An Audit of the Knowledge and Practice of the Active Management of the Third Stage of Labor in a Resource Constrained Setting

Background: The high incidence of post-partum haemorrage (PPH) in South Africa draws into question the knowledge and practice of HCPs with regard to AMTSL. Hence we carried out this assessment of HCPs knowledge and practice of AMTSL in the Pietermaritzburg Metropolitan Area (PMB). Aim: To evaluate HCP’s knowledge and practice of AMTSL in the Pietermaritzburg Metropolitan Area and to determine if AMTSL is being correctly implemented. Method: A cross sectional questionnaire based survey of 280 HCPs involved in maternity services, at a tertiary, regional and district hospital and 3 clinics. Results: 94% of questionnaires were completed by HCPs, 52.2% being midwives and 47.8% doctors. 71.2% of midwives and 71.1% of the doctors defined AMTSL according to the FIGO/WHO definition, with 93% of midwives and 91.9% of doctors practising AMTSL. Manual removal of the placenta was incorrectly listed as a part of AMTSL by 60.3% of midwives and 50.5% of the doctors. 64% of midwives and 42.3% of doctors incorrectly thought that the routine administration of a uterotonic agent was part of expectant management of the third stage of labour (EMTSL). Early cord clamping was practised by 69% of midwives and 73.8% of doctors, while 92% of midwives and 82.8% of doctors delivered the placenta by controlled cord traction. At caesarean delivery 65% of obstetric doctors and 87% of anaesthetic doctors use oxytocin (as a combination dose of intravenous bolus and infusion). Conclusion: This study highlights that while there is a deficiency in the knowledge and practice of the HCPs with regard to AMTSL in our setting, the majority do practise AMTSL, with most of the recommended components being implemented.