# A National Survey on Current Practices in Management of The Third Stage of Labor in Second Trimester Deliveries

## TL;DR

This survey shows that there is no standard approach for managing retained placenta after second trimester deliveries, with wide variation in medication use and expectant management duration.

## Contribution

The study provides the first national survey characterizing current clinical practices for managing the third stage of labor in second trimester deliveries.

## Key findings

- 67% of institutions lack a protocol for managing the third stage of labor in second trimester deliveries.
- Oxytocin and misoprostol are the most commonly used medications for medical management.
- Expectant management is used by 42% of providers with a median duration of 120 minutes.

## Abstract

Retained placenta complicates roughly 21–30% of second trimester deliveries. Literature and clinical guidelines regarding management of the third stage of labor are limited, leading to a wide variation in practice. The purpose of this study is to clarify providers’ current management practices and their supporting rationale.

A cross-sectional survey was administered to obstetric providers who have managed retained placenta following second trimester deliveries in the last five years via two national listservs of obstetric providers. Descriptive statistics were used to characterize provider characteristics and practices for managing the third stage of labor in second trimester deliveries, including sequence of interventions, medication selection, and time allotted for expectant management.

Of the 113 survey participants, most respondents were OB/Gyn Generalists practicing in urban academic centers. Sixty-seven percent of respondents reported their institution did not have a protocol for managing the third stage of labor in second trimester deliveries. Half of providers reported medical management as first line (53%), with oxytocin and misoprostol being the most commonly used medications. Forty-two percent of participants elected for expectant management as first line, with a median of 120 minutes in duration (inter-quartile range: 30, 240 minutes). Most providers reported that their current practice was either learned practice from a mentor, based on clinical guidelines/scientific literature, or based on clinical scenario.

Management practices for the third stage of labor in second trimester deliveries vary widely across providers, particularly regarding medication selection and duration of expectant management. Many providers reported practice preferences that do not align with extremely limited existing data or clinical guidelines.