Active management of third stage of labour, post–partum haemorrhage and maternal death rate in the Vanga Health Zone, Province of Bandundu, Democratic Republic of the Congo

Background: Post-partum haemorrhage (PPH) is the single largest cause of maternal death worldwide and a particular burden for developing countries. In Africa, about 33.9 % of maternal deaths are due to PPH. In the Democratic Republic of the Congo (DRC), the prevalence of PPH is unknown. PPH can be prevented with active management of the third stage of labour (AMTSL). Objectives: To describe the practice of AMTSL in Vanga Health Zone and to calculate the incidence of PPH in Vanga Health Zone.Method: An intervention study with post-test-only design was conducted among health maternity wards using a data collection sheet to obtain information. All pregnant women attending Vanga Health maternity wards constituted the study population. Frequencies were determined for variables of interest.Results: From April 2007 to March 2008, 6339 deliveries took place at Vanga Health maternity wards, representing 71% of the institutional delivery rate. The number of deliveries realised with the practice of (AMTSL) were 5562; 366 cases of PPH were reported, making an incidence of 5.77%. Three cases of maternal deaths – two of which were related to PPH – were reported during the study period, which means there was a decline of 70% compared with the previous two years.Conclusion: The prevalence of PPH has been estimated to be 5.77%; PPH represents the cause of 67% of all maternal deaths. The extension of AMTSL practice, combined with the assurance of better supplies of oxytocin to enhance drug management, is strongly advised/suggested. As a number of births still take place outside the health maternity wards, the introduction of oral misoprostol could be considered a part of AMTSL for use by patients being treated by traditional midwives.

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Obstetrical Haemorrhagic Mortality in a Tertiary Hospital of the Limpopo Province, South Africa

Medical Science & Healthcare Practice ◽

10.22158/mshp.v1n1p42 ◽

2017 ◽

Vol 1 (1) ◽

pp. 42

Author(s):

Sam T Ntuli

Keyword(s):

South Africa ◽

Maternal Death ◽

Post Partum ◽

Tertiary Hospital ◽

Limpopo Province ◽

Hospital Death ◽

Maternal Deaths ◽

Obstetric Haemorrhage ◽

District Hospitals ◽

Post Partum Haemorrhage

Background: Obstetric haemorrhage is potentially fatal. Its frequency contributes to assessment of population health. So this study purpose was to assess the maternal deathsdue to obstetric haemorrhage in a tertiary hospital of the Limpopo Province, South Africa. Methods: Allmaternal deaths, which occurred at Pietersburg Hospitalfrom January 2011 to December 2015 were reviewed. The hospital death register was used to collate the list of maternal deaths.Maternalage, parity, referring facility, date of admission and death, ward where death occurred, and causes of deathwere collected from delivery registers and patient medical records.Results: There were 232 maternal deaths of which 48 (20.7%) were due to obstetrical haemorrhage. The mean age of the 48 women was 31.7±6.7 year range 15-48 years. Thirty one of 48 haemorrhagic deaths (65%) occurred within 24 hours of admission, 16 of 48 (33%) had a parity of 3 or more, 19 (40%) died in ICU and 12 (25%) in casualty. Forty three of 48 women (90%) were referred, of which 36 (84%) were from district hospitals. Post-partum haemorrhage accounted for 39 of 48 (81%) deaths followed by unspecifiedante-partum haemorrhage accounting for 4 (8%) and placenta abruption 2 of 48 (4%).Conclusion: This study demonstrated that a maternal death due to obstetric haemorrhage remains a major concern in Limpopo Province. Post-partum haemorrhage was the main cause of deaths.

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INTRAMUSCULAR OXYTOCIN VERSUS SUBLINGUAL MISOPROSTOL AS A COMPONENT OF ACTIVE MANAGEMENT OF THIRD STAGE OF LABOUR FOR PREVENTION OF PRIMARY POST-PARTUM HAEMORRHAGE

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2018/721 ◽

2018 ◽

Vol 7 (28) ◽

pp. 3204-3210

Author(s):

Sukumar Mitra ◽

Jhumee Baraik

Keyword(s):

Post Partum ◽

Active Management ◽

Third Stage ◽

Sublingual Misoprostol ◽

Post Partum Haemorrhage

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EFFECTS OF SUBLINGUAL MISOPROSTOL AS ADJUNCT TO OXYTOCIN FOR ACTIVE MANAGEMENT OF THIRD STAGE OF LABOUR IN PATURIENTS AT RISK OF POST-PARTUM HAEMORRHAGE IN ABAKALIKI : A COMPARISON OF 200 VERSUS 400 MICROGRAMS

International Research Journal of Obstetrics and Gynecology ◽

10.28933/irjog-2020-04-1506 ◽

2020 ◽

pp. 28

Author(s):

Keyword(s):

At Risk ◽

Post Partum ◽

Active Management ◽

Third Stage ◽

Sublingual Misoprostol ◽

Post Partum Haemorrhage

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Active Management of Third Stage Labor Is Associated with a Lower Cord Blood Unit Volume.

