The effect of early nipple stimulation on third stage of labour duration and estimated blood loss: A systematic review and meta-analysis

IF 2.6 3区医学 Q1 NURSING

Midwifery Pub Date : 2025-06-04 DOI:10.1016/j.midw.2025.104478

Zoe Y. Zervides , Maria M. Witkowiak , Dana O. Alzoubi , Reem B. Zalloum , Natalie E. Bourdakos , Fatma A.M. Abdulsalam , Hayato Nakanishi , Christian A. Than , Shavi Fernando , Sir Sabaratnam Arulkumaran

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引用次数: 0

Abstract

Background

Post-partum haemorrhage due to uterine atony remains a leading cause of maternal mortality worldwide with a high portion occurring in under resourced settings. The risk of post-partum haemorrhage increases with prolonged duration of the third stage of labour. Early nipple stimulation promotes the early release of oxytocin, which has beneficial effects on uterine tone. Therefore, this meta-analysis evaluates the impact of early nipple stimulation on the duration of the third stage of labour and estimated blood loss.

Aim

To assess whether early nipple stimulation following uncomplicated deliveries effects the duration of the third stage of labour and estimated blood loss.

Methods

A comprehensive search was conducted in PubMed, EMBASE, Cochrane, CiNAHL, Scopus and Web of Science, covering studies published up to February 5^th 2024. Eligible studies included randomised control trials and observational studies involving women with singleton pregnancies and live foetuses who engaged in nipple stimulation in the third stage. Studies that reported the duration of the third stage of labour and/or estimated blood loss were included. Exclusion criteria comprised stillbirths, multiple pregnancies and the use of general anaesthesia. Data was analysed using a random-effects model. This review was registered with PROSPERO (CRD42023494605).

Results

Nine studies involving 789 mothers were included. Early nipple stimulation reduced blood loss and improved uterine tone. When synthetic oxytocin was not used, early nipple stimulation reduced the duration of the third stage of labour.

Conclusion

Early nipple stimulation may be a viable alternative to uterotonics in uncomplicated deliveries, especially in low-resource settings. Further high-quality primary research is indicated to build upon the preliminary findings of this current meta-analysis.

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早期乳头刺激对分娩第三期持续时间和估计出血量的影响：一项系统回顾和荟萃分析

背景子宫张力引起的产后出血仍然是全世界孕产妇死亡的主要原因，其中很大一部分发生在资源不足的环境中。产后出血的风险随着第三产程的延长而增加。早期乳头刺激促进催产素的早期释放，这对子宫张力有有益的影响。因此，本荟萃分析评估了早期乳头刺激对分娩第三阶段持续时间和估计出血量的影响。目的评估无并发症分娩后早期乳头刺激是否影响第三产程的持续时间和估计的出血量。方法综合检索PubMed、EMBASE、Cochrane、CiNAHL、Scopus和Web of Science，检索截止到2024年2月5日已发表的研究。符合条件的研究包括随机对照试验和观察性研究，涉及单胎妊娠妇女和在第三阶段进行乳头刺激的活胎。包括报告第三产程持续时间和/或估计失血量的研究。排除标准包括死产、多胎妊娠和使用全身麻醉。数据采用随机效应模型进行分析。本综述已在普洛斯彼罗注册（CRD42023494605）。结果纳入9项研究，涉及789名母亲。早期乳头刺激可减少失血，改善子宫张力。当不使用合成催产素时，早期乳头刺激缩短了分娩第三阶段的持续时间。结论早期乳头刺激可能是一种可行的替代子宫强直术在简单分娩，特别是在低资源环境。进一步的高质量的初步研究是建立在当前的荟萃分析的初步发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Midwifery 医学-护理

CiteScore

4.50

自引率

7.40%

发文量

221

审稿时长

13.4 weeks

期刊介绍： Midwifery publishes the latest peer reviewed international research to inform the safety, quality, outcomes and experiences of pregnancy, birth and maternity care for childbearing women, their babies and families. The journal’s publications support midwives and maternity care providers to explore and develop their knowledge, skills and attitudes informed by best available evidence. Midwifery provides an international, interdisciplinary forum for the publication, dissemination and discussion of advances in evidence, controversies and current research, and promotes continuing education through publication of systematic and other scholarly reviews and updates. Midwifery articles cover the cultural, clinical, psycho-social, sociological, epidemiological, education, managerial, workforce, organizational and technological areas of practice in preconception, maternal and infant care. The journal welcomes the highest quality scholarly research that employs rigorous methodology. Midwifery is a leading international journal in midwifery and maternal health with a current impact factor of 1.861 (© Thomson Reuters Journal Citation Reports 2016) and employs a double-blind peer review process.