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

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4. Findings regarding the management of the third stage of laborThe principle objectives of this study were to measure the use of AMTSL according toFIGO/ICM criteria and to measure current practices regarding the management of the third andfourth stages of labor outside of this definition. This section describes the management of thethird and fourth stages of labor by focusing on 1) the overall use of uterotonic drugs; 2) thetiming, mode of administration, and dose of these drugs; 3) the practice of the individualcomponents of AMTSL; 4) the correct use of AMTSL; and 5) the observation of potentiallyharmfulpractices.Description of the study sampleA total of 190 deliveries were observed in 26 maternity hospitals in this study. There were nodeliveries during the observation period in two hospitals. The weighted number of observeddeliveries is 190.Deliveries were observed in all regions of El Salvador, with 31 percent in the Oriental region, 25percent in the Occidental region and between 13 and 16 percent from other three regions. SeeTable 4.1. The large majority of observed deliveries took place in district hospitals (81 percent),with approximately one-fifth (17 percent) in regional hospitals and only two percent from thecentral referral hospital. All of the hospitals in the sample are located in urban areas. Ninety-fivepercent of observed deliveries were in facilities that handle 1,000 or more deliveries per year.Three-quarters of the observed deliveries were attended by general practitioners or residentdoctors, with six percent attended by an obstetrician. Interns were responsible for 18 percentobserved deliveries. In these hospitals, nurses attended only two percent of observed deliveries.The observed deliveries were mainly among young women between 20 and 29 years old (66percent). Thirty percent of the deliveries were first deliveries. Only seven percent of thedeliveries were to high parity women with four or more births. All of the deliveries were singlevaginal deliveries.In 42 percent of the deliveries, the women had received a uterotonic drug before the third stageof labor. Ten percent were induced, 19 percent augmented, and 13 percent were both inducedand augmented. In only 60 percent of deliveries did women receive a uterotonic drug during thethird or fourth stages of labor. In all cases, oxytocin was the uterotonic drug used.Table 4.1 Percent distribution of observed deliveries by characteristics of the health facilityand the womanCharacteristics of thefacility% ofdeliveriesn ofdeliveriesCharacteristics of thewoman% ofdeliveriesn ofdeliveriesRegionAge of womanMetropolitan 15.1 29
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 12 and 13: Supplies and logisticsThe sufficien
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: ased on current consumption of oxyt
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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