Volume 111, Issue 1 p. 32-36
Clinical articles

Uterine massage to reduce postpartum hemorrhage after vaginal delivery

Hany Abdel-Aleem

Corresponding Author

Hany Abdel-Aleem

Department of Obstetrics and Gynecology, Women's Health Centre, Assiut University Hospital, Assiut, Egypt

Corresponding author. Department of Obstetrics and Gynecology, Women's Health Centre, Assiut University Hospital, 71511 Assiut, Egypt.Search for more papers by this author
Mandisa Singata

Mandisa Singata

Effective Care Research Unit, Eastern Cape Department of Health and Universities of the Witwatersrand and Fort Hare, South Africa

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Mahmoud Abdel-Aleem

Mahmoud Abdel-Aleem

Department of Obstetrics and Gynecology, Women's Health Centre, Assiut University Hospital, Assiut, Egypt

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Nolundi Mshweshwe

Nolundi Mshweshwe

Effective Care Research Unit, Eastern Cape Department of Health and Universities of the Witwatersrand and Fort Hare, South Africa

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Xoliswa Williams

Xoliswa Williams

Effective Care Research Unit, Eastern Cape Department of Health and Universities of the Witwatersrand and Fort Hare, South Africa

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G. Justus Hofmeyr

G. Justus Hofmeyr

Effective Care Research Unit, Eastern Cape Department of Health and Universities of the Witwatersrand and Fort Hare, South Africa

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First published: 02 December 2016
Citations: 31

Abstract

Objective

To determine the effectiveness of sustained uterine massage started before delivery of the placenta in reducing postpartum hemorrhage.

Methods

A randomized controlled trial conducted in Egypt and South Africa between September 2006 and February 2009. A total of 1964 pregnant women were randomly allocated to 1 of 3 treatment groups: intramuscular oxytocin, sustained uterine massage, or both treatments. Blood loss within 30 minutes of delivery was recorded.

Results

The incidence of blood loss of 300 mL or more within 30 minutes of delivery was significantly higher in the massage group than in the massage plus oxytocin (RR 1.88; 95% CI, 1.29–2.74 in Assiut, and RR 1.3; 95% CI, 1.00–1.68 in SA) and the oxytocin only group (RR 1.7; 95% CI, 1.11–2.61 in Assiut, and RR 2.24; 95% CI, 1.54–3.27 in SA). In both centers, use of additional uterotonics was significantly higher in the uterine massage group compared with the other 2 groups.

Conclusion

Uterine massage was less effective than oxytocin for reducing blood loss after delivery. When oxytocin was used, there was no additional benefit from uterine massage. The effectiveness of uterine massage in the absence of oxytocin was not studied. ACTRN: 12609000372280.