Pdf management of third stage of labor researchgate. We did not assess any studies as free of selective reporting bias. In summary, the three key steps of active management of the third stage of labour are. When you were pregnant, a midwife should have explained to you about the 2 options for the third stage, and about the pros and cons of each. Routine use of active management of the third stage of labor for all. This quasi experimental study was conducted in the unit b of department of obstetrics and gynaecology, lady reading hospital from june december 2006.
They are called active management and physiological management. Active management of the third stage of labour rhl. All these resources are available entirely free and can be accessed. Use of active management of the third stage of labour in. How effective are the components of active management of.
Controlled cord traction for the third stage of labour. Active management of the third stage of labour without. You can usually hold your baby during this stage if you want to. Active management of the third stage of labour consists of interventions designed to facilitate the delivery of the placenta by increasing uterine contractions and to prevent primary postpartum haemorrhage pph by averting uterine atony. Active management of the third stage of labour the bmj. Active management of the third stage of labour involves giving a prophylactic uterotonic, early. A comparison of active management and expectant management of the third stage of labour. Who recommendation on active management of labour rhl. Evidence supports active management of third stage labor amtsl for preventing pph. Where processes differ between campuses, those that refer to the sandringham campus are differentiated by pink text or have the heading. Pdf active management of the third stage of labour. Administration of a uterotonic drug oxy tocin, 10 iu injection, is the drug of choice 2. The active management of the third stage of labor glowm. The third stage of labor may be managed expectantly or actively.
Please use one of the following formats to cite this article in your essay, paper or report. Guidelines for oxytocin administration after birth. Here, we present current opinion and protocols for amtsl. Pdf on aug 1, 2014, latika sahu and others published. Purpose in accordance with the icmfigo joint statement ref the womens policy is to use active management of the third stage of labour 1,2. Oxytocin for the active management of third stage of.
But theres also a third option mixed management combining active and physiological approaches begley et al, 2011. Clinical criteria for exclusion individuals active management of third stage of labour. Active management of third stage should be recommended to all women as it shortens the third stage and reduces the risk of postpartum haemorrhage and. Active vs physiological management of third stage of labour. Delivering the placenta in the third stage of labour. Since 2007, who recommendations have supported active management of the third stage of labour amtsl as a critical intervention for pph prevention. Active management of the third stage of labor amtsl. Active management consists of several interventions packaged together and the relative contribution of each of the components is unknown. Management of third stage of labour recommends that amtsl should be practiced by all skilled attendants at.
Active management of the third stage of labour reduces the risk of postpartum haemorrhage. Women who are at low risk for postpartum hemorrhage and wish to avoid routine administration of postpartum oxytocin should be advised that active management of the third stage of labor has been shown to reduce the risk of pph. Active management of the third stage of labor amtsl describes interventions with the common goal to prevent postpartum hemorrhage pph. The disparity between current evidence and practice on active management of third stage of labour amtsl demands assessment of providers knowledge on the subject. Active management of the third stage of labor amtsl is a feasible and inexpensive intervention that can help save thousands of womens lives. Active management of the third stage of labor has been shown to reduce the incidence of pph, the need for blood transfusion, and the use of therapeutic uterotonics during the third stage of labor andor within the first 24 hours after birth. It is offered to women in most hospital labour wards to reduce the risk of serious bleeding after the birth. Evidence supporting this recommendation can be found in the source guideline document, available at. Active management of the third stage of labor obstetrics. A clinical tutorial paths maternal and newborn health technology initiative, in collaboration with south africas kwazulu natal department of health, produced this essential training video on active management of the third stage of labor. Active management of the third stage of labor is recommended for the prevention of postpartum hemorrhage and commonly entails prophylactic administration of a uterotonic agent, controlled cord traction, and uterine massage.
While oxytocin is the firstchoice uterotonic, it is not known whether its effectiveness varies by route of administration. Active management is a routine intervention during this stage. Oxytocin administration for management of third stage of. Improvement in the active management of the third stage of labor for. The period from just after the baby is expelled until just after the placenta is expelled is called the third stage of labor the third stage of labor can be managed actively with several standard procedures, or it can be managed expectantly also known as physiological.
