Integrated Maternal and Newborn Care Basic Skills Course ...

Reference Manual
• Controlled cord traction (CCT) with simultaneous countertraction to the uterus.
• Uterine massage immediately after delivery of the placenta.
Current evidence indicates active management of the third stage of labor (administration of
uterotonic drugs, controlled cord traction, and fundal massage after delivery of the placenta) can
reduce the incidence of postpartum hemorrhage by up to 60 percent in situations where:
• National guidelines support the use of AMTSL (active management of the third
stage of labor).
• Health workers receive training in using AMTSL and administering uterotonic
drugs.
• Injection safety is ensured.
• Necessary resources (uterotonic drugs and cold chain for storage of
uterotonic drugs; equipment, supplies, and consumables for infection
prevention and injection safety) are available.
Skilled birth attendants all over the world can play an important role in preventing unnecessary
maternal deaths by applying this simple, low cost, evidence-based intervention.
Approaches for Managing the Third Stage
There are two main approaches for managing the third stage of labor: the physiologic (or
expectant) approach and the active approach. Table compares how the third stage is
managed using each of these approaches.
Integrated maternal and newborn care
Basic skills course
63