Prendiville 1988 (Bristol trial) |
IM syntometrine (5 units oxytocin + 0.5 mg ergometrine) (IM 10 units oxytocin if raised BP) Immediately after birth of anterior shoulder
Clamp cord 30 seconds after birth.
CCT when uterus contracted.
|
Try not to give oxytocic.
Try to leave cord attached to baby until placenta delivered
Try not to use CCT or any manual interference with uterus at the fundus
Encourage mother to adopt posture aiding delivery with gravity
If placenta not delivered spontaneously wait, try putting baby to breast, and encourage maternal effort as above
|
|
Full expectant management 403 (48%).
Full active management 168 (20%).
278 (32%) had mixed management.
Cord left unclamped till pulsation ceased 48%.
Placenta delivered by maternal effort 60% and CCT 40%.
416 (49%) upright.
30% received utero-tonic for treatment.
|
Begley 1990 (Dublin trial) |
IV ergometrine 0.5 mg immediately following birth.
Try to clamp cord within 30 seconds.
When uterus contracted, attempt CCT.
Try not to give any special instructions re posture.
|
No oxytocic drug routinely.
Try to leave cord attached to baby until pulsation has ceased
Placenta may be delivered by maternal effort or gentle controlled cord traction once separated
Encourage mother to breastfeed. Help her to kneel/sit/squat
|
All given IV ergometrine before delivery of placenta.
89% cord clamped and cut.
93% CCT and 5% maternal effort.
7% upright and 93% recumbent.
|
14% were given er-gometrine for treatment, not prophylactically, 6 (0.83%) before placenta delivered
Cord left unclamped till pulsation ceased 42%.
Placenta delivered by maternal effort 32% and gentle CCT 66%
11% upright.
|
Rogers 1998 (Hinchingbrooke trial) |
IM syntometrine (5 units oxytocin + 0.5 mg ergometrine) (IM 10 units oxytocin if raised blood pressure)
As soon as possible after birth of anterior shoulder (within 2 minutes of birth)
Immediate cord clamping and cutting.
CCT or maternal effort.
Women randomised to upright and recumbent in both arms.
|
|
699 (93.4%) had full active management.
2 (0.3%) had fully expectant management.
47 (6.2%) had mixed.
95% given prophylactic uterotonic before delivery of placenta
93% cord clamped before pulsation ceased.
46% CCT.
44% upright (when placenta delivered).
|
488 (63.9%) had full expectant management.
19 (2.5%) had fully active management.
257 (33.6%) had mixed.
21% received oxytocic for treatment, 2.5% pro-phylactically
Cord left unclamped till pulsation ceased 70%.
Placenta delivered by CCT 12%.
43% upright (when placenta delivered).
|
Thilaganathan 1993 (Brighton trial) |
Syntometrine 1 mL (IM or IV, route not specified).
As soon as baby born.
Cord was “immediately clamped”.
Placenta delivered with CCT.
|
No oxytocic.
Cord not cut or clamped until after pulsation ceased (unless there were contraindications)
Deliver placenta by maternal effort after signs of separation. “when the placenta could be felt in the vagina, the midwife could then assist delivery of the placenta”
Upright position encouraged.
|
|
|
Khan 1997 (Abu Dhabi trial) |
IM oxytocin 10 units at delivery of anterior shoulder .
Immediate cord clamping and cutting.
CCT as soon as the uterus was contracted firmly - repeated every 23 minutes
|
No oxytocic prior to delivery of placenta.
Cord clamped and cut after delivery.
No CCT.
No fundal massage.
Maternal expulsion after signs of separation.
IV infusion of oxytocin 10 units in 500 mL normal saline given slowly
|
|
|