Effects of Placental Delivery with Lower Uterine Compression on Blood Loss in Normal Labor Mothers
Article Sidebar
Main Article Content
Abstract
Purpose: To compare the amount of blood loss 2 hours after delivery between vaginal delivery groups who underwent placental delivery with the Modified Crede' maneuver and 10 minutes of uterine compression and vaginal delivery groups who underwent placental delivery with controlled cord traction and 10 minutes of uterine compression.
Design: Experimental research with post-test only control group design.
Methods: The sample group was women who gave birth in the first two hours after delivery and received services at a delivery room unit, in one hospital at Chiang Rai Province, during May - August 2024. They were randomly assigned using lottery to two groups with 33 subjects each: the experimental group (or women who gave birth vaginally and received the Modified Crede’ maneuver with 10 minutes of lower uterine compression) and the control group (or women who gave birth vaginally and received the controlled cord traction with 10 minutes of lower uterine compression). Data were collected using a maternal blood loss record form. General data were analyzed using descriptive statistics and the mean blood loss was compared using the independent t-test.
Main findings: General characteristics of the experimental and control groups including age, occupation, education level, and information about delivery such as gestational age, number of pregnancies, episiotomy, prenatal oxytocin intake, prenatal red blood cell concentration, birth weight of newborn, and delivery duration were not different. There was no difference in the mean amount of blood loss after placental delivery between two groups.
Conclusion and recommendations: No difference of the amount of blood loss at 2 hours after delivery was found between women with normal delivery who underwent placental delivery with the modified Crede' maneuver and 10 minutes of uterine compression and those who underwent the controlled cord traction and 10 minutes of uterine compression. Thus, the choice of methods for placenta delivery should depend on the skill and expertise of a midwife. In addition, a combination with the compression of the lower uterus immediately after delivery of the placenta for 10 minutes can reduce the amount of blood loss after delivery.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright Notice: Nursing Science Journal of Thailand has exclusive rights to publish and distribute the manuscript and all contents therein. Without the journal’s permission, the dissemination of the manuscript in another journal or online, and the reproduction of the manuscript for non-educational purpose are prohibited.
Disclaimer: The opinion expressed and figures provided in this journal, NSJT, are the sole responsibility of the authors. The editorial board bears no responsibility in this regard.
References
World Health Organization. WHO recommendations on the assessment of postpartum blood loss and use of a treatment bundle for postpartum hemorrhage. Geneva: World Health Organization; 2023. 40 p.
Department of Health, Ministry of Public Health. Thai maternal mortality ratio per 100,000 live births [Internet]. Nonthaburi: Ministry of Public Health; 2024 [cited 2024 Jul 24]. Available from: https://dashboard.anamai.moph.go.th/dashboard/mmr/index?year=2022. (in Thai).
Shields LE, Goffman D, Caughey AB. ACOG practice bulletin: clinical management guidelines for obstetrician-gynecologists. Obstet Gynecol. 2017;130(4):e168-86. doi: 10.1097/AOG.0000000000002351.
Chantrapitak W, Anunsakunwat W, Suwikrom S, Wattanaluangarun R. The correlation of lower uterine segment atony after delivery with atonic postpartum hemorrhage. Charoenkrung Pracharak Hospital Journal. 2019;15(1):1-13. (in Thai).
Chantrapitak W, Anunsakunwat W, Sritippayawan S, Lojindarat S, Srijuntuek K, Wattanaluangarun R. Lower Uterine Segment Compression (LUSC), procedure for treatment and prevention of postpartum hemorrhage. Charoenkrung Pracharak Hospital Journal. 2014;10(1):45-52. (in Thai).
Hongranai S. Antepartum, intrapartum and postpartum: nursing care. Bangkok: Protexts; 2020. 260 p. (in Thai).
Hersh AR, Carroli G, Hofmeyr J, Garg B, Gulmezoglu M, Lumbiganon P, et al. Third stage of labor: evidence-based practice for prevention of adverse maternal and neonatal outcomes. Am J Obstet Gynecol. 2024;230(3):S1046-60.e1. doi: 10.1016/j.ajog.2022.11.1298.
Sitkulanan P. Obstetric nursing: midwifery nursing practice. 7th ed. Bangkok: Thammasat Press; 2024. 209 p. (in Thai).
Masuzawa Y, Yaeko K. Uterine activity during the two hours after placental delivery among low-risk pregnancies: an observational study. J Matern Fetal Neonatal Med. 2017;30(20):2446-51. doi: 10.1080/14767058.2016.1253057.
Yüksel H. A novel approach to primary lower uterine segment atony. Taiwan J Obstet Gynecol. 2015;54(4):452-4. doi: 10.1016/j.tjog.2014.05.010.
Chantrapitak W, Srijuntuek K, Wattanaluangarun R. The efficacy of lower uterine segment compression for prevention of early postpartum hemorrhage after vaginal delivery. J Med Assoc Thai. 2011;94(6):649-56.
Hongranai S, Sopajaree C, Ruangrit P, Doungnit W. Effect of duration of lower uterine segment compression immediately after placental delivery on amount of blood loss in normal delivery. Thai Red Cross Nursing Journal. 2019;12(2):179-92. (in Thai).
Ruangrit P. The output of lower uterine segment compression and uterine massage for prevention of early postpartum hemorrhage after vaginal delivery. Paper presented at: Naresuan Research Conference 13th: Research and Innovation, Driving the Economy and Society; 2017 Jul 20-21; Phitsanulok, Thailand. (in Thai).
Silpasuwan P, Wiwatwongkasem C, Silpasuwan W. Research methods in public health. 2nd ed. Bangkok: Vitoon Binding & Printing; 1995. 338 p. (in Thai).
Tewapitak P, Pholphoke P. The effects of lower uterine segment compression after Modified Crede’ maneuver on blood loss in the postpartum period. Journal of Health Science Research. 2021;15(3):158-69. (in Thai).
Hofmeyr GJ, Mshweshwe NT, Gülmezoglu AM. Controlled cord traction for the third stage of labour. Cochrane Database Syst Rev. 2015;1(1):CD008020. doi: 10.1002/14651858.CD008020.pub2.
Fissahaye B, Dheresa M, Assefa N, Tesfaye D, Eyeberu A, Balis B, et al. Active management of the third stage of labor and associated factors among maternity care providers in public health facilities in Eastern Ethiopia: a multi-center study. BMC Pregnancy Childbirth. 2023;23(1):701. doi: 10.1186/s12884-023-06009-2.
Ntchompbopughu TW, Thomas EO, Nicholas T. Active management of the third stage of labour: knowledge and challenges of obstetric caregivers in selected health facilities in Fako Division, Cameroon. Open J Obstet Gynecol. 2021;11(12):1815-35. doi: 10.4236/ojog.2021.1112169.
Gelaw KA, Assefa Y, Birhan B, Gebeyehu NA. Practices and factors associated with active management of the third stage of labor in East Africa: systematic review and meta-analysis. BMC Pregnancy Childbirth. 2023;23(1):438. doi: 10.1186/s12884-023-05761-9.
Sirisomboon R. Evidence-based intrapartum management. In: Rueangwutlert P, Orrungroj N, Charoenwit T, Phatthanawijarn L, Kosonchuenwijit J, Punyathalang T, editors. Head, heart, hands: healing the high-risk. Bangkok: Tana Press; 2022. p.27-34. (in Thai).
