ctive management reduces mean maternal blood loss at birth and probably reduces the rate of primary blood loss greater than 500 mL,and the use of therapeutic uterotonics. Active management also probably reduces the mean birthweight of the baby, reflecting the lowerblood volume from interference with placental transfusion. In addition, it may reduce the need for maternal blood transfusion. However,active management may increase maternal diastolic blood pressure, vomiting after birth, afterpains, use of analgesia from birth up todischarge from the labour ward, and more women returning to hospital with bleeding (outcome not pre-specified).