AMTSL Learning Materials

 

Introduction

Efforts such as the Safe Motherhood Initiative and the World Health Organization (WHO) Making Pregnancy Safer Division and strategies to meet the United Nations Millennium Development Goals are supporting worldwide activities to reduce maternal and newborn mortality. Despite these efforts, hundreds of thousands of women and babies die or become disabled due to complications of pregnancy and childbirth every year; half of these maternal deaths occur within 24 hours of childbirth (1).

Postpartum hemorrhage (PPH) is the leading direct cause of maternal death in developing countries and results from problems during and immediately after the third stage of labor (2). PPH is an unpredictable and rapid cause of maternal death worldwide, with two-thirds of women with PPH having no identifiable risk factors. Seventy to ninety percent of immediate PPH is attributed to uterine atony (failure of the uterus to properly contract after birth) (3, 4).

Fortunately, research shows that using simple, low-cost interventions can help avoid most of these tragic outcomes. Current evidence indicates active management of the third stage of labor (administration of uterotonic drugs, controlled cord traction, and fundal massage after delivery of the placenta) can prevent up to 60 percent of uterine atony (5) in situations where:

  • National guidelines support the use of active management of the third stage of labor (AMTSL).
  • Health workers receive training in using AMTSL and administering uterotonic drugs.
  • Injection safety is ensured.
  • Necessary resources (uterotonic drugs and cold chain for storage of uterotonic drugs; equipment, supplies, and consumables for infection prevention and injection safety) are available

Ongoing research in various settings continues to identify the best approaches for preventing and managing postpartum bleeding and its complications. By developing national guidelines, training skilled birth attendants, improving work environments of skilled providers, and supporting the development of improved access to care, more women will have access to this life-saving intervention.

About the learning materials

POPPHI developed a learning package on the prevention of postpartum hemorrhage consisting of a reference manual, participant’s notebook, and facilitator’s guide. This learning package was developed for use by nurses, midwives, and doctors providing childbirth and immediate postpartum care.  

Information about implementing AMTSL is featured in this reference manual as well as the corresponding participant’s notebook and facilitator’s guide. These documents comprise a set and should be used together. These resources are distinguished within the series by a corresponding icon located at the top of the right hand page:

Reference manual

learning materials

Facilitator’s guide

learning materials

Participant’s notebook

learning materials

Training objectives

This course is designed to be utilized for in-service training, with the overall objective of providing updates about AMTSL use to equip nurses, midwives, and clinical and health workers to carry out the following:

    • Provide safe, respectful, and friendly care to women, newborns, and their families. Women and families will then be more likely to utilize the health care system with confidence because they know they will receive competent, compassionate care.  
    • Follow an evidence-based protocol for safe care during active management of the third stage of labor and in the immediate postpartum, including clear guidelines on when to refer mothers with complications, ensuring timely action is taken.
    • Provide greater protection from infection for their clients and themselves.
    • Store uterotonics correctly to maintain their potency.

This three-day core clinical training will provide the information needed to perform AMTSL and help prevent PPH and will focus on the following core topics:

  • Review of the third stage of labor and evidence for use of AMTSL.
  • Causes and prevention of PPH.
  • Uterotonic drugs.
  • Steps in AMTSL.

Some country programs may decide to include some of the “additional topics” in their PPH prevention training course. Additional topics that may be included in country programs include:

  • Infection prevention.
  • Birth preparedness and complication readiness.
  • Managing complications during the third stage of labor.

Participants are encouraged to apply their knowledge and skills to improving clinical services and training other providers. Ultimately, this training will help improve the quality of care for women—mothers, wives, and vital members of the community—and help them stay healthy.

POPPHI Prevention of postpartum hemorrhage: Components of learning materials

How to use the learning materials

  • By clicking on the links below you will be able to download the various components.  

Acrobat Reader 6.0 or higher is required to open the files. 

Although the Microsoft Word documents have the advantage that they can be edited, the formatting is unstable (Microsoft defaults to the setting of the computer on which the file is opened) and may require a great deal of reformatting when you open the document on your computer.  It is advisable to review the formatting in all Microsoft documents, specifically the bullet points, before printing the document.  The Acrobat (PDF) documents will not undergo formatting changes, but they cannot be edited.

PowerPoint slides for each session have been converted into Microsoft Word and integrated into the body of the Facilitator’s Guide. This facilitates editing the slides and should theoretically assist with preparation for class sessions. As a result, however, the Microsoft Word document is very large and may require considerable time to download if the internet connection is slow.

Reference Manual, Participant’s Notebook,

Facilitator’s Guide, and Slides

Reference Manual

Participant’s Notebook

Slides

Facilitator’s Guide

PDF

Word

PDF

Word

PPT

PDF

Word

Complete Manual

3,511K

5,840K

1323K

2133K

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2,961K

38,815K

Introduction

530K

353K

493K

431K

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718K

764K

Tools for trainers

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780K

1,036K

Participant evaluation forms

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460K

354K

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Core Topic 1: Third stage of labor and evidence for using AMTSL   

1,008K

2,070K

450K

274K

6,464K

981K

4,740K

Core Topic 2: PPH causes and prevention   

505K

299K

459K

267K

1,369K

727K

5,285K

Core Topic 3:  Uterotonic drugs

600K

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642K

1,166K

722K

5,254K

Core Topic 4:  ATMSL

1,655K

1,959K

780K

955K

4,068K

1,663K

9,322K

Additional Topic 1: Infection prevention

605K

430K

507K

340K

1,190K

846K

5,480K

Additional Topic 2: Birth preparedness and complication readiness

473K

302K

464K

251K

1,081K

693K

5,166K

Additional Topic 3: Managing complications during the third stage of labor

686K

600K

569K

397K

2,368K

970K

6,691K

Appendices

1,064K

1,696K

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Training evaluation form

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29K

42K

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References

1 World Health Organization (WHO) Mother-Baby Package: Implementing Safe Motherhood in Countries. WHO/FHE/MSM/94.11. Geneva: WHO; 1994.

2 AbouZahr C. Antepartum and postpartum haemorrhage. In: Murray CJL, Lopez AD, eds. Health Dimensions of Sex and Reproduction. Boston, MA: Harvard University Press; 1998:165–190.

3 Stephenson P. Active Management of the Third Stage of Labor: A Simple Practice to Prevent Postpartum Hemorrhage. USAID Global Health Technical Brief. June 2005. MAQ website. Available at: http://www.maqweb.org/techbriefs/tb13activemgmt.shtml. Accessed April 2, 2007.

4 World Health Organization (WHO). Biennial Report 2000–2001: Research on Reproductive Health at WHO. Geneva: WHO; 2002. Available at: http://www.who.int/reproductive-health/publications/
biennial_reports/2000-01/Chapter_2.PDF
. Accessed April 2, 2007.

5 Prendiville WJ, Harding JE, Elbourne DR, Stirrat GM. The Bristol third stage trial: active versus physiological management of the third stage of labour. British Medical Journal. 1988;297: 1295–1300.