Impact of Reorientation and Training of Active Management of the Third Stage of Labor in a New Medical College of Chhattisgarh, India
Shipra Shrivastava, Nalini Mishra
Maternal mortality, Postpartum hemorrhage, Visual estimation of blood loss,Active management of third stage of labor
Citation Information :
Shrivastava S, Mishra N. Impact of Reorientation and Training of Active Management of the Third Stage of Labor in a New Medical College of Chhattisgarh, India. J Mahatma Gandhi Univ Med Sci Tech 2017; 2 (3):138-142.
Active management of third stage of labor (AMTSL) is a best practice that reduces the incidence of postpartum hemorrhage (PPH). The present study was done with an objective to document the prevalent practice in regard to various components of AMTSL and the impact of reorientation session.
Materials and methods
A total 200 women fulfilling the inclusion criteria (low-risk singleton pregnancy at term) and anticipating vaginal delivery were enrolled in the study. In the first stage of the study, observation and documentation of ongoing practice of management of third stage of labor in 100 consecutive women (group I) was followed by reorientation session. In the second stage, again 100 women were observed and documented as above (group II). The changes and its impact in terms of blood loss and incidence of PPH were noted and compared with group I.
None of the women of group I was given injection oxytocin in comparison to 77 women of group II. Controlled cord traction (CCT) was done in 44 women of group I as against 97 of group II women. No significant change in the timing of cord clamping was observed. The PPH occurred in only three women of group II in comparison to 11 of group I (p ≤ 0.05).
The level of adherence to AMTSL was low particularly for the use of oxytocin as first-line prophylactic uterotonic. The change in practice after a session of reorientation was positive and was associated with significant reduction in the incidence of PPH. The study reiterates the importance of frequent trainings.
How to cite this article
Shrivastava S, Mishra N. Impact of Reorientation and Training of Active Management of the Third Stage of Labor in a New Medical College of Chhattisgarh, India. J Mahatma Gandhi Univ Med Sci Tech 2017;2(3):138-142.
United Nations. Official list of MDG indicators. New York: United Nations; 2008. Available from: http://mdgs.un.org.
WHO. Trends in maternal mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015.
UNICEF. Sustainable development goals: 17 goals to transform our world. United Nations. 2015. Countdown to 2015: maternal, newborn and child survival.[Internet]. New York: WHO and UNICEF; 2012. [cited 2012 Sep 1]. Available from: http://www.countdown2015mnch.org/documents/2012Report/2012-Complete.pdf.
WHO. Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and the World Bank estimates. Geneva: WHO; 2012.
Rath W. Active management of the third stage of labour (AMTSL)—the end of a 50 years-dogma? Z Geburtshilfe Neonatol 2013 Oct;217(5):173-176.
World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage. Geneva: WHO; 2012.
Leduc D, Senikas V, Lalonde AB; Clinical Practice Obstetrics Committee. Active management of the third stage of labour: prevention and treatment of postpartum hemorrhage. J Obstet Gynaecol Can 2009 Oct;31(10):980-993.
Hofmeyr GJ, Mshweshwe NT, Gülmezoglu AM. Controlled cord traction for the third stage of labour. Cochrane Database Syst Rev 2015 Jan;1:CD008020.
MDG 2011-2013. United Nations: The Millennium Development Goals Report 2013.
Office of Registrar General. Special bulletin on maternal mortality in India. India: Office of Registrar General; 2010.
Sample Registration System (SRS). Special bulletin on maternal mortality in India 2010-12. New Delhi: SRS; 2013. [cited 2013 Dec]. Available from: www.censusindia.gov.in/vital_statistics/SRS_Bulletins/MMR_Bulletin-2010-12.pdf.
Census Population. Chhattisgarh population census data 2011. Chhattisgarh: Census Population; 2011. Available from: https://www.census2011.co.in/census/state/chhattisgarh.html.
Begley CM, Gyte GM, Devane D, McGuire W, Weeks A. Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev 2015 Mar;3:CD007412.
Westhoff G, Cotter AM, Tolosa JE. Prophylactic oxytocin for the third stage of labour to prevent postpartum haemorrhage. Cochrane Database Syst Rev 2013 Oct;10:CD001808.
Garabedian C, Simon M, Closset E, Ducloy-Bouthors AS, Schaffar A, Deruelle P, Gautier S, Depret S, Subtil D. Systematic prophylactic oxytocin injection and the incidence of postpartum hemorrhage: a before-and-after study. J Gynecol Obstet Biol Reprod (Paris) 2016 Feb;45(2):147-154.
