Management of the 3rd stage of labour to prevent post-partum haemorrhage: joint statement: International Confederation of Midwives (ICM) International Federation of Gynaecologists and Obstetricians (FIGO).

ICM and FIGO are key partners in global Sale Motherhood efforts to reduce maternal death and disability in the world. Their mission statements share a common commitment in promoting the health, human rights and well-being of all women, most especially those at greatest risk for death and disability associated with childbearing. FIGO and ICM promote evidence-based, effective interventions that, when used properly with informed consent, can reduce the incidence of maternal mortality and morbidity in the world.

Severe bleeding is the single most important cause of maternal death worldwide. More than half of all maternal deaths occur within 24 hours of delivery, mostly from excessive bleeding. Every pregnant woman may face life-threatening blood loss at the time of delivery; women with anaemia are particularly vulnerable since they may not tolerate even moderate amounts of blood loss. Every woman needs to be closely observed and, if needed, stabilised during the immediate post-partum period.

Upon review of the available evidence, FIGO and ICM agree that active management of the third stage of labour is proven to reduce the incidence of post-partum haemorrhage (PPH), the quantity of blood loss, and the use of blood transfusion.

Active management of the third stage of labour consists of interventions designed to facilitate the delivery of the placenta by increasing uterine contractions and to prevent PPH by averting uterine atony. The usual components include:

* Administration of uterotonic agents

* Controlled cord traction

* Uterine massage after delivery of the placenta, as appropriate.

In this regard, national professional associations have an important and collaborative role to play in:

* Advocacy for skilled care at birth;

* Dissemination of this statement to all members of the organisation and facilitation of its implementation;

* Public education about the need for adequate prevention and treatment of post-partum haemorrhage;

* Publication of the statement in national midwifery, obstetric and medical journals, newsletters and websites;

* Address legislative and other barriers that impede the prevention and treatment of post-partum haemorrhage;

* Incorporation of active management of the third stage of labour in national standards and clinical guidelines, as appropriate;

* Incorporation of active management of the third stage into pre-service and in-service curricula for all skilled birth attendants;

* Working with national pharmaceutical regulatory agencies, policymakers and donors to assure that adequate supplies of uterotonics and injection equipment are available.

Enonce conjoint (ICM/FIGO): Prise en charge du 3ieme...