Biresaw Wassihun Alemu


Background: The third stage is the most perilous for the woman because of the risk of postpartum hemorrhage (PPH). Proper management of the third stage of labor is an effective intervention to prevent maternal mortality.

Objective: This study aimed to assess the status of active management of the third stage of labor practice and associated factors among obstetric care providers working in public health facilities of Gamo and Gofa zone, southern Ethiopia

Methods: In this institution -based cross-sectional study, 356 health care providers who were working in public health facilities of the Gamo and Gofa zone were involved. Interview administered, a pre-tested and semi-structured questionnaire with an observational checklist was used to collect the data. Epi Data version 3.2 was used to code and enter data, which were analyzed using SPSS version 24. Descriptive statistics were calculated for each variable, and binary logistic regression analysis with 95% confidence intervals (CIs) was carried out to determine the associations between predictor variables and outcome variables

Result:  The finding of the study revealed that 48.1% of health care providers have a good practice on Active management of the third stage of labor. Clinical years of experience (AOR = 4.32; 95%CI: (2.78-9.10), having taking in-service basic emergency obstetric care (B-EmOC) training (AOR = 2.34; 95%CI: 1.87-4.46), having a satisfactory delivery room (AOR=1.86 95% CI 1.32-2.24) were significantly associated with a Good practice active management of the third stage of labor

Conclusion: The finding of this study showed that the practice of active management of the third stage of labor was poor. Clinical years of experience, having a satisfactory delivery room, and taking in-service training were some of the factors associated with good practice towards active management of the third stage of labor. Providing competency-based training and promoting the use of up-to-date clinical guidelines and ensuring regular training will be needed to improve the practice of the third stage of labor




Keywords: Active management, Third stage of labor, Practice, Ethiopia

1. Stanton C, Armbruster D, Knight R, Ariawan I, Gbangbade S, Getachew A, Portillo JA, Jarquin D, Marin F, Mfinanga S, Vallecillo J. Use of active management of the third stage of labor in seven developing countries.
2. World Health Organization. WHO recommendations for the prevention and treatment of postpartum hemorrhage. World Health Organization; 2012.
3. Gülmezoglu AM, Lumbiganon P, Landoulsi S, Widmer M, Abdel-Aleem H, Festin M, Carroli G, Qureshi Z, Souza JP, Bergel E, Piaggio G. Active management of the third stage of labor with and without controlled cord traction: a randomized, controlled, non-inferiority trial. The Lancet. 2012 May 5;379(9827):1721-7.
4. Taylor U DP, Miller S. Prevention and Treatment of postpartum Hemorrhage in Low-Resource Settings. FIGO Guidelines. 2012;117:108–18.
5. Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, et al. Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5. The lancet. 2010;375(9726):1609-23.
6. Carroli G, Cuesta C, Abalos E, Gulmezoglu AM. Epidemiology of postpartum hemorrhage: a systematic review. Best practice & research Clinical obstetrics & gynecology. 2008;22(6):999-1012.
7. Ajenifuja K, Adepiti C, Ogunniyi S. Postpartum hemorrhage in a teaching hospital in Nigeria: a 5-year experience. African health sciences. 2010;10(1).
8. Organization WH. Trends in maternal mortality: 1990-2015: estimates from WHO, UNICEF, UNFPA, World Bank Group, and the United Nations Population Division: executive summary. 2015.
9. ICF CSACEa. Ethiopia Demographic and Health Survey Key Indicators Report. Addis Ababa, Ethiopia, and Rockville, Maryland, USA CSA, and ICF. 2016
10. Leduc D, Senikas V, Lalonde AB, Ballerman C, Biringer A, Delaney M, Duperron L, Girard I, Jones D, Lee LS, Shepherd D. Active management of the third stage of labor: prevention and treatment of postpartum hemorrhage. Journal of obstetrics and gynecology Canada. 2009 Oct 1;31(10):980-93.
11. Mfinanga GS, Kimaro GD, Ngadaya E, Massawe S, Mtandu R, Shayo EH, et al. Health facility-based Active Management of the Third Stage of Labor: findings from a national survey in Tanzania. Health Research Policy and Systems. 2009;7(1):6.
12. Adane D, Belay G, Arega A, Wassihun B, Gedefaw G, Gebayehu K. Practice and factors associated with active management of the third stage of labor among obstetric care providers in Amhara region referral hospitals, North Ethiopia, 2018: A cross-sectional study. PloS one. 2019 Oct 3;14(10):e0222843.
13. Tenaw Z, Yohannes Z, Amano A. Obstetric care providers' knowledge, practice, and associated factors towards active management of the third stage of labor in Sidama Zone, South Ethiopia. BMC pregnancy and childbirth. 2017;17(1):292.
14. Andualem Henok RY. Factors Associated With Knowledge, Attitude, And Practice Of Midwives On Active Management Of the Third Stage Of Labour At Selected Health Centers Of Addis Ababa, Ethiopia. Resources Development and Management. 2015;10.
15. Bimbashi A, Ndoni E, Dokle A, Duley L. Care during the third stage of labor: obstetricians' views and practice in an Albanian maternity hospital. BMC pregnancy and childbirth. 2010;10:4
16. Raams TM, Browne JL, Festen-Schrier VJ, Klipstein-Grobusch K, Rijken MJ. Task shifting in active management of the third stage of labor: a systematic review. BMC pregnancy and childbirth. 2018 Dec 1;18(1):47.
17. Oladapo OT, Fawole AO, Loto OM, Adegbola O, Akinola OI, Alao MO, Adeyemi AS. Active management of the third stage of labor: a survey of providers’ knowledge in southwest Nigeria. Archives of gynecology and obstetrics. 2009 Dec 1;280(6):945.
18. Deepak NN, Mirzabagi E, Koski A, Tripathi V. Knowledge, attitudes, and practices related to uterotonic drugs during childbirth in Karnataka, India: a qualitative research study. PloS one. 2013;8(4):e62801
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