Sentilhes L, Vayssière C, Deneux-Tharaux C, Aya AG, Bayoumeu F, Bonnet MP, Djoudi R, Dolley P, Dreyfus M, Ducroux-Schouwey C, et al. Postpartum hemorrhage: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF): in collaboration with the French Society of Anesthesiology and Intensive Care (SFAR). Eur J Obstet Gynecol Reprod Biol 2016 Mar;198:12-21.
Pantoja T, Abalos E, Chapman E, Vera C, Serrano VP. Oxytocin for preventing postpartum haemorrhage (PPH) in non-facility birth settings. Cochrane Database Syst Rev 2016 Apr;4:CD011491.
Dupont C, Ducloy-Bouthors AS, Huissoud C. Clinical and pharmacological procedures for the prevention of postpartum haemorrhage in the third stage of labor. J Gynecol Obstet Biol Reprod (Paris) 2014 Dec;43(10):966-997.
Dagdeviren H, Cengiz H, Heydarova U, Caypinar SS, Kanawati A, Guven E, Ekin M. Intramuscular versus intravenous prophylactic oxytocin for postpartum hemorrhage after vaginal delivery: a randomized controlled study. Arch Gynecol Obstet 2016 Nov;294(5):911-916.
Vendittelli F, Barasinski C, Pereira B, Dreyfus M, Lémery D, Bouvier-Colle MH; HERA Group. Policies for management of postpartum haemorrhage: the HERA cross-sectional study in France. Eur J Obstet Gynecol Reprod Biol 2016 Oct;205:21-26.
Springhall E, Wallace EM, Stewart L, Knight M, Mockler JC, Davies-Tuck M. Customised management of the third stage of labour. Aust N Z J Obstet Gynaecol 2017 Jun;57(3):302-307.
Chaudhuri P, Majumdar A. A randomized trial of sublingual misoprostol to augment routine third-stage management among women at risk of postpartum hemorrhage. Int J Gynaecol Obstet 2016 Feb;132(2):191-195.
Schack SM, Elyas A, Brew G, Pettersson KO. Experiencing challenges when implementing active management of third stage of labor (AMTSL): a qualitative study with midwives in Accra, Ghana. BMC Pregnancy Childbirth 2014 Jun;14:193.
Gulmezoglu AM, Lumbiganon P, Landoulsi S, Widmer M, Abdel-Aleem H, Festin M, Carroli G, Qureshi Z, Souza JP, Bergel E, et al. Active management of the third stage of labour with and without controlled cord traction: a randomised, controlled, non-inferiority trial. Lancet 2012 May;379(9827):1721-1727.
Althabe F, Alemán A, Tomasso G, Gibbons L, Vitureira G, Belizan JM, Buekens P. A pilot randomized controlled trial of controlled cord traction to reduce postpartum blood loss. Int J Gynaecol Obstet 2009 Oct;107(1):4-7.
Gambheera H, Williams S. Shared challenges in psychiatric research in India and Sri Lanka. Indian J Psychiatry 2010 Jan;52(Suppl 1):S80-S82.
Mallick N, Ray S, Mukhopadhyay S. Eating behaviors and body weight concerns among adolescent girls. Adv Public Health 2014 Jul;2014:257396.
Witcomb GL, Arcelus J, Chen J. Can cognitive dissonance methods developed in the West for combatting the ‘thin ideal’ help slow the rapidly increasing prevalence of eating disorders in non-Western cultures? Shanghai Arch Psychiatry 2013 Dec;25(6):332-340.
Rosenblum GD, Lewis M. The relations among body image, physical attractiveness, and body mass in adolescence. Child Dev 1999 Jan-Feb;70(1):50-64.
Rodriguez R, Marchand E, Ng J, Stice E. Effects of a cognitive dissonance-based eating disorder prevention program are similar for Asian American, Hispanic, and White participants. Int J Eat Disord 2008 Nov;41(7):618-625.
Crandall, R.; Reser, A. Attributions and weight-based prejudice. In: Brownell K, Puhl R, Schwartz M, Rudd L, editors. Weight bias: nature, consequences and remedies. New York: Guildford Press; 2005. pp. 83-96.
Khan AN, Khalid S, Khan HI, Jabeen M. Impact of today's media on university student's body image in Pakistan: a conservative, developing country's perspective. BMC Public Health 2011 May;11:379.
Calado M, Lameiras M, Sepulveda AR, Rodríguez Y, Carrera MV. The mass media exposure and disordered eating behaviours in Spanish secondary students. Eur Eat Disord Rev 2010 Sep-Oct;18(5):417-427.
