Policies for manual removal of placenta at vaginal delivery: variations in timing within Europe

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abstract
The length of the third stage of labour is a potential modifiable risk factor for postpartum haemorrhage at vaginal delivery, but there is no definitive evidence that early intervention to remove the placenta manually will prevent postpartum haemorrhage. We report a wide variation between countries in Europe in policies about the timing of manual removal of placenta. Two groups of countries with clearly divergent policies were identified. A randomised controlled trial is needed to provide definitive evidence on the risks and benefits of manual removal of placenta at different timings after vaginal delivery
Authors & affiliation: 
C Deneux-Tharaux,a A Macfarlane,b C Winter,c W-H Zhang,d S Alexander,d M-H Bouvier-Colle,a the EUPHRATES Group* a INSERM, UMR S149, IFR 69, UPMC, Epidemiological Research Unit on Perinatal Health and Women’s health, Hopital Tenon, Paris, France b Department of Midwifery, City University, London, UK c School of Nursing and Midwifery, University of Dundee, Dundee, UK d Perinatal Epidemiology Research Unit, Universite´ Libre de Bruxelles, Brussels, Belgium Correspondence: Dr C Deneux-Tharaux, INSERM U149 Batiment de recherche, Hopital Tenon 4 rue de la chine, 75020 Paris, France. Email cdeneux.u149@chusa.jussieu.fr
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Published In: 
(2009) BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY. 116(1). p.119-124
Publication date: 
Thursday, January 1, 2009