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Review
. 2018 Feb 6;18(1):47.
doi: 10.1186/s12884-018-1677-5.

Task Shifting in Active Management of the Third Stage of Labor: A Systematic Review

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Free PMC article
Review

Task Shifting in Active Management of the Third Stage of Labor: A Systematic Review

Tessa M Raams et al. BMC Pregnancy Childbirth. .
Free PMC article

Abstract

Background: Active management of the third stage of labor (AMTSL) describes interventions with the common goal to prevent postpartum hemorrhage (PPH). In low- and middle-income countries, implementation of AMTSL is hampered by shortage of skilled birth attendants and a high percentage of home deliveries. Task shifting of specific AMTSL components to unskilled birth attendants or self-administration could be a strategy to increase access to potentially life-saving interventions. This study was designed to evaluate the effect, acceptance and safety of task shifting of specific aspects of AMTSL to unskilled birth attendants.

Methods: A systematic search was conducted in five databases in September 2015 to identify intervention studies of AMTSL implemented by unskilled birth attendants or pregnant women themselves. Quality of studies was evaluated with an adapted Cochrane Collaboration assessment tool.

Results: Of 2469 studies screened, 21 were included. All studies assessed implementation of uterotonics (misoprostol tablets or oxytocin injections), administered by community health workers (CHWs), auxiliary midwives, traditional birth attendants (TBAs) or self-administration at antenatal (home) visits or delivery. Task shifting for none of the other AMTSL components was reported. Task shifting of provision of uterotonics reduced the risk of PPH (RR 0.16 to 1) compared to standard care (13 studies, n = 15.197). The correct dose and timing was reported for 83.4 to 99.8% (5 studies, n = 6083) and 63 to 100% (9 studies, n = 8378) women respectively. Uterotonics were recommended to others by 80 to 99.7% (7 studies, n = 6445); 80 to 99.4% (5 studies, n = 2677) would use the drug at next delivery. Willingness to pay for uterotonics varied from 54.6 to 100% (7 studies, n = 6090).

Conclusion: Task shifting of AMTSL has thus far been evaluated for administration of uterotonics (misoprostol tablets and oxytocin injected by CHWs and auxiliary midwives) and resulted in reduction of PPH, high rates of appropriate use and satisfaction among users. In order to increase AMTSL coverage in low-staffed health facilities, task shifting of uterine massage or postpartum tonus assessment to unskilled attendants or delivered women could be considered. Task shifting of controlled cord traction is currently not recommended.

Keywords: Active management of the third stage of labor; Community health workers; Low- and middle-income countries; Postpartum hemorrhage; Self-administration; Task shifting; Traditional birth attendants.

Conflict of interest statement

Ethics approval and consent to participate

Not applicable

Consent for publication

Not applicable

Competing interests

Marcus J Rijken, one of the co-authors of this systematic review, is a member (associate editor) of the editorial board of BMC Pregnancy and Childbirth.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart of literature search and selection process. PPH: postpartum haemorrhage
Fig. 2
Fig. 2
Bar graph showing the risk distribution according to the different variables on which 21 articles were assessed. Blinding of researcher/clinician was only evaluated if intervention was compared to control group

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References

    1. Sheldon WR, Blum J, Vogel JP, Souza JP, Gülmezoglu AM, Winikoff B. Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization multicountry survey on maternal and newborn health. BJOG. 2014;121(Suppl):5–13. doi: 10.1111/1471-0528.12636. - DOI - PubMed
    1. Breu F, Guggenbichler S, Wollmann J. World health statistics 2013. Vasa. 2013;168
    1. Lalonde A, Daviss BA, Acosta A, Herschderfer K. Postpartum hemorrhage today: ICM/FIGO initiative 2004-2006. Int J Gynaecol Obstet. 2006;94:243–253. doi: 10.1016/j.ijgo.2006.04.016. - DOI - PubMed
    1. Dept. of Reproductive Health and Research . World Health Organization, dept. of reproductive health and research, World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage. Geneva: World Health Organization Press; 2012.
    1. Sibley LM, Spangler SA, Barry D, Tesfaye S, Desta BF, Gobezayehu AG. A regional comparison of distribution strategies and women’s awareness, receipt, and use of misoprostol to prevent postpartum hemorrhage in rural Amhara and Oromiya regions of Ethiopia. J Midwifery Womens Health. 2014;59(Suppl 1):S73–S82. doi: 10.1111/jmwh.12136. - DOI - PubMed
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