Active management of the third stage of labor: Uterine Tonus Assessment by Midwife vs. Patient self-administration - Trial PACTR201402000736158

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Summary

Rationale: Postpartum haemorrhage (PPH) is the most common cause of maternal death worldwide. The active management of the third stage of labour (AMTSL) is recognized as an effective strategy to prevent morbidity and mortality associated with PPH and reduce blood loss. AMTSL includes the provision of uterotonic drugs, controlled cord traction, delayed cord clamping and cutting, massage of the uterus, and monitoring of the uterine tonus. Although professional guidelines recommend the steps of AMTSL to be performed by health professionals, the reality of hospital understaffing in many low- and middle income countries (LMICs) necessitates task-shifting of the final AMTSL component to patients. Yet, whether uterus tonus assessment yields the same effect when performed by patients and midwives has not been formally evaluated. Objective: To determine whether there is a difference in effectiveness of routine uterine tonus assessment (every 15 minutes, for 2 hours) when performed by a midwife or self-administered by a patient on the incidence of postpartum hemorrhage. mean blood loss, and other maternal and neonatal outcomes.

ICD-10 Classifications