The practice of active management of third stage of labour:findings from Dar es salaam Municipal Hospitals

Abstract

Background The third stage of labour is defined as the interval between birth of the baby and complete expulsion of the placenta. Some degree of blood loss occurs after the birth of the baby due to separation of the placenta. This period is a risky period because the uterus may not contract well after birth and heavy blood loss can endanger the life of the mother. Active Management of the Third Stage of Labour (AMTSL) reduces the occurrence of severe postpartum haemorrhage by approximately 60 –70%. Active management consists of three interventions packages or steps. These are administration of oxytocin within one minute after delivery of the baby, controlled cord traction and uterine massage.

Objective: To evaluate the performance of health care providers on AMTSL in Dar e s salaam municipal hospitals.

Methodology: This was an observational cross sectional study in three municipal hospitals of Dar es Salaam. It was a prospective direct observation of child birth, particularly in the third stage of labour. A total of 400 deliveries were observed. Study design.

Results: The active management of the third stage of labour was correctly done for 46% of observed deliveries. Oxytocin administration within one minute of the birth of the baby was done in 54.3%, controlled cord traction in 85.2% and uterine massage in 93% of observed deliveries.

Conclusion Active management of the third stage of labour is an important skill to be acquired by every health care provider. Early preparation of oxytocin before delivery contributes a lot in provision of oxytocin within one minute of the delivery of the baby and therefore this practice should be highly addressed to every health care provider.