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The effect of the homeopathic remedies Arnica montana and Bellis perennis on mild postpartum bleeding - A randomized, double-blind, placebo-controlled study - Preliminary results


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To evaluate the effect of Arnica Montana and Bellis perennis on postpartum blood loss. Double blind, placebo-controlled, randomized, clinical trial. Department of Gynecology, Shaare Zedek Medical Center, Jerusalem. Forty parturients were randomized to one of three groups: Arnica montana C6 and Bellis perennis C6 (n=14), Arnica montana C30 and Bellis perennis C30 (n=14), or double placebo (n=12). After 48 h the Arnica/placebo was halted, and patients continued the Bellis/placebo until cessation of lochia. Hemoglobin levels (Hb) at 48 and 72 h postpartum. At 72 h postpartum, mean Hb levels remained similar after treatment with homeopathic remedies (12.7 versus 12.4) as compared to a significant decrease in Hb levels in the placebo group (12.7 versus 11.6; p<0.05), in spite of less favorable initial characteristics of the treatment group. The mean difference in Hb levels at 72 h postpartum was -0.29 (95% CI -1.09; 0.52) in the treatment group and -1.18 (95% CI -1.82; -0.54) in the placebo group (p<0.05). Treatment with homeopathic Arnica montana and Bellis perennis may reduce postpartum blood loss, as compared with placebo.
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YCTIM 765 1—4
Complementary Therapies in Medicine (2005) xxx, xxx—xxx
The effect of the homeopathic remedies Arnica
montana and Bellis perennis on mild postpartum
bleeding—A randomized, double-blind,
placebo-controlled study—Preliminary results
Menachem Oberbauma,, Narine Galoyanb, Liat Lerner-Gevac, Shepherd
Roee Singera, Sorina Grisarub, David Shashar d, Arnon Samueloffb
aThe Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Jerusalem 91031,
11 bDepartment of Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel12 cWomen and Children’s Health Research Unit, Gertner Institute for Epidemiology and Health Policy
Research, Chaim Sheba Medical Center, Tel Hashomer, Israel
14 dDepartment of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel
Objective: To evaluate the effect of Arnica Montana and Bellis perennis on postpar-
tum blood loss.
Design: Double blind, placebo-controlled, randomized, clinical trial.
Setting: Department of Gynecology, Shaare Zedek Medical Center, Jerusalem.
Interventions: Forty parturients were randomized to one of three groups: Arnica
montana C6 and Bellis perennis C6 (n= 14), Arnica montana C30 and Bellis perennis
C30 (n= 14), or double placebo (n= 12). After 48 h the Arnica/placebo was halted,
and patients continued the Bellis/placebo until cessation of lochia.
Main outcome measures: Hemoglobin levels (Hb) at 48 and 72 h postpartum.
Results: At 72 h postpartum, mean Hb levels remained similar after treatment with
homeopathic remedies (12.7 versus 12.4) as compared to a significant decrease in
Hb levels in the placebo group (12.7 versus 11.6; p< 0.05), in spite of less favorable
initial characteristics of the treatment group. The mean difference in Hb levels at
72 h postpartum was 0.29 (95% CI 1.09; 0.52) in the treatment group and 1.18
(95% CI 1.82; 0.54) in the placebo group (p< 0.05).
Conclusion: Treatment with homeopathic Arnica montana and Bellis perennis may
reduce postpartum blood loss, as compared with placebo.
© 2005 Published by Elsevier Ltd.
The funding source was not involved in any way in the collection, analysis, and interpretation of data; in the writing of the
report; and in the decision to submit the paper for publication.
*Corresponding author. Tel.: +972 2 6666 395; fax: +972 2 6666 975.
E-mail addresses:, (M. Oberbaum).
10965-2299/$ — see front matter © 2005 Published by Elsevier Ltd.
