Postpartum Hemorrhage and Active Management of the Third Stage of Labor (AMTSL) in a Sub-Saharan Africa Maternity

Objective: To assess why the prevalence of postpartum hemorrhage still high while applying active management of the third stage of labor procedure.

Material and methods: It was a retrospective comparative study that lasted for forty-two months period, from July 1st, 2011 to December 31, 2014 about 7466 deliveries. We divided the patients into 2 groups. The case group encompassed all patients for whom the AMTSL procedure was executed. The control group was made of patients who did not receive AMTSL procedure.

Results: During the study period, we registered 7466 vaginal deliveries. The prevalence of postpartum hemorrhage reached 3.7%. For the population that benefited from controlled cord traction for placental extraction, the prevalence was 2.9% whereas those who have not benefited from controlled cord traction presented a postpartum hemorrhage in 09.76% therefore three times higher (p<0.00001). The most represented age group was 20-34 years old (76.7% for cases and 74.5% for controls). The nulliparous constituted 32.6% of cases while the multiparous were 32.2% of controls. In over half of the cases, they have been referred (56.5% for cases and 52.9% of controls). The delivery delay was inferior to 5 minutes with 71.75% of cases against 33.35% of controls (p<0.00001). Atony was the prevailing etiology in both groups (78.8% for cases and 65.5% for controls). Postpartum haemorrhage was lethal in 3.2% of cases with controlled cord traction against 17.2% without controlled cord traction making 5 times higher (p<0.00001). The main etiology of death was coagulopathy.