Blood ◽

10.1182/blood.v106.11.5282.5282 ◽

2005 ◽

Vol 106 (11) ◽

pp. 5282-5282

Author(s):

Valerie Lapierre ◽

Stephane Maddens ◽

Stephanie Vuillemin ◽

Chrystelle Vidal ◽

Michelle Menetrier ◽

...

Keyword(s):

Multivariate Analysis ◽

Cord Blood ◽

Post Partum ◽

Univariate Analysis ◽

Active Management ◽

Cell Content ◽

Second Stage ◽

Cd34 Cells ◽

Third Stage ◽

Post Partum Haemorrhage

Abstract Aim: It has been demonstrated that active management of third stage of labour (AMTSL) (prophylactic administration of a uterotonic agent, early cord blood clamping and controlled cord blood traction) reduces the risk of primary post partum haemorrhage compared with expectant (or physiological) management. However this strategy might decrease the cord blood unit (CBU) volume which is collected in order to be banked for therapeutic use. Knowing that efficacy of CBU transplantation correlates with CD34+ progenitor cells content (which is correlated with the collected volume of CBU), we conducted a retrospective study to analyse the impact of AMTSL on volume and CD34 progenitor’s content of CBU. Material and Method: From Jan 1st 2001 to Oct 2nd, 2004 the maternity affiliated to the Besançon CBB performed 3838 CBU collections after normal deliveries. Different factors that might impact on CBU volume and CD34+ cell content were analysed: age, parity, and smoking habit of the mother, gestational age, type of initiation and duration of first labour stage, duration (from the beginning of labour to initiation of the pushing phase), time of the second stage of labour (from the initiation of pushing time to the birth of the baby), foetal cardiac rhythm (FCR) alterations during labour, type of delivery (assisted or not) and variables of the third stage of labour (AMTSL, uterine revision, primary post partum haemorrhage occurrence, placenta weight). Moreover, variables in relation with the baby were studied: sex, weight, Apgar score at 1 and 5 minutes. Each factor were submitted to a univariate analysis. Multivariate analysis was carried only onto factors significant after univariate analysis. Analysis concerning volume was performed on all 3838 CBU while analysis for CD34+ cells content was performed only on CBU with a volume > 80 ml (minimum volume required for banking in our CBB) Results: In univariate analysis, assisted initiation of first stage of labour (p=0.04), FCR modification during labour (p=0.01), uterine revision (p=0.01), primary post partum haemorrhage (p=0.01), gestational stage (p=0.0001), duration of second stage labour (P=0.0001), placenta and baby weight (both p=0.0001) instrumental expulsion (p= 0.0001) and male baby (p=0.01) were associated with higher CBU volume. Conversely, AMSTL (p= 0.01) and Apgar sore at 1 and 5 minutes (p=0.0007 and 0.004 respectively) were associated with lower CBU volume. In multivariate analysis, only assisted initiation of first stage of labour (p=0.02), primary post partum haemorrhage (p=0.0001), duration of second stage labour (P=0.003), placenta and baby weight (both p=0.0001) were associated with higher CBU volume. However, AMSTL (p= 0.03) and Apgar sore at 1 (p=0.003) were associated with lower CBU volume. Concerning CD34+ cells, in multivariate analysis, only maternal age (p=0.02), gestational stage (p=0.0001), FCR modification during labour (p=0.001), duration of second stage labour (p=0.0001), placenta and baby weight (respectively p= 0.001 and p=0.0001) were associated with higher CD34+ cells content in CBU. Conversely, only Apgar sore at 1 (p=0.0001) was associated with lower CD34+ cells content in CBU. Conclusion: AMSTL is associated with a low CBU volume but not with a low CD34+ cell count. In view of the know generalized use of AMSTL, such findings could have on impact on the determination of volume and CD34+ cell content threshold required for CBU banking.

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A prospective randomized controlled trial for comparison of oral misoprostol with methyl ergometrine in the third stage of labour for prevention of post-partum haemorrhage

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20172560 ◽

2017 ◽

Vol 6 (7) ◽

pp. 2825 ◽

Cited By ~ 1

Author(s):

Sushma Gore ◽

Atul Padmawar ◽

Sabir Khan Pathan

Keyword(s):

Post Partum ◽

Tertiary Care ◽

Active Management ◽

Oral Misoprostol ◽

Vaginal Deliveries ◽

Third Stage ◽

Group A ◽

Post Partum Haemorrhage ◽

Group B ◽

Study Participants

Background: Near about 11% of women having live births have severe PPH (Globally 14 million women per year). About 3.9% of vaginal deliveries and 6.4% of cesarean section get PPH. Near about 1.4 million women die of PPH every year. Frequency of PPH is related to management of third stage of labour. Objective of the study was to compare the efficacy of misoprostol with conventional oxytocics for active management of third stage of labour.Methods: The present study was carried out in tertiary care teaching hospital for a period of three years from June 2007-May 2010. A total of 364 study participants who reported to labour ward with labour pains in latent phase and subsequently went in spontaneous labour were enrolled and randomly distributed to two groups and given oral misoprostol and i.v. ergometrine.Results: The mean age in Group A was 23.17±2.55 and 24.31±3.28 respectively. It was observed that most the study participants in both the groups had the duration of third stage of labour in between 10-14 minutes i.e. 29% in Group A and 36.3% in Group B respectively. The duration of third stage of labour was significantly more in Group B compared to Group A.Conclusions: Misoprostol is a promising drug in the management of third stage of labour for the prevention of post- partum haemorrhage.

