglandins for prevention of postpartum haemorrhage.Cochrane Database Syst Rev. 2001;(4):CD000494. Review. Update in: Cochrane Database Syst Rev. 2002;(3):CD000494. 35: Lamont RF, Morgan DJ, Logue M, Gordon H.Related Articles, Links A prospective randomised trial to compare the efficacy and safety of hemabate and syntometrine for the prevention of primary postpartum haemorrhage.Prostaglandins Other Lipid Mediat. 2001 Oct;66(3):203-10. 36: Gulmezoglu AM, Villar J, Ngoc NT, Piaggio G, Carroli G, Adetoro L, Abdel-Aleem H, Cheng L, Hofmeyr G, Lumbiganon P, Unger C, Prendiville W, Pinol A, Elbourne D, El-Refaey H, Schulz K; WHO Collaborative Group To Evaluate Misoprostol in the Management of the Third Stage of Labour.Related Articles, Links WHO multicentre randomised trial of misoprostol in the management of the third stage of labour.Lancet. 2001 Sep 1;358(9283):689-95. 37: Ng PS, Chan AS, Sin WK, Tang LC, Cheung KB, Yuen PM.Related Articles, Links A multicentre randomized controlled trial of oral misoprostol and i.m. syntometrine in the management of the third stage of labour.Hum Reprod. 2001 Jan;16(1):31-35.
38: Baskett TF.Related Articles, Links A flux of the reds: evolution of active management of the third stage of labour.J R Soc Med. 2000 Sep;93(9):489-93. No abstract available. 39: Prendiville WJ, Elbourne D, McDonald S.Related Articles, Links Active versus expectant management in the third stage of labour.Cochrane Database Syst Rev. 2000;(3):CD000007. Review.
40: McDonald S, Prendiville WJ, Elbourne D.Related Articles, Links Prophylactic syntometrine versus oxytocin for delivery of the placenta.Cochrane Database Syst Rev. 2000;(2):CD000201. Review. Update in: Cochrane Database Syst rev.2004;(1):CD000201. 41: Prendiville WJ, Elbourne D, McDonald S.Related Articles, Links Active versus expectant management in the third stage of labour.Cochrane Database Syst Rev. 2000;(2):CD000007. Review. Update in: Cochrane Database Syst Rev. 2000;(3):CD000007. 42: Dimitrov A, Nikolov A, Krusteva K, Lazarova L, Gurchev E, Karag'ozov I.Related Articles, Links [The active management of the placental period with Remestyp]Akush Ginekol (Sofiia). 1999;38(4):15-7. Bulgarian. 43: Diab KM, Ramy AR, Yehia MA.Related Articles, Links The use of rectal misoprostol as active pharmacological management of the third stage of labor.J Obstet Gynaecol Res. 1999 Oct;25(5):327-32. 44: Anderson T.Related Articles, Links Active versus expectant management of the third stage of labour.Pract Midwife. 1999 Feb;2(2):10-1. Review. No abstract available. 45: Perez-Escamilla R, Dewey KG.Related Articles, Links Active versus expectant management of third stage of labour.Lancet. 1998 May 30;351(9116):1659-60; author reply 1660. No abstract available. 46: Prendiville W.Related Articles, Links Active versus expectant management of third stage of labour.Lancet. 1998 May 30;351(9116):1659; author reply 1660. No abstract available. 47: Odent M.Related Articles, Links Active versus expectant management of third stage of labour.Lancet. 1998 May 30;351(9116):1659; author reply 1660. No abstract available. 48: Rogers J, Wood J, McCandlish R, Ayers S, Truesdale A, Elbourne D.Related Articles, Links Active versus expectant management of third stage of labour: the Hinchingbrooke randomised controlled trial.Lancet. 1998 Mar 7;351(9104):693-9. 49: Walder J.Related Articles, Links Misoprostol: preventing postpartum haemorrhage.Mod Midwife. 1997 Sep;7(9):23-7. 50: de Groot AN.Related Articles, Links The role of oral (methyl)ergometrine in the prevention of postpartum haemorrhage.Eur J Obstet Gynecol Reprod Biol. 1996 Oct;69(1):31-6. Review.
51: Prendiville WJ.Related Articles, Links The prevention of post partum haemorrhage: optimising routine management of the third stage of labour.Eur J Obstet Gynecol Reprod Biol. 1996 Oct;69(1):19-24. Review. 52: Dimitrov A, Nalbanski B, Borisov S, Nikolov A, Dzherov L, Gamishev G.Related Articles, Links [The side effects of the prevention of blood loss in the placental period]Akush Ginekol (Sofiia). 1996;35(3):11-3. Bulgarian.
53: Chua S, Chew SL, Yeoh CL, Roy AC, Ho LM, Selamat N, Arulkumaran S, Ratnam SS.Related Articles, Links A randomized controlled study of prostaglandin 15-methyl F2 alpha compared with syntometrine for prophylactic use in the third stage of labour.Aust N Z J Obstet Gynaecol. 1995 Nov;35(4):413-6. 54: de Groot AN.Related Articles, Links Prevention of postpartum haemorrhage.Baillieres Clin Obstet Gynaecol. 1995 Sep;9(3):619-31. Review. 55: Khan GQ, John IS, Chan T, Wani S, Hughes AO, Stirrat GM.Related Articles, Links Abu Dhabi third stage trial: oxytocin versus Syntometrine in the active management of the third stage of labour.Eur J Obstet Gynecol Reprod Biol. 1995 Feb;58(2):147-51. 56: Dahiya P, Puri M, Rathee S.Related Articles, Links Influence of intraumbilical oxytocin on the third stage of labour.Indian J Med Sci. 1995 Feb;49(2):23-7. 57: Makkonen M, Suonio S, Saarikoski S.Related Articles, Links Intraumbilical oxytocin for management of retained placenta.Int J Gynaecol Obstet. 1995 Feb;48(2):169-72. 58: Gyte GM.Related Articles, Links Evaluation of the meta-analyses on the effects, on both mother and baby, of the various components of 'active' management of the third stage of labour.Midwifery. 1994 Dec;10(4):183-99. 59: Phillips CA, Kinch RA.Related Articles, Links Management of the third stage of labor: a survey of practice among Texas obstetricians.Tex Med. 1994 Dec;90(12):44-7. 60: McDonald SJ, Prendiville WJ, Blair E.Related Articles, Links Randomised controlled trial of oxytocin alone versus oxytocin and ergometrine in active management of third stage of labour.BMJ. 1993 Nov 6;307(6913):1167-71. Erratum in: BMJ 1993 Dec 4;307(6917):1454.
