El Salvador - Active Management of the Third Stage of Labor - POPPHI

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Supplies and logisticsThe sufficient availability of high-quality uterotonic drugs, needles, and syringes at national andlocal levels is essential for routine use of AMTSL. Effective use of AMTSL also requiresappropriate conditions during transport and storage to ensure the use of chemically-active drugsand safe, sterile needles and syringes.Figure 1.1. Determinants of the routine use of AMTSL.PolicyProviderHistoricalprecedent,influence ofleader,WHO,in-servicetrainingNationalguidelinesPresence inpre-servicetrainingKnowledge,skills inAMTSLAMTSLprotocolin hospital“Champions” foruse of AMTSLMotivationto useExpectedbehaviorin hospitalImplementationProperstorageWomanreceivesAMTSLLogisticsUterotonicsincluded onEssentialDrug List(oxytocin=drug ofchoice)SufficientamountprocuredTransportissuesProcurementat hospitallevelAvailabilityof sufficientoxytocics,needles,syringe on siteThe aim of this study is to provide ministries of health (MOHs) and their international partnerswith the descriptive information necessary to assess AMTSL practices and identify majorbarriers to its use. The findings will inform interventions that improve adoption andimplementation of AMTSL.The study’s specific research questions are as follows:1. For what proportion of deliveries is AMTSL used at a national level? Which components ofAMTSL (e.g., prophylactic use of oxytocic agents, controlled cord traction, and fundalmassage) are practiced, and how consistently are they practiced?2. Is AMTSL formally promoted in the Standard Treatment Guidelines (STGs) in each countryat national and/or facility levels? If so, since when? How is AMTSL defined in thestandards?3. How is the need for AMTSL drugs quantified at national and facility levels?4. Which uterotonic drug (e.g., oxytocin, ergometrine, or a prostaglandin) is used? How is itstored?5. At the facility level, is enough oxytocin available to allow for routine use of AMTSL?6
6. What are the major barriers to correct use of AMTSL, as defined by WHO and FIGO/ICM intheir joint statement on the prevention of postpartum hemorrhage?7
Page 1 and 2: ActiveManagementof the ThirdStage o
Page 3: Federation of Gynecology and Obstet
Page 6 and 7: AcronymsAMTSLActive management of t
Page 8 and 9: palpation to assess the need for co
Page 10 and 11: 1. BackgroundPostpartum hemorrhage
Page 14 and 15: 2. MethodsThis study is part of a m
Page 16 and 17: Data entry and analysisThe study te
Page 18: Table 3.1. Availability and storage
Page 21 and 22: ased on current consumption of oxyt
Page 23 and 24: 4. Findings regarding the managemen
Page 25 and 26: delivery of the placenta, followed
Page 27 and 28: (38 versus 30 percent, and these di
Page 29 and 30: With massage immediately after deli
Page 31 and 32: Duration of the third stage of labo
Page 33 and 34: 5. Conclusions and recommendationsT
Page 35 and 36: definition described in the clinica

El Salvador - Active Management of the Third Stage of Labor - POPPHI

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