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

Undefined
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.
 
 
Authors & affiliation: 
C Winter,a A Macfarlane,b C Deneux-Tharaux,c W-H Zhang,d S Alexander,d P Brocklehurst,e M-H Bouvier-Colle,c W Prendiville,f V Cararach,g J van Roosmalen,h I Berbik,i M Klein,j D Ayres-de-Campos,k R Erkkola,l LM Chiechi,m J Langhoff-Roos,n B Stray-Pedersen,o C Troegerp a School of Nursing and Midwifery, University of Dundee, Dundee, UK b Department of Midwifery, City University, London, UK c INSERM UMR S149, Universite´ PMC-Paris 6, Paris, France d Perinatal Epidemiology Research Unit, Universite´ Libre de Bruxelles, Brussels, Belgium e National Perinatal Epidemiology Unit, Oxford, UK f Department of Obstetrics and Gynaecology, Royal College of Surgeons of Ireland, Coombe Hospital, Dublin, Ireland g Hospital Clı´nic, IDIBAPS, University of Barcelona, Barcelona, Spain h Leiden University Medical Centre, Leiden, the Netherlands i Hungarian Society of Obstetrics and Gynaecology, Budapest, Hungary j Hanusch-Krankenhaus Gynakolog, University of Vienna, Vienna, Austria k Faculdade de Medicina da Universidade do Porto, Porto, Portugal l University Central Hospital of Turku, Turku, Finland m Unita di Obstetrica e gynecologia policlinica, University of Bari, Bari, Italy n Department of Obstetrics and Gynaecology, University of Copenhagen, Copenhagen, Denmark o Rikshospitalet, University of Oslo, Oslo, Norway p Pra¨natale Medizin, Universita¨ts Frauenklinik, Basel, Switzerland Correspondence: Prof A Macfarlane, Department of Midwifery, City University, 24 Chiswell Street, London EC1Y 4TY, UK. Email A.J.Macfarlane@city.ac.uk
Ranking: 
Staff Members: 
Published In: 
BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY - BJOG 2007 volume 114 issue 7 pages 845 - 854
Publication date: 
Sunday, July 1, 2007