title: The effect of guideline variations on the implementation of active management of the third stage of labor.
abstract: OBJECTIVE
  To determine whether healthcare providers performed active management of the third stage of labor (AMTSL) as defined by FIGO/ICM and WHO, and as described by the Cochrane Collaboration.
  
  
  METHODS
  In a prospective observational study, a questionnaire regarding knowledge of AMTSL was administered to healthcare providers in the largest maternity teaching center in Colombia. It was subsequently observed whether and how the healthcare providers performed AMTSL in practice. The percentage of correct use of AMTSL was calculated.
  
  
  RESULTS
  Healthcare providers indicated they knew what AMTSL was but disagreed on the timing of prophylactic oxytocin use. In total, 241 deliveries were observed. Oxytocin at varying doses and routes was used in 239 (99.2%) deliveries. In all deliveries, the umbilical cord was clamped early. In 49 (20.3%) deliveries, controlled cord traction was performed. Uterine massage was carried out in 213 (88.4%) deliveries. According to the FIGO/ICM and WHO definitions, and the Cochrane Collaboration description, correct use of AMTSL occurred in 0.8%, 0.0%, and 8.3%, of cases, respectively.
  
  
  CONCLUSIONS
  Correct use of AMTSL is low at the largest maternity teaching center in Colombia. There is an urgent need for a single definition of AMTSL, which could be used globally for research, training, and scaling-up the performance of AMTSL.
authors.affiliation: Universidad de Cartagena, Cartagena de Indias, Colombia. jezidmiranda@gmail.com
authors.forename: Jezid E
authors.initials: JE
authors.lastname: Miranda
authors.forename: Jose
authors.initials: J
authors.lastname: Rojas-Suarez
authors.forename: Angel
authors.initials: A
authors.lastname: Paternina
authors.forename: Ray
authors.initials: R
authors.lastname: Mendoza
authors.forename: Camilo
authors.initials: C
authors.lastname: Bello
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Tolosa
mesh_terms: D000293:Adolescent; D000328:Adult; D003105:Colombia; D036861:Delivery, Obstetric / Q000379:methods; D004305:Dose-Response Relationship, Drug; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007749:Labor Stage, Third; D008405:Massage / Q000379:methods*; D010120:Oxytocics / Q000008:administration & dosage; D010121:Oxytocin / Q000008:administration & dosage*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
chemical_list: D010120:Oxytocics; D010121:Oxytocin