Active management of third stage of labour: a survey of providers' knowledge in southwest Nigeria.
BACKGROUND
The disparity between current evidence and practice on active management of third stage of labour (AMTSL) demands assessment of providers' knowledge on the subject.


OBJECTIVE
To assess the level and determinant(s) of accurate knowledge of obstetric providers regarding AMTSL.


METHODS
Questionnaire-based survey of 361 labour and delivery professionals in public tertiary obstetric centres in southwest Nigeria.


RESULTS
Female nurses at different cadres accounted for most of the respondents. Majority (90.6%) of the respondents reported being aware of AMTSL as an obstetric intervention and 49.7% were aware of FIGO/ICM recommendation on AMTSL. Out of 13 potential third stage interventions, 102 respondents (28.3%) correctly and exclusively identified the components of AMTSL as defined by FIGO/ICM. Many procedures reserved for treatment of complicated third stage of labour such as manual placental removal (37.7%), blood transfusion (20.2%), bimanual uterine compression (24.7%) and uterine artery ligation (13.9%) were also selected as AMTSL components. Multivariate logistic regression analysis indicated that being in administrative position (adjusted OR: 2.68; CI 1.19-6.02) and frequent compared to rare or no consultation of books, journal and internet sources for information (adjusted OR: 2.58; CI 1.21-5.52) increased the odds of having accurate knowledge of AMTSL while being a nurse/midwife (adjusted OR: 0.15; CI 0.05-0.39), matron (adjusted OR: 0.25; CI 0.08-0.79) or intern (adjusted OR: 0.07; CI 0.01-0.29) compared to postgraduate resident doctors reduced the odds of having accurate knowledge of AMTSL.


CONCLUSIONS
AMTSL was a familiar but poorly understood intervention among obstetric care providers in this region. Improvement in healthcare quality and practitioners' adherence to recommended guidelines on AMTSL urgently requires educational interventions that target those who provide routine delivery care and organisation of the health care delivery system in such a way that enables providers to act on acquired knowledge.
Oladapo
Olufemi T
OT
Department of Obstetrics and Gynaecology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. tixon_y2k@hotmail.com
Fawole
Adeniran O
AO
Loto
Olabisi M
OM
Adegbola
Omololu
O
Akinola
Oluwarotimi I
OI
Alao
Moses O
MO
Adeyemi
Adewale S
AS
D000328:Adult; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D007749:Labor Stage, Third / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D011795:Surveys and Questionnaires; D055815:Young Adult