YCTIM 765 1—4
2 M. Oberbaum et al.
Postpartum hemorrhage (PPH) is a major cause of2
perinatal morbidity and mortality worldwide. It oc-
curs in 4% of all vaginal deliveries and is the third4
leading cause of maternal mortality in the USA.1
Worldwide, PPH is responsible for up to 125,000 ma-6
ternal deaths, and morbidity in 20 million women
annually. Prophylactic administration of oxytocic8
agents is the standard of care for this condition,9
reducing the incidence of PPH by 40%.2However,10
these intravenous agents have significant side ef-11
fects and contraindications. Therefore, an alterna-12
tive hemostatic therapy, administered orally, de-13
void of side effects and safe to use while breast-
feeding would be a welcome advent.15
For more than 200 years, homeopathy has been16
used during pregnancy and labor (e.g. Ref. 3), but17
only few, poorly performed studies have been per-18
formed to investigate its effect.4The need for indi-19
vidualization presents a major obstacle to the sci-
entific evaluation of homeopathic remedies. Home-
opathic medications are generally prescribed based22
upon the characteristics of the individual patient,23
and only secondarily upon diagnosis. A few ex-24
ceptions exist, in which a particular homeopathic25
medicine may be employed based upon a spe-26
cific indication. Two of these are Arnica montana
(Leopard’s bane), and Bellis perennis (the common
daisy).3,5 Arnica is used to treat trauma in any sys-29
tem, particularly with extravasation of blood, while30
Bellis is widely employed in trauma to the uterus,
including the trauma of labor and cesarean sec-32
tion. Both drugs are considered anti-hemorrhagic33
and analgesic. Therefore, both are commonly used
in homeopathy to treat complaints developing in
conjunction with labor.3,5 We examined the efficacy36
of these two medicines in preventing PPH in a dou-
ble -blinded, randomized placebo controlled trial.38
Between February and August 2003, parturients at40
Shaare Zedek Medical Center who fulfilled inclusion41
criteria were invited to participate in the study. In-42
cluded were women aged 20—35, at week 37—4343
of pregnancy, after one to four previous deliveries,
and scheduled for spontaneous vaginal delivery of
a single fetus. Exclusion criteria were previous ce-
sarean section, antepartum or postpartum hemor-47
rhage in previous pregnancies, and coagulopathies.48
All women received standard obstetric care. The49
study was approved by the hospital’s institutional
review board.
After obtaining informed consent, patients were 52
randomized in a double-blinded manner using block 53
randomization lists6into three groups: (1) Arnica 54
and Bellis, both in a dilution of 106of the stem 55
solution; (2) Arnica and Bellis, both in dilution of 56
1060; and (3) identical placebos. Two different 57
potencies were chosen in order to be able to 58
compare the effect of remedies below (1012)to 59
remedies above Avogadro’s number (1060). Based 60
on the experience, low potencies have a weaker 61
effect than high potencies, but their specificity is 62
not as pronounced as high potencies. We added this 63
explanation in Patients where withdrawn from the 64
study if cesarean section or instrumental delivery 65
was later required. 66
Experimental and placebo drugs were prepared 67
by Ainsworth Pharmacy, London, in accordance 68
with the British Homoeopathic Pharmacopoeia. The 69
stem tinctures of Arnica, Bellis, and 40% alcohol as 70
placebo were diluted by a factor of ten with 40% al- 71
cohol, and vigorously shaken. This was repeated 6 72
and 30 times, yielding final concentrations of 1012 73
and 1060, respectively. One drop of each of the fi- 74
nal dilutions was impregnated separately on seven 75
grams of 3—4 mm spherical sucrose pills (Werners, 76
Germany). One dose of all medications consisted of 77
three tablets. 78
The study medications were distributed in two 79
vials containing pills impregnated with either 80
Arnica and Bellis 1012, Arnica and Bellis 1060 ,81
or two placebos. Patients were treated immedi- 82
ately after delivery by sucking three pills of the 83
medicated or placebo Arnica pills, followed a few 84
minutes later by medicated or placebo Bellis. This 85
was repeated every 5 h for the first 24 h, then three 86
times daily. After 48 h the Arnica/placebo was 87
halted and patients continued the Bellis/placebo 88
until cessation of lochia. 89
Venous hemoglobin levels were measured before 90
delivery (baseline) and 48 and 72 h later. 91
Non-compliance was defined as failure to take 92
medications during the first 48 h (during hospital- 93
ization). Non-compliant patients were included in 94
their intention to treat group for the purpose of 95
analyses. 96
This report presents preliminary results of an 97
on going clinical trial. The sample size for the 98
entire trial was calculated to be 210 eligible pa- 99
tients, under the assumptions of ˛= 0.05, power 100
80%, expected differences in Hb level 1 gram% in 101
the placebo and 0.4 gram% in the treatment groups. 102
We present herein the preliminary results of the 103
first 45 patients that were enrolled. For purposes 104
of analysis of this pilot sample, patients receiv- 105
ing Arnica and Bellis in either dilution were ag- 106
gregated (treatment group) and compared with 107
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Effect of homeopathic remedies on mild postpartum bleeding 3
Table 1 Baseline characteristics of the homeopathy and placebo groups.
