title: Policies for care during the third stage of labour: a survey of maternity units in Syria.
abstract: BACKGROUND
  Care for women during the third stage aims to reduce the risk of major haemorrhage, but is very variable. The current World Health Organisation (WHO) recommendation is that care should include administration of a uterotonic (oxytocin, if it is available) soon after birth of the baby, delayed cord clamping, and delivery of the placenta by controlled cord traction.
  
  
  METHODS
  To ascertain care policies used during the third stage of labour in maternity units in Syria, we conducted a survey of 69 maternity units in obstetric and general public hospitals. A brief questionnaire was administered by face to face interview or telephone with senior obstetricians and midwives. Outcome measures were the use of prophylactic uterotonic drugs, timing of cord clamping, use of controlled cord traction, and treatment for postpartum haemorrhage. Obstetricians were asked about both vaginal and caesarean births, midwives only about vaginal births.
  
  
  RESULTS
  Responses were obtained for 66 (96%) hospitals: a midwife and an obstetrician were interviewed in 40; an obstetrician only in 20; a midwife only in 6. Responses were similar, although midwives were more likely to report that the umbilical cord was clamped after 1-3 minutes or after cessation of pulsation (2/40 obstetricians and 9/40 midwives). Responses have therefore been combined.One hospital reported never using a prophylactic uterotonic drug. The uterotonic was Syntometrine(R) (oxytocin and ergometrine) in two thirds of hospitals; given after delivery of the placenta in 60 (91%) for vaginal births, and in 47 (78%) for caesarean births. Cord clamping was within 20 seconds at 42 hospitals 64%) for vaginal births and 45 (75%) for caesarean births. Controlled cord traction was never used in a quarter (17/66) of hospitals for vaginal births and a half (32/60) for caesarean births.68% of respondents (45/66) thought there was a need for more randomised trials of interventions during the third stage of labour.
  
  
  CONCLUSIONS
  Most maternity units report using Syntometrine(R), usually given after delivery of the placenta, clamping the cord within 20 seconds, and using controlled cord traction.
authors.affiliation: North Middlesex University Hospital NHS Trust, Academic Foundation Trainee, Sterling Way, London N18 1QX, UK. hematar@hotmail.co.uk
authors.forename: Hosam E
authors.initials: HE
authors.lastname: Matar
authors.forename: Muhammad Q
authors.initials: MQ
authors.lastname: Almerie
authors.forename: Mohamad
authors.initials: M
authors.lastname: Alsabbagh
authors.forename: Muhammad
authors.initials: M
authors.lastname: Jawoosh
authors.forename: Yara
authors.initials: Y
authors.lastname: Almerie
authors.forename: Asma
authors.initials: A
authors.lastname: Abdulsalam
authors.forename: Lelia
authors.initials: L
authors.lastname: Duley
mesh_terms: D036861:Delivery, Obstetric / Q000379:methods*; D004874:Ergonovine / Q000627:therapeutic use; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D006489:Hemostatic Techniques; D006801:Humans; D007749:Labor Stage, Third; D008880:Midwifery; D010120:Oxytocics / Q000627:therapeutic use; D010121:Oxytocin / Q000627:therapeutic use; D057184:Practice Patterns, Nurses'; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D013593:Syria; D014592:Uterine Hemorrhage / Q000517:prevention & control*
chemical_list: D010120:Oxytocics; C038346:syntometrine; D010121:Oxytocin; D004874:Ergonovine