According to the WHO, each year about 140,000 women die of postpartum hemorrhage, which occur in 5-15% of births. The most common cause of postpartum hemorrhage remains hypotension uterus. Many methods of prevention of obstetric hemorrhage developed, but not all of them have high efficiency. Massive bleeding, life-threatening women, are observed very often. At the present time, the question of active or waiting tactics of the third stage of labour remains controversial. Active tactics of the third stage of labour is recognized as the main method of prevention of postpartum hemorrhage, and includes the use of oxytocin - drug first-line and second-line drugs – ergometrine and prostaglandins. Also the traction of the umbilical cord with extra pressure on the uterus to the placenta (controlled traction of the umbilical cord) is carried out. In contrast of active tactics, waiting tactics involve independent birth of the placenta. Active tactic of third stage of labour compared with expectant tactics leads to reduced blood loss, but its use increases the risk of side effects. Clear organization for the prevention of postpartum hemorrhage is the real basis of the reduction of maternal mortality and remote serious consequences for the mother.
postpartum hemorrhage, maternal mortality, oxytocin, ergometrine, prostaglandins, controlled traction of the umbilical cord, waiting tactics.
1. Baev O.R. Primenenie karbetotsina dlya profilaktiki poslerodovykh krovotecheniy. Akusherst-vo i ginekologiya. 2013. № 7. C.101-105.
2. Baev O.R. Profilaktika krovotecheniy v posledovom i rannem poslerodovom periode. Kakie ispol´zovat´ preparaty?. Akusherstvo i ginekologiya. 2011. № 7. C. 16-20.
3. Baskett Tomas F., Kalder Endryu A. Operativnoe akusherstvo Manro Kerra. M.: Rid Elsiver, 2010. 392 s.
4. Lazarenko A. Vedenie tret´ego perioda rodov s pozitsii dokazatel´noy meditsiny. Zdorov´e Ukrainy. 2012. № 1. S. 19.
5. Profilaktika poslerodovykh krovotecheniy. Informatsionno-obrazovatel´nyy vestnik «Zdo-rov´e sem´i». 2007. №1. S. 2-8.
6. Radzinskiy V.E. Akusherskaya agressiya. M.: Izdatel´stvo Status Praesens, 2011. 688 s.
7. Savel´eva G.M. Akusherstvo. Pod red. Savel´evoy G.M. M.: Meditsina. 2000. 816 s.
8. Chernukha E.A. Rodovoy blok. M.: Triada-Kh, 2005. 712 s.
9. Butwick A.J., Coleman L., Cohen S.E., Riley E.T., Carvalho B. Minimum Effective bolus dose of oxy-tocin during elective cesarean delivery. Br. J. Anaesth. 2010. Vol. 104. № 3. P. 338-343.
10. Callaghan W.M., Kuklina E.V., Berg G. Trends in postpartum haemorrhage: Unated States, 1994-2006. Am. J. Obstet. Gynecol. 2010. Vol. 202. № 4. P. 353. e1-353.e6.
11. Chong Y.S., Su L.L., Arulkumaran S. Current strategies for the prevention of postpartum haemorr-hage in the third stage of labour. Curr Opin Obstet. Gynecol. 2004. Vol. 16. № 2. P. 143-150.
12. Deneux-Tharaux C., Sentilhes L., Maillard F., Closset E., Vardon D. et al. Effect of routine controlled cord traction as part of the active management of the third stage of labour on postpartum haemorrhage: multicentre randomised controlled trial. BMJ. 2013. P. 34.
13. Which uterotonic is better to prevent the postpartum hemorrhage? Latest news in terms of clinical ef-ficacy, side effects, and contraindications: a systematic review /Gizzo S., Patrelli T.S., Gangi S.D., Carrozzini M., Saccardi C. [et al.]. Reprod Sci. 2013. Vol.20. №9. P. 1009-1011.
14. Gulmezoglu A.M., Forna F., Villar J., Hofmeyr G. J. Prostaglandins for preventing postpartum hae-morrhage. Cochrane Database Syst. Rev. 2007 CD000494.
15. Karen L. Preventing Postpartum Hemorrhage: Managing the Third Stage of labor. Am Fam Physi-cian. 2006. Vol.73. № 6. P. 1025-1028.
16. Active management of the third stage of labour: prevention and treatment of postpartum hemorrhage /Leduc D., Senikas V., Lalonde A.B., Ballerman C., Biringer A. [et al.]// J. Obstet. Gynaecol. Can. 2009. Vol. 31. №10. P. 980-993.
17. Maggan E.F. The length of the third stage of labor and the risk of postpartum hemorrhage. Obstet. Gynecol. 2005. Vol. 105. № 2. P. 290-293.
18. Oyelese Y., Scorza W.E., Mastrolia R., Smulian J.C. Postpartum haemorrage . Obstet Gynecol Clin North Am. 2007. Vol. 34. № 3. P. 421-441.
19. Side effects of oral misoprostol for the prevention of postpartum hemorrhage: results of a community-based randomized controlled trial in rural India / Patted S.S., Goudar S.S., Naik V.A., Bellad M.B., Edlavitch S.A., Kodkany B.S. [et al.]. J. Matern. Fetal Neonatal Med. 2009. Vol. 22. № 1. P. 24-28.
20. Sheldon W.R., Durocher J., Winikoff B., Blum J., Trussell J. How effective are the components of ac-tive management of the third stage of labor?. BMC Pregnancy Childbirth. 2013. P. 46.
21. Higher-dose oxytocin and hemorrhage after vaginal delivery: a randomized controlled trial / Tita A.T., Szychowski J.M., Rouse D.J., Bean C.M., Chapman V., Nothern A. [et al.] . Obstet. Gynecol. 2012. Vol. 119. №2. P. 293-300.
