The effect of uterine massage after vaginal delivery on the duration of placental delivery and amount of postpartum hemorrhage

Pinar Kadirogullari; Berna Aslan Cetin; Mustafa Goksu; Hale Cetin Arslan; Kerem Doga Seckin

doi:10.1007/s00404-023-07211-5

The effect of uterine massage after vaginal delivery on the duration of placental delivery and amount of postpartum hemorrhage

Arch Gynecol Obstet. 2023 Sep 12. doi: 10.1007/s00404-023-07211-5. Online ahead of print.

Authors

Pinar Kadirogullari¹, Berna Aslan Cetin², Mustafa Goksu², Hale Cetin Arslan², Kerem Doga Seckin³

Affiliations

¹ Department of Obstetrics and Gynecology, Acıbadem University Atakent Hospital, Istanbul, Turkey. pinarsezer33@hotmail.com.
² Department of Obstetrics and Gynecology, Health Sciences University, Istanbul Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey.
³ Department of Obstetrics and Gynecology, Istinye University Liv Hospital Vadi Istanbul, Istanbul, Turkey.

PMID: 37698604
DOI: 10.1007/s00404-023-07211-5

Abstract

Objective: The aim of this study was to investigate the effects of uterine massage performed before placental delivery on the third stage of labor and postpartum hemorrhage after vaginal delivery.

Materials and methods: The study was designed as a prospective randomized controlled study. Between June 2018 and June 2019, 242 women who gave birth in Istanbul Kanuni Sultan Suleyman Training and Research Hospital were included in the study. The women were divided into two groups; group 1 received uterine massage after vaginal delivery before placental delivery (n: 128) and group 2 did not receive massage (n: 114). Demographic characteristics, delivery times of the baby and placenta, duration of uterine massage, amount of postpartum hemorrhage and postpartum hemoglobin values of both groups were recorded.

Results: Baseline characteristics were similar in both groups. Placental output time after delivery was 8.3 ± 4.2 min in group 1 and 13.5 ± 6.3 min in group 2. The third stage of labor was significantly shorter in group 1 (p = 0.012). The amount of blood loss of 500 mL or more after delivery was higher in group 2 but not statistically different (p > 0.05). Hemoglobin value measured within 12-24 h after delivery was significantly lower in group 2 (hemoglobin < 8 g/dL after 12-24 h p = 0.003; hemoglobin < 10 g/dL after 12-24 h p = 0.001). Delta hb value was also significantly lower in group 2 (p = 0.03). With this result, it was determined that bleeding intense enough to require transfusion was more common in group 2.

Conclusion: In patients delivering vaginally, uterine massage before placental delivery shortens the placental delivery time and reduces postpartum hemorrhage. In addition to oxytocin and controlled cord traction to reduce postpartum blood loss, uterine massage should be routinely used in the active management of the third stage of labor.

Clinical trials number: NCT03858569.

Keywords: Postpartum hemorrhage; Third stage of labor; Uterine massage; Vaginal delivery.

Associated data

ClinicalTrials.gov/NCT03858569