An evaluation of the practice of active management of third stage of labour in a teaching hospital

Authors

  • Naima Fathima Department of Obstetrics and Gynaecology, SVS Medical College Hospital, Mahabubnagar, Telangana, India
  • M.V. Ramana Rao Department of Obstetrics and Gynaecology, SVS Medical College Hospital, Mahabubnagar, Telangana, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20161445

Keywords:

Atonic PPH, AMTSL, Maternal mortality, Oxytocin

Abstract

Background: Worldwide post-partum haemorrhage (PPH) is the most common cause of maternal mortality. Atonic PPH accounts for 80% of the cases. Risk of PPH can be reduced by 60% by actively managing the third stage of labour. International Federation of Gynecology and Obstetrics (FIGO), International Confederation of Midwives (ICM) and World Health Organization (WHO) recommend routine use of active management of third stage of labour (AMTSL). The present study was done to evaluate the practices of AMTSL.

Methods: 100 Case sheets of women who had vaginal delivery were randomly taken and analyzed for the data regarding the components of AMTSL. Microsoft excel was used for analysis.

Results: The main component of AMTSL, Oxytocin 10 IU IM was used in 80% of the cases for prevention of PPH. Methylergometrine was used in 20% of the cases. Documentation of controlled cord traction was not present. Uterine massage was not routinely done and documented.

Conclusions: WHO recommends all the components of AMTSL and uterotonic is the most significant component. Controlled cord traction should be used where trained person is available. It is necessary to train the staff and create awareness about the AMTSL. Correct documentation is essential for feedback and auditing. Methylergometrine should be used as a second line drug for the treatment of post-partum haemorrhage.

References

Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division.

International confederation of midwives, International Federation of Gynecology and Obstetrics. Joint statement: Management of the third stage of labour to prevent post-partum haemorrhage. London: FIGO; 2003.

International Confederation of Midwives, International Federation of Gynecology and Obstetrics. Prevention and treatment of post-partum haemorrhage: new advances for low resource settings. Int J Gynecol Obstet. 2007;97(2):160-3.

WHO recommendations for the prevention and treatment of postpartum haemorrhage. Geneva: World Health Organization; 2012. Available at http://apps.who.int/iris/bitstream/10665/75411/1/9789241548502_eng.pdf. Accessed 25 February 2015.

Lale S, Doris C, Alison G, Ozge T, Ann BM, Jane D, et al, Global causes of maternal death: a WHO systematic analysis. Lancet Global Health. 2014; 2(6):323-333.

Guidance note on prevention and management of post-partum haemorrhage. Available at http:// nrhm.gov.in/nrhm-components/rmnch-a/ maternal-health/guidelines.html. Accessed on 25 February 2015.

Prendiville WJ, Harding JE, Elbourne DR, Stirrat GM. The bristol third stage trial: active versus physiological management of third stage of labour. British Med J. 1988;297(6659):1295-300.

Rogers J, Wood J, Mc R, Ayers S, Truesdale A, Elbourne D. Active versus expectant management of third stage of labour: the Hinchingbrooke randomised controlled trial. Lancet. 1998;351(9104):693-9.

Begley CM, Gyte GM, Devane D, Mc W, Weeks A. Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev. 2015;9(11):CD007412.

Sheldon WR, Durocher J, Winikoff B, Blum J, Trussell J. How effective are the components of active management of the third stage of labor? BMC Pregnancy Childbirth. 2013;13:46.

Gulmezoglu AM, Lumbiganon P, Landoulsi S, Widmer M, Abdel AH, Festin M, et al. Active management of the third stage of labour with and without controlled cord traction: a randomised, controlled, non-inferiority trial. Lancet. 2012:379(9827);1721-7.

Cherine M, Khalil K, Hassanein N, Sholkamy H, Breebaart M, Elnoury A. Management of the third stage of labor in an Egyptian teaching hospital. Int J Gynaecol Obstet. 2004;87(1):54-8.

Bartlett L, Cantor D, Lynam P, Kaur G, Rawlins B, Ricca J et al. Facility-based active management of the third stage of labour: assessment of quality in six countries in sub-Saharan Africa. Bull World Health Organ. 2015;93(11):759-67.

Stanton C, Armbruster D, Knight R, Ariawan I, Gbangbade S, Getachew A et al. Use of active management of the third stage of labour in seven developing countries. Bull World Health Organ. 2009;87(3):207-15.

Stanton CK, Deepak NN, Mallapur AA, Katageri GM, Mullany LC, Koski A, et al. Direct observation of uterotonic drug use at public health facility-based deliveries in four districts in India. Int J Gynaecol Obstet. 2014;127(1):25-30.

Rath W. Active management of the third stage of labour (AMTSL) the end of a 50 years-dogma? Z Geburtshilfe Neonatol. 2013;217(5):173-6.

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Published

2017-01-05

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Original Research Articles