Active management of third stage of labor: evidence versus practice.
OBJECTIVE
To determine the correct use of active management of third stage of labor (AMTSL) (using the full complement of existing standard definitions) and compare the outcomes of third stage of labor in women who received AMTSL (according to these definitions) with those who did not.


METHODS
Observational, cross-sectional survey.


METHODS
Seven tertiary centers in southwest Nigeria.


METHODS
Women undergoing non-instrumental vaginal deliveries.


METHODS
Prospective direct observations of childbirth procedures. AMTSL was defined according to Cochrane review, ICM/FIGO (International Confederation of Midwives/International Federation of Gynecology and Obstetrics), and WHO (World Health Organization) recommendations. Main outcome measures. Use of AMTSL and its components and outcome of third stage of labor.


RESULTS
There was a high rate of compliance with most of the individual components of AMTSL. The use of AMTSL varied widely with the definition applied and tended to decrease with increasing strictness of the criteria (Cochrane review: 88.9%; ICM/FIGO: 42%; WHO: 1.8%). The frequencies of adverse labor outcomes were generally low (postpartum hemorrhage (PPH): 4.9%; severe PPH: 0.8%; retained placenta: 1.9%; uterine inversion: 0.0%). Frequencies of PPH, postpartum anemia, and mean blood loss among women who received AMTSL according to the Cochrane review definition were significantly lower than for those who did not (p < 0.05). There was no significant difference between any of the outcomes for women who received AMTSL according to the ICM/FIGO definition and those who did not.


CONCLUSIONS
The survey reveals substantial definition-dependent variation in the providers' adherence to recommended AMTSL practices. The clinical implications of the current practice in this population suggest the need for randomized comparison of various AMTSL packages to determine their comparative effectiveness in the prevention of PPH.
Oladapo
Olufemi T
OT
Maternal and Fetal Health Research Unit, Department of Obstetrics & Gynecology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria. tixon_y2k@hotmail.com
Akinola
Oluwarotimi I
OI
Fawole
Adeniran O
AO
Adeyemi
Adewale S
AS
Adegbola
Omololu
O
Loto
Olabisi M
OM
Fabamwo
Adetokunbo O
AO
Alao
Moses O
MO
Sotunsa
John O
JO
D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006801:Humans; D007749:Labor Stage, Third / Q000502:physiology*; D009549:Nigeria; D018457:Placenta, Retained / Q000517:prevention & control; D006473:Postpartum Hemorrhage / Q000517:prevention & control; D011247:Pregnancy; D011446:Prospective Studies; D019687:Uterine Inversion / Q000517:prevention & control; D055815:Young Adult