The effect of guideline variations on the implementation of active management of the third stage of labor

Jezid E. Miranda, Jose Rojas-Suarez, Angel Paternina, Ray Mendoza, Camilo Bello, Jorge E. Tolosa

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

Objective To determine whether healthcare providers performed active management of the third stage of labor (AMTSL) as defined by FIGO/ICM and WHO, and as described by the Cochrane Collaboration. Methods In a prospective observational study, a questionnaire regarding knowledge of AMTSL was administered to healthcare providers in the largest maternity teaching center in Colombia. It was subsequently observed whether and how the healthcare providers performed AMTSL in practice. The percentage of correct use of AMTSL was calculated. Results Healthcare providers indicated they knew what AMTSL was but disagreed on the timing of prophylactic oxytocin use. In total, 241 deliveries were observed. Oxytocin at varying doses and routes was used in 239 (99.2%) deliveries. In all deliveries, the umbilical cord was clamped early. In 49 (20.3%) deliveries, controlled cord traction was performed. Uterine massage was carried out in 213 (88.4%) deliveries. According to the FIGO/ICM and WHO definitions, and the Cochrane Collaboration description, correct use of AMTSL occurred in 0.8%, 0.0%, and 8.3%, of cases, respectively. Conclusion Correct use of AMTSL is low at the largest maternity teaching center in Colombia. There is an urgent need for a single definition of AMTSL, which could be used globally for research, training, and scaling-up the performance of AMTSL.

Original languageEnglish (US)
Pages (from-to)266-269
Number of pages4
JournalInternational Journal of Gynecology and Obstetrics
Volume121
Issue number3
DOIs
StatePublished - Jun 2013

Keywords

  • Colombia
  • Controlled cord traction
  • Cord clamping
  • Postpartum hemorrhage
  • Vaginal deliveries

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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