Preventing postpartum haemorrhage: active management of the third stage of labour

Parreira, Vitória; MSc, RN Nádia C Ferreira Gomes

doi:10.1111/jocn.12361

Cited by 9 publications

(11 citation statements)

References 25 publications

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“…Furthermore, the current study found that palpation of the abdomen for early detection of an atonic uterus, assessment for placenta completeness and inspecting for cervical or vaginal tears were deemed important and become harmful if not observed when performing AMTSL. Other studies found similar observation on delayed cord clamping as a component of AMTSL but mixed findings on consideration of CCT and or UM 7,19,21,22 .…”

Section: Discussionmentioning

confidence: 60%

“…Third stage of labour (TSL) is the most critical period for PPH which is defined as the time from the birth of the baby until the expulsion of the placenta and membrane. PPH can be derived from uterine atone, lesions in the birth canal, uterine rupture, retained placental tissue or bleeding disorders 7 . However, uterus to contract and retract following child birth has been the most common cause of PPH.…”

Section: Introductionmentioning

confidence: 99%

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Knowledge and barriers on correct use of modified guidelines for active management of third stage of labour: a cross sectional survey of nurse-midwives at three referral hospitals in Dar es Salaam, Tanzania

Ramadhani

Liu

Lembuka³

2020

Afr H. Sci.

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Background: Despite the fact that it is possibly preventable, postpartum haemorrhage (PPH) is the global most deadly form of obstetric bleeding, mainly sub-Saharan Africa with at least one-fourth of maternal deaths in East African regions. Active management of third stage of labour (AMTSL) is recommended to prevent PPH. However, AMTSL guidelines have been revised since 2006. Objectives: To examine the current status of nurse-midwives’ knowledge on modified AMTSL guidelines and highlight barriers to AMTSL correct use. Method: Descriptive cross sectional survey was conducted to 160 nurse-midwives at three referral hospitals in Dar es Sa- laam, Tanzania. One-way, interactive modes ANOVA and Chi square (χ2) test were run in SPSS 21 version to compare the association of independent and dependent variables. Results: Virtually all nurse-midwives knew the first recommended uterotonic (99.4%) and delayed cord clamping (98.8%) protocols as modified. Knowledge was significantly contributed by multiple factors; p=0.001. Reported correct AMTSL use was 46.8% which was significantly affected by AMTSL training (χ2 = 6.732, p = 0.009) and prioritizing atteding an asphyx- iated baby (χ2 = 5.647, p = 0.017). Conclusion: Regardless of high nurse-midwives’ AMTSL knowledge; it is imperative that responsible authorities plan ap- propriate strategies to solve reported barriers affecting correct AMTSL use. Keywords: Nurse-midwives’ knowledge, maternal bleeding, maternal mortality, third stage of labour, AMTSL, atonic uterus

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Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Knowledge and barriers on correct use of modified guidelines for active management of third stage of labour: a cross sectional survey of nurse-midwives at three referral hospitals in Dar es Salaam, Tanzania

Ramadhani

Liu

Lembuka³

2020

Afr H. Sci.

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“…Augmentation of labor with synthetic oxytocin is increasingly used worldwide [ 1 – 4 ]. Its purpose is to avoid or treat dystocia (prolonged labor) and associated adverse outcomes, such as a negative birth experience and cesarean section on maternal request in next pregnancy [ 5 , 6 ], chorioamnionitis, operative birth and post-partum hemorrhage [ 7 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

De-medicalization of birth by reducing the use of oxytocin for augmentation among first-time mothers – a prospective intervention study

Gaudernack

Frøslie²,

Michelsen

et al. 2018

BMC Pregnancy Childbirth

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BackgroundThe use of synthetic oxytocin for augmentation of labor is rapidly increasing worldwide. Hyper-stimulation is the most significant side effect, which may cause fetal distress and operative delivery. We performed an intervention consisting of an educational program and modified guidelines to achieve a more appropriate use of oxytocin.MethodsThis prospective intervention study included 431 first-time mothers at term with spontaneous onset of labor before (October 2012 to May 2013), and 664 after the intervention (April 2014 to April 2015). Our outcomes were prevalence and duration of oxytocin treatment, mode of delivery, indication for operative delivery, episiotomy, anal sphincter tears, bleeding, labor duration, pain relief and the effect of oxytocin on mode of delivery.ResultsAfter the intervention, 52.9% were diagnosed with dystocia, compared with 68.9% before (p < 0.001). Oxytocin was not always used in accordance with the guidelines, but a significant reduction in oxytocin rates from 63.3% to 54.1% (p < 0.001) was obtained. More women without dystocia according to the existing guidelines were augmented after the intervention (18.9% vs 8.4%, p < 0.001). Assessing all labors, the median duration of oxytocin treatment was reduced by 72% (from 90 to 25 min) without increasing the median duration of labor (385 min in both groups). There was a moderate reduction in operative vaginal deliveries from 26.9 to 21.5% (p = 0.04), and dystocia as an indication for these deliveries increased (p = 0.01). There was a moderate increase in caesarean sections from 6.7 to 10.2% (p = 0.05), but no increase in dystocia as an indication for these deliveries. Women receiving oxytocin were more likely to have an operative vaginal birth, even after adjusting for birth weight, epidural analgesia and labor duration, OR: 2.1 (CI 1.1-4.0) before and OR 2.7 (CI 1.6-4.5) after the intervention.ConclusionsOur intervention led to a significant reduction in the use of oxytocin. However, more than half of the women remained diagnosed with dystocia. Operative vaginal births seem to be associated with oxytocin treatment. Therefore, augmentation with oxytocin should be used with caution and only when medically indicated. Even more modified guidelines for augmentation than the ones applied in this study might be appropriate.

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“…The secondary-type, on the other hand, is that which occurs after 24 h [4] . The causes of primary postpartum hemorrhage may be uterine atony, cervicovaginal lacerations, uterine rupture, and bleeding disorders, among which the most common cause is uterine atony [3] . On the other hand, in the secondary-type of postpartum hemorrhage, the causes may be retained placental tissue, late involution of the placental insertion site, infection, and coagulation disorders [6] .…”

Section: Introductionmentioning

confidence: 99%

The effect of the use of oxytocin on blood loss during different postpartum periods

Fidan¹,

Keskin²,

Ulubay³

et al. 2014

Journal of Perinatal Medicine

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Preventing postpartum haemorrhage: active management of the third stage of labour

Abstract: There is a need to determine gaps in the clinical practices of midwives in regard to the active management of third stage of labour, to update knowledge and practices with the latest scientific evidence.

Cited by 9 publications

References 25 publications

Knowledge and barriers on correct use of modified guidelines for active management of third stage of labour: a cross sectional survey of nurse-midwives at three referral hospitals in Dar es Salaam, Tanzania

Knowledge and barriers on correct use of modified guidelines for active management of third stage of labour: a cross sectional survey of nurse-midwives at three referral hospitals in Dar es Salaam, Tanzania

De-medicalization of birth by reducing the use of oxytocin for augmentation among first-time mothers – a prospective intervention study

The effect of the use of oxytocin on blood loss during different postpartum periods

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