61: Mitchell GG, Elbourne DR.Related Articles, Links The Salford Third Stage Trial. Oxytocin plus ergometrine versus oxytocin alone in the active management of the third stage of labor.Online J Curr Clin Trials. 1993 Aug 13;Doc No 83:[2305 words; 32 paragraphs] Review. 62: Thilaganathan B, Cutner A, Latimer J, Beard R.Related Articles, Links Management of the third stage of labour in women at low risk of postpartum haemorrhage.Eur J Obstet Gynecol Reprod Biol. 1993 Jan;48(1):19-22. 63: Pierre F, Mesnard L, Body G.Related Articles, Links For a systematic policy of i.v. oxytocin inducted placenta deliveries in a unit where a fairly active management of third stage of labour is yet applied: results of a controlled trial.Eur J Obstet Gynecol Reprod Biol. 1992 Jan 31;43(2):131-5. 64: Van Dongen PW, Van Roosmalen J, De Boer CN, Van Rooij J.Related Articles, Links Oxytocics for the prevention of post-partum haemorrhages. A review.Pharm Weekbl Sci. 1991 Dec 13;13(6):238-43. Review. 65: [No authors listed]Related Articles, Links A study of the relationship between the delivery to cord clamping interval and the time of cord separation. Oxford Midwives Research Group.Midwifery. 1991 Dec;7(4):167-76. 66: Athavale RD, Nerurkar NM, Dalvi SA, Bhattacharya MS.Related Articles, Links Umbilical vein oxytocin in the management of third stage of labour.J Postgrad Med. 1991 Oct;37(4):219-20. 67: Poeschmann RP, Doesburg WH, Eskes TK.Related Articles, Links A randomized comparison of oxytocin, sulprostone and placebo in the management of the third stage of labour.Br J Obstet Gynaecol. 1991 Jun;98(6):528-30. 68: Thomas IL, Jeffers TM, Brazier JM, Burt CL, Barr KE.Related Articles, Links Does cord drainage of placental blood facilitate delivery of the placenta?Aust N Z J Obstet Gynaecol. 1990 Nov;30(4):314-8. 69: Begley CM.Related Articles, Links The effect of ergometrine on breast feeding.Midwifery. 1990 Jun;6(2):60-72. 70: Begley CM.Related Articles, Links A comparison of 'active' and 'physiological' management of the third stage of labour.Midwifery. 1990 Mar;6(1):3-17. 71: Candussi G, Carlomagno G, Bouche C, Luksa V.Related Articles, Links [Administration of uterotonic drugs at the end of the expulsion stage. Comparison of the use of oxytocin and ergometrine maleate]Minerva Ginecol. 1989 Nov;41(11):535-40. Italian.
72: Harding JE, Elbourne DR, Prendiville WJ.Related Articles, Links Views of mothers and midwives participating in the Bristol randomized, controlled trial of active management of the third stage of labor.Birth. 1989 Mar;16(1):1-6. 73: Guidotti RJ.Related Articles, Links Active versus physiological management of third stage of labour.BMJ. 1989 Jan 7;298(6665):50. No abstract available. 74: Prendiville WJ, Harding JE, Elbourne DR, Stirrat GM.Related Articles, Links The Bristol third stage trial: active versus physiological management of third stage of labour.BMJ. 1988 Nov 19;297(6659):1295-300. 75: Thornton S, Davison JM, Baylis PH.Related Articles, Links Plasma oxytocin during third stage of labour: comparison of natural and active management.BMJ. 1988 Jul 16;297(6642):167-9. 76: Prendiville W, Elbourne D, Chalmers I.Related Articles, Links The effects of routine oxytocic administration in the management of the third stage of labour: an overview of the evidence from controlled trials.Br J Obstet Gynaecol. 1988 Jan;95(1):3-16. Review. 77: Heinonen PK, Pihkala H.Related Articles, Links Pharmacologic management and controlled cord traction in the third stage of labour.Ann Chir Gynaecol Suppl. 1985;197:31-5. 78: Sorbe B.Related Articles, Links Active pharmacologic management of the third stage of labor. A comparison of oxytocin and ergometrine.Obstet Gynecol. 1978 Dec;52(6):694-7. 79: Cumming DC, Taylor PJ.Related Articles, Links Puerperal uterine inversion: report of nine cases.Can Med Assoc J. 1978 May 20;118(10):1268-70. 80: Beazley JM.Related Articles, Links The active management of labor.Am J Obstet Gynecol. 1975 May;122(2):161-8. No abstract available.
81: Saha N, Ghosh AK.Related Articles, Links Active management of third stage of labour by controlled cord traction.J Indian Med Assoc. 1975 May 1;64(9):234-6. No abstract available. 82: Fliegner JR, Hibbard BM.Related Articles, Links Active management of the third stage of labour.Br Med J. 1966 Sep 10;2(5514):622-3. No abstract available.