uterine massage to reduce postpartum hemorrhage in women expected to deliver normally: A randomised trial

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Bleeding from the genital tract after childbirth (postpartum haemorrhage) is a major cause of maternal mortality and disability in under-resourced areas with poor access to health services. It is the leading cause of maternal mortality in Sub-Saharan Africa and Egypt and yet is largely preventable. In these settings, poor nutrition, malaria and anaemia add to the health risk. Heavy bleeding directly following childbirth or within 24 hours is most common. Possible causes are the uterus failing to contract after delivery (uterine atony), a retained placenta, inverted or ruptured uterus, and cervical, vaginal, or perineal lacerations. In well-resourced settings haemorrhage is reduced by routine active management of delivery of the placenta, the third stage of labour. Facilities for resuscitation, blood transfusion and surgical interventions are also available. The 2004 joint statement of the International Confederation of Midwives and the International Federation of Gynaecologists and Obstetricians recommends routine massage of the uterus after delivery of the placenta to promote contraction. This involves placing a hand on the woman's lower abdomen and stimulating the uterus by repetitive massaging or squeezing movements to stimulate uterine contraction. This trials aime to evaluate the effect of uterine massage before delivery of the placenta on the blood loss after delivery.

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