An evaluation of the practice of active management of third stage of labour in a teaching hospital

Naima Fathima, M.V. Ramana Rao


Background: Worldwide post-partum haemorrhage (PPH) is the most common cause of maternal mortality. Atonic PPH accounts for 80% of the cases. Risk of PPH can be reduced by 60% by actively managing the third stage of labour. International Federation of Gynecology and Obstetrics (FIGO), International Confederation of Midwives (ICM) and World Health Organization (WHO) recommend routine use of active management of third stage of labour (AMTSL). The present study was done to evaluate the practices of AMTSL.

Methods: 100 Case sheets of women who had vaginal delivery were randomly taken and analyzed for the data regarding the components of AMTSL. Microsoft excel was used for analysis.

Results: The main component of AMTSL, Oxytocin 10 IU IM was used in 80% of the cases for prevention of PPH. Methylergometrine was used in 20% of the cases. Documentation of controlled cord traction was not present. Uterine massage was not routinely done and documented.

Conclusions: WHO recommends all the components of AMTSL and uterotonic is the most significant component. Controlled cord traction should be used where trained person is available. It is necessary to train the staff and create awareness about the AMTSL. Correct documentation is essential for feedback and auditing. Methylergometrine should be used as a second line drug for the treatment of post-partum haemorrhage.


Atonic PPH, AMTSL, Maternal mortality, Oxytocin

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