title: Reduced postpartum hemorrhage after implementation of active management of the third stage of labor in rural Honduras.
abstract: OBJECTIVE
  To assess outcomes after auxiliary nurses were trained and given resources to use active management of the third stage of labor (AMTSL) for all women giving birth in a low-resource, low-risk, rural, public birth center setting in northern rural Honduras.
  
  
  METHODS
  Auxiliary nurses received training on estimation of blood loss before the preintervention phase of the study (July 2004 through April 2005) and AMTSL, including use of intramuscular oxytocin, and estimation of blood loss prior to the intervention phase (July 2007 through June 2008). Preintervention and intervention data on use of oxytocin, blood loss postpartum, hemorrhage rates, and management interventions were collected and compared.
  
  
  RESULTS
  After nurses received training on AMTSL using intramuscular oxytocin, the use of intramuscular oxytocin during the third stage of labor increased from 63.8% to 96.5%. Postpartum hemorrhage rates decreased from 14.8% to 5.9% (P=0.001). Use of intrapartum oxytocin, which can have adverse effects, also increased: from 6.1% to 22.7% (P<0.001).
  
  
  CONCLUSIONS
  Training auxiliary nurses to perform AMTSL using oxytocin in this birth center setting was effective in reducing the rate of postpartum hemorrhage; however, increased use of intrapartum oxytocin may be an unintended outcome of the increased accessibility of oxytocin.
authors.affiliation: Women's Studies Department, University of Michigan, Ann Arbor, USA. kanelow@umich.edu
authors.forename: Lisa Kane
authors.initials: LK
authors.lastname: Low
authors.forename: Joanne Motino
authors.initials: JM
authors.lastname: Bailey
authors.forename: Emma
authors.initials: E
authors.lastname: Sacks
authors.forename: Chayla
authors.initials: C
authors.lastname: Robles
authors.forename: Lilian
authors.initials: L
authors.lastname: Medina
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006297:Health Services Accessibility; D006721:Honduras / Q000453:epidemiology; D006801:Humans; D007273:Injections, Intramuscular; D007749:Labor Stage, Third; D008427:Maternal Health Services / Q000458:organization & administration / Q000592:standards; D009728:Nursing Assistants / Q000193:education* / Q000458:organization & administration / Q000592:standards; D017063:Outcome Assessment, Health Care; D010120:Oxytocics / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D010121:Oxytocin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000517:prevention & control*; D011247:Pregnancy; D019035:Rural Health Services / Q000458:organization & administration / Q000592:standards; D055815:Young Adult
chemical_list: D010120:Oxytocics; D010121:Oxytocin