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.. Objectives: The aim of our study is to determine the effectiveness of uterine massage with active management and compare it with active management alone, in primary postpartum hemorrhage prevention. Study Design: Randomized control trial. Period: 8 months from September 2014 to April 2015. Setting: Tertiary Care Hospital in Karachi, Pakistan. Method: The study population consists of n=118 patients, both emergency and elected cases, who came to the gynecology and obstetrics ward at our hospital. The patient population was divided into two groups, group I received active management of labor ( third stage ) while group II received active management of labor (third stage) in addition to the uterine massage (for a 2hr duration), the outcome was measured by measuring the amount of blood loss and the need for uterotonic agents. A p value of less than 0.05 was considered significant. Results: The study population consisted of n=118 patients, undergoing spontaneous labor, and divided into two groups, the mean blood loss in group I (control group) was 211.4mls and in group II (massage group) was 167.8mls (p value= 0.015). In group I n=15 patients required additional uterotonic support, while in group II only n=3 patients required it (p value= 0.00058). Conclusion: According to the results of our study, uterine massage in addition to the active management of labor reduces post-partum hemorrhage, and it also reduces the requirement for additional uterotonic agents for the control of hemorrhage.

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PRIMARY POSTPARTUM HEMORRHAGE; THE EFFECTIVENESS OF UTERINE MASSAGE WITH ACTIVE MANAGEMENT AS COMPARED TO ACTIVE MANAGEMENT ALONE, IN THE PREVENTION AT A TERTIARY CARE HOSPITAL IN KARACHI PAKISTAN