Characteristic Treatment group (n= 28) Control group (n= 12)
Maternal age (years) 26.4 ±0.6 27.4 ±1.8
Parity (n) 1.82 ±1.59 1.83 ±1.40
First delivery 8 (28.57%) 2 (16.67%)
Episiotomy (yes) 9 (32.14%) 3 (25.00%)
Birth weight (g) 3327 ±461.39 3447.27 ±366.71
Birth weight 4000 g (n) 4 (14.28%) 1 (8.33%)
Oxytocin use (yes) 5 (19.2%) 2 (18.2%)
Hct at baseline (%) 33.79 ±3.73 32.81 ±4.33
Hemoglobin level at baseline (gram%) 12.7 ±0.2 12.7 ±0.4
placebo, in order to achieve the most conservative108
Primary endpoint was change in average Hb
levels at 48 and 72 h postpartum as compared
with baseline. Statistical methods included two-112
sample T-test and non-parametric test for evaluat-113
ing differences between the study groups for quan-114
titative parameters. The paired T-test and non-
parametric Sign rank test were applied for test-
ing differences between baseline assessment and
post-baseline assessment. Due to the small sample118
size, all analyses were performed using both meth-119
ods. Since similar results were evident, T-test and
paired T-test calculations are presented. All statis-121
tical analysis was performed using SAS statistical122
Forty-five patients enrolled in the study, 31 in the
treatment group and 14 in the control group. Five126
patients, three in the treatment group and two in127
the control group, were excluded because of need128
for cesarean section or instrumental delivery; thus129
40 women, 28 in the treatment group and 12 in the130
control group concluded the study. One patient in131
each group was defined as non-compliant.132
Table 1 summarizes the baseline characteristics133
of women in two groups. There was no difference in134
the baseline mean Hb level (Hb = 12.7) in the treat-135
ment and placebo groups (95% CI 12.3; 13.3 and 95%
CI 11.8; 13.6, respectively). At 48 h following deliv-
ery, the mean Hb levels were 12.5 (95% CI 12.3;
13.2) and 11.4 (95% CI 11.7; 13.6) in the treatment
and placebo groups, respectively (n.s.).
At 72 h the mean Hb levels were 12.4 (95% CI141
11.5; 13.3) and 11.6 (95% CI 10.4; 12.8) in the treat-
ment and placebo groups, respectively (p< 0.05)143
(Fig. 1).144
The mean difference in Hb levels at 72 h postpar-145
tum was 0.29 (95% CI 1.09; 0.52) in the treat-
Figure 1 Mean Hb levels at baseline, after 48 and 72 h
in the treatment and placebo groups.
ment group and 1.18 (95% CI 1.82; 0.54) in the 147
placebo group (p< 0.05). 148
No side effects were recorded in either group. 149
Discussion and conclusion 150
To the best of our knowledge, this is the first study 151
that examines homeopathic treatment in a double 152
blinded, randomized, placebo controlled trial in a 153
delivery ward setting. While the hemoglobin level 154
following delivery dropped in the control group as 155
expected, the hemoglobin level in the treatment 156
group remained stable. 157
The therapeutic effect was marked and statisti- 158
cally significant at 72 h. No side effects were ob- 159
served in either group. Our results may be limited 160
by the small sample size and possible imbalance in 161
initial parameters. However, in comparing groups 162
we note more nulipara (28.57% versus 16.67%), epi- 163
siotomies (32.14% versus 25.00%) and macrosomia’s 164
(14.28% versus 8.33%) in the treatment group than 165
in the placebo group (Table 1), suggesting that the 166
treatment group was at higher risk for bleeding than 167
the control group, enhancing rather than mitigat- 168
ing our findings. We are aware on no similar stud- 169
ies with which to compare our results. We have 170
no plausible biological explanation for our findings 171
YCTIM 765 1—4
4 M. Oberbaum et al.
in light of the miniscule concentrations of homeo-172
pathic medicines involved.173
A larger study is currently in progress to cor-
roborate these findings, as well as evaluate the
analgesic effect of this combination.
