Uterine massage for preventing postpartum haemorrhage

Cochrane Review by Hofmeyr GJ, Abdel-Aleem H, Abdel-Aleem MA

This record should be cited as: Hofmeyr GJ, Abdel-Aleem H, Abdel-Aleem MA. Uterine massage for preventing postpartum haemorrhage. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD006431. DOI: 10.1002/14651858.CD006431.pub2.

ABSTRACT

Title

Uterine massage for preventing postpartum haemorrhage

Background

Postpartum haemorrhage (PPH) (bleeding from the genital tract after childbirth) is a major cause of maternal mortality and disability, particularly in under-resourced areas. In these settings, poor nutrition, malaria and anaemia may aggravate the effects of PPH. In addition to the standard known strategies to prevent and treat PPH, there is a need for simple, non-expensive techniques which can be applied in low-resourced settings to prevent or treat PPH.

Objectives

To determine the effectiveness of uterine massage after birth and before or after delivery of the placenta, or both, to reduce postpartum blood loss and associated morbidity and mortality.

Search strategy

We searched theCochrane Pregnancy andChildbirthGroup’sTrialsRegister (March 2008), theCochraneCentral Register ofControlled Trials (The Cochrane Library 2007, Issue 2) and PubMed (1966 to June 2007).

Selection criteria

All published, unpublished and ongoing randomised controlled trials comparing uterine massage alone or in addition to uterotonics before or after delivery of the placenta, or both, to non-massage.

Data collection and analysis

Both authors extracted the data independently using the agreed form.

Main results

One randomised controlled trial inwhich 200womenwere randomised to receive uterinemassage or nomassage after activemanagement of the third stage of labour. The numbers of women with blood loss more than 500 ml was small, with wide confidence intervals and no statistically significant difference (risk ratio (RR) 0.52, 95% confidence interval (CI) 0.16 to 1.67). There were no cases of retained placenta in either group. The mean blood loss was less in the uterine massage group at 30 minutes (mean difference (MD) -41.60, 95% CI -75.16 to -8.04) and 60 minutes after enrolment (MD -77.40, 95% CI -118.71 to -36.09 ml) . The need for additional uterotonics was reduced in the uterine massage group (RR 0.20, 95% CI 0.08 to 0.50). Two blood transfusions were administered in the control group.

Authors' conclusions

The present review adds support to the 2004 joint statement of the International Confederation of Midwives and the International Federation of Gynaecologists and Obstetricians on the management of the third stage of labour, that uterine massage after delivery of the placenta is advised to prevent PPH. However, due to the limitations of the one trial reviewed, trials with sufficient numbers to estimate the effects of sustained uterine massage with great precision, both with and in the absence of uterotonics, are needed.

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