title: Survey of prophylactic use of uterotonics in the third stage of labour in the Netherlands.
abstract: OBJECTIVE
  aim of this study was to investigate current knowledge and practice regarding AMTSL in midwifery practices and obstetric departments in the Netherlands.
  
  
  METHODS
  web-based and postal questionnaire.
  
  
  METHODS
  in August and September 2011 a questionnaire was sent to all midwifery practices and all obstetric departments in the Netherlands.
  
  
  METHODS
  all midwifery practices (528) and all obstetric departments (91) in the Netherlands.
  
  
  RESULTS
  the response was 87.5%. Administering prophylactic uterotonics was seen as a component AMTSL by virtually all respondents; 96.1% of midwives and 98.8% of obstetricians. Cord clamping was found as a component of AMTSL by 87.4% of midwives and by 88.1% of obstetricians. Uterine massage was only seen as a component of AMTSL by 10% of the midwives and 20.2% of the obstetricians. Midwifery practices routinely administer oxytocin in 60.1% of births. Obstetric departments do so in 97.6% (p<0.01). Compared to 1995, the prophylactic use of oxytocin had increased in 2011 both by midwives (10-59.1%) and by obstetricians (55-96.4%) (p<0.01).
  
  
  CONCLUSIONS
  prophylactic administration of uterotonics directly after childbirth is perceived as the essential part of AMTSL. The administration of uterotonics has significantly increased in the last decade, but is not standard practice in the low-risk population supervised by midwives.
  
  
  CONCLUSIONS
  the evidence for prophylactic administration of uterotonics is convincing for women who are at high risk of PPH. Regarding the lack of evidence of AMTSL to prevent PPH in low risk (home) births, further research concerning low-risk (home) births, supervised by midwives in industrialised countries is indicated. A national guideline containing best practices concerning management of the third stage of labour supervised by midwives, should be composed and implemented.
authors.affiliation: Department of Obstetrics, Leiden University Medical Centre, Albinusdreef 2, Leiden, The Netherlands. m.smit.verlos@lumc.nl
authors.forename: M
authors.initials: M
authors.lastname: Smit
authors.forename: G
authors.initials: G
authors.lastname: van Stralen
authors.forename: R
authors.initials: R
authors.lastname: Wolterbeek
authors.forename: J
authors.initials: J
authors.lastname: van Dillen
authors.forename: J
authors.initials: J
authors.lastname: van Roosmalen
authors.forename: Y
authors.initials: Y
authors.lastname: Slootweg
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006306:Health Surveys; D006801:Humans; D007749:Labor Stage, Third / Q000187:drug effects*; D008880:Midwifery; D009426:Netherlands; D010120:Oxytocics / Q000627:therapeutic use*; D057184:Practice Patterns, Nurses' / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011795:Surveys and Questionnaires
chemical_list: D010120:Oxytocics