A multifaceted intervention to increase prophylactic oxytocin use during the third stage of labor and to reduce routine episiotomies in Nicaragua.

GARCIA ELORRIO; ALEMÁN A; CAFFERATA ML; COLOMAR M; TOMASSO G; LACAYO Y; ESPINOZA H; VILLADIEGO S; ENGELBRECHT S; ALTHABE F

INTERNATIONAL JOURNAL OF GYNECOLOGY OBSTETRICS

ELSEVIER IRELAND LTD

Lugar: Amsterdam; Año: 2014 vol. 127

0020-7292

AbstractOBJECTIVE:To assess the effect of a multifaceted intervention among skilled birth attendants on the use of oxytocin during the third stage of labor, the active management of the third stage of labor (AMTSL), and the rate of routine episiotomy during vaginal births in two health districts in Nicaragua.METHODS:An uncontrolled before-and-after study design was used. The rates of oxytocin use in the third stage of labor, AMTSL, and episiotomy were measured for vaginal births occurring in eight hospitals and health centers during 2011-2012, before and after implementation of a multifaceted facility-based intervention. The intervention involved the use of opinion leaders, interactive workshops to develop and implement evidence-based guidelines, academic detailing, the use of reminders, and feedback on the rates of oxytocin use and episiotomy.RESULTS:Oxytocin use during the third stage of labor increased significantly from 95.3% to 97.4% (P=0.003). The episiotomy rate dropped significantly from 31.2% to 21.2% overall, and from 59.6% to 40.5% in primiparous women (P