title: The current state of active third stage management to prevent postpartum hemorrhage: a cross-sectional study.
abstract: OBJECTIVE
  To investigate the implementation of the International Confederation of Midwives/International Federation of Gynecology and Obstetrics (ICM/FIGO) guideline on active third stage management in vaginal deliveries in daily clinical practice.
  
  
  METHODS
  Observational, cross-sectional study.
  
  
  METHODS
  One tertiary and one teaching hospital in the Netherlands.
  
  
  METHODS
  Women undergoing vaginal deliveries.
  
  
  METHODS
  A case record form was completed after every vaginal delivery. Primary outcome was adequate guideline adherence, defined as initial administration of 10 IU oxytocin, performance of controlled cord traction and uterine massage. Adequate guideline adherence was a priori estimated to be 10%. With a sample size of 600, i.e. 300 women per hospital, the standard error of the resulting percentage would be less than 2% for each hospital.
  
  
  RESULTS
  Six hundred and twenty six women were included. Guideline adherence was adequately performed in 48% of vaginal deliveries. Oxytocin was administered after birth in 98% of deliveries and in 80% the correct dose was used. Controlled cord traction was performed in 63% and uterine massage in 93%; however, the latter was performed as advised (at least eight times) in only 8%. The amount of blood loss was not associated with the use of either 5 or 10 IU oxytocin (p = 0.818). Controlled cord traction and uterine massage were more frequently performed when blood loss exceeded 500 mL (p < 0.001).
  
  
  CONCLUSIONS
  Active third stage management according to the ICM/FIGO guideline is adequately performed in only 48% of all vaginal deliveries. Results of this study call for training programs to increase adherence to the ICM/FIGO guideline.
authors: Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
authors: Babette W
authors: BW
authors: Prick
authors: Amber A
authors: AA
authors: Vos
authors: Wim C J
authors: WC
authors: Hop
authors: Henk A
authors: HA
authors: Bremer
authors: Eric A P
authors: EA
authors: Steegers
authors: Johannes J
authors: JJ
authors: Duvekot
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007749:Labor Stage, Third; D016014:Linear Models; D009426:Netherlands; D010120:Oxytocics / Q000008:administration & dosage*; D010121:Oxytocin / Q000008:administration & dosage*; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D010120:Oxytocics; D010121:Oxytocin
keywords: Active management; controlled cord traction; implementation; oxytocin; postpartum hemorrhage; third stage; uterine massage; vaginal birth