title: International survey on variations in practice of the management of the third stage of labour.
abstract: OBJECTIVE
  To determine the use of the active management of the third stage of labour in 15 university-based obstetric centres in ten developing and developed countries and to determine whether evidence-based practices were being used.
  
  
  METHODS
  From March 1999 to December 1999, the Global Network for Perinatal and Reproductive Health (GNPRH) conducted an observational, cross-sectional survey to assess the use of the practice and its components. Prospective data on patient characteristics and the interventions used in the management of the third stage of labour were collected using standardized methods. Data on approximately 30 consecutive vaginal deliveries in each centre (452 in total) were included.
  
  
  RESULTS
  Significant intracountry and intercountry variation in the practice of the active management of the third stage of labour was found (111/452 deliveries used active management), which confirmed the existence of a large gap between knowledge and practice.
  
  
  CONCLUSIONS
  Areas identified for improvement are the urgent implementation of the evidence-based clinical management practice defined as the active management of the third stage of labour; increased accessibility to systematic reviews in developing countries; and the conduction of clinical trials that assess the impact of this intervention in other settings.
authors.affiliation: College of Medicine-Philippine General Hospital, University of the Philippines Manila. mfestin@hotmail.com
authors.forename: Mario R
authors.initials: MR
authors.lastname: Festin
authors.forename: Pisake
authors.initials: P
authors.lastname: Lumbiganon
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Tolosa
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Finney
authors.forename: Katherine
authors.initials: K
authors.lastname: Ba-Thike
authors.forename: Tsungai
authors.initials: T
authors.lastname: Chipato
authors.forename: Hernando
authors.initials: H
authors.lastname: Gaitán
authors.forename: Liangzhi
authors.initials: L
authors.lastname: Xu
authors.forename: Sompop
authors.initials: S
authors.lastname: Limpongsanurak
authors.forename: Suneeta
authors.initials: S
authors.lastname: Mittal
authors.forename: Abraham
authors.initials: A
authors.lastname: Peedicayil
authors.forename: Noor
authors.initials: N
authors.lastname: Pramono
authors.forename: Manorama
authors.initials: M
authors.lastname: Purwar
authors.forename: Sheela
authors.initials: S
authors.lastname: Shenoy
authors.forename: Sean
authors.initials: S
authors.lastname: Daly
mesh_terms: D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000379:methods*; D019049:Developed Countries; D003906:Developing Countries; D019317:Evidence-Based Medicine; D005260:Female; D019538:Health Care Surveys; D006302:Health Services Research; D006801:Humans; D007749:Labor Stage, Third / Q000187:drug effects; D010121:Oxytocin / Q000494:pharmacology / Q000627:therapeutic use; D006473:Postpartum Hemorrhage / Q000188:drug therapy; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D014470:Umbilical Cord
chemical_list: D010121:Oxytocin