The aim of this dissertation is outlined in the introduction, which includes a paragraph on physiology and pathophysiology of the third stage of labour. The next paragraph handles the management of... Show moreThe aim of this dissertation is outlined in the introduction, which includes a paragraph on physiology and pathophysiology of the third stage of labour. The next paragraph handles the management of the third stage of labour. Furthermore, the clinical problems __retained placenta__ and __puerperal uterine inversion__ are outlined. In the last paragraph, the terms __quality of life__ and __illness perceptions__ are clarified. Part 2 of this dissertation contains the Dutch contribution to explore a possible global rise in incidence of postpartum haemorrhage (chapter 1). The current knowledge and practice regarding active management of the third stage of labour in midwifery practices and obstetric departments in the Netherlands is presented (chapter 2). In part 3 of this dissertation, the problems associated with abnormal placentation are explored. Misoprostol turned out not to be beneficial over placebo in the management of retained placenta (chapter 3 and 4). In chapter 5, a cohort of fifteen women with puerperal inversion of the uterus is presented. Experiencing an event such as major obstetric haemorrhage does not seem to be associated with diminished quality of life. Clinical characteristics imply a big impact of the event on women and their partners. Show less
Smit, M.; Stralen, G. van; Wolterbeek, R.; Dillen, J. van; Roosmalen, J. van; Slootweg, Y. 2013
OBJECTIVE: aim of this study was to investigate current knowledge and practice regarding AMTSL in midwifery practices and obstetric departments in the Netherlands. DESIGN: web-based and postal... Show moreOBJECTIVE: aim of this study was to investigate current knowledge and practice regarding AMTSL in midwifery practices and obstetric departments in the Netherlands. DESIGN: web-based and postal questionnaire. SETTING: in August and September 2011 a questionnaire was sent to all midwifery practices and all obstetric departments in the Netherlands. PARTICIPANTS: all midwifery practices (528) and all obstetric departments (91) in the Netherlands. MEASUREMENTS AND FINDINGS: the response was 87.5%. Administering prophylactic uterotonics was seen as a component AMTSL by virtually all respondents; 96.1% of midwives and 98.8% of obstetricians. Cord clamping was found as a component of AMTSL by 87.4% of midwives and by 88.1% of obstetricians. Uterine massage was only seen as a component of AMTSL by 10% of the midwives and 20.2% of the obstetricians. Midwifery practices routinely administer oxytocin in 60.1% of births. Obstetric departments do so in 97.6% (p<0.01). Compared to 1995, the prophylactic use of oxytocin had increased in 2011 both by midwives (10-59.1%) and by obstetricians (55-96.4%) (p<0.01). KEY CONCLUSIONS: prophylactic administration of uterotonics directly after childbirth is perceived as the essential part of AMTSL. The administration of uterotonics has significantly increased in the last decade, but is not standard practice in the low-risk population supervised by midwives. IMPLICATIONS FOR PRACTICE: the evidence for prophylactic administration of uterotonics is convincing for women who are at high risk of PPH. Regarding the lack of evidence of AMTSL to prevent PPH in low risk (home) births, further research concerning low-risk (home) births, supervised by midwives in industrialised countries is indicated. A national guideline containing best practices concerning management of the third stage of labour supervised by midwives, should be composed and implemented. Show less
