ArticleBirth (Berkeley, Calif.)2019
Physiologic childbirth and active management of the third stage of labor: A latent class model of risk for postpartum hemorrhage.
Article in Birth (Berkeley, Calif.), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 20 citations in OpenAlex.
- A Comparison of Physiologic Third-Stage Care, Expectant Management, and Oxytocin Prophylaxis in the Prevention of Postpartum Hemorrhage Following Physiologic Labor and Birth: A Systematic Review.Journal of midwifery & women's healthPooled it
- Midwives' Physiological Approach at the Third Stage of Labour: A Scoping Review.Birth (Berkeley, Calif.) · 2026Article
- More than the passage of time: neonatal health and active labor duration, the mediating role of chorioamnionitis.American journal of obstetrics and gynecology · 2025Observational
- A prolonged latent phase: An early career in oxytocin during birth.Comprehensive psychoneuroendocrinology · 2023Article
- Skin-to-Skin Contact in the Third Stage of Labor and Postpartum Hemorrhage Prevention: A Scoping Review.Maternal and child health journal · 2023Article
- Maternal Morbidity Predicted by an Intersectional Social Determinants of Health Phenotype: A Secondary Analysis of the NuMoM2b Dataset.Reproductive sciences (Thousand Oaks, Calif.) · 2022Article
- Induction of labor or expectant management? Birth outcomes for nulliparous individuals choosing midwifery care.Birth (Berkeley, Calif.) · 2021Article
- Factors affecting third-stage management and postpartum hemorrhage in planned midwife-led home and birth center births in the United States.Birth (Berkeley, Calif.) · 2020Article
- Current Resources for Evidence-Based Practice, November 2020.Journal of obstetric, gynecologic, and neonatal nursing : JOGNN · 2020Article
- Birthing the placenta: women's decisions and experiences.BMC pregnancy and childbirth · 2019Article
Corrections and comments
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Authors and funding
4 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundPostpartum hemorrhage (PPH) is a threat to maternal mortality worldwide. Evidence supports active management of third stage labor (AMTSL) for preventing PPH. However, trials of AMTSL include women at varying risk levels, such as women undergoing physiologic labor and those with labor complications. Counseling women about their risk for PPH and AMTSL is difficult as many women who appear low-risk can still have PPH.
methodsThis study uses outcomes of 2322 vaginal births from a hospital midwifery service in the United States to examine risks for PPH and effectiveness of AMTSL. Using a latent class analysis approach, physiologic birth practices and other risk factors for PPH were analyzed to understand if discrete classes of clinical characteristics would emerge. The effect of AMTSL on the PPH outcome was also considered by class.
resultsA four-class solution best fit the data; each class was clinically distinct. The two largest Classes (A and B) represented women with term births and lower average parity, with higher rates of nulliparity in Class B. Class A women had more physiologic birth elements and less labor induction or labor dysfunction compared with Class B. PPH and AMTSL use was higher in Class B. In Class B, AMTSL lowered risk for PPH. However, in Class A, AMTSL was associated with higher risk for PPH and delayed placental delivery (>30 minutes). DISCUSSION: AMTSL may not be as beneficial to women undergoing physiologic birth. Further study of the etiology of PPH in these women is indicated to inform preventive care.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.