A Comparison of Physiologic Third-Stage Care, Expectant Management, and Oxytocin Prophylaxis in the Prevention of Postpartum Hemorrhage Following Physiologic Labor and Birth: A Systematic Review.

Only 7 studies met the inclusion criteria, most were conducted in the 1990s, and none were based in the United States. The physiologic-care comparison rests on one nonrandomized study, so confounding and bias could explain the reduction in severe blood loss. All nonrandomized studies were rated at high risk of bias, mainly because key confounders were not controlled. Some oxytocin arms included other active-management measures, so the effect of oxytocin alone cannot be separated. Blood loss was measured differently across studies, including objective measurement and visual estimation, which may make comparisons less reliable. The review could not examine important subgroups such as birth setting or parity because there were too few studies. Few studies reported outcomes that matter to patients, such as satisfaction, well-being, hypovolemic shock, or death.

The authors declared no conflicts of interest.

Do not conclude that physiologic third-stage care is proven safer than oxytocin prophylaxis. The reduction in blood loss of at least 1000 mL came from one nonrandomized study of 3436 participants with low certainty, while expectant management without support increased blood loss of at least 1000 mL compared with oxytocin.