A study on active management of third stage of labour as per WHO guidelines: efficacy and complications
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20151605Keywords:
Oxytocin, Active management of third stage of labour (AMTSL), Postpartum haemorrhage PPH, Blood lossAbstract
Background: the objective of the study was to evaluate efficacy and complications of AMTSL as per WHO guidelines.
Methods: A total of 100 low risk patients assigned randomly at obstetrics department, P.D.U. medical college, Rajkot. Hundred women received i.m. oxytocin 10 IU at the delivery of anterior shoulder of the baby, received uterine massage and delivery of placenta by controlled cord traction and blood loss is measured.
Results: Mean blood loss is 119 ml. One case had blood loss >500 ml. Mean duration of third stage of labour is 5.16 minutes. Mean time taken by uterus to contract was 3.8 minutes.
Conclusions: AMTSL must be employed for prevention of postpartum haemorrhage (PPH) as advised by W.H.O. AMTSL as a routine protocol significantly brings down incidence of PPH.
References
TajMahal History and Pictures at http:// www.indianchild.com /taj_mahal.html.
Post partumhemorrhage. Wed, Sept 21, 2011 Available from: URL: http://www.internationalmidwives.org/Projects/POPPHI/PostP artumHaemorrhage/tabid/339/Default.aspx
AbouZahr C. Global burden of maternal death and disability. Br Med Bull. 2003;67(1):1-11.
AbouZahr C, Wardlaw T. Maternal mortality at the end of a decade: signs of progress? Bulletin of the World Health Organization. 2001;79:561-8.
Li XF. The postpartum period: the key to maternal mortality. International Journal of Gynecology and Obstetrics. 1996;54:1–10.
WHO; Recommendations for the Prevention of Postpartum Hemorrhage. sec1:4; page 2.
Prendiville WJ, Elbourne D, McDonald S. Active versus expectant management in the third stage of labour. Cochrane Database. Syst. Rev. 2000, Issue 3.
Jennifer B, Ndola P, Jill D, Martine H. Proposal For The Inclusion Of Misoprostol In The Who Model List Of Essential Medicines; 17th Expert Committee on the Selection and Use of Essential Medicines Geneva, March. 2009;page5,6.
WHO. 2012. WHO recommendations for the prevention and treatment of postpartum haemorrhage.WHO:Geneva.http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/9789241548502/en/index.html.
Prendiville WJ, Harding JE, Elbourne DR, StirratGM. The Bristol third stage trial: active versus physiological management of the third stage of labor. Br Med J. 1988;297:1295-300.
Rogers J, Wood J, McCandlish R, Ayers S, TruesdaleA, Elbourne D. Active versus expectant management of third stage of labor: the Hinchingbrooke randomized controlled trial. Lancet 1998;351:693-9.
Khan GQ, John IS, Wani S, Doherty T, Sibai BM. Controlled cord traction versus minimal intervention techniques in delivery of the placenta: a randomized controlled trial. Am J ObstetGynecol. 1997;177:770-4.
Kodkany BS, Derman RJ. A textbook of postpartum hemorrhage: a comprehensive guide to evaluation,management and surgical intervention; special FOGSI ed.jaypee brothers. 2006;1(4):35-41.
Williams JW. The tolerance of freshly delivered women to excessive loss of blood. Am J ObstetGynecol. 1919;90:1
Duthie SJ, Ven D, Yung GL, Guang DZ, Chan SY, Ma HK. Discrepancy between laboratory determination and visual estimation of blood loss during normal delivery.Eur J ObstetGynecolReprodBiol. 1990;38:119–24.
Patel A, Goudar SS, Geller SE. Drape esti- mation versus visual assessment for estimating postpartum hemorrhage. Int J Gynaecol Obstet. 2006;93:220–4.
Geller SE, Patel A, Naik VA. Conduct- ing international collaborative research in devel- oping nations. Int J Gynaecol Obstet. 2004;87:267–71.
Hofmeyr GJ. Evidence-based intrapartum care. Best Pract Res ClinObstetGyn- aecol. 2005;19:103-5.
