International survey on variations in practice of the management of the third stage of labour.
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.
Festin
Mario R
MR
College of Medicine-Philippine General Hospital, University of the Philippines Manila. mfestin@hotmail.com
Lumbiganon
Pisake
P
Tolosa
Jorge E
JE
Finney
Kathryn A
KA
Ba-Thike
Katherine
K
Chipato
Tsungai
T
Gaitán
Hernando
H
Xu
Liangzhi
L
Limpongsanurak
Sompop
S
Mittal
Suneeta
S
Peedicayil
Abraham
A
Pramono
Noor
N
Purwar
Manorama
M
Shenoy
Sheela
S
Daly
Sean
S
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
D010121:Oxytocin