{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T05:58:47Z","timestamp":1791266327914,"version":"4.1.0"},"reference-count":23,"publisher":"BMJ","issue":"6659","license":[{"start":{"date-parts":[[1988,11,19]],"date-time":"1988-11-19T00:00:00Z","timestamp":595900800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ"],"published-print":{"date-parts":[[1988,11,19]]},"abstract":"<jats:p>OBJECTIVE--To compare the effects on fetal and maternal morbidity of routine active management of third stage of labour and expectant (physiological) management, in particular to determine whether active management reduced incidence of postpartum haemorrhage. DESIGN--Randomised trial of active versus physiological management. Women entered trial on admission to labour ward with allocation revealed just before vaginal delivery. Five months into trial high rate of postpartum haemorrhage in physiological group (16.5% v 3.8%) prompted modification of protocol to exclude more women and allow those allocated to physiological group who needed some active management to be switched to fully active management. Sample size of 3900 was planned, but even after protocol modification a planned interim analysis after first 1500 deliveries showed continuing high postpartum haemorrhage rate in physiological group and study was stopped. SETTING--Maternity hospital. PARTICIPANTS--Of 4709 women delivered from 1 January 1986 to 31 January 1987, 1695 were admitted to trial and allocated randomly to physiological (849) or active (846) management. Reasons for exclusion were: refusal, antepartum haemorrhage, cardiac disease, breech presentation, multiple pregnancy, intrauterine death, and, after May 1986, ritodrine given two hours before delivery, anticoagulant treatment, and any condition needing a particular management of third stage. INTERVENTIONS--All but six women allocated to active management actually received it, having prophylactic oxytocic, cord clamping before placental delivery, and cord traction; whereas just under half those allocated to physiological management achieved it. A fifth of physiological group received prophylactic oxytocic, two fifths underwent cord traction and just over half clamping of the cord before placental delivery. ENDPOINT--Reduction in incidence of postpartum haemorrhage from 7.5% under physiological management to 5.0% under active management. MEASUREMENTS AND MAIN RESULTS--Incidence of postpartum haemorrhage was 5.9% in active management group and 17.9% in physiological group (odds ratio 3.13; 95% confidence interval 2.3 to 4.2), a contrast reflected in other indices of blood loss. In physiological group third stage was longer (median 15 min v 5 min) and more women needed therapeutic oxytocics (29.7% v 6.4%). Apgar scores at one and five minutes and incidence of neonatal respiratory problems were not significantly different between groups. Babies in physiological group weighed mean of 85 g more than those in active group. When women allocated to and receiving active management (840) were compared with those who actually received physiological management (403) active management still produced lower rate of postpartum haemorrhage (odds ratio 2.4;95% CI1.6 to 3.7). CONCLUSIONS--Policy of active management practised in this trial reduces incidence of postpartum haemorrhage, shortens third stage, and results in reduced neonatal packed cell volume.<\/jats:p>","DOI":"10.1136\/bmj.297.6659.1295","type":"journal-article","created":{"date-parts":[[2009,4,2]],"date-time":"2009-04-02T15:19:55Z","timestamp":1238685595000},"page":"1295-1300","source":"Crossref","is-referenced-by-count":225,"title":["The Bristol third stage trial: active versus physiological management of third stage of labour."],"prefix":"10.1136","volume":"297","author":[{"given":"W. J.","family":"Prendiville","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. E.","family":"Harding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. R.","family":"Elbourne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. M.","family":"Stirrat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1988,11,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/S0266-6138(87)80003-7","article-title":"The