摘要积极管理第三产程的措施包括预防性使用缩宫素,立即钳夹脐带及控制性牵拉脐带、子宫按摩,积极管理第三产程作为预防产后出血的主要方法,能有效缩短第三产程时间、预防严重的产后出血,这是发展中国家妇女死亡的主要原因.在发达国家,产后出血发生率较低,但积极管理已成为许多国家的标准做法,并在世界范围内已沿用数10年.积极管理第三产程最常见的并发症是疼痛及缩宫素药物的不良反应,此外还有子宫内翻、胎盘残留等严重并发症.因此,近年来,就第三产程中采取各种干预措施,特别是对于低危孕产妇的第三产程进行积极处理,人们对其提出了质疑,认为对所有产妇使用积极处理第三产程证据不足.笔者旨在比较第三产程的不同管理方式,对合理的、个性化管理第三产程提供依据,促进自然分娩.

abstractsActive management of the third stage of labour involves giving a prophylactic uterotonic, early cord clamping, controlled cord traction and uterine massage. Active management of the third stage, as the main package of procedure to prevent postpartum hemorrhage, can effectively shorten the third stage of labor and reduce the incidence of severe postpartum hemorrhage, this is a major cause of women dying in developing countries . In developed countries, severe bleeding occurs much less often, yet active management has become standard practice in many countries for several decades. The most common complications of active management of the third stage of labor are pain and side effects of oxytocin, in addition to serious complications such as inversion of uterus and retained placental. Therefore, in recent years, a variety of interventions have been adopted in the third stage of labour, especially for low-risk pregnant women, which have been questioned and the evidence for using active management for all women is insufficient. The purpose of this article is to compare the effectiveness and variations of different management of the third stage of labour, and provide the basis for reasonable and individualized management of the third stage of labour, ultimately promote the natural labour.