Active management of third stage of labour: a survey of providers’ knowledge in southwest Nigeria

  • Olufemi T. OladapoEmail author
  • Adeniran O. Fawole
  • Olabisi M. Loto
  • Omololu Adegbola
  • Oluwarotimi I. Akinola
  • Moses O. Alao
  • Adewale S. Adeyemi
Original Article



The disparity between current evidence and practice on active management of third stage of labour (AMTSL) demands assessment of providers’ knowledge on the subject.


To assess the level and determinant(s) of accurate knowledge of obstetric providers regarding AMTSL.


Questionnaire-based survey of 361 labour and delivery professionals in public tertiary obstetric centres in southwest Nigeria.


Female nurses at different cadres accounted for most of the respondents. Majority (90.6%) of the respondents reported being aware of AMTSL as an obstetric intervention and 49.7% were aware of FIGO/ICM recommendation on AMTSL. Out of 13 potential third stage interventions, 102 respondents (28.3%) correctly and exclusively identified the components of AMTSL as defined by FIGO/ICM. Many procedures reserved for treatment of complicated third stage of labour such as manual placental removal (37.7%), blood transfusion (20.2%), bimanual uterine compression (24.7%) and uterine artery ligation (13.9%) were also selected as AMTSL components. Multivariate logistic regression analysis indicated that being in administrative position (adjusted OR: 2.68; CI 1.19–6.02) and frequent compared to rare or no consultation of books, journal and internet sources for information (adjusted OR: 2.58; CI 1.21–5.52) increased the odds of having accurate knowledge of AMTSL while being a nurse/midwife (adjusted OR: 0.15; CI 0.05–0.39), matron (adjusted OR: 0.25; CI 0.08–0.79) or intern (adjusted OR: 0.07; CI 0.01–0.29) compared to postgraduate resident doctors reduced the odds of having accurate knowledge of AMTSL.


AMTSL was a familiar but poorly understood intervention among obstetric care providers in this region. Improvement in healthcare quality and practitioners’ adherence to recommended guidelines on AMTSL urgently requires educational interventions that target those who provide routine delivery care and organisation of the health care delivery system in such a way that enables providers to act on acquired knowledge.


Postpartum haemorrhage Active management Third stage Obstetric providers 



The authors are indebted to all maternity care providers who took part in this study. The contributions of Dr. O. Ayoola-Sotubo (OOUTH), Dr. B.A. Olofinbiyi, Dr. A. Adewumi (OAUTHC), Dr. Y. Oshodi, Dr. A. Adegboyega (LASUTH), Dr. O. Atanda (LAUTECHTH), Dr. O. Bamgbopa (FMC), Dr. O.M. Akindele, Dr. A.A. Okunowo (OAUTHC), Mrs. Greene, Mrs. Ajai and Mrs. Afolabi (UCH) with respect to coordination of data collection are hereby acknowledged.

Conflict of interest statement

I certify that there is no actual or potential conflict of interest in relation to this article.


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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Olufemi T. Oladapo
    • 1
    Email author
  • Adeniran O. Fawole
    • 2
  • Olabisi M. Loto
    • 3
  • Omololu Adegbola
    • 4
  • Oluwarotimi I. Akinola
    • 5
  • Moses O. Alao
    • 6
  • Adewale S. Adeyemi
    • 7
  1. 1.Maternal and Fetal Health Research Unit, Department of Obstetrics and GynaecologyOlabisi Onabanjo University Teaching HospitalSagamuNigeria
  2. 2.Department of Obstetrics and GynaecologyUniversity College HospitalIbadanNigeria
  3. 3.Department of Obstetrics, Gynaecology and PerinatologyObafemi Awolowo University Teaching Hospital ComplexIle-IfeNigeria
  4. 4.Department of Obstetrics and GynaecologyLagos University Teaching HospitalLagosNigeria
  5. 5.Department of Obstetrics and GynaecologyLagos State University Teaching HospitalLagosNigeria
  6. 6.Department of Obstetrics and GynaecologyFederal Medical CentreAbeokutaNigeria
  7. 7.Department of Obstetrics and GynaecologyLAUTECH Teaching HospitalOsogboNigeria

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