An Audit of Active Management of Third Stage of Labour in a Tertiary Hospital
Keywords:
postpartum haemorrhage, labour, third stage, Active managementAbstract
Background: Postpartum haemorrhage is a potentially life-threatening, but preventable condition which is the leading cause of maternal mortality globally. Active management of third stage of labour, has been found to be a useful intervention in the prevention of primary postpartum haemorrhage. However, the recent modication in the traditional Active management of third stage of labour by Royal College of Obstetricians and Gynaecologist, guideline would necessitate the auditing of our Active management of third stage of labour and postpartum haemorrhage in this centre.
Aim:To determine the effectiveness of Active management of third stage of labour in prevention of postpartum hemorrhage in Aminu Kano Teaching Hospital, Kano .
Methods: This is a two-year retrospective descriptive study done at Aminu Kano Teaching Hospital, Kano. Records of patients who delivered in this hospital, those that had AMTSL and those that had PPH were retrieved from the labour ward delivery record book. Patients' case les were retrieved, studied and recorded in a proforma. These were compared with the criteria obtained from the Royal College of Obstetricians and Gynaecologist guidelines. Data collected was fed into the computer and analyzed using SPSS Statistics version 19 software.
Results: During the study period, there were 4,827 clients that had vaginal delivery with active management of third stage of labour. One hundred and seven of them had postpartum hemorrhage, thus giving an incidence of 2.2%. Among the 107 cases, only 84 (78.5%) case notes could be retrieved from the medical records department and the labour ward register and these were the ones
analyzed. Twenty-three (21.5%) case note could not be retrieved. Among the 84 women whose case records were retrieved, the mean age of the subjects was 32 years S.D +/-1.3 years. The most common risk factor for Post-partum haemorrhage is Abruptio placentae
(53.3%). Administration of oxytocin and Controlled cord traction achieved standard for prevention of postpartum haemorrhage (95.2%).
Conclusion: This audit shows that Active management of third stage of labour by the use of oxytocics immediately after delivery and Controlled cord traction remain as effective as the recent World Health Organization revised Active Management of third stage of labour which involved use of oxytocics alone, in the prevention of postpartum haemorrhage.
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