Amr maneuver with Oxytocin 10 IU IV prevents postpartum hemorrhage, showing potential over standard active management
Background
Postpartum hemorrhage (PPH) remains a leading cause of maternal mortality worldwide, often due to uterine atony. Current standard-of-care involves active management of the third stage of labor, typically with uterotonics like Oxytocin and controlled cord traction. Despite these measures, PPH incidence remains significant, highlighting a critical need for improved or alternative strategies to enhance uterine contraction and reduce blood loss, especially in resource-limited settings or for patients with risk factors.
Study Design
This randomized controlled trial enrolled 309 patients undergoing delivery, dividing them into two groups. The control group (n=153) received Oxytocin 10 IU I.V at anterior shoulder delivery, followed by Oxytocin 5 IU IM and the Brandt Andrews maneuver. The study group (n=156) received Oxytocin 10 IU I.V at anterior shoulder delivery, after which oxytocin administration was stopped, and cervical traction (the Amr maneuver) was applied. The primary objective was to compare the efficacy of the Amr maneuver in preventing postpartum hemorrhage against the standard active management protocol.
Why It Matters
If effective, the Amr maneuver could offer a novel, potentially low-cost, and accessible method for PPH prevention, particularly valuable in settings where advanced medical resources are scarce or where patients may be less responsive to conventional uterotonics. This could lead to significant reductions in maternal morbidity and mortality. For clinicians, it might introduce an additional tool in the PPH prevention toolkit, potentially integrated into existing protocols or used as an alternative for specific patient profiles. The protocol involves a specific sequence of oxytocin administration followed by the maneuver, suggesting a refined approach to active management of the third stage of labor.
amr maneuver
postpartum hemorrhage
oxytocin
delivery
obstetrics
clinical trial