Background: Postpartum haemorrhage (PPH) is a direct cause of maternal death worldwide. PPH usually occurs during the third stage of labour; most women receive some prophylactic management that includes pharmacological and non-pharmacological interventions.
Objectives: We summarize systematic reviews that assessed the effects of PPH prophylactic managements during the third stage of labour.
Methods: We searched MEDLINE, Embase, and the Cochrane Database of Systematic Reviews to identify all relevant systematic reviews of randomized controlled trials of prophylactic managements for PPH in the third stage of labour compared with no treatment, placebo, or a different management. Two review authors independently extracted data and assessed methodological quality using AMSTAR (A MeaSurement Tool to Assess systematic Reviews), and the quality of the evidence using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach for primary outcomes. We summarized results narratively.
Results: We identified 26 systematic reviews: 16 Cochrane and 10 non-Cochrane. Cochrane Systematic Reviews were high quality; non-Cochrane systematic review quality varied. The following third-stage interventions suggested effective reduction of the incidence of severe PPH: active management of the third stage of labour compared to physiological management; active management compared to expectant management; administration of oxytocin compared to placebo, and use of tranexamic acid compared to placebo. Some third-stage management reduced the need for blood transfusion: active management compared to physiological management; active management compared to expectant management; oral misoprostol compared to placebo, and tranexamic acid compared to placebo.
Conclusions: Most methods of effective PPH prophylactic management were supported by evidence, however the evidence was of limited to low or moderate quality. High-quality studies are needed. The outcome measures of the included systematic reviews varied. It is recommended that the outcome measures of trials about prophylactic PPH intervention align with the World Health Organization guideline.