Conflict of interest statement
None declared.
This study was supported by the Mirski Foundation,181
Shaare Zedek Medical Center, Jerusalem.
References 182
1. ACOG educational bulletin. Postpartum hemorrhage. Num- 183
ber 243, January 1998. American College of Obstetricians 184
and Gynecologists. Int J Gynaecol Obstet 1998;61:79—86. 185
2. Prendiville WJ, Harding JE, Elbourne DR, Stirrat GM. The Bris- 186
tol third stage trial: active versus physiological management 187
of third stage of labour. BMJ 1988;297:1295—300. 188
3. Moskowitz R. Homoeopathic medicines for pregnancy &189
childbirth. Berkley, CA: North Atlantic Books; 1992. 190
4. Smith C. Homoeopathy for induction of labour. Cochrane 191
Database Syst Rev 2003;4:CD003399. 192
5. Jouanny J. The essentials of homeopathic materia medica.193
Bordeaux, France: Laboratoires Boiron; 1980. p. 44—7, 68—9. 194
6. SAS Institute Inc.. SAS/STAT®software: changes and en- 195
hancements through release 6.11. Cary SAS Institute Inc.; 196
1996, 1104 pp. 197
... (15) En la actualidad se reconoce su uso como anti-inflamatorio en los traumatismos de tejidos blandos(16) además se ha usado para disminuir la perdida de sangre luego del parto. (17) Existen reportes de otras sustancias que pueden causar hepatotoxicidad; como el Poleo, que produce necrosis centrilobular hepática (18) Y la valeriana que esta asociada a hepatitis. Si bien al paciente se le descartaron otras enfermedades, también se aclaró muy bien el antecedente del consumo de árnica, la cual fue utilizada como analgésico, sin otro antecedente, su hepatitis toxica se debió al consumo de esta medicina herbaria y ahora él es un candidato para trasplante de hígado. ...
... También se ha reportado su actividad antiinflamatoria, antipirética, antiespasmódica, astringente, depurativa, diurética, expectorante, mucolítica, disolvente, tónica y vulneraria (Duke et al., 2002). Se han identificado en sus flores saponinas triterpénicas de tipo oleanano, flavonoides y poliacetilenos en extractos (Avato et al., 1997;Costa Marques et al., 2013;Morikawa et al., 2015) y se ha demostrado su actividad antihiperlipidémica, antitumoral, reductora de la glucosa en sangre, fotoprotectora e inmunomoduladora en los queratinocitos de la piel, reductora de la pérdida de sangre posparto, promotora de la síntesis de colágeno en fibroblastos dérmicos, antioxidante, inhibidora de la acetilcolinesterasa y antimicrobiana (Avato et al., 1997;Oberbauma et al., 2005;Morikawa et al., 2010;Costa Marques et al., 2013; Sturms et al., 1905: t. 9;Cabrera, 1971: 19, fig. 9.;Keil, 2012;Sancho, 2014: 124. ...
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Bellis perennis (Asteraceae, Astereae), especie de uso ornamental y maleza de cultivos agrícolas, se encuentra naturalizada en diferentes partes del mundo. Hasta el momento, en Argentina solo había sido registrada en el extremo sur, en las provincias patagónicas de Chubut y Tierra del Fuego e Islas del Atlántico sur, incluyendo las islas Malvinas. Se comunica la presencia de esta especie exótica en la Provincia de Buenos Aires, en los partidos de Azul y Olavarría, constituyendo el primer registro para el centro de Argentina en su área pampeana. Se describe, se ilustra con fotografías y se presentan nuevas observaciones respecto a su distribución y hábitat.
... were determined as the major constituents [184]. Previous studies reported that B. perennis showed wound healing activity, anxiolytic properties, antitumor activity, antibacterial, antifungal, antioxidant, postpartum antihemorrhagic, pancreatic lipase inhibitor cytotoxic activity, and antimicrobial activity [185][186][187][188][189][190][191]. ...
