Abstract
BackgroundRelatively little is known about current practice during the third stage of labour in low and middle income countries. We conducted a survey of attitudes and an audit of practice in a large maternity hospital in Albania.MethodsSurvey of 35 obstetricians and audit of practice during the third stage was conducted in July 2008 at a tertiary referral hospital in Tirana. The survey questionnaire was self completed. Responses were anonymous. For the audit, information collected included time of administration of the uterotonic drug, gestation at birth, position of the baby before cord clamping, cord traction, and need for resuscitation.Results77% (27/35) of obstetricians completed the questionnaire, of whom 78% (21/27) reported always or usually using active management, and 22% (6/27) always or usually using physiological care. When using active management: 56% (15/27) gave the uterotonic after cord clamping; intravenous oxytocin was almost always the drug used; and 71% (19/27) clamped the cord within one minute. For physiological care: 42% (8/19) clamped the cord within 20 seconds, and 96% (18/19) within one minute. 93% would randomise women to a trial of early versus late cord clamping.Practice was observed for 156 consecutive births, of which 26% (42/156) were by caesarean section. A prophylactic uterotonic was used for 87% (137/156): this was given after cord clamping for 55% (75/137), although timing of administration was not recorded for 21% (29/137). For 85% of births (132/156) cord clamping was within 20 seconds, and for all babies it was within 50 seconds. Controlled cord traction was used for 49% (76/156) of births.ConclusionsMost obstetricians reported always or usually using active management for the third stage of labour. For timing and choice of the uterotonic drug, reported practice was similar to actual practice. Although some obstetricians reported they waited longer than one minute before clamping the cord, this was not observed in practice. Controlled cord traction was used for half the births.
Highlights
Little is known about current practice during the third stage of labour in low and middle income countries
Traditionally active management was defined as administration of a prophylactic uterotonic drug, immediate clamping of the umbilical cord, and controlled cord traction [1,2]
Active management reduces the relative risk of postpartum haemorrhage by around 60%, compared with physiological care [2]
Summary
Little is known about current practice during the third stage of labour in low and middle income countries. Active management was defined as administration of a prophylactic uterotonic drug, immediate clamping of the umbilical cord, and controlled cord traction [1,2]. There is evidence that this may have harmful effects for the child [3,4]. The main aim of care during the third stage of labour is to prevent postpartum haemorrhage. Active management reduces the relative risk of postpartum haemorrhage by around 60%, compared with physiological care [2]. Much of this reduction in risk is due to the use of a prophylactic uterotonic drug, ideally oxytocin[7,8] when is best to give it remains uncertain [9]. The impact of other commonly used components of active management, such as controlled cord traction,[10] and uterine massage[11] is unclear
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