Volume 117, Issue 3 p. 278-282
Clinical articles

Sustainable scale-up of active management of the third stage of labor for prevention of postpartum hemorrhage in Ecuador

Jorge Hermida

Corresponding Author

Jorge Hermida

University Research Co., LLC, Bethesda, USA

Corresponding author at: University Research, 7200 Wisconsin Avenue, Suite 600, Bethesda, MD 20814, USA. Tel.: + 1 301 941 8505; fax: + 1 301 941 8427.Search for more papers by this author
Bernarda Salas

Bernarda Salas

University Research Co., LLC, Bethesda, USA

Formerly Ministry of Health, Quito, Ecuador (2007–2009)

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Nancy L. Sloan

Nancy L. Sloan

University Research Co., LLC, Bethesda, USA

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First published: 06 April 2012
Citations: 14

Abstract

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.