Reduced postpartum hemorrhage after implementation of active management of the third stage of labor in rural Honduras.

Abstract

OBJECTIVE:

To assess outcomes after auxiliary nurses were trained and given resources to use active management of the third stage of labor (AMTSL) for all women giving birth in a low-resource, low-risk, rural, public birth center setting in northern rural Honduras.

METHODS:

Auxiliary nurses received training on estimation of blood loss before the preintervention phase of the study (July 2004 through April 2005) and AMTSL, including use of intramuscular oxytocin, and estimation of blood loss prior to the intervention phase (July 2007 through June 2008). Preintervention and intervention data on use of oxytocin, blood loss postpartum, hemorrhage rates, and management interventions were collected and compared.

RESULTS:

After nurses received training on AMTSL using intramuscular oxytocin, the use of intramuscular oxytocin during the third stage of labor increased from 63.8% to 96.5%. Postpartum hemorrhage rates decreased from 14.8% to 5.9% (P=0.001). Use of intrapartum oxytocin, which can have adverse effects, also increased: from 6.1% to 22.7% (P<0.001).

CONCLUSION:

Training auxiliary nurses to perform AMTSL using oxytocin in this birth center setting was effective in reducing the rate of postpartum hemorrhage; however, increased use of intrapartum oxytocin may be an unintended outcome of the increased accessibility of oxytocin.

• Authors: Lisa Kane Low, Joanne Motino Bailey, Emma Sacks, Chayla Robles, Lilian Medina
• Journal: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics (Int J Gynaecol Obstet) Vol. 119 Issue 3 Pg. 217-20 (Dec 2012) ISSN: 1879-3479 [Electronic] United States
• PMID: 22980430 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Chemical References

• Oxytocics
• Oxytocin

Topics

• Adolescent
• Adult
• Female
• Health Services Accessibility
• Honduras (epidemiology)
• Humans
• Injections, Intramuscular
• Labor Stage, Third
• Maternal Health Services (organization & administration, standards)
• Nursing Assistants (education, organization & administration, standards)
• Outcome Assessment, Health Care
• Oxytocics (administration & dosage, adverse effects, therapeutic use)
• Oxytocin (administration & dosage, adverse effects, therapeutic use)
• Postpartum Hemorrhage (epidemiology, prevention & control)
• Pregnancy
• Rural Health Services (organization & administration, standards)
• Young Adult