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This study is aimed at determining some of the plants traditionally used in the treatment of diseases by the local people living in Kastamonu province center and surrounding villages. A face-to-face questionnaire was applied and semi-structured interviews were conducted with 52 informants, 34 women and 18 men. Identification of 92 plants belonging to 41 families has been confirmed and their medicinal uses have been recorded. The most used families were Rosaceae (13 taxa), Asteraceae (11), and Lamiaceae (11). The most preferred folk recipes of medicinal plants was decoction (55 taxa) and in preparations and applications, the most used were the leaves (45 taxa). According to the International Classification of Primary Care categories, plants were the most used for digestive disorders (37 taxa), respiratory disorders (27 taxa), and urological disorders (24 taxa). The highest use-value was recorded for Urtica dioica (0.519), and highest relative frequency citation was recorded for Tilia rubra subsp. caucasica (0.231). Male genital diseases had the highest informant consensus factor value (0.83). New areas of use were also determined for Pilosella leucopsilon subsp. pilisquama, Galium palustre, and Astragalus nitens. With this study, new information for folkloric medicines is presented and the usage of herbal drugs in the study area are enhanced.
... It is also known to contain pyrrolizidine alkaloids (tussilagin and isotussilagin) [40]. It has been used for centuries in dermatology as an antiphlogistic, antibiotic, and anti-inflammatory remedy [41]. The pharmaceutical form in traditional topical use is presented as herbal preparations in semi-solid and liquid dosage forms for cutaneous use [42]. ...
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Skin disorders of different etiology, such as dermatitis, atopic dermatitis, eczema, psoriasis, wounds, burns, and others, are widely spread in the population. In severe cases, they require the topical application of drugs, such as antibiotics, steroids, and calcineurin inhibitors. With milder symptoms, which do not require acute pharmacological interventions, medications, dietary supplements, and cosmetic products of plant material origin are gaining greater popularity among professionals and patients. They are applied in various pharmaceutical forms, such as raw infusions, tinctures, creams, and ointments. Although plant-based formulations have been used by humankind since ancient times, it is often unclear what the mechanisms of the observed beneficial effects are. Recent advances in the contribution of the skin microbiota in maintaining skin homeostasis can shed new light on understanding the activity of topically applied plant-based products. Although the influence of various plants on skin-related ailments are well documented in vivo and in vitro, little is known about the interaction with the network of the skin microbial ecosystem. The review aims to summarize the hitherto scientific data on plant-based topical preparations used in Poland and Ukraine and indicate future directions of the studies respecting recent developments in understanding the etiology of skin diseases. The current knowledge on investigations of interactions of plant materials/extracts with skin microbiome was reviewed for the first time.
... The original meta-analysis by Mathie et al yielded a statistically significantly greater efficacy of homeopathy than placebo (SMD: −0.33, 95% CI −0.44 to -0.21).13 For our example, we included the 19 RCTs,[41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] which were published between 2002 and 2014. We chose 2002 as a threshold because ClinicalTrials. ...
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Objectives To assess the magnitude of reporting bias in trials assessing homeopathic treatments and its impact on evidence syntheses. Design A cross-sectional study and meta-analysis. Two persons independently searched, the EU Clinical Trials Register and the International Clinical Trials Registry Platform up to April 2019 to identify registered homeopathy trials. To determine whether registered trials were published and to detect published but unregistered trials, two persons independently searched PubMed, Allied and Complementary Medicine Database, Embase and Google Scholar up to April 2021. For meta-analyses, we used random effects models to determine the impact of unregistered studies on meta-analytic results. Main outcomes and measures We report the proportion of registered but unpublished trials and the proportion of published but unregistered trials. We also assessed whether primary outcomes were consistent between registration and publication. For meta-analyses, we used standardised mean differences (SMDs). Results Since 2002, almost 38% of registered homeopathy trials have remained unpublished, and 53% of published randomised controlled trials (RCTs) have not been registered. Retrospective registration was more common than prospective registration. Furthermore, 25% of primary outcomes were altered or changed compared with the registry. Although we could detect a statistically significant trend toward an increase of registrations of homeopathy trials (p=0.001), almost 30% of RCTs published during the past 5 years had not been registered. A meta-analysis stratified by registration status of RCTs revealed substantially larger treatment effects of unregistered RCTs (SMD: −0.53, 95% CI −0.87 to −0.20) than registered RCTs (SMD: −0.14, 95% CI −0.35 to 0.07). Conclusions Registration of published trials was infrequent, many registered trials were not published and primary outcomes were often altered or changed. This likely affects the validity of the body of evidence of homeopathic literature and may overestimate the true treatment effect of homeopathic remedies.
