Percent of women who received prophylactic oxytocin for vaginal delivery before delivery of placenta
The percent of women during a specified time period in both facility and community deliveries who received prophylactic oxytocin during vaginal delivery before the delivery of the placenta in order to prevent postpartum hemorrhage (PPH). The timely administration of oxytocin is one component of the active management of the third stage of delivery (AMTSL). The following activities are components of AMTSL:
- Administer a uterus-contracting drug (uterotonic) within one minute after birth (oxytocin is the drug of choice).
- Apply controlled cord traction and counter traction to the uterus to deliver the placenta.
- Massage the uterus through the abdomen after delivery of the placenta and monitor for further signs of bleeding.
For further background on this indicator, see WHO (2009).
This indicator is calculated as:
(Number of women who received prophylactic oxytocin for vaginal delivery before the delivery of the placenta / Total number of vaginal deliveries within the reference period) x 100
Data from facility records, health information systems (HIS), and specialized surveys that include community deliveries can be used to calculate this indicator. A population-based estimate can be used for the expected number of deliveries for a country, but using actual numbers of facility and community deliveries provides higher quality and usefulness at the facility and local level (WHO, 2009). The data can be disaggregated by the type of facility (public, private, non-governmental, community based) and by other relevant factors such as districts and urban/rural location.
Facility records, country and district level HIS, surveys
This indicator measures a key component of AMTSL and, as a routine indicator for country-level HIS, helps inform the healthcare system on how to allocate resources and improve function. The occurrence of PPH is responsible for 25 to 50 percent of all maternal deaths in many low-income countries and can be prevented by the simple, low-cost interventions of AMTSL.
In addition, AMTSL helps reduce blood loss and thereby decreases the incidence and severity of anemia. It can also reduce the need for emergency obstetric care, blood transfusions, and reduce the costs associated with emergency care (WHO, 2009). The WHO recommended goal is AMTSL to be offered by skilled attendants to all women. This indicator can be used as a proxy to track the administration of AMTSL and relates to achieