Management Of Third Stage Research Articles

Effect of Competency-Based Education on Interns Nursing Students' Performance Regarding Active Management of Third Stage of Labor

Effect of Competency-Based Education on Interns Nursing Students' Performance Regarding Active Management of Third Stage of Labor

Effect of Competency-Based Education on Interns Nursing Students' Performance Regarding Active Management of Third Stage of Labor

Effect of Competency-Based Education on Interns Nursing Students' Performance Regarding Active Management of Third Stage of Labor

Oxytocin receptor single nucleotide polymorphism predicts atony-related postpartum hemorrhage

BackgroundPostpartum hemorrhage remains a key contributor to overall maternal morbidity in the United States. Current clinical assessment methods used to predict postpartum hemorrhage are unable to prospectively identify about 40% of hemorrhage cases. Oxytocin is a first-line pharmaceutical for preventing and treating postpartum hemorrhage, which acts through oxytocin receptors on uterine myocytes. Existing research indicates that oxytocin function is subject to variation, influenced in part by differences in the DNA sequence within the oxytocin receptor gene. One variant, rs53576, has been shown to be associated with variable responses to exogenous oxytocin when administered during psychological research studies. How this variant may influence myometrial oxytocin response in the setting of third stage labor has not been studied. We tested for differences in the frequency of the oxytocin receptor genotype at rs53576 in relationship to the severity of blood loss among a sample of individuals who experienced vaginal birth.MethodsA case–control prospective design was used to enroll 119 postpartum participants who underwent vaginal birth who were at least 37 weeks of gestation. Cases were defined by either a 1000 mL or greater blood loss or instances of heavier bleeding where parturients were given additional uterotonic treatment due to uterine atony. Controls were matched to cases on primiparity and labor induction status. Genotype was measured from a maternal blood sample obtained during the 2nd postpartum month from 95 participants. Statistical analysis included bivariate tests and generalized linear and Poisson regression modeling.ResultsThe distribution of the genotype across the sample of 95 participants was 40% GG (n = 38), 50.5% AG (n = 48) and 9.5% AA (n = 9). Blood loss of 1000 mL or greater occurred at a rate of 7.9% for GG, 12.5% for AG and 55.6% for AA participants (p = 0.005). Multivariable models demonstrated A-carriers (versus GG) had 275.2 mL higher blood loss (95% CI 96.9–453.4, p < 0.01) controlling for parity, intrapartum oxytocin, self-reported ancestry, active management of third stage or genital tract lacerations. Furthermore, A-carrier individuals had a 79% higher risk for needing at least one second-line treatment (RR = 1.79, 95% CI = 1.08–2.95) controlling for covariates. Interaction models revealed that A-carriers who required no oxytocin for labor stimulation experienced 371.4 mL greater blood loss (95% CI 196.6–546.2 mL).ConclusionsWe provide evidence of a risk allele in the oxytocin receptor gene that may be involved in the development of postpartum hemorrhage among participants undergoing vaginal birth, particularly among those with fewer risk factors. The findings, if reproducible, could be useful in studying pharmacogenomic strategies for predicting, preventing or treating postpartum hemorrhage.

Comparative Efficacy of Syntometrine Versus Oxytocin in Active Management of Third Stage of Labour

Objective: The study's objective is to examine the effectiveness of syntometrine and oxytocin in actively managing the third stage of labour in order to lower the risk of PPH and other undesirable third stage outcomes. Study Design: Randomized/Prospective study Place and Duration: Gynae &amp; Obs department of Combined Military Hospital Peshawar for the duration from 1st June 2021 to 30th November 2021. Methods: This study comprised of 140 females of third stage labour. Age of the females was 18-40 years. After getting informed written consent detailed demographics of enrolled cases were recorded. Patients were equally divided in two groups. Group I had 70 patients and received syntometrine (5 IU Synthetic Oxytocin and 0.5 mg ergometrine maleate) and in group II oxytocin was given to 70 females. Outcomes among both groups were recorded in terms of blood loss and postpartum hemorrhage. SPSS 23.0 was used to analyze all data. Results: The mean age of the patients was 28.3±6.18 years and had mean BMI 27.6±11.25 kg/m2. Mean gestational age was 36.11±5.19 weeks. Frequency of primigravida was 80 (57.1%). Frequency of emergency delivery was found in 85 (60.7%) cases while 55 (39.3%) females admitted to OPD. 72 (51.4%) females were from rural areas and 67 (47.8%) cases were educated. We found that mean blood loss in group II was higher 165.1±8.66 ml as compared to group I 118.7±9.39 ml with p value &lt;0.005. There was no any PPH found in group I while in group II PPH found in 3 (4.3%) cases. Frequency of hypertension was higher in group I. We found higher number of adverse outcomes among females of syntometrine group as compared to oxytocin group. Conclusion: In this study we concluded that use of syntometrine in third stage of labour was effective and useful in terms of reduction in blood loss and PPH as compared to oxytocin while frequency of adverse events and hypertension was higher in syntometrine group as compared to oxytocin. Keywords: Pregnant Females, Third Stage Labour, Syntometrine, Oxytocin, Blood Loss

Comparison of Oral Misoprostol with Intravenous Oxtocin in the Prevention of Primary Postpartum Haemorrhage in ESUT Teaching Hospital: A Randomized Controlled Trial

Background: Postpartum haemorrhage (PPH) is one of the major causes of maternal mortality globally. About 14 million patients suffer from postpartum haemorrhage annually worldwide, of which about 140,000 die. The active management of third stage of labour with the use of uterotonic drugs has reduced the risk of postpartum haemorrhage significantly. The most common uterotonic drug currently in use is oxytocin but the problem of insufficient skilled manpower for its administration, inadequacy of electric power supply to ensure the stability of the drug at appropriate temperature, and its high cost have made widespread use of oxytocin difficult in the resource-poor countries. This has made the search for an effective, affordable, stable and available alternative necessary. Misoprostol, an analogue of prostaglandin-E1, has a good uterotonic activity, is highly affordable, does not require specialized skill to administer and is very stable at room temperature. It also has multiple routes of administration, which makes its use in resource-poor countries indispensable. Aim: To determine if there is any difference in the efficacy of intravenous oxytocin over oral misoprostol in the prevention of primary postpartum haemorrhage. Study Design: This was a prospective, double-blinded, randomized study of uncomplicated pregnant women who had vaginal delivery in ESUT Teaching Hospital, Enugu. Sample Size: Two hundred (200) pregnant women who satisfied the inclusion criteria were recruited in this study with each arm of the study accommodating 100 participants. Methodology: The eligible women were recruited on presentation to the labour ward after giving their consent. They were randomly allocated into 2 groups: A and B. Group A received 2 tablets (400mcg) of oral misoprostol and 1mililtre (ml) of sterile water intravenously while group B received 2 tablets of white vitamin c and 1ml (10iu) of intravenous oxytocin immediately after cord clamping and cutting following the delivery of the baby. Pre-weighed delivery mats and vulval pads were used to collect the blood at delivery and for the first 24 hours for weighing and estimation of blood loss. A proforma was used to record the necessary data. Statistical Analysis: Data collected from the study was analyzed with the Statistical Package for Social Sciences (SPSS) computer software version 20.0 for windows. Statistical analysis was both descriptive and inferential at 95% confidence level. The socio-demographic variables were used to categorize the data and this was subjected to comparative statistical evaluation to yield frequencies, means, and percentages. Test of significance between class differences was by Pearson’s Chi-square test for categorical variables and student’s t-test for continuous variables. All P&lt;0.05 at one degree of freedom (df=1) was considered statistically significant. Results: Two hundred pregnant women were recruited into the study with 100 women on each arm and all completed the study. The amounts of blood loss (in mililitre) in the misoprostol and oxytocin arms were 339.36 ± 122.28 and 378.52 ± 148.24, respectively. Forty-three women had PPH (blood loss ≥ 500ml) but there was no significant difference in the amount of blood loss and occurrence of PPH on both arms of the study. Conclusion: There was no difference in the efficacy of oxytocin over misoprostol in the management of the 3rd stage of labour for preventing PPH. We therefore, recommend that misoprostol can be adopted as an alternative/substitute to oxytocin in the management of the third stage of labour especially in the developing countries for prevention of PPH.

Comparison of Intravenous Versus Intra-Umbilical Oxytocin for Blood Loss and Placental Separation Time for Active Management of Third Stage of Labour

Objectives: To comparison intravenous (IV) versus intra-umbilical oxytocin for blood loss and placental separation time for active management of third stage of labour (TSL). Methodology: This randomized controlled trial was done at “The department of Obstetrics &amp; Gynaecology”, Sialkot Medical College, Sialkot, Pakistan from December 2021 to May 2022. A total of 100 women (50 in each group), aged 18-40 years with singleton cephalic pregnancy having active labour were randomly allocated to either Group-A (IV oxytocin) or Group-B (intra-umbilical oxytocin). Time of placental separation along with blood loss were noted in all women. Results: In a total of 100 women, mean age was 27.1±7.18 years. Mean gestational age was 38.12±1.3 weeks. Mean blood loss in Group-A (IV group) was 416.80±23.24 ml vs. 186.74±34.72 ml in Group-B (intraumbilical group), p&lt;0.0001. Placental separation time was 4.84±1.22 minutes in Group-A versus 1.70±0.72 minutes min in Group-B (p&lt;0.0001). Conclusion: Mean blood loss and time of placental separation were significantly less with intra-umbilical oxytocin in comparison to IV oxytocin for active management of TSL. Keywords: Blood loss, intraumbilical, intravenous, oxytocin

Comparative study between intraumbilical oxytocin injection and placental cord drainage in management of third stage of labour

Comparative study between intraumbilical oxytocin injection and placental cord drainage in management of third stage of labour

Efficacy and safety of perrectal 400 microgram misoprostol versus intravenous 200 microgram methylergometrine in the management of third stage of labor for prevention of postpartum haemorrhage

Background: Objective: Postpartum haemorrhage (PPH) is a major cause of mortality and morbidity during childbirth, especially in developing countries. Misoprostol is a cheap, safe, widely available, and stable at room temperature, does not required any intravenous accesses and having few mild side effects. In resource-poor countries with limited facilities, misoprostol may be one of the important interventions to prevent PPH. We aimed to assess the effectiveness of perrectal low dose misoprostol for the prevention of PPH. Method: We designed a prospective randomized control trial, single centre study. 138 indoor low risk pregnant women with gestational age at least 37 weeks who anticipated vaginal delivery were randomly assigned to perrectal 400 microgram misoprostol (n = 71) or intravenous 200 microgram (n = 67) methylergometrine after delivery of baby and placenta. The primary outcome was incidence of PPH (estimated blood loss &gt;500 ml after delivery of baby and placenta). Results: In this study out of 138 low risk pregnancy, no women developed PPH, no patient required additional dose of oxytocin, no patient required any form of transfusion.

Effectiveness of lecture cum demonstration on knowledge regarding active management of third stage of labour among B.SC nursing IV year students

Pregnancy is a God-given wonder, and a mother's delight begins the moment new life begins to stir inside her and a tiny heartbeat is heard for the first time. (Sr. Jolly Joseph et al., 2013) . Labor is process of fetus being expelled from the uterus. Multiple factors are used to track the progress of the labor. The time between the baby's birth and the placenta and membranes being delivered is commonly referred to as the third stage of labor. Because of the possibility of postpartum haemorrhage, the third stage is the most dangerous for the woman (PPH).

Anesthetic Management in Parturients With Fontan Physiology

Anesthetic Management in Parturients With Fontan Physiology

Predictors of time to recovery from postpartum hemorrhage in Debre Markos comprehensive specialized hospital, Northwest, Ethiopia, 2020/21

BackgroundPostpartum hemorrhage is one of the leading causes of maternal deaths worldwide. Early recovery is a performance indicator and better health outcome of patients with postpartum hemorrhage. Therefore, this study aimed to assess time to recovery from postpartum hemorrhage and its predictors in Debre Markos Comprehensive Specialized Hospital, Ethiopia, 2020.MethodsA retrospective follow-up study was conducted among 302 women who were diagnosed with postpartum hemorrhage from January 1, 2016 to December 31, 2020 at Debre Markos Comprehensive Specialized Hospital. Consecutive sampling technique was employed. To show the statistical significant difference between each group of variables, log rank test was used. Kaplan Meier analysis to estimate time to recovery and cox proportional-hazard regression analysis to determine independent predictors were carried out cautiously. Adjusted hazard ratio used to determine the strength of association.ResultThe median recovery time from postpartum hemorrhage was 13 h with range of (10 to 17 h). Blood transfusion (AHR: 1.8, 95% CI (1.39, 2.57)), NASG utilization (AHR: 6.5, 95% CI (4.58, 9.42)) fluid resuscitation (AHR 2.9, 95% CI (1.48, 5.54)), active management of third stage of labor (AHR: 1.7, 95% CI (1.18, 2.45)) and history of antenatal care follow-up (AHR: 2.6, 95% CI (1.91, 3.56)) were the predictors, which shorten the recovery time. Comorbidities like anemia at the time of admission (AHR: 0.62 95% CI (0.44, 0.89)), retroviral infection (AHR: 0.33, 95% CI (0.16, 0.67)) and Hepatitis B-Virus infection (AHR: 0.52, 95% CI (0.32, 0.82)) delay the recovery rate from postpartum hemorrhage.ConclusionMothers in North-West Ethiopia stays morbid from postpartum hemorrhage for more than half a day. Their recovery time was affected by Non-Pneumatic Anti-Shock Garment utilization, implementation of emergency management components like blood transfusion and fluid resuscitation, history of antenatal care follow up, and being comorbid with viral infections. Non-pneumatic anti-shock garment application to every mother with postpartum hemorrhage and implementation of proper emergency management approach are vital for rapid recovery from postpartum hemorrhage.

Comparative Study between Umbilical Cord Drainage, Cord Clamping and Intraumbilical Vein Oxytocin Injection in Management of Third Stage of Labour

Comparative Study between Umbilical Cord Drainage, Cord Clamping and Intraumbilical Vein Oxytocin Injection in Management of Third Stage of Labour

Early Postpartum Complications and Maternal Mortality: An Experience of Mymensingh Medical College Hospital, Bangladesh

A cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Mymensingh Medical College Hospital (MMCH), Bangladesh, between April and September of 2010, to observe and evaluate common complications in early puerperium. A total of 384 patients were selected for the study, who were admitted with immediate postpartum complications, or who experienced complications after delivery at MMCH. Most of the patients 202(52.6%) belongs to 21-30 years age group followed by 118(30.73%) in &gt;30 years and 64(16.67%) in ≤20 years group. Low parity accounts for most patients, 217(56.5%), while grand multiparity was documented in 42(10.9%) patients. 211(54.95%) patients had no history of antenatal checkup. 179(46.62%) patients had home delivery, while the rest had institutional delivery. 239(62.24%) patients had normal vaginal delivery, while 129(33.6%) had Caesarean operation, 7(1.82%) needed vacuum extraction and 2.34% had forceps’ delivery. 146(38.02%) had their delivery without attending doctor, nurse/midwife or skilled birth attendant. Most of the patients, 281(73.18%), had their symptoms and signs within 24 hours of delivery, while 41(10.67%) and 62(16.15%) had within 48 hours and within 7 days respectively. Primary postpartum haemorrhage (PPH) was the leading complication found in 114(29.68%) patients, while the other major complications were puerperal sepsis 53(13.8%), urinary tract infection 40(10.42%), postpartum eclampsia 38(9.9%). 329(85.68%) patients were discharged without any morbidity; however, maternal mortality was observed in 18(4.68%) cases. Puerperal sepsis 5(28%), postpartum eclampsia 4(22%) and pulmonary embolism 3(17%) were the leading causes of mortality. Skilled obstetric care, active management of third stage of labour, prevention and treatment of anaemia, and maintenance of strict asepsis during delivery can prevent a considerable incidence of those complications.&#x0D; CBMJ 2021 January: vol. 10 no. 02 P: 85-90

A Study of structured teaching programme on active management of third stage of labour among staff nurses working in DR. Tandon Nursing college and Test tube IVF center at Agra (U.P)

A Study of structured teaching programme on active management of third stage of labour among staff nurses working in DR. Tandon Nursing college and Test tube IVF center at Agra (U.P)

UTEROTONIC USE IN THE ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR (AMTSL): SYSTEMATIC REVIEW

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Maternal mortality rate in Indonesia has decreased from 184/100,000 live birth (LB) (2016) to 177/100,000 LB (2017), but this number is still high enough than SDGs target of 70/100,000 LB. The one of direct cause of maternal death is hemorrhage, especially postpartum hemorrhage (PPH). Causes of PPH are uterine atony, laceration of birth canal, resistant placenta and uterine inversion. PPH prevention method is Active Management of Third Stage of Labor (AMTSL). The objective of this systematic review is to analyze the use of uterotonics in AMTSL.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This systematic review used the PRISMA protocol, articles taken from Google Scholar, Science Direct, and Pub Med. The time span of the research article was 2010 to 2021.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Result:&lt;/strong&gt; The results of the study describe that the use of uterotonics in single use or combination in third stage of labor can reduce the risk of PPH and shorten the time of the stage. The side effects were reported in misoprostol and methyl ergometrine than oxytocin. In addition, combination therapy with oxytocin and misoprostol can reduce the length of the third stage and the potential for a decrease in hemoglobin within 24 hours of delivery. In Indonesia, if oxytocin is not available, maternal nipple stimulation is performed as nonpharmacological therapy or ergometrine 0.2 mg is given to patients without complications of high blood pressure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; The use of uterotonics is adjusted to its cost-effectiveness, ability to store and refrigerate also the benefits compare to the side effects to the patients.&lt;/p&gt;

A Study of structured teaching programme on active management of third stage of labour among staff nurses working in DR. Tandon Nursing college and Test tube IVF center at Agra (U.P)

A Study of structured teaching programme on active management of third stage of labour among staff nurses working in DR. Tandon Nursing college and Test tube IVF center at Agra (U.P)

Knowledge and skills on active management of third stage of labor for prevention of post-partum haemorrhage among health care providers in Lake Zone, Tanzania: a cross sectional study

BackgroundHealth care providers (HCPs) knowledge and skills are both crucial in saving the lives of mothers and their newborns during childbirth. This study aimed to assess the knowledge and skills of HCPs on active management of third stage of labor (AMTSL) for prevention of PPH in Lake Zone Tanzania.MethodsA cross-sectional analytical hospital-based study which included 340 HCPs who were randomly selected, the study was conducted from March to May 2019 in lake zone, Tanzania. Data were collected using standardized questionnaire and observational checklist. Predictors of knowledge and skills on AMTSL were determined using binary logistic regression under multivariable analysis using SPSS version 23.0. p-value less than 0.05 was considered significant.ResultsMost 200 (58.8%) of the participants were aged between 25 and 34 years with mean age 31.4 ± 6.26 years. Majority 240 (67.6%) were females. Of all HCPs, 171 (50.3%) had adequate knowledge whereas 153 (45.0%) had adequate skills on AMTSL. Males (AOR = 1.96, 95% CI 1.18–3.26), HCPs with University education (AOR = 3.29, 95% CI 1.19–9.13) and previous BEmONC training (AOR = 2.20, 95% CI 1.24–3.91) were found to be the predictors of adequate knowledge on AMTSL. HCPs aged ≥ 45 years (AOR = 9.35, 95% CI 1.74–10.28) and HCPs working at a hospital (AOR = 1.78, 95% CI 1.12–2.82) were associated with having adequate skills on AMTSL.ConclusionHCPs included in this study demonstrated low skills on AMTSL as compared to knowledge which needs immediate attention. We recommend continuous in-service training and supportive supervision among HCPs working in labour wards for improving their knowledge and skills on AMTSL. This will help to reduce maternal morbidity and mortality related to PPH.

Acute uterine inversion – A complication revisited; a case series and review of literature

Abstract Objectives The objective of this case series is to discuss the various presentations of acute uterine inversion and to discuss how these varied presentations can cause a diagnostic confusion. Differences in acute uterine inversion following a vaginal delivery and a cesarean section are also discussed along with the management of acute uterine inversion, emphasizing the need for a rapid diagnosis and management. Case presentation Three such cases of acute uterine inversion – two after vaginal delivery (one second-degree inversion and one third degree inversion) and one during cesarean section have been discussed along with their management. Conclusions Uterine inversion is a potentially life-threatening complication which can be prevented by active and careful management of third stage of labor and avoiding cord traction prior to development of the signs of placental separation. Early stages of uterine inversion may be confused with a prolapsed fibroid or a cervical polyp. Prompt management can avert maternal mortality and morbidity.

Cervical prolapse in pregnancy.

Cervical prolapse during pregnancy is extremely rare but can cause complications in antepartum or intrapartum period and can have long term sequelae-for mother and fetus. A 32-year-old grand multipara (previous 4 vaginal deliveries) with moderate anaemia (Hb-7.6gm/dl) and poor nutritional status (BMI-17kg/m2), presented with 35 weeks´ pregnancy and preterm labor pains with a prolapsed hyperemic cervix 4-5cm dilated protruding out of introitus. We proceeded with fluid and blood products´ resuscitation and close monitoring of labor till delivery of 2100gm male baby with APGAR score 8. Active management of third stage of labor was done with oxytocics to prevent post-partum haemorrhage. After manually repositing the cervix and uterus inside for the time being, the woman was sent to post-natal ward. Daily dressing of prolapse with magnesium sulphate done. A supportive ring pessary with ideal fit for the lady was placed against symphysis pubis resting in the posterior fornix on post-partum day 8. We counseled the lady for interval sterilisation to prevent future pregnancies and telephonic follow up was taken. Here, multiple vaginal deliveries, anaemia, poor nutritional status were significant contributing factors in both preterm labour pains and cervical prolapse. These etiological factors contribute to major health hazards in developing nations. Surveillance and correction of these comorbidities is of utmost importance in pre-conceptional and antepartum period itself.

Active Management of Third Stage of Labor: Practice and Associated Factors among Obstetric Care Providers in North Wollo, Amhara Region, Ethiopia.

Background World Health Organization strongly recommends that every obstetrical provider at birth needs to have knowledge and skills on active management of the third stage of labor and use it routinely for all women. However, implementation of this lifesaver intervention by skilled birth attendants is questionable because 3% to 16.5% of women still experience postpartum hemorrhage. Even though coverage of giving births at health facilities in Ethiopia increases, postpartum hemorrhage accounts for 12.2% of all maternal deaths occurring in the country. Lack of the necessary skills of birth attendants is a major contributor to these adverse birth outcomes. Objectives This study aimed to assess the active management of the third stage of labor practice and associated factors among obstetric care providers. Methods An institution-based cross-sectional study design was applied from March 15 to April 15, 2020. Multistage sampling techniques were used to get 254 participants, and data were collected using self-administered structured questionnaires and an observation checklist. Data were entered into EpiData version 3.1 and exported to Statistical Package for the Social Sciences (SPSS) version 23.0 for analyses. The multivariable logistic regression model was used at 95% confidence interval with P value <0.05. Among the 232 providers participating in the study, only 75 (32.3%) of respondents had a good practice. The practice of the provider was significantly associated with work experience (adjusted odd ratio 0.206 (95% confidence interval, 0.06–0.63)), knowledge (adjusted odd ratio (2.98 (95% confidence interval, 1.45–6.14)), the presence of assistance (adjusted odd ratio 2.04 (95% confidence interval, 1.06–3.93)), and time of uterotonic drug preparation (adjusted odd ratio 4.69 (95% confidence interval, 2.31–9.53)). Conclusion Only one-third of obstetric care providers had good practice during active management of third stage of labor. Practice was significantly associated with work experience, knowledge, the presence of assistance during third-stage management, and time of uterotonic drug preparation. Consistent and sustainable on job training and clinical audit should be applied in all facilities with regular supportive supervision and monitoring. Furthermore, team work and adequate preparation should be done to facilitate the management of active third stage of labor.