Abstract:
Background: Hemorrhage is the leading cause of obstetric mortality. Studies show that Active
Management of Third Stage of Labor (AMTSL) reduces Post Partum Hemorrhage (PPH). This study
describes the practice of AMTSL and barriers to its effective use in Tanzania.
Methods: A nationally-representative sample of 251 facility-based vaginal deliveries was observed
for the AMTSL practice. Standard Treatment Guidelines (STG), the Essential Drug List and medical
and midwifery school curricula were reviewed. Drug availability and storage conditions were
reviewed at the central pharmaceutical storage site and pharmacies in the selected facilities.
Interviews were conducted with hospital directors, pharmacists and 106 health care providers in
29 hospitals visited. Data were collected between November 10 and December 15, 2005.
Results: Correct practice of AMTSL according to the ICM/FIGO definition was observed in 7% of
251 deliveries. When the definition of AMTSL was relaxed to allow administration of the
uterotonic drug within three minutes of fetus delivery, the proportion of AMTSL use increased to
17%. The most significant factor contributing to the low rate of AMTSL use was provision of the
uterotonic drug after delivery of the placenta. The study also observed potentially-harmful
practices in approximately 1/3 of deliveries. Only 9% out of 106 health care providers made correct
statements regarding the all three components of AMTSL. The national formulary recommends
ergometrine (0.5 mg/IM) or oxytocin (5 IU/IM) on delivery of the anterior shoulder or immediately
after the baby is delivered. Most of facilities had satisfactory stores of drugs and supplies.
Uterotonic drugs were stored at room temperature in 28% of the facilities.