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Roundtable: Making Pregnancy Safer in Myanmar: Introducing Misoprostol to Prevent Post-Partum Haemorrhage as Part of Active Management of the Third Stage of Labour

Reproductive Health Matters ◽

10.1016/s0968-8080(07)30317-0 ◽

2007 ◽

Vol 15 (30) ◽

pp. 214-215 ◽

Cited By ~ 7

Author(s):

Thein Thein Htay

Keyword(s):

Post Partum ◽

Active Management ◽

The Third ◽

Third Stage ◽

Post Partum Haemorrhage

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A comparative study of efficacy of oxytocin, methylergometrine and misoprostol in prevention of post-partum haemorrhage

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20171957 ◽

2017 ◽

Vol 6 (5) ◽

pp. 1960 ◽

Cited By ~ 1

Author(s):

Anjuman Alam ◽

Paresh Shyam ◽

Swapnil Goswami

Keyword(s):

Blood Loss ◽

Post Partum ◽

Active Management ◽

Singleton Pregnancy ◽

Primary Parameter ◽

Third Stage ◽

Drug Storage ◽

Trained Personnel ◽

Post Partum Haemorrhage ◽

Spontaneous Onset

Background: To compare the efficacy of oxytocin, methylergometrine and misoprostol in active management of third stage of labour (AMTSL).Methods: A clinical study was conducted on 330 low risk pregnant women with a healthy singleton pregnancy and spontaneous onset of labour at term; allocated into three groups where active management of third stage of labour was done with either Oxytocin 10 IU intramuscular, or Methylergometrine 0.2 mg intramuscular, or tab Misoprostol 600µg sublingual on 110 women each group. Primary parameter was blood loss during labour. Secondary parameters were the duration of third stage of labour and changes in haemoglobin level.Results: Blood loss during labour in Oxytocin group was 145.86±11.53 ml, which was significantly less than that in Methylergometrine (164.02±9.36 ml) and Misoprostol groups (183.18±9.70 ml), but no patient in any of the groups had blood loss more than 200ml. Duration of third stage of labour was significantly less in Oxytocin group (5.13±1.91 mins) than in. Methylergometrine (6.16±1.85 mins), and Misoprostol groups (6.47±1.51 mins). No patient had prolonged third stage in any of the groups. There was no significant change in pre-and post-delivery haemoglobin levels in all the groups.Conclusions: Though injectable uterotonics are effective for active management of third stage of labour (AMTSL), misoprostol can also be effectively used, especially in settings where there is no adequate trained personnel and drug storage facility.

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Active management of third stage of labor

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v1i2.1490 ◽

1970 ◽

Vol 1 (2) ◽

pp. 25-27

Author(s):

Meena Thapa ◽

Rachana Saha ◽

Sumita Pradhan ◽

Sushil Thakur ◽

Archan Shamsher Rana

Keyword(s):

Blood Loss ◽

Post Partum ◽

College Teaching ◽

Uterine Atony ◽

Active Management ◽

Retained Placenta ◽

Average Blood Loss ◽

Cord Clamping ◽

Third Stage Of Labor ◽

Third Stage

Objective: Overall objective of the study was to see effects of active management of third stage of labour (AMSTL) with oxytocin. Specific objective of the study was to look for incidence of Post-Partum Haemorrhage (PPH), length of 3rd stage, incidence of retained placenta and average blood loss. Methodology: A hospital based prospective, descriptive, observational study was carried out from 1st July 2005 to 30th June 2006 at department of Obstetrics and Gynaecology, Kathmandu Medical College Teaching Hospital (KMCTH). All patients undergoing vaginal delivery excluding twins, polyhydraminios and instrumental deliveries were included in the study. The active management of 3rd stage included administration of 10 units IU of oxytocin, early cord clamping, controlled cord traction and uterine massage. Blood loss was estimated by visual inspection and measured by jar pressed against perineum. Result: Total number of deliveries during the study period was 530. There were 13 cases of PPH. Incidence of PPH was 2.4%. There were six cases each of uterine atony and genital tract trauma. One case was of retained placenta requiring Manual Removal (MRP). Average third stage duration was less than 5 minutes. Average blood loss was 90 ml. In 2 cases the third stage lasted more than 30 mins. Conclusion: Active management of 3rd stage of labour reduces the incidence of PPH from uterine atony, reduces the duration as well as average blood loss during third stage.condition. Key words: Labor analgesia; epidural, combined spinal epidural; complications, dural puncture, postdural puncture headache (PDPH); prevention. doi:10.3126/njog.v1i2.1490 N. J. Obstet. Gynaecol Vol. 1, No. 2, p. 25 - 27 Nov-Dec 2006

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