Skip to main content
. 2019 Feb 13;2019(2):CD007412. doi: 10.1002/14651858.CD007412.pub5

Comparison 1. Active versus expectant management of 3rd stage of labour (all women).

Outcome or subgroup title No. of studies No. of participants Statistical method Effect size
1 Severe primary postpartum haemorrhage (PPH) at time of birth (clinically estimated or measured blood loss ≥ 1000 mL) 3 4636 Risk Ratio (M‐H, Random, 95% CI) 0.34 [0.14, 0.87]
1.1 Higher‐income setting 3 4636 Risk Ratio (M‐H, Random, 95% CI) 0.34 [0.14, 0.87]
1.2 Lower‐income setting 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
2 Very severe primary PPH at time of birth (clinically estimated or measured blood loss ≥ 2500 mL) 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
2.1 Higher‐income setting 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
2.2 Lower‐income setting 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
3 Maternal mortality 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
3.1 Higher‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
3.2 Lower‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
4 Maternal Hb < 9 g/dL 24‐72 hours postpartum 2 1572 Risk Ratio (M‐H, Random, 95% CI) 0.50 [0.30, 0.83]
4.1 Higher‐income setting 2 1572 Risk Ratio (M‐H, Random, 95% CI) 0.50 [0.30, 0.83]
4.2 Lower‐income setting 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
5 Admission to neonatal special/intensive care 2 3207 Risk Ratio (M‐H, Random, 95% CI) 0.81 [0.60, 1.11]
5.1 Higher‐income setting  2 3207 Risk Ratio (M‐H, Random, 95% CI) 0.81 [0.60, 1.11]
5.2 Lower‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
6 Neonatal jaundice requiring phototherapy or exchange transfusion 2 3142 Risk Ratio (M‐H, Random, 95% CI) 0.96 [0.55, 1.68]
6.1 Higher‐income setting  2 3142 Risk Ratio (M‐H, Random, 95% CI) 0.96 [0.55, 1.68]
6.2 Lower‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
7 Neonatal polycythaemia treated with dilutional exchange transfusion 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
7.1 Higher‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
7.2 Lower‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
8 Severe primary PPH after placental delivery and up to 24 hours (clinically estimated or measured blood loss ≥ 1000 mL) 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
8.1 Higher‐income setting   0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
8.2 Lower‐income setting   0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
9 Severe primary PPH at time of birth and up to 24 hours (clinically estimated or measured blood loss ≥ 1000 mL) 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
9.1 Higher‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
9.2 Lower‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
10 Primary blood loss ≥ 500 mL at time of birth (clinically estimated or measured) 3 4636 Risk Ratio (M‐H, Random, 95% CI) 0.34 [0.27, 0.44]
10.1 Higher‐income setting  3 4636 Risk Ratio (M‐H, Random, 95% CI) 0.34 [0.27, 0.44]
10.2 Lower‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
11 Primary blood loss ≥ 500 mL after delivery of placenta and up to 24 hours (clinically estimated or measured) 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
11.1 Higher‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
11.2 Lower‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
12 Primary blood loss ≥ 500 mL at time of birth and up to 24 hours (clinically estimated or measured) 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
12.1 Higher‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
12.2 Lower‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
13 Mean maternal blood loss (mL) at time of birth (clinically estimated or measured) 2 2941 Mean Difference (IV, Random, 95% CI) ‐78.80 [‐95.96, ‐61.64]
13.1 Higher‐income setting  2 2941 Mean Difference (IV, Random, 95% CI) ‐78.80 [‐95.96, ‐61.64]
13.2 Lower‐income setting  0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
14 Mean maternal blood loss (mL) after delivery of placenta and up to 24 hours (clinically estimated or measured) 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
14.1 Higher‐income setting  0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
14.2 Lower‐income setting  0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
15 Mean maternal blood loss (mL at time of birth and up to 24 hours (clinically estimated or measured) 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
15.1 Higher‐income setting  0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
15.2 Lower‐income setting  0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
16 Maternal blood transfusion 4 4829 Risk Ratio (M‐H, Random, 95% CI) 0.35 [0.22, 0.55]
16.1 Higher‐income setting  4 4829 Risk Ratio (M‐H, Random, 95% CI) 0.35 [0.22, 0.55]
16.2 Lower‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
17 Clinical signs of severe blood loss 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
17.1 Higher‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
17.2 Lower‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
18 Therapeutic uterotonics during third stage and/or within 24 hours 4 4829 Risk Ratio (M‐H, Random, 95% CI) 0.19 [0.15, 0.23]
18.1 Higher‐income setting  4 4829 Risk Ratio (M‐H, Random, 95% CI) 0.19 [0.15, 0.23]
18.2 Lower‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
19 Mean length of third stage 1 1429 Mean Difference (IV, Random, 95% CI) ‐0.30 [‐1.87, 1.27]
19.1 Higher‐income setting  1 1429 Mean Difference (IV, Random, 95% CI) ‐0.30 [‐1.87, 1.27]
19.2 Lower‐income setting  0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
20 Manual removal of placenta as defined by study authors 4 4829 Risk Ratio (M‐H, Random, 95% CI) 1.78 [0.57, 5.56]
20.1 Higher‐income setting  4 4829 Risk Ratio (M‐H, Random, 95% CI) 1.78 [0.57, 5.56]