Rodgers R, Chabrol H. The impact of exposure to images of idealized thin models on body dissatisfaction in young French and Italian women. Encephale 2009 Jun;35(3):262-268.
Blond A. Impacts of exposure to images of ideal bodies on male body dissatisfaction: a review. Body Image 2008 Sep;5(3):244-250.
Morris AM, Katzman DK. The impact of the media on eating disorders in children and adolescents. Paediatr Child Health 2003 May;8(5):287-289.
Grilo CM, Masheb RM, Brody M, Burke-Martindale CH, Rothschild BS. Binge eating and self-esteem predict body image dissatisfaction among obese men and women seeking bariatric surgery. Int J Eat Disord 2005 May;37(4):347-351.
Daniali S, Azadbakht L, Mostafavi F. Relationship between body satisfaction with self esteem and unhealthy body weight management. J Educ Health Promot 2013 Jul;2:29.
Huang JS, Norman GJ, Zabinski MF, Calfas K, Patrick K. Body image and self-esteem among adolescents undergoing an intervention targeting dietary and physical activity behaviors. J Adolesc Health 2007 Mar;40(3):245-251.
Wang, Y.; Wu, Y.; Wilson, RF.; Bleich, S.; Cheskin, L.; Weston, C.; Showell, N.; Fawole, O.; Lau, B.; Segal, J. Childhood obesity prevention programs: comparative effectiveness review and meta-analysis. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013. [cited 2013 Jun]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK148737/.
Khan MA, Mahomed MF, Ashshi AM, Faiz A. Drug resistance patterns of Acinetobacter baumannii in Makkah, Saudi Arabia. Pak J Med Res 2012 Oct-Dec;51(4):127-131.
Shields RK, Clancy CJ, Gillis LM, Kwak EJ, Silveira FP, Massih RC, Eschenauer GA, Potoski BA, Nguyen MH. Epidemiology, clinical characteristics and outcomes of extensively drug-resistant Acinetobacter baumannii infections among solid organ transplant recipients. PLoS One 2012 Dec;7(12):e52349.
Prashanth K, Badrinath S. In vitro susceptibility pattern of Acinetobacter species to commonly used cephalosporins, quinolones and aminoglycosides. Indian J Med Microbiol 2004 Apr-Jun;22(2):97-103.
Armin S, Karimi A, Fallah F, Tabatabaii RS, Alfatemi SM, Khiabanirad P, Shiva F, Fahimzad A, Rahbar M, Mansoorghanaii R, et al Antimicrobial resistance pattern of Acinetobacter baumannii, Pseudomonas aeruginosa and Staphylococcus aureus isolated from patients with nosocomial infection admitted to Tehran hospitals. Arch Pediatr Infect Dis 2015 Oct;3(4):e32554.
Qureshi ZA, Abbasi SA, Mirza IA, Malik N, Amjad A, Sattar A, Ikram A. Antimicrobial susceptibility pattern of Acinetobacter species-one year experience in a tertiary care setting. Infect Dis J 2011 Mar;20(1):269-272.
Spencer L, Bubner T, Bain E, Middleton P. Screening and subsequent management for thyroid dysfunction pre-pregnancy and during pregnancy for improving maternal and infant health. Cochrane Database Syst Rev 2015 Sep;9:CD011263.
Li M, Yao Q, Xing A. A clinical analysis of 188 cases of pregnancy complicated with critical heart disease. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2014 Nov;39(11):1145-1150.
Bhatla N, Lal S, Behera G, Kriplani A, Mittal S, Agarwal N, Talwar KK. Cardiac disease in pregnancy. Int J Gynaecol Obstet 2003 Aug;82(2):153-159.
Gelson E, Curry R, Gatzoulis MA, Swan L, Lupton M, Steer P, Johnson M. Effect of maternal heart disease on fetal growth. Obstet Gynecol 2011 Apr;117(4):886-891.
Arora N, Kausar H, Jana N, Mandal S, Mukherjee D, Mukherjee R. Congenital heart disease in pregnancy in a low-income country. Int J Gynaecol Obstet 2015 Jan;128(1):30-32.
Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000 Jul;183(1):S1-S22.
Agency for Healthcare Research and Quality. Management of chronic hypertension during pregnancy. Evidence Report/Technology Assessment no.14. AHRQ publication no. 00-E011. Rockville, MD: Agency for Healthcare Research and Quality; 2000.
Ferrer RL, Sibai BM, Mulrow CD, Chiquette E, Stevens KR, Cornell J. Management of mild chronic hypertension during pregnancy: a review. Obstet Gynecol 2000 Nov;96(5 Pt 2):849-860.
