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How effective are the components of active management of the third stage of labor?
336
Abstracts / Contraception 84 (2011) 302–336
opportunities to engage in scholarship beyond the traditional curriculum. The SC program at Brown University was launched in 2007 to provide students with structure to pursue in-depth inquiry in an interdisciplinary area of study. Faculty from the Family Medicine and Obstetrics and Gynecology departments collaboratively developed the SC in Women's Reproductive Health, Freedom and Rights. We sought to describe this program, which aims to help students develop research, clinical and advocacy skills to promote women's reproductive health. Methods: Three to five first-year medical students enter the program each year. They carry out 3-year, longitudinal, mentored projects; attend monthly seminars; and complete position papers and clinical electives in reproductive health. The program evaluation includes a qualitative analysis of written and verbal feedback from students and mentors. Results: In the program's first 4 years, 15 students participated, producing 18 national presentations and 11 peer-reviewed publications. Benefits of the program according to students include strong mentoring and the development of skills for successful scholarship. Through the monthly group meetings, a community of scholarship emerged that provided peer feedback and support. Mentors note that the program attracts talented, energetic students who produce high-quality work and that the relationship benefits mentors as well as students. Conclusions: The 3-year mentorships fostered by the program promoted success in carrying out high-quality scholarly projects. The SC program provides a unique platform to support talented students to develop as future leaders in women's reproductive health.
P100
HOW EFFECTIVE ARE THE COMPONENTS OF ACTIVE MANAGEMENT OF THE THIRD STAGE OF LABOR?
Sheldon W Princeton University, Princeton, NJ, USA Blum J, Durocher J, Trussell J, Winikoff B Objectives: Assess the independent and combined effectiveness of the three interventions recommended for active management of the third stage of labor and examine the effect of route of oxytocin administration on postpartum blood loss. Methods: We performed a secondary data analysis from two randomized controlled trials of uterotonic options for treatment of postpartum hemorrhage. The analysis involved eight hospitals from four countries using two clinical regimes: one in which oxytocin prophylaxis was administered following birth of the baby and the other in which it was not. We used logistic regression to examine associations between clinical and demographic variables and postpartum blood loss of 700 mL or more. Results: Data were analyzed from 8212 women in the no-oxytocin prophylaxis regime and from 30,933 in the oxytocin prophylaxis regime. Among those who did not receive oxytocin, provision of controlled cord traction reduced postpartum hemorrhage risk by 48% compared with no active management interventions (pb.001). Among those who received oxytocin and no other interventions, intravenous administration reduced hemorrhage risk by 76% compared with intramuscular administration (pb.001). When oxytocin was administered intramuscularly, the addition of controlled cord traction reduced hemorrhage risk by two-thirds (pb.001). When oxytocin was administered intravenously, there was no added benefit to controlled cord traction or uterine massage. Conclusions: Controlled cord traction plays an important role in preventing postpartum hemorrhage when oxytocin prophylaxis is unavailable and when oxytocin is administered intramuscularly. When oxytocin is available, intravenous administration appears to be superior to intramuscular administration.
Abstracts / Contraception 84 (2011) 302–336
opportunities to engage in scholarship beyond the traditional curriculum. The SC program at Brown University was launched in 2007 to provide students with structure to pursue in-depth inquiry in an interdisciplinary area of study. Faculty from the Family Medicine and Obstetrics and Gynecology departments collaboratively developed the SC in Women's Reproductive Health, Freedom and Rights. We sought to describe this program, which aims to help students develop research, clinical and advocacy skills to promote women's reproductive health. Methods: Three to five first-year medical students enter the program each year. They carry out 3-year, longitudinal, mentored projects; attend monthly seminars; and complete position papers and clinical electives in reproductive health. The program evaluation includes a qualitative analysis of written and verbal feedback from students and mentors. Results: In the program's first 4 years, 15 students participated, producing 18 national presentations and 11 peer-reviewed publications. Benefits of the program according to students include strong mentoring and the development of skills for successful scholarship. Through the monthly group meetings, a community of scholarship emerged that provided peer feedback and support. Mentors note that the program attracts talented, energetic students who produce high-quality work and that the relationship benefits mentors as well as students. Conclusions: The 3-year mentorships fostered by the program promoted success in carrying out high-quality scholarly projects. The SC program provides a unique platform to support talented students to develop as future leaders in women's reproductive health.
P100
HOW EFFECTIVE ARE THE COMPONENTS OF ACTIVE MANAGEMENT OF THE THIRD STAGE OF LABOR?
Sheldon W Princeton University, Princeton, NJ, USA Blum J, Durocher J, Trussell J, Winikoff B Objectives: Assess the independent and combined effectiveness of the three interventions recommended for active management of the third stage of labor and examine the effect of route of oxytocin administration on postpartum blood loss. Methods: We performed a secondary data analysis from two randomized controlled trials of uterotonic options for treatment of postpartum hemorrhage. The analysis involved eight hospitals from four countries using two clinical regimes: one in which oxytocin prophylaxis was administered following birth of the baby and the other in which it was not. We used logistic regression to examine associations between clinical and demographic variables and postpartum blood loss of 700 mL or more. Results: Data were analyzed from 8212 women in the no-oxytocin prophylaxis regime and from 30,933 in the oxytocin prophylaxis regime. Among those who did not receive oxytocin, provision of controlled cord traction reduced postpartum hemorrhage risk by 48% compared with no active management interventions (pb.001). Among those who received oxytocin and no other interventions, intravenous administration reduced hemorrhage risk by 76% compared with intramuscular administration (pb.001). When oxytocin was administered intramuscularly, the addition of controlled cord traction reduced hemorrhage risk by two-thirds (pb.001). When oxytocin was administered intravenously, there was no added benefit to controlled cord traction or uterine massage. Conclusions: Controlled cord traction plays an important role in preventing postpartum hemorrhage when oxytocin prophylaxis is unavailable and when oxytocin is administered intramuscularly. When oxytocin is available, intravenous administration appears to be superior to intramuscular administration.