AIM: The study was undertaken to meet the need of the Ministry of Health to have local evidence on the effectiveness of active management of third-stage labor (AMTSL) in reducing the incidence of postpartum hemorrhage (PPH) > or = 500 mL and the need for PPH treatment. METHODS: Using a quasi-experimental design, AMTSL was introduced for all births attended by government midwives (at home, community, and district levels) in one district while standard practice without AMTSL was continued in three neighboring districts (with a 1:2 ratio of participants). Oxytocin (10 IU) was administered either by standard disposable syringe and needle or by a prefilled, single-use injection device. Postpartum blood loss was estimated using standard containers; other outcome measures included the duration of third stage, the need for additional treatments, and final maternal condition. A total of 3607 women participated (1236 in the intervention district and 2371 in the comparison districts). Multivariate logistic regression was used to control for age, parity, place of delivery, and first-stage oxytocin augmentation. RESULTS: AMTSL was associated with reduced risks for prolonged third stage beyond 30 min (odds ratio [OR] = 0.20, 95%; confidence interval [CI]: 0.11, 0.35), supplemental oxytocin (OR = 0.68, 95% CI: 0.49, 0.94), and bimanual compression (OR = 0.63, 95%; CI: 0.41, 0.98). When cases with first-stage oxytocin augmentation were excluded, AMTSL was associated with a 34% reduction in PPH incidence (OR = 0.66, 95%; CI: 0.45, 0.98). CONCLUSION: This study supports the value of AMTSL in reducing the incidence of PPH, shortening the third stage of labor, and reducing the need for additional treatments.
AIM: The study was undertaken to meet the need of the Ministry of Health to have local evidence on the effectiveness of active management of third-stage labor (AMTSL) in reducing the incidence of postpartum hemorrhage (PPH) > or = 500 mL and the need for PPH treatment. METHODS: Using a quasi-experimental design, AMTSL was introduced for all births attended by government midwives (at home, community, and district levels) in one district while standard practice without AMTSL was continued in three neighboring districts (with a 1:2 ratio of participants). Oxytocin (10 IU) was administered either by standard disposable syringe and needle or by a prefilled, single-use injection device. Postpartum blood loss was estimated using standard containers; other outcome measures included the duration of third stage, the need for additional treatments, and final maternal condition. A total of 3607 women participated (1236 in the intervention district and 2371 in the comparison districts). Multivariate logistic regression was used to control for age, parity, place of delivery, and first-stage oxytocin augmentation. RESULTS: AMTSL was associated with reduced risks for prolonged third stage beyond 30 min (odds ratio [OR] = 0.20, 95%; confidence interval [CI]: 0.11, 0.35), supplemental oxytocin (OR = 0.68, 95% CI: 0.49, 0.94), and bimanual compression (OR = 0.63, 95%; CI: 0.41, 0.98). When cases with first-stage oxytocin augmentation were excluded, AMTSL was associated with a 34% reduction in PPH incidence (OR = 0.66, 95%; CI: 0.45, 0.98). CONCLUSION: This study supports the value of AMTSL in reducing the incidence of PPH, shortening the third stage of labor, and reducing the need for additional treatments.
Authors: Cynthia K Stanton; Samuel Newton; Luke C Mullany; Patience Cofie; Charlotte Tawiah Agyemang; Edward Adiibokah; Niamh Darcy; Sadaf Khan; Alice Levisay; John Gyapong; Deborah Armbruster; Seth Owusu-Agyei Journal: BMC Pregnancy Childbirth Date: 2012-06-07 Impact factor: 3.007
Authors: Cynthia K Stanton; Samuel Newton; Luke C Mullany; Patience Cofie; Charlotte Tawiah Agyemang; Edward Adiibokah; Seeba Amenga-Etego; Niamh Darcy; Sadaf Khan; Deborah Armbruster; John Gyapong; Seth Owusu-Agyei Journal: PLoS Med Date: 2013-10-01 Impact factor: 11.069