Practice and factors associated with active management of third stage of labor among obstetric care providers in Amhara region referral hospitals, North Ethiopia, 2018: A cross sectional study.

Daniel Adane,Getahun Belay,Getnet Gedefaw,Azimeraw Arega,Kassahun Gebayehu,Biresaw Wassihun,Charles A Ameh

doi:10.1371/journal.pone.0222843

Abstract

Active management of third stage of labor is the most indispensable intervention to avert post-partum hemorrhage which is one of the typical causes of maternal morbidity and mortality. Therefore, the aim of the study was to assess practice and factors associated with active management of third stage of labor among obstetric care providers in referral hospitals. Institution based cross-sectional study design was conducted from April 1-30, 2018. Simple random sampling technique was used to select a total of 356 obstetric care providers. Data were collected using pretested, structured and self-administered questionnaires. Data were entered to Epi data version 3.1 statistical software and exported to SPSS 23 for analysis. Bivariate and multivariate logistic regression analyses were performed to identify associated factors. P value <0.05 with 95% confidence level were used to declare statistical significance. This study revealed that practice of active management of third stage of labor was 61.2%. Age group of 20-30 years [AOR = 1.95 (95%CI;1.13-3.38)], Being male obstetric care provider [AOR = 1.74 (95%CI;1.03-2.94)], having work experience ≥2 years [AOR = 1.95(95%CI;1.13-3.38)], availability of oxytocin [AOR = 5.46 (95%CI; 2.41-12.3)], having exposure to manage third stage of labor [AOR = 2.91(95%CI; 1.55-5.48)], and having good knowledge [AOR = 2.67 (95%CI; 1.46-4.90)], were the factors associated with practice. This study showed that practice of active management of third stage of labor was high. Age group between 20-30 years, being a male obstetric care provider, having ≥2years work experience, availability of oxytocin, exposure to third stage management and having good knowledge were factors associated with practice. Therefore, all referral hospitals and concerned bodies need efforts to focus on providing training to increase health care provider's knowledge so as to sustain good practice through appropriate interventions.

Highlights

Third stage of labor is the period following from the delivery of the fetus to the expulsion of the placenta and membranes
This study showed that practice of active management of third stage of labor was high
Age group between 20–30 years, being a male obstetric care provider, having 2years work experience, availability of oxytocin, exposure to third stage management and having good knowledge were factors associated with practice

Summary

Introduction

Third stage of labor is the period following from the delivery of the fetus to the expulsion of the placenta and membranes. Active management of third stage of labor includes three interrelated but independent components such as, prophylactic administration of an uterotonic drugs (oxytocin), controlled cord traction and uterine massage [2]. World Health Organization (WHO) recommends active management of the third stage of labor as a critical intervention for postpartum hemorrhage (PPH) prevention which decreases the occurrence rate of PPH by 60–70% [2]. Active management of third stage of labor (AMTSL) is defined as the stage of labor from the delivery of the fetus to the expulsion of the placenta and membranes, which includes the following AMTSL components such as: prophylactic administration of an uterotonic drugs (oxytocin), controlled cord traction and uterine massage [2]. Active management of third stage of labor is the most indispensable intervention to avert post-partum hemorrhage which is one of the typical causes of maternal morbidity and mortality. The aim of the study was to assess practice and factors associated with active management of third stage of labor among obstetric care providers in referral hospitals

Objectives

Methods

Findings

Discussion

Conclusion