16/09/2020
Tutkimuksen perusteella vaikuttaa siltä, että jos istukkavaiheessa saa oksitosiinia
(niin kuin suurin osa synnyttäjistä saa), ei kohdun painamisesta ole enää lisäapua verenvuodon vähentämisessä. Meilläkin kohdun painaminen tehdään aika lailla rutiinisti kaikille ja sehän siis sattuu, usein paljonkin.
Olisiko nyt aika muuttaa toimintatapoja?
Uterine massage involves placing a hand on the birthing person’s lower abdomen and stimulating the uterus to contract by rubbing and squeezing. (Massage is really a misnomer, since the forceful rubbing can be quite painful!)
Two large randomized trials have compared blood loss between people assigned to synthetic oxytocin alone or in combination with uterine massage. The uterine massage in addition to synthetic oxytocin did not reduce blood loss compared to synthetic oxytocin alone. In one of the trials, 378 (32.3%) of people reported pain when receiving uterine massage and 16 (1.4%) people asked to stop the massage because of pain. So, not only was the procedure unnecessary—it was often painful!
None of the randomized trials compared expectant management with and without uterine massage, so all of this research is on active management. In other words, we do not have evidence to guide the use of uterine massage with people who do not receive Pitocin® in the third stage of labor.
Uterine massage is distinct from the postpartum assessment of fundal tone, which is recommended to identify uterine atony. Uterine atony is loss of muscle tone in the uterine muscle, which means the uterus is not able to contract as well to stop bleeding after birth. It is the most common cause of postpartum hemorrhage. To assess fundal tone, the care provider places their hand lightly on top of the uterus to feel whether or not it’s contracting regularly.
For more info visit evidencebasedbirth.com/thirdstage
References
1) Hofmeyr, G. J., Abdel-Aleem, H. and Abdel-Aleem, M.
A. (2013). Uterine massage for preventing postpartum haemorrhage. Cochrane Database of Systematic Reviews, Issue 7. Art. No.: CD006431.
2) Chen, M., Chang, Q., Duan, T., et al. (2013). Uterine massage to reduce blood loss after vaginal delivery: a randomized controlled trial. Obstet Gynecol. 122(2 Pt 1), 290–295.
⠀⠀⠀⠀⠀
