Active management of third stage of labour: evidence versus practice
Loading...
Date
2009
Authors
Oladapo, O.T
Akinola, O.I
Fawole, A.O
Adeyemi, A.S
ADEGBOLA, O
Loto, O.M
Fabanwo, A.O
Alao, M.O
Sotunsa, J.O
Journal Title
Journal ISSN
Volume Title
Publisher
Informa Healthcare
Abstract
Objective. To determine the correct use of active management of third stage of labor (AMTSL) (using the full complement of
existing standard definitions) and compare the outcomes of third stage of labor in women who received AMTSL (according to
these definitions) with those who did not. Design. Observational, cross-sectional survey. Setting. Seven tertiary centers in
southwest Nigeria. Population. Women undergoing non-instrumental vaginal deliveries. Methods. Prospective direct observations
of childbirth procedures. AMTSL was defined according to Cochrane review, ICM/FIGO (International Confederation
of Midwives/International Federation of Gynecology and Obstetrics), and WHO (World Health Organization) recommendations.
Main outcome measures. Use of AMTSL and its components and outcome of third stage of labor. Results. There was a
high rate of compliance with most of the individual components of AMTSL. The use of AMTSL varied widely with the
definition applied and tended to decrease with increasing strictness of the criteria (Cochrane review: 88.9%; ICM/FIGO: 42%;
WHO: 1.8%). The frequencies of adverse labor outcomes were generally low (postpartum hemorrhage (PPH): 4.9%; severe
PPH: 0.8%; retained placenta: 1.9%; uterine inversion: 0.0%). Frequencies of PPH, postpartum anemia, and mean blood loss
among women who received AMTSL according to the Cochrane review definition were significantly lower than for those who
did not (p < 0.05). There was no significant difference between any of the outcomes for women who received AMTSL
according to the ICM/FIGO definition and those who did not. Conclusions. The survey reveals substantial definition-dependent
variation in the providers’ adherence to recommended AMTSL practices. The clinical implications of the current practice in
this population suggest the need for randomized comparison of various AMTSL packages to determine their comparative
effectiveness in the prevention of PPH.
Description
Keywords
Postpartum hemorrhage, active management, evidence-based medicine