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Variations in policies for management of the third stage of labour and the immediate management of postpartum haemorrhage in Europe

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Abstract:

Background

The EUropean Project on obstetric Haemorrhage Reduction: Attitudes, Trial, and Early warning System (EUPHRATES) is a set of five linked projects, the first component of which was a survey of policies for management of the third stage of labour and immediate management of postpartum haemorrhage following vaginal birth in Europe. Objectives

The objectives were to ascertain and compare policies for management of the third stage of labour and immediate management of postpartum haemorrhage in maternity units in Europe following vaginal birth. Design

Survey of policies. Setting

The project was a European collaboration, with participants in 14 European countries. Sample

All maternity units in 12 countries and in selected regions of two countries in Europe. Methods

A postal questionnaire was sent to all or a defined sample of maternity units in each participating country. Main outcome measures

Stated policies for management of the third stage of labour and the immediate management of postpartum haemorrhage. Results

Policies of using uterotonics for the management of the third stage were widespread, but policies about agents, timing, clamping and cutting the umbilical cord and the use of controlled cord traction differed widely. For immediate management of postpartum haemorrhage, policies of massaging the uterus were widespread. Policies of catheterising the bladder, bimanual compression and in the choice of drugs administered were much more variable. Conclusions

Considerable variations were observed between and within countries in policies for management of the third stage of labour. Variations were observed, but to a lesser extent, in policies for the immediate management of postpartum haemorrhage after vaginal birth. In both cases, policies about the pharmacological agents to be used varied widely.

Keywords: Management policies; obstetric emergencies; postpartum haemorrhage; third stage of labour

Document Type: Research Article

DOI: https://doi.org/10.1111/j.1471-0528.2007.01377.x

Affiliations: 1: School of Nursing and Midwifery, University of Dundee, Dundee, UK 2: INSERM UMR S149, Université PMC-Paris 6, Paris, France 3: Perinatal Epidemiology Research Unit, Université Libre de Bruxelles, Brussels, Belgium 4: National Perinatal Epidemiology Unit, Oxford, UK 5: Department of Obstetrics and Gynaecology, Royal College of Surgeons of Ireland, Coombe Hospital, Dublin, Ireland 6: Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain 7: Leiden University Medical Centre, Leiden, the Netherlands 8: Hungarian Society of Obstetrics and Gynaecology, Budapest, Hungary 9: Hanusch-Krankenhaus Gynakolog, University of Vienna, Vienna, Austria 10: Faculdade de Medicina da Universidade do Porto, Porto, Portugal 11: University Central Hospital of Turku, Turku, Finland 12: Unita di Obstetrica e gynecologia policlinica, University of Bari, Bari, Italy 13: Department of Obstetrics and Gynaecology, University of Copenhagen, Copenhagen, Denmark 14: Rikshospitalet, University of Oslo, Oslo, Norway 15: Pränatale Medizin, Universitäts Frauenklinik, Basel, Switzerland

Publication date: 2007-07-01

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