Preventing Postpartum Hemorrhage through Active Management of the Third Stage of Labor

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Preventing Postpartum Hemorrhage through Active
Management of the Third Stage of Labor

• or Life is But a Stage, and We Should All Be
  Actively Managing It

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OBJECTIVES

• Review the use of active management of the third
  stage of labor to prevent PPH
• Examine new approaches for the prevention of PPH
• Discuss program issues related to prevention of
  PPH

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Presenters

• Amanda Huber
• PPH Program Manager
• PRIME II/Intrah
• University of North
• Carolina, Chapel Hill

• Patricia Gomez
• Dir. of Midwifery Services
• MNH Program
• JHPIEGO-an affiliate of
• Johns Hopkins University

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130,000 women bleed to death
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We Know That

• Preventing PPH is the single most powerful way to
  decrease maternal mortality in most countries.
• So what can we do to prevent it?

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What is Active Management of Third Stage of
Labor (AMTSL)?

• Oxytocin 10 IU IM or IV within one minute after
  birth of baby
• Controlled cord traction with counter-traction to
  uterus
• Fundal massage

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Comparison of Active and Physiologic Management
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Another Way to Prevent PPH?

• PPH, mostly due to atonic uterus, remains major
  cause of maternal death
• Emergency care often unavailable in homes and
  remote health facilities
• Oxytocin requires cold chain and injection
• Ergometrine contraindicated for women with high
  blood pressure

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How Management Affects the Risk of PPH
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Lessons Learned

• Stakeholder partnership leadership by MOH and
  national professional societies is key, even if
  it is labor-intensive
• Policy environment must allow midlevel
  providers to administer oxytocics
• Drug supply security the earlier this is
  addressed, the better

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Dénouement

• Our goal is that AMTSL, with high-quality
  oxytocics, is performed for every normal birth
  that is attended by a skilled provider.

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End of soliloquies

• Time for dialogue!