http://www.loc.gov/mods/v3 http://www.loc.gov/standards/mods/v3/mods-3-2.xsd
Existing versus active management of third stage of labour in Bharatpur Hospital Chitwan District Nepal
ABSTRACT: Many maternal deaths across the world result from complications of third stage labour during delivery of placenta. The high MMR in Nepal is due to PPH that is 46.2%. An intervention study on existing versus active management of third stage of labour was conducted in 2001 at Bharatpur hospital of government in Chitwan district. The objective of my study was to determine the effectiveness of active management of third stage of labour over existing management in relation to maternal blood loss, PPH and duration of third stage of labour. Interview schedule and observation checklist was prepared and pretested in 10% sample before data collection. The study population was the mothers admitted in Bharatpur hospital with spontaneous labour pain for normal delivery during my study intervention period of 4 weeks. Sample selection was done by simple random technique. Total 208 women were selected randomly to either active management or existing management. In active management (n=105) prophylactic syntocinon 10 unit IM given soon after baby's birth, immediate cord clamped and cut, placenta delivered by controlled cord traction. In existing management (n=103) no prophylactic syntocinon given, cord clamped and cut immediate after baby's birth, delivery of placenta by controlled cord traction after confirming the placental separation, and ergometrine 0.25 mg IM given after delivery of placenta. The study result revealed that significant difference were found between two groups on amount of blood loss/PPH, duration of third stage of labour, need of additional oxytocin and IV fluid infusion. The incidence of PPH (blood loss 500 & >500ml) was found significantly greater in existing management group 12.6%, than active management group 1.9% (RR 0.54; CI 0.42-0.69, p value<0.002) . The duration of third stage of labour was found significantly longer in existing management group than in active management group (7.5 vs 5.7 min) p value <0.012 The additional oxytocin required, more to the existing management group in compared to active management group, to control third stage bleeding, that is 16.5% vs 5.7%, p value 0.013 was found significant. It is concluded that active management of third stage labour is more safe, useful and practical than existing management of third stage of labour to reduce PPH. The results will be recommended to all hospital having maternity services and nursing institution for implementation in near future.