Sridharan R, Murthy BN. Prevalence and pattern of epilepsy in India. Epilepsia 1999 May;40(5):631-636.
Viale L, Allotey J, Cheong-See F, Arroyo-Manzano D, McCorry D, Bagary M, Mignini L, Khan KS, Zamora J, Thangaratinam S, et al. Epilepsy in pregnancy and reproductive outcomes: a systematic review and meta-analysis. Lancet 2015 Nov;386(10006):1845-1852.
Smyth A, Oliveira GH, Lahr BD, Bailey KR, Norby SM, Garovic VD. A systematic review and meta-analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis. Clin J Am Soc Nephrol 2010 Nov;5(11):2060-2068.
Hazes JM, Coulie PG, Geenen V, Vermeire S, Carbonnel F, Louis E, Masson P, De Keyser F. Rheumatoid arthritis and pregnancy: evolution of disease activity and pathophysiological considerations for drug use. Rheumatology (Oxford) 2011 Nov;50(11):1955-1968.
Velu PP, Gravett CA, Roberts TK, Wagner TA, Zhang JS, Rubens CE, Gravett MG, Campbell H, Rudan I. Epidemiology and aetiology of maternal bacterial and viral infections in low- and middle-income countries. J Glob Health 2011 Dec;1(2):171-188.
UNAIDS: UNAIDS report on the global AIDS epidemic. 2010. Available from http://www.unaids.org/globalreport/Global_report.htm
Ioannidis JP, Abrams EJ, Ammann A, Bulterys M, Goedert JJ, Gray L, Korber BT, Mayaux MJ, Mofenson LM, Newell ML, et al. Perinatal transmission of human immunodeficiency virus type 1 by pregnant women with RNA virus loads <1000 copies/ml. J Infect Dis 2001 Feb;183(4):539-545.
Anglemyer A, Rutherford GW, Horvath T, Baggaley RC, Egger M, Siegfried N. Antiretroviral therapy for prevention of HIV transmission in HIV-discordant couples. Cochrane Database Syst Rev 2013 Apr;4:CD009153.
Rimoin DL, Connor JM, Pyeritz RE, Korf BR. Emery and Rimoin's principles and practice of medical genetics. Churchill Livingstone Elsevier; 2007.
Verma IC, Puri RD. Global burden of genetic disease and the role of genetic screening. Semin Fetal Neonatal Med 2015 Oct;20(5):354-363.
White SJ, Boldt KL, Holditch SJ, Poland GA, Jacobson RM. Measles, mumps, and rubella. Clin Obstet Gynecol 2012 Jun;55(2):550-559.
American College of Obstetricians and Gynecologists. ACOG educational bulletin: viral hepatitis in pregnancy. Int J Gynaecol Obstet 1998 Nov;63:195-202.
Geeta MG, Riyaz A. Prevention of mother to child transmission of hepatitis B infection. Indian Pediatr 2013;50:189-192.
Swamy GK, Beigi RH. Maternal benefits of immunization during pregnancy. Vaccine 2015 Nov;33(47):6436-6440.
Sukumaran L, McCarthy NL, Kharbanda EO, McNeil MM, Naleway AL, Klein NP, Jackson ML, Hambidge SJ, Lugg MM, Li R, et al. Association of Tdap vaccination with acute events and adverse birth outcomes among pregnant women with prior tetanus-containing immunizations. JAMA 2015 Oct;314(15):1581-1587.
Singru SA, Tilak VW, Gandham N, Bhawalkar JS, Jadhav SL, Pandve HT. Study of susceptibility towards Varicella by screening for the presence of IgG antibodies among nursing and medical students of a Tertiary Care Teaching Hospital in Pune, India. J Glob Infect Dis 2011 Jan-Mar;3(1):37-41.
Nathwani D, Maclean A, Conway S, Carrington D. Varicella infections in pregnancy and the newborn. A review prepared for the UK Advisory Group on Chickenpox on behalf of the British Society for the Study of Infection. J Infect 1998;36 (Suppl 1):59-71.
Michaan N, Amzallag S, Laskov I, Cohen Y, Fried M, Lessing JB, Many A. Maternal and neonatal outcome of pregnant women infected with H1N1 influenza virus (swine flu). J Matern Fetal Neonatal Med 2012 Feb;25(2):130-132.
Smith NM, Bresee JS, Shay DK, Uyeki TM, Cox NJ, Strikas RA. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2006 Jul;55(RR-10):1-42.