Sustainable scale-up of active management of the third stage of labor for prevention of postpartum hemorrhage in Ecuador.
Int J Gynaecol Obstet
; 117(3): 278-82, 2012 Jun.
Article
em En
| MEDLINE
| ID: mdl-22483573
OBJECTIVE: To analyze the Ecuadorian experience regarding the adoption, scale-up, and institutionalization of active management of the third stage of labor (AMTSL) for prevention of postpartum hemorrhage via continuous quality improvement (CQI) processes. METHODS: Average AMTSL implementation rates for women with vaginal deliveries were compared using unweighted provincial aggregate data from facilities participating in 3 phases of AMTSL programming. Months taken to implement AMTSL at 80% or more and 90% or more compliance were compared across phases. RESULTS: Rate of oxytocin administration during the first 3 months was 5.0% in phase 1, 9.8% in phase 2, and 72.2% in phase 3 (P≤0.001 vs phases 1 and 2). The average number of months provinces took to increase oxytocin administration to 80% or more and 90% or in more women with vaginal deliveries was, respectively, 21.6±18.7 and 30.6±16.4 in phase 1, 23.5±15.1 and 30.1±14.9 in phase 2, and 4.7±4.9 (P≤0.01 vs phase 1; P≤0.001 vs phase 2) and 4.0±3.4 (P≤0.001 vs phases 1 and 2) in phase 3. By December 2009, AMTSL implementation was sustained at 90% or more in all provinces. CONCLUSION: CQI processes identified resistance and operational barriers, and developed mechanisms to overcome them.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Ocitócicos
/
Terceira Fase do Trabalho de Parto
/
Ocitocina
/
Melhoria de Qualidade
/
Hemorragia Pós-Parto
Tipo de estudo:
Prognostic_studies
Limite:
Female
/
Humans
/
Pregnancy
País/Região como assunto:
America do sul
/
Ecuador
Idioma:
En
Revista:
Int J Gynaecol Obstet
Ano de publicação:
2012
Tipo de documento:
Article
País de afiliação:
Estados Unidos
País de publicação:
Estados Unidos