Active Management of Third Stage of Labor: Practice and Associated Factors among Obstetric Care Providers in North Wollo, Amhara Region, Ethiopia

Background. World Health Organization strongly recommends that every obstetrical provider at birth needs to have knowledge and skills on active management of the third stage of labor and use it routinely for all women. However, implementation of this lifesaver intervention by skilled birth attendants is questionable because 3% to 16.5% of women still experience postpartum hemorrhage. Even though coverage of giving births at health facilities in Ethiopia increases, postpartum hemorrhage accounts for 12.2% of all maternal deaths occurring in the country. Lack of the necessary skills of birth attendants is a major contributor to these adverse birth outcomes. Objectives. This study aimed to assess the active management of the third stage of labor practice and associated factors among obstetric care providers. Methods. An institution-based cross-sectional study design was applied from March 15 to April 15, 2020. Multistage sampling techniques were used to get 254 participants, and data were collected using self-administered structured questionnaires and an observation checklist. Data were entered into EpiData version 3.1 and exported to Statistical Package for the Social Sciences (SPSS) version 23.0 for analyses. The multivariable logistic regression model was used at 95% confidence interval with P value <0.05. Among the 232 providers participating in the study, only 75 (32.3%) of respondents had a good practice. The practice of the provider was significantly associated with work experience (adjusted odd ratio 0.206 (95% confidence interval, 0.06–0.63)), knowledge (adjusted odd ratio (2.98 (95% confidence interval, 1.45–6.14)), the presence of assistance (adjusted odd ratio 2.04 (95% confidence interval, 1.06–3.93)), and time of uterotonic drug preparation (adjusted odd ratio 4.69 (95% confidence interval, 2.31–9.53)). Conclusion. Only one-third of obstetric care providers had good practice during active management of third stage of labor. Practice was significantly associated with work experience, knowledge, the presence of assistance during third-stage management, and time of uterotonic drug preparation. Consistent and sustainable on job training and clinical audit should be applied in all facilities with regular supportive supervision and monitoring. Furthermore, team work and adequate preparation should be done to facilitate the management of active third stage of labor.

Effect of Intramuscular Administration of Dexamethasone on Shortening of the Duration of Induction of Labor

Background Induction of labor refers to iatrogenic stimulation of uterine contractions to accomplish delivery prior to the onset of spontaneous labor. Induction of labor is undertaken when both of the following criteria are met: Continuing the pregnancy is believed to be associated with greater maternal or fetal risk than intervention to deliver the pregnancy, and there is no contraindication to vaginal birth. Aim of the Work to evaluate the effect of intramuscular administration of dexamethasone on the duration of vaginal delivery in women undergoing induction of labor. Patients and Methods This double-blinded randomized controlled study was conducted on 60 termed pregnant women who were divided into two groups, Dexamethasone group: injected with 2 ml of the product (dexamethasone®) 12 hours before initiation of labor induction and placebo group: injected with 2 ml distilled water 12 hours before initiation of labor induction. The two groups were induced by the same standard protocol. Determination of interval between initiation of induction and beginning of active phase, duration of active phase, duration of 2nd stage and duration 3rd stage have been detected for both groups and statistically analyzed. Results There were significant statistical differences between the two studied groups as regard rate of cervical dilatation. There were high significant statistical differences between the two studied groups as regard duration between initiation of labor induction and beginning of active phase of labor, duration of active phase of labor and duration of second and third stage of labor. Conclusion an intramuscular injection of dexamethasone before labor induction is found to shorten the duration of labor induction by decreasing the interval between the initiation of induction and the beginning of the active phase, duration of active phase and duration of second stage of labor with no observed maternal or neonatal complications.

A Comparative Study of Active Management of the Third Stage of Labor IV Methergine and IM Oxytocin

Postpartum haemorrhage (PPH) has been more common over the last three decades, accounting for 11% of all pregnancy-related deaths in the United States. In the third stage of labour, risk classification and active management are crucial preventative techniques. To avoid negative effects, a multidisciplinary approach to PPH patient care is required. To treat uterine atony, uterotonic medicines like oxytocin are used in combination with manipulative procedures like uterine massage and balloon tamponade. The amount of blood loss, duration of the third stage, need for MRP, incidence of PPH, need for repeated oxytocics, and its side effects were measured in Group I 100 women who were administered injection oxytocin 10 IU injection methergin 0.2 mg IV within one minute of the baby's delivery. The mean blood loss at vaginal delivery in Group I was 100-150 ml and in group I P value 0.027, which was statistically significant .In Group II was 160-200 ml with P value 0.036, which was statistically significant. The mean duration of third stag labour in Group 1 was 124.6 min and Group 2 was 144.8 min intravenous methergin is a better uterotonic when compared to intramuscular oxytocin to reduce the amount of blood loss at delivery and prevent complications like atonic PPH.

