Postpartum Hemorrhage and Active Management of the Third Stage of Labor (AMTSL) in a Sub-Saharan Africa Maternity

Introduction. Globally, postpartum hemorrhage is the most common cause of maternal mortality and morbidity, and it accounts for more than 25% of all maternal deaths. The majority of death due to postpartum hemorrhage is caused by uterine atony. Routine and correct usage of active management of the third stage of labor decreases the occurrence of postpartum hemorrhage by 60% when compared to expectant management of the third stage of labor. The purpose of this study was to assess midwife knowledge, practice, and associated factors towards active management of the third stage of labor at governmental health institutions in the Tigray region, 2018. Results. These study results showed that from the total study participants ( N = 278 ), 170 (61.2%) were good in knowledge and 121 (43.5%) were good in practice towards active management of the third stage of labor. Training related to active management of the third stage of labor ( AOR = 2.119 , 95 % CI = 1.141 , 3.3937) and practice level of midwives ( AOR = 8.089 , 95 % CI = 4.103 , 15.950) became significantly associated with the knowledge level. The educational level of midwives ( AOR = 3.811 , 95 % CI = 2.015 , 7.210), training related to active management of the third stage of labor ( AOR = 2.591 , 95 % CI = 1.424 , 4.714), and knowledge level of midwives towards active management of the third stage of labor ( AOR = 7.324 , 95 % CI = 3.739 , 14.393) were significantly associated with the practice level. This study showed that training related to active management of the third stage of labor was significantly associated with the knowledge and practice level of midwives. The educational level and knowledge level of midwives were significantly associated with the practice level of midwives towards active management of the third stage of labor. Therefore, midwives should update their academic level and knowledge. Health institutions in collaboration with the Tigray Regional Health Bureau should arrange training for all midwives to bring change.

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Prevention of postpartum hemorrhage: The role of active management of the third stage of labor

International Journal of Gynecology & Obstetrics ◽

10.1016/s0020-7292(06)60004-0 ◽

2006 ◽

Vol 94 ◽

pp. S122-S123 ◽

Cited By ~ 3

Author(s):

Deborah Armbruster

Keyword(s):

Postpartum Hemorrhage ◽

Active Management ◽

The Third ◽

Third Stage Of Labor ◽

Third Stage

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Reduced postpartum hemorrhage after implementation of active management of the third stage of labor in rural Honduras

International Journal of Gynecology & Obstetrics ◽

10.1016/j.ijgo.2012.07.007 ◽

2012 ◽

Vol 119 (3) ◽

pp. 217-220 ◽

Cited By ~ 2

Author(s):

Lisa Kane Low ◽

Joanne Motino Bailey ◽

Emma Sacks ◽

Chayla Robles ◽

Lilian Medina

Keyword(s):

Postpartum Hemorrhage ◽

Active Management ◽

The Third ◽

Third Stage Of Labor ◽

Third Stage

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Active Management of the Third Stage of Labor With a Combination of Oxytocin and Misoprostol to Prevent Postpartum Hemorrhage

Obstetrics and Gynecology ◽

10.1097/aog.0000000000001626 ◽

2016 ◽

Vol 128 (4) ◽

pp. 805-811 ◽

Cited By ~ 9

Author(s):

Thibaud Quibel ◽

Idir Ghout ◽

François Goffinet ◽

Laurent J. Salomon ◽

Julie Fort ◽

...

Keyword(s):

Postpartum Hemorrhage ◽

Active Management ◽

The Third ◽

Third Stage Of Labor ◽

Third Stage

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Rectal Misoprostol versus Intramuscular Oxytocin for Prevention of Post Partum Hemorrhage

Kathmandu University Medical Journal ◽

10.3126/kumj.v9i1.6254 ◽

2012 ◽

Vol 9 (1) ◽

pp. 8-12 ◽

Cited By ~ 8

Author(s):

A Shrestha ◽

A Dongol ◽

C D Chawla ◽

R Adhikari

Keyword(s):

Side Effects ◽

Outcome Measures ◽

Postpartum Hemorrhage ◽

Expectant Management ◽

Active Management ◽

Secondary Outcome ◽

The Third ◽

Third Stage Of Labor ◽

Significant Difference ◽

Third Stage

Background Postpartum hemorrhage (PPH) is an important cause of maternal morbidity and mortality especially in the developing countries. Compared to expectant management, active management decreases the incidence of PPH. Objective To compare the effectiveness of rectal misoprostol with intramuscular oxytocin in the prevention of postpartum hemorrhage. Methods This is a prospective, randomized and analytical study from 1stSeptember 2009 to 28th February 2010 at Department of Obstetrics and Gynecology, Dhulkhel Hospital - Kathmandu University Hospital, Dhulikhel, Nepal. A total of 200 women were included to receive either 1000 micrograms rectal misoprostol tablets or 10 units of oxytocin intramuscularly. Primary outcome measures were the incidence of postpartum hemorrhage or a change in hematocrit or hemoglobin from admission to day two post delivery. Secondary outcome measures including severe postpartum hemorrhage and the duration of the third stage of labor were noted. Also the side effects of both misoprostol and oxytocin were recorded. Results The frequency of postpartum hemorrhage was 4% in the misoprostol subjects and 6% in the control subjects (P=0.886) There were no significant difference among the groups in the drop of hematocrit (P>0.05). Secondary outcome measures including severe postpartum hemorrhage and the duration of the third stage of labor were similar in both groups. Similarly, the side effects between the misoprostol and oxytocin group within 6 hours was statistically significant (p=0.003) whereas the side effects within 24hours was statistically not significant (p=0.106). ConclusionRectal misoprostol is as effective as intravenous oxytocin in preventing postpartum hemorrhage with the similar incidence of side effects and is worthwhile to be used as a uterotonic agent for the routine management of third stage of labor.http://dx.doi.org/10.3126/kumj.v9i1.6254 Kathmandu Univ Med J 2011;9(1):8-12

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Cervical traction: a simple step ahead in the prevention of postpartum hemorrhage

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193148 ◽

2019 ◽

Vol 8 (8) ◽

pp. 3174

Author(s):

Harshita Naidu ◽

Sujatha B. S. ◽

Muralidhar V. Pai

Keyword(s):

Blood Loss ◽

Postpartum Hemorrhage ◽

Active Management ◽

Control Group ◽

Case Group ◽

Postpartum Blood Loss ◽

The Third ◽

Third Stage Of Labor ◽

Third Stage ◽

Cervical Traction

Background: Postpartum hemorrhage is the most common preventable cause of maternal mortality in developing countries. The present study aimed to examine the impact of cervical traction technique in reducing the amount of postpartum blood loss and rate of PPH.Methods: This was a case-control, pilot study conducted in a tertiary hospital between June 2017 to June 2018. A total of 200 singletons, low-risk pregnant females, undergoing normal vaginal delivery, were enrolled in this study. Subjects showing a high risk for PPH were excluded. Patients were randomized as case group (n=100) and control group (n=100). The case group received sustained traction for 90 seconds to anterior and posterior lip of the cervix with active management of the third stage of labor, whereas the control group received routine active management of the third stage of labor. All subjects were followed up for 6 hours post-delivery. The amount of blood loss, hematocrit and hemoglobin post-delivery were compared between both groups.Results: The mean blood loss (ml), decrease in hemoglobin (g/L) and decrease in hematocrit post-delivery in cases were significantly low compared to controls (207±37.6 versus 340±49, P<0.01), (0.78±0.2 versus 1.4±0.3, P=0.03) and (1.7±0.2 versus 3.5±0.2, P<0.01). PPH occurred in 7 of 200 (3.5%) patients. The difference in the number of PPH was not significant (5/100; 5% versus 2/100; 2% P=0.2). There were no complications reported due to cervical traction.Conclusions: Cervical traction is a simple and safe maneuver to reduce the amount of postpartum blood loss. Larger RCT is recommended to investigate the reduction in PPH rate.

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