The original description of active management of the third stage of labour had three componentsdelivery of a prophylactic uterotonic drug, early cord clamping and cutting, and controlled cord traction. Information about implementing active management of the third stage of labor is featured in this reference manual as well as the corresponding participants notebook and facilitators guide. If the third stage of labor lasts longer that 18 minutes, it is associated with a significant risk of pph. Active management of the third stage of labour involves giving a prophylactic uterotonic, early cord clamping and controlled cord traction to deliver the placenta. Active management of the third stage of labor with a. Task shifting of specific amtsl components to unskilled birth attendants or self. Active management was introduced to try to reduce haemorrhage, a major contributor to maternal mortality. The third stage of labour is the period during which the womans body pushes out the babys placenta. With expectant management, signs of placental separation are awaited and the placenta is delivered spontaneously. The reference manuals and facilitators guides are available as one large file and also in smaller sections for easier downloading. Definition of pph primary pph is defined as excessive bleeding that occurs in the first 24 hours after delivery. Active management of the third stage of labour pregnancy.
Active management of the third stage of labour with and. This multicenter, doubleblind, randomized, placebocontrolled trial recruited women in the first stage of labor with expected vaginal deliveries at 3642 weeks of gestation. These recommendations clarify the most important components of active management of the third stage of labour amtsl and suggest that there should be an expanded emphasis on ensuring that every woman, regardless of where she delivers, is offered a highquality uterotonic at the time of birth. Active management of third stage should be recommended to all women as it shortens the third stage and reduces the risk of postpartum haemorrhage and the need for blood transfusion. Who recommendation on the use of a package of care for active management of labour for prevention of delay in labour.
Having first palpated the uterus to check there is no other baby, give a uterotonic drug within 1 minute of delivery. Active management of the third stage of labour includes administering a uterotonic after birth of the baby, controlled cord traction and clamping and cutting of the cord once the uterus contracts. Physiologic childbirth and active management of the third stage of. Expulsion of the product of the conception after fetal. Placental expulsion also called afterbirth occurs when the placenta comes out of the birth canal after childbirth.
Third stage of labour aim to support staff in discussing with women the management of the third stage of labour. Attitudes towards active management of third stage of labour was positive, 3 97. Active versus physiological management of the third stage of labour. Postpartum hemorrhage, active management of the third stage of labor. Active management of the third stage of labour the open.
To evaluate the effectiveness and safety of misoprostol administered simultaneously with oxytocin as part of the active management of the third stage of labor. This essay is primarily concerned with the arguments that are currently active in relation to the benefits and disadvantages of having either an active or passive third stage of labour. Continuous support during labour as a separate intervention is recommended in the who recommendations for augmentation of labour. Physical and psychological symptom profiling and event. Manual removal of the placenta as defined by study authors. Generally, you have two options for how you do the third stage of labour. The third stage of labor relies intrinsically on the maternal oxytocin release.
A safe, costeffective, and sustainable intervention more humane and ethical than having to deal with the complications of pph, especially for women who already may be anemic or malnourished2 a practice that can save facilities money, according to studies conducted in. Active management of the third stage of labor with and without controlled cord traction. Active management of the third stage of labor with and. Active management of the third stage of labor path. Questionnairebased survey of 361 labour and delivery professionals in public tertiary obstetric centres in southwest nigeria. Active management of the third stage of labour oxytocin administration a promote maternal production of oxytocin by providing a safe, warm environment with uninterrupted skin to skin contact between mother and baby, and encourage. Role of the midwife in physiological third stage of labour. Active management of the third stage of labor amtsl includes three steps.
Steps for active management of the third stage of labor amtsl when birth is attended by a. Task shifting in active management of the third stage of. Active management of the third stage of labour new who recommendations help to focus implementation1 who recommendations for active management of the third stage of labour amtsl, 2012 the use of uterotonics for the prevention of postpartum haemorrhage pph during the third stage of labour is recommended for all births. The use of uterotonics for the prevention of postpartum haemorrhage pph during the third stage of labour is recommended for all births. Research supports a spontaneous, clientled approach to bearing down in the second stage of labour enkin et al.
The midwifes role includes the regular assessment of the length of the third stage, placental birth time and process, monitoring of any blood loss and assessment of. Active management of the third stage of labour amtsl reduces the occurrence of severe postpartum haemorrhage by approximately 6070%. To assess the level and determinants of accurate knowledge of obstetric providers regarding amtsl. Spanish pdf, 771 kb these recommendations clarify the most important components of active management of the third stage of labour amtsl and suggest that there should be an expanded emphasis on ensuring that every woman, regardless of where she delivers, is offered a highquality uterotonic at the time of birth. The third stage of labour happens after your baby is born, when your womb contracts and the placenta comes out through your vagina. We aimed to assess whether controlled cord traction can be omitted from active management of this stage without increasing the risk of severe haemorrhage. To find out the difference between active and expectant management of third stage of labour in terms of amount of blood loss and duration of third stage of labour. For the active management of third stage of labour and treatment of postpartum haemorrhage.
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