... ▪ Another study depicted that Arnica and Bellis per helped in reducing postpartum haemorrhage. After major blood loss after delivery as compared to placebo group, Hb levels remained same while the placebo group showed marked decrease in Hb levels [28] . ...
... 13 Homeopathy is the second largest medical system in the world today, recognized by the World Health Organization. 14 The effects of this method on pain relief, [15][16][17] cancer recovery, 18 treatment of middle ear infection, 19 chronic periodontitis, 20 and treatment of AUB [21][22][23] have been reviewed. However, researchersare still looking for more evidence in the field about the effectiveness of this method in the treatment of AUB. ...
... 15 Arnica in combination with Ruta graveolens, Aconitum napellus, Bellis perennis, Hamamelis virginiana, Hypericum perforatum, Calendula officinalis, Ledum palustre, Bryonia alba is effective for treating inflammation 16 . Various analytical methods such as gas chromatography with mass selective detection (GC-MSD), spectrophotometric, reverse-phase liquid chromatography (RPLC) and proton nuclear magnetic resonance spectroscopy (HNMR) have been used for analysing the quantity of lactones presents in the plant 17 . Arnica montana has significant anti-inflammatory potential. ...
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Medicinal plants have been used throughout history in the treatment of many diseases in traditional Anatolian folk medicine as well as all over the world. The rapid increase in agricultural and industrial activities due to the increasing population around the world causes air, water and soil pollution, and accumulation of potentially toxic elements in medicinal plants. In this study, plant mineral nutrients and potentially toxic elements analyzes were carried out in 38 plant species belonging to the medicinally important families Asteraceae, Fabaceae and Lamiaceae. The percentage of macroelements (in %) varies between 0.20 and 1.46 for calcium, 0.08 and 1.35 for potassium, 0.04 and 0.24 for magnesium, 0.01 and 0.34 for sodium, while concentrations of microelements and potentially toxic elements (in mg kg⁻¹) vary between 3.21 and 721.28 for aluminum, 41.33 and 231.01 for boron, 0.01 and 0.61 for cadmium, 1.09 and 47.79 for chromium, 12.90 and 43.13 for copper, 17.75 and 1109.39 for iron, 51.50 and 715.48 for manganese, 0.12 and 9.42 for nickel, 1.58 and 22.11 for lead and finally 80.82 and 260.08 for zinc. In addition, estimated daily intake (EDI), target hazard quotient (THQ), and hazard index (HI) for potentially toxic elements, and Recommended Dietary Allowance (RDA) values for mineral nutrients were calculated. In some samples in industrial and mining areas, accumulation of some potentially toxic elements was slightly above the permissible limits set by the World Health Organization (WHO). In Summary, the importance of collecting medicinal plants from protected areas such as mountainous rural areas, far from mining, close to clean rivers, and regular control of values with potentially toxic elements analyzes for human health has been understood once again.
