Uterine Tonus Assessment by Midwives versus Patient self-assessment in the active management of the third stage of labor (UTAMP): study protocol for a randomized controlled trial

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dc.contributor.author Browne, J.L.
dc.contributor.author Damale, N.K.R.
dc.contributor.author Raams, T.M.
dc.contributor.author Van der Linden, E.L.
dc.contributor.author Maya, E.T.
dc.contributor.author Doe, R.
dc.contributor.author Rijken, M.J.
dc.contributor.author Adanu, R.
dc.contributor.author Grobbee, D.E.
dc.contributor.author Franx, A.
dc.contributor.author Klipstein-Grobusch, K.
dc.date.accessioned 2018-09-14T07:49:36Z
dc.date.available 2018-09-14T07:49:36Z
dc.date.issued 2015-12
dc.identifier.other DOI: 10.1186/s13063-015-1111-5
dc.identifier.uri http://ugspace.ug.edu.gh/handle/123456789/24157
dc.description.abstract Background: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide and accounts for one third of maternal deaths in low-income and middle-income countries. PPH can be prevented by active management of the third stage of labor (AMTSL), a series of steps recommended by the World Health Organization to be performed by skilled birth attendants (SBAs). Task shifting in the AMTSL step of uterotonic drugs administration to community health workers, traditional birth attendants and self-administration has been investigated as a strategy to increase access to quality obstetric care considering persistent SBA and facility-based delivery shortages. The aim of this study is to assess task shifting in the final step of AMTSL and compare uterine tonus assessment by a SBA to self-assessment. Methods and Design: The study is an individual-level two-arm non-inferiority randomized controlled trial (RCT). A total of 800 women will be recruited in Korle Bu Teaching Hospital in Accra, Ghana. Adult women in labor at term with an expected vaginal delivery who received antenatal instructions for self-assessment of uterine tonus will be eligible for inclusion. Women with an increased risk for PPH will be excluded. Women will be randomized to uterine tone assessment by a skilled birth attendant (midwife) or uterine tone self-assessment (with the safety back-up of a midwife present in case of PPH or uterine atony). Postpartum blood loss will be measured through weighing of disposable mats. The main study endpoints are PPH (>= 500 ml blood loss), severe PPH (>= 1000 ml blood loss), mean blood loss, and routine maternal and neonatal outcomes. Participants and caregivers will not be blinded given the nature of the intervention. Discussion: A reduction of PPH-related maternal mortality requires full implementation of AMTSL. Task shifting of uterine tone assessment may contribute to increased AMTSL implementation in (clinical) settings where SBAs capacity is constrained. (PDF) Uterine Tonus Assessment by Midwives versus Patient self-assessment in the active management of the third stage of labor (UTAMP): Study protocol for a randomized controlled trial. Available from: https://www.researchgate.net/publication/287482511_Uterine_Tonus_Assessment_by_Midwives_versus_Patient_self-assessment_in_the_active_management_of_the_third_stage_of_labor_UTAMP_Study_protocol_for_a_randomized_controlled_trial [accessed Sep 14 2018]. en_US
dc.language.iso en en_US
dc.publisher Trials en_US
dc.subject Active management of third stage of labor en_US
dc.subject Uterine tonus assessment en_US
dc.subject Postpartum hemorrhage en_US
dc.subject Low and middle-income countries en_US
dc.subject Task shifting en_US
dc.title Uterine Tonus Assessment by Midwives versus Patient self-assessment in the active management of the third stage of labor (UTAMP): study protocol for a randomized controlled trial en_US
dc.type Article en_US


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