20.2 Lower‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
21 Postnatal diastolic blood pressure > 90 mmHg between birth of baby and discharge from the labour ward 3 4636 Risk Ratio (M‐H, Random, 95% CI) 4.10 [1.63, 10.30]
21.1 Higher‐income setting  3 4636 Risk Ratio (M‐H, Random, 95% CI) 4.10 [1.63, 10.30]
21.2 Lower‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
22 Postnatal vomiting between birth of baby and discharge from the labour ward 3 4636 Risk Ratio (M‐H, Random, 95% CI) 2.47 [1.36, 4.48]
22.1 Higher‐income setting  3 4636 Risk Ratio (M‐H, Random, 95% CI) 2.47 [1.36, 4.48]
22.2 Lower‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
23 Any analgesia between birth of the baby and discharge from labour ward 1 1429 Risk Ratio (M‐H, Random, 95% CI) 2.53 [1.34, 4.78]
23.1 Higher‐income setting  1 1429 Risk Ratio (M‐H, Random, 95% CI) 2.53 [1.34, 4.78]
23.2 Lower‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
24 Women's assessment of pain during third stage as reported by study authors 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
24.1 Higher‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
24.2 Lower‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
25 Secondary blood loss/any vaginal bleeding needing treatment (after 24 hours and up to 6 weeks) 3 4636 Risk Ratio (M‐H, Random, 95% CI) 1.10 [0.40, 2.99]
25.1 Higher‐income setting 3 4636 Risk Ratio (M‐H, Random, 95% CI) 1.10 [0.40, 2.99]
25.2 Lower‐income setting 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
26 Amount of lochia either estimated or measured after 24 hours and up to discharge from hospital 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
26.1 Higher‐income setting  0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
26.2 Lower‐income setting  0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
27 Surgical evacuation of retained products of conception 3 4636 Risk Ratio (M‐H, Random, 95% CI) 0.74 [0.32, 1.71]
27.1 Higher‐income setting  3 4636 Risk Ratio (M‐H, Random, 95% CI) 0.74 [0.32, 1.71]
27.2 Lower‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
28 Afterpains ‐ abdominal pain associated with the contracting uterus in the postpartum period 1 1429 Risk Ratio (M‐H, Random, 95% CI) 2.53 [1.34, 4.78]
28.1 Higher‐income setting  1 1429 Risk Ratio (M‐H, Random, 95% CI) 2.53 [1.34, 4.78]
28.2 Lower‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
29 Apgar score < 7 at 5 minutes 1 1695 Risk Ratio (M‐H, Random, 95% CI) 1.00 [0.38, 2.66]
29.1 Higher‐income setting  1 1695 Risk Ratio (M‐H, Random, 95% CI) 1.00 [0.38, 2.66]
29.2 Lower‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
30 Birthweight 2 3207 Mean Difference (IV, Random, 95% CI) ‐76.90 [‐108.51, ‐45.30]
30.1 Higher‐income setting  2 3207 Mean Difference (IV, Random, 95% CI) ‐76.90 [‐108.51, ‐45.30]
30.2 Lower‐income setting  0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
31 Neonatal encephalopathy assessed using Sarnat staging (Sarnat 1976; Table 1) 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
31.1 Higher‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
31.2 Lower‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
32 Neonatal mortality 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
32.1 Higher‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
32.2 Lower‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
33 Intraventricular haemorrhage ‐ Papille grade III/IV ‐ (for infants born before 34 weeks' gestation only) 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
33.1 Higher‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
33.2 Lower‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
34 Number of infants who received a red blood cell transfusion 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
34.1 Higher‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
34.2 Lower‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
35 Infant Hb level at 24 to 72 hours 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
35.1 Higher‐income setting  0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
35.2 Lower‐income setting  0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
36 Infant Hb level at 3‐6 months 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
36.1 Higher‐income setting  0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
36.2 Lower‐income setting  0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
37 Infant iron indices (ferritin) at 3 to 6 months. 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
37.1 Higher‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
37.2 Lower‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
38 Exclusive breastfeeding at discharge from hospital 1 1695 Risk Ratio (M‐H, Random, 95% CI) 1.01 [0.96, 1.07]
38.1 Higher‐income setting  1 1695 Risk Ratio (M‐H, Random, 95% CI) 1.01 [0.96, 1.07]
38.2 Lower‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
39 Neurodevelopmental, cognitive or developmental outcomes assessed after age 18 months 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
39.1 Higher‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
39.2 Lower‐income setting  0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
40 Return to hospital as in‐ or outpatient because of bleeding (not pre‐specified) 2 2941 Risk Ratio (M‐H, Random, 95% CI) 2.21 [1.29, 3.79]
40.1 Higher‐income setting 2 2941 Risk Ratio (M‐H, Random, 95% CI) 2.21 [1.29, 3.79]
40.2 Lower‐income setting 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
41 Postnatal maternal mean Hb (outcome not pre‐specified) 3 4062 Mean Difference (IV, Random, 95% CI) 0.52 [0.44, 0.60]
41.1 Higher‐income setting  3 4062 Mean Difference (IV, Random, 95% CI) 0.52 [0.44, 0.60]
41.2 Lower‐income setting  0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]