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To compare the effects on fetal and maternal morbidity of routine active management of third stage of labour and expectant (physiological) management, in particular to determine whether active management reduced incidence of postpartum haemorrhage. Randomised trial of active versus physiological management. Women entered trial on admission to labour ward with allocation revealed just before vaginal delivery. Five months into trial high rate of postpartum haemorrhage in physiological group (16.5% v 3.8%) prompted modification of protocol to exclude more women and allow those allocated to physiological group who needed some active management to be switched to fully active management. Sample size of 3900 was planned, but even after protocol modification a planned interim analysis after first 1500 deliveries showed continuing high postpartum haemorrhage rate in physiological group and study was stopped. Maternity hospital. Of 4709 women delivered from 1 January 1986 to 31 January 1987, 1695 were admitted to trial and allocated randomly to physiological (849) or active (846) management. Reasons for exclusion were: refusal, antepartum haemorrhage, cardiac disease, breech presentation, multiple pregnancy, intrauterine death, and, after May 1986, ritodrine given two hours before delivery, anticoagulant treatment, and any condition needing a particular management of third stage. All but six women allocated to active management actually received it, having prophylactic oxytocic, cord clamping before placental delivery, and cord traction; whereas just under half those allocated to physiological management achieved it. A fifth of physiological group received prophylactic oxytocic, two fifths underwent cord traction and just over half clamping of the cord before placental delivery. ENDPOINT: Reduction in incidence of postpartum haemorrhage from 7.5% under physiological management to 5.0% under active management. Incidence of postpartum haemorrhage was 5.9% in active management group and 17.9% in physiological group (odds ratio 3.13; 95% confidence interval 2.3 to 4.2), a contrast reflected in other indices of blood loss. In physiological group third stage was longer (median 15 min v 5 min) and more women needed therapeutic oxytocics (29.7% v 6.4%). Apgar scores at one and five minutes and incidence of neonatal respiratory problems were not significantly different between groups. Babies in physiological group weighed mean of 85 g more than those in active group. When women allocated to and receiving active management (840) were compared with those who actually received physiological management (403) active management still produced lower rate of postpartum haemorrhage (odds ratio 2.4;95% CI1.6 to 3.7). Policy of active management practised in this trial reduces incidence of postpartum haemorrhage, shortens third stage, and results in reduced neonatal packed cell volume.
This is one of series of reviews of cervical ripening and labour induction using standardised methodology. Homoeopathy involves the use, in dilution, of substances which cause symptoms in their undiluted form. A type of herb, 'caulophyllum' is one type of homoeopathic therapy that has been used to induce labour. To determine the effects of homoeopathy for third trimester cervical ripening or induction of labour. The Cochrane Pregnancy and Childbirth Group Trials Register (13 May 2003), and bibliographies of relevant papers. Randomised controlled trials comparing homeopathy used for third trimester cervical ripening or labour induction with placebo/no treatment or other methods listed above it on a predefined list of labour induction methods. A generic strategy was developed to deal with the large volume and complexity of trial data relating to labour induction. This involved a two-stage method of data extraction. The initial data extraction was done centrally. Two trials involving 133 women were included in the review. The trials were placebo controlled and double blind, but the quality was not high. Insufficient information was available on the method of randomisation and the study lacked clinically meaningful outcomes. This trials demonstrated no differences in any primary or secondary outcome between the treatment and control group. There is insufficient evidence to recommend the use of homoeopathy as a method of induction. It is likely that the demand for complementary medicine will continue and women will continue to consult a homoeopath during their pregnancy. Although caulophyllum is a commonly used homoeopathic therapy to induce labour, the treatment strategy used in the one trial in which it was evaluated may not reflect routine homoeopathy practice. Rigorous evaluations of individualised homeopathic therapies for induction of labour are needed.
Homoeopathic medicines for pregnancy & 189 childbirth
  • R Moskowitz
Moskowitz R. Homoeopathic medicines for pregnancy & 189 childbirth. Berkley, CA: North Atlantic Books; 1992. 190
changes and enhance-ments through release 6.11. Cary SAS Institute Inc.; 1996
  • Sas Institute Inc
  • Sas
  • Stat
SAS Institute Inc. SAS/STAT ® software: changes and enhance-ments through release 6.11. Cary SAS Institute Inc.; 1996. 1104 p.
The essentials of homeopathic materia medica
  • J Jouanny
Jouanny J. The essentials of homeopathic materia medica. 193
American College of Obstetricians and Gynecologists
ACOG educational bulletin. Postpartum hemorrhage. Num-183 ber 243, January 1998. American College of Obstetricians 184 and Gynecologists. Int J Gynaecol Obstet 1998;61:79-86. 185
SAS/STAT ® software: changes and en-195 hancements through release 6.11. Cary SAS Institute Inc
  • Sas Institute Inc
SAS Institute Inc.. SAS/STAT ® software: changes and en-195 hancements through release 6.11. Cary SAS Institute Inc.; 196 1996, 1104 pp.