Efficacy of Lower Uterine Segment Compression in Women with 3rd Stage of Labor Blood Loss More Than 300 ml for the Prevention of Early Postpartum Hemorrhage: A Multi-Center Open-Labeled Randomized Controlled Trial LUSC to Prevent Early PPH in Blood Loss ≥ 300 ml in 3rd Stage of Labor: RCT
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Abstract
OBJECTIVE: To compare the efficacy of 20-minute lower uterine segment compression (LUSC) and conventional treatment for postpartum hemorrhage (PPH) prevention in women with blood loss > 300 ml in the 3rd stage of labor.
METHODS: Patients were recruited from four hospitals under the Bangkok Metropolitan Administration. In total, 1082 postpartum patients who experienced the 3rd stage of labor bleeding exceeding 300 ml were enrolled in this study, and were randomly equally split into a control group, in which patients received conventional treatment for PPH prevention, and the LUSC group, in which patients received 20-minute LUSC and conventional PPH prevention measures. LUSC was administered by compressing the suprapubic area covering the lower uterine segment using four digits (index to little finger) of one hand until bleeding had ceased. The primary and secondary outcome of this study were to assess amount of blood loss in the 4th stage of labor and the rate of PPH of LUSC group compare to control group.
RESULTS: A total of 1,128 patients with the 3rd stage bleeding exceeding 300 ml were identified, 34 patients declined participation, and 12 patients were excluded due to twin pregnancies (6 cases), hydramnios (2 cases), and hysterectomy (4 cases). 541 patients in control group had mean age 28.70 + 6.48 year while 541 patients in LUSC group had mean age 27.41 + 6.22 year (p = 0.001). There were statistically significant differences in parity, the duration of rupture of the membrane, duration of the 2nd and 3rd stages of labor, birth attendant, and the degree of perineal tear between the two groups. The mean volumes of blood loss in the 4th stage of labor of the control group were 90 (50,150) ml versus 50 (40,70) ml in the LUSC group (p < 0.001). PPH occurred in 45.5% of the control group compared to only 26.1% in the LUSC group (p < 0.001).
CONCLUSION: 20-minute LUSC is effective for reducing blood loss and preventing PPH in patients who experience more than 300 ml blood loss in the 3rd stage of labor.
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