PLACENTAL BLOOD DRAINAGEIN ACTIVE MANAGEMENT OF THIRD STAGE OF LABOUR AFTER VAGINAL DELIVERY

Background: Labour is a physiologic process during which the fetus, membranes, umbilical cord and placenta are expelled from the uterus. The process of labour is divided into three stages: Stage I: Commences with the start of labour pains and ends with full dilatation of the cervix. Stage II: Begins with full dilatation of the cervix and ends with complete expulsion of the fetus. Stage III: This stage commences with the delivery of entire fetus and ends with the delivery of placenta and membranes. Objectives: (i) Estimate the duration of third stage of labour in patients in whom placental blood drainage was done and those patients in whom placental blood was not drained. (ii) Measure the amount of blood loss in those with PBD and in those in whom PBD is not done. (iii) Measure the fall in Haemoglobin concentration 48 hours following delivery in both groups. Methods: This was a prospective, hospital based, case control study conducted in the Post Graduate Department of Obstetrics and Gynaecology, Lal Ded Hospital, Government Medical College, Srinagar. Hundred patients with term pregnancy (≥37 weeks of gestation) with single live foetus undergoing normal vaginal delivery were included in the study. Patients were randomly allocated into two groups, one with 50 patients in whom PBD was done and another group of 50 patients in whom PBD was not done. Results: In the present study, the average age of the patients was 30.4 years in study group and 30.7 years in the control group. The mean gestational age at delivery in our study was 38.5 and 38.8 weeks in the study and control group, respectively. Primigravida formed the biggest group (34%) in the study group in our study, while women with second pregnancy formed the most populous group (36%) in control series. The mean duration of the third stage was 170.2 seconds in the cases group in contrast to 248.3 seconds in the control group. (p-value <0.001). The mean blood loss in cases group was 171.8 ml while in patients belonging to control group, the mean blood loss was measured to be 234.7 ml. (p-value <0.001). None of the patients in cases group developed PPH while 4% of the control patients developed PPH in the post-partum period. None of the patients in the case series required blood transfusion while 2 patients (4%) in the control series required blood transfusion. Conclusion: From the present study, it can be concluded that placental blood drainage as part of active management of third stage of labour is effective in reducing the duration of third stage of labour. The amount of blood loss and also the incidence of PPH. It is a procedure which needs minimal expertise, can be practiced in rural settings with limited number of specialists, even by trained birth attendants. In addition it can be practiced safely in patients in whom volume overload is to be avoided.