policy and practice of midwifery study: introduction and methods","volume":"3","author":"Garcia, J.; Garforth, S.; Ayers, A.","year":"1987","unstructured":"Garcia J, Garforth S, Ayers A. The policy and practice of midwifery study: introduction and methods. Midwifery 1987;3:2-9.","journal-title":"Midwifery"},{"key":"ref_2","first-page":"272","article-title":"Discussion","volume":"1985","author":"Chamberlain, G.V.P.","unstructured":"Chamberlain GVP. Discussion. In: Chamberlain GVP, Orr CJB, Sharp F, eds. Litigation and obstetrics and gynaecology. 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The placental venous pressure during and after the third stage of labour following early cord ligation. Journal ofObstetrics and Gynaecology of the British Commonwealth 1966;73:747-56.","journal-title":"Journal ofObstetrics and Gynaecology of the British Commonwealth"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1111\/j.1469-8749.1966.tb01809.x","article-title":"Postnatal placental respiration","volume":"8","author":"Dunn, P.M.","year":"1966","unstructured":"Dunn PM. Postnatal placental respiration. Dev Med Child Neurol 1966;8:607.","journal-title":"Dev Med Child Neurol"},{"key":"ref_6","first-page":"138","article-title":"Caesarean section and the prevention of respiratory distress syndrome of the newbom","volume-title":"medicine: report ofthe third European congress ofperinatal medicine, Lausanne","author":"Dunn, P.M.","year":"1973","unstructured":"Dunn PM. Caesarean section and the prevention of respiratory distress syndrome of the newbom. In: Bossart H, ed. Perinatal medicine: report ofthe third European congress ofperinatal medicine, Lausanne. Beme: Hans Huber, 1973:138-45."},{"key":"ref_7","first-page":"47","article-title":"Management of childbirth in normal women: the third stage and fetal adaptation","volume-title":"medicine: report of the ninth European congress of perinatal medicine, Dublin","author":"Dunn, P.M.","year":"1985","unstructured":"Dunn PM. Management of childbirth in normal women: the third stage and fetal adaptation. In: Clinch J, Matthews T, eds. Perinatal medicine: report of the ninth European congress of perinatal medicine, Dublin. Lancaster: MTP Press, 1985:47-54."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1111\/j.1471-0528.1966.tb06079.x","article-title":"Influence of early cord ligation on the transplacental passage of foetal cells. ournal ofObstetrics and","volume":"73","author":"Dunn, P.M.; Fraser, I.D.; Raper, A.B.","year":"1966","unstructured":"Dunn PM, Fraser ID, Raper AB. Influence of early cord ligation on the transplacental passage of foetal cells. ournal ofObstetrics and Gynaecology of the British Commonwealth 1966;73:757-60.","journal-title":"Gynaecology of the British Commonwealth"},{"key":"ref_9","first-page":"114","article-title":"Management of the third stage of labour-another cascade of intervention?","volume":"l:","author":"Inch, S.","year":"1985","unstructured":"Inch S. Management of the third stage of labour-another cascade of intervention? Midnnfery 1985;l:114-22.","journal-title":"Midnnfery"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/j.1471-0528.1988.tb06475.x","article-title":"The effects of routine oxytocic administration in the management of the third stage of labour: an overview of the evidence from controlled trials","volume":"95","author":"Prendiville, W.; Elboume, D.; Chalmers, I.","year":"1988","unstructured":"Prendiville W, Elboume D, Chalmers I. The effects of routine oxytocic administration in the management of the third stage of labour: an overview of the evidence from controlled trials. BrJ Obstet Gynaecol 1988;95:3-16.","journal-title":"BrJ Obstet Gynaecol"},{"issue":"12","key":"ref_11","first-page":"555","article-title":"Current practices in labour","volume":"8","author":"Romney, M.; White, V.","year":"1984","unstructured":"Romney M, White V. Current practices in labour. In: Field P, ed. Perinatal nursing. Edinburgh: Churchill Livingstone, 1984. (Recent Advances in Nursing, Vol 8.) 12 Houlton M, Austin J, Jenkins D, Tumer G, Wilkins D. A microcomputer in the delivery suite. BrJ Obstet Gynaecol 1984;91:555-9.","journal-title":"(Recent Advances in Nursing; A microcomputer in the delivery suite"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/S0033-0620(85)80003-7","article-title":"Betablockade during and after myocardial infarction: an overview of the randomised controlled trials","volume":"27","author":"Yusuf, S.; Peto, R.; Lewis, J.","year":"1985","unstructured":"Yusuf S, Peto R, Lewis J, et al. Betablockade during and after myocardial infarction: an overview of the randomised controlled trials. Prog Cardiovasc Dis 1985;27:335-71.","journal-title":"Prog Cardiovasc Dis"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1111\/j.1471-0528.1987.tb02255.x","article-title":"Postpartum haemorrhage-a continuing problem","volume":"94","author":"Gilbert, L.; Porter, W.; Brown, V.","year":"1987","unstructured":"Gilbert L, Porter W, Brown V. Postpartum haemorrhage-a continuing problem. BrJ Obstet Gynaecol 1987;94:67-71.","journal-title":"BrJ Obstet Gynaecol"},{"key":"ref_14","article-title":"Report on confidential enquiries into maternal deaths 1976-1978","author":"Department of Health and Social Security","year":"1982","unstructured":"Department of Health and Social Security. Report on confidential enquiries into maternal deaths 1976-1978. London: HMSO, 1982."},{"key":"ref_15","article-title":"Report on confidential enquiries into maternal deaths 1979-1981","author":"Department of Health and Social Security","year":"1986","unstructured":"Department of Health and Social Security. Report on confidential enquiries into maternal deaths 1979-1981. London: HMSO, 1986."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1111\/j.1471-0528.1985.tb01456.x","article-title":"Concomitant and repeated happenings of complications of the third stage of labour","volume":"92","author":"Hall, M.H.; Halliwell, R.; Carr-Hill, R.","year":"1985","unstructured":"Hall MH, Halliwell R, Carr-Hill R. Concomitant and repeated happenings of complications of the third stage of labour. Br J Obstet Gynaecol 1985;92: 732-8.","journal-title":"Br J Obstet Gynaecol"},{"key":"ref_17","article-title":"Maternity hospital in-patient enquiry. Maternity tables 1977-1981, England and Wales","author":"Office of Population Censuses and Surveys, Department of Health and Social Security, Welsh Office","year":"1986","unstructured":"Office of Population Censuses and Surveys, Department of Health and Social Security, Welsh Office. Maternity hospital in-patient enquiry. Maternity tables 1977-1981, England and Wales. London: HMSO, 1986."},{"issue":"17","key":"ref_18","first-page":"9","article-title":"Blood loss during and immediately after delivery","volume":"1961","author":"Newton, M.; Mosey, L.M.; Egli, G.E.; Gifford, W.B.; Hull, C.T.","unstructured":"Newton M, Mosey LM, Egli GE, Gifford WB, Hull CT. Blood loss during and immediately after delivery. Obstet Gynecol 1961;17:9-18.","journal-title":"Obstet Gynecol"},{"key":"ref_19","first-page":"42","article-title":"Physiology of the third stage of labour","author":"Inch, S.","year":"1988","unstructured":"Inch S. Physiology of the third stage of labour. Midwives Chronicle and Nursing Notes 1988;February:42-3.","journal-title":"Midwives Chronicle and Nursing Notes"},{"key":"ref_20","article-title":"The third stage oflabour: physiology and managemett","author":"National Childbirth Trust","year":"1985","unstructured":"National Childbirth Trust. The third stage oflabour: physiology and managemett. London: National Childbirth Trust, 1985."},{"key":"ref_21","article-title":"Views of mothers and midwives participating in the Bristol randomised controlled trial ofactive management of the third stage of labor","author":"Harding, J.E.; Elboume, D.R.; Prendiville, W.J.","unstructured":"Harding JE, Elboume DR, Prendiville WJ. Views of mothers and midwives participating in the Bristol randomised controlled trial ofactive management of the third stage of labor. 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