Mohamed Cherine, MD¹, Nevine Hassanein, MD², Amr Elnoury, MD³, Hania Sholkamy, PhD⁴, Miral Breebaart, BA⁵, and Karima Khalil, MBBCH, MPH⁵. (1) Galaa Hospital, 7 El-Gomhoreya El-Motaheda st., Mohandessin, Cairo, Egypt, (202) 12 215 8631, shereen57@hotmail.com, (2) John Snow Incorporation, 2 El-Alaily St, El-Ekbal, Avenue El-Saraya Station, Alexandria, Egypt, (3) National Laser Institute, Cairo University, 7 Abd-el-moneim Reyad st, Mohandessin, Cairo, Egypt, (4) Anthropology Department, American University in Cairo, 11 El-Saraya st, El Dokki, Cairo, Egypt, (5) The Population Council, 59 Misr-Helwan Agricultural Rd, Cairo, Egypt

Objectives: The study was carried out to collect baseline data on facility-based obstetric practices for normal labor that have an impact on maternal and fetal health. Postpartum hemorrhage is the leading cause of maternal death worldwide, in Egypt and in the facility studied. This paper focuses on facility-based management of the third stage of labor in a busy teaching hospital; documenting practices and exploring barriers to adoption of evidence-based management protocols shown to reduce postpartum hemorrhage and maternal mortality. Methods: Labor and deliveries of one hundred and seventy-six women were observed by female obstetricians using an observation checklist. General ward activities were documented. The women were interviewed postpartum and all study findings were shared with the providers for their input. Results: All women received some form of active management of the third stage of labor. However, this was correctly done in only 15% of the women observed. The most common deviations from correct active management for the remaining 85% were: giving ecbolics after delivery of the placenta (60%) and without controlled cord traction (49%). Passive management of the third stage was not done appropriately for any observed delivery. Conclusion: The protective value of actively managing the third stage of labor and thereby potentially preventing postpartum hemorrhage was lost to the majority (85%) of the deliveries observed, where the component steps were inappropriately performed. Practitioners should follow evidence-based protocols for active management of the third stage, given the contribution of postpartum hemorrhage to maternal deaths in Egypt.

Learning Objectives:

• To present a previously undocumented level of third stage mismanagement in an influential Egyptian teaching hospital.
• To describe a useful methodology for documenting actual obstetric practice that can be adapted elsewhere

Keywords: Labor,

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.