Total Uterine Inversion After Normal Vaginal Delivery: A Case Report

Puerperal uterine inversion is a rare obstetric emergency that may cause maternal mortality. We describe a multiparous woman with total uterine inversion after a normal vaginal delivery. A 28-years-old, gravid 3, pregnant woman was admitted to the hospital in the first stage of labor. She had a past medical history of curettage due to abnormal vaginal bleeding following her second vaginal delivery and the present pregnancy proceeded without complications. After the delivery, due to the history of placental adhesion, umbilical cord traction was avoided and after 20 min, the patient was asked to push hard. During a Valsalva maneuver, the uterus and the placenta were suddenly expelled from the vagina. The placenta was completely adherent to the decidua and the patient displayed no signs of shock. Then manual repositioning of the uterus was performed by a closed fist and a subtotal abdominal hysterectomy was performed. Pathological examination revealed placenta accreta and the placenta was found completely adherent at the fundus. Uterine inversion usually occurs unexpectedly and is unpreventable in some cases. Assessment of the possible risk factors before delivery may help predict its occurrence. Therefore, in women with a positive history, special measures should be taken in the third stage of labor to manage the possibility of inversion.

Study of effect of intra-umbilical oxytocin along with active management in third stage of labor

Background: The aim of the study was to determine effect of intra-umbilical oxytocin along with active management on duration and amount of blood loss in 3rd of stage of labor.Methods: This was a hospital based prospective, randomized, case-control study conducted in the department of OBG between 1st September 2019 to 31st December 2020. After obtaining permission from ethical committee, screening of inclusion and exclusion criteria and informed consent of participants, 300 cases were enrolled. In group A (control) 20 ml normal saline and in group B (case) 20 IU oxytocin diluted in normal saline to make a 20 ml solution was given intra-umbilically along with standard active management of third stage labor. The data was systematically recorded and analysed.Results: Both the groups were comparable in terms of demographic data. A statistically significant reduction in the duration of third stage of labor (1.83±0.64 min in group B vs 2.92±0.79 min in group A), amount of blood loss (203.73±62.11 ml in group B vs 328.83±87.18 ml group A) and fall in haemoglobin (9.28±1.03 g/dl in the study group A vs 9.97±1.28 g/dl in group B) and haematocrit (31.20±3.05% in study group A vs 33.60±3.31% in study group B) were noted, taking p value significant <0.05.Conclusions: Intra-umbilical oxytocin was associated with a significant reduction in duration and amount blood loss in third stage of labor.

Risk Factors for Hemorrhage in The Third Stage of Labor: A Systematic Review Protocol

BackgroundPostpartum hemorrhage (PPH) is the most common form of obstetric hemorrhage. This is the main cause of maternal death around the world: the incidence varies among countries and accounts for 27% (in some countries, more than 50%) of direct obstetric maternal deaths, mainly in the postpartum period. Recognizing risk factors for PPH in prenatal care and during childbirth care is the first stage to prevent maternal death from PPH. The objective this review is: To identify the risk factors for hemorrhage in the third stage of labor described in the literature from 2000 to 2020. MethodsA protocol for a Systematic Review and Meta-analysis study was developed, supported by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and, registered in the International Prospective Register of Systematic Reviews (PROSPERO). The research question for conducting the review was structured according to the PEOS strategy (P — Populations/People/Patient/ Problem, E — Exposure (s), O — Outcome, S — Study design): P — women aged from 10 to 49 years, in labor; E — risk factors for hemorrhage in the third stage of labor; O — women with hemorrhage during birth and postpartum; S — observational studies (case control and cohort). Thus, the defined question was: what are the risk factors for hemorrhage in the third stage of labor described in the literature from 2000 to 2020? As for the planning of electronic searches, databases were consulted by using the platform of the Coordination for the Improvement of Higher Education Personnel in Brazil (CAPES, as per its Portuguese acronym). Due to the characteristics of each database, specific search strategies were chosen for each database. After applying the eligibility criteria, the articles that are selected will have the quality of the evidence evaluated by applying the Grading of Recommendations, Assessment, Development and Evaluation (GRADE), with the online tool GRADEpro GDT.Discussion Prevention and control of hemorrhage must be initiated in the prenatal period, requiring competent professionals to carry out the appropriate clinical evaluation to classify the degree of risk to which the woman is exposed. This systematic review will support the studies of professionals who working in Angola and Brazil.Systematic review registrationPROSPERO available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021219303

A framework proposal for digital interventions in perinatal education: the result of a content analysis to WHO intra-partum care recommendations

Purpose This research proposes a framework to guide the development and analysis of digital interventions, namely, through mobile applications, regarding labor and birth. By complying with current scientific evidence, this paper aims to contribute to the safeness and completeness of perinatal health education targeting expectant parents. Design/methodology/approach A content analysis was conducted on a document containing World Health Organization guidelines for intra-partum, considering the following categories: timeframe, care options, category of recommendation, to create a data set clearly distinguishing between recommendations and non-recommendations. Context-specific and research-context recommendations, details from dosages, measurements and timings, infant care and non-immediate postpartum topics were considered out of the scope of this study. Findings The results were summarized in a table, ready to be used as a data set, including the following 16 care options ranging from health, well-being and/or rights: respect, communication, companionship, pregnant person’s monitoring, status, fetal monitoring, pain relief, pain management, amenities, labor delay prevention, progress, freedom of choice, facilitation of birth, prevention of postpartum hemorrhage, umbilical cord care and recovery. These were distributed across six timeframes: always, admission, first, second and third stage of labor and immediate postpartum. In addition, recommendations and non-recommendations are displayed in different columns. Originality/value This transdisciplinary research intends to contribute to: future research on perinatal education; the creation of digital interventions, namely, m-health ones, targeting expectant parents by providing a framework of content coverage; the endorsement of the rights to Information and to decision-making. Ultimately, when put into practice, the framework can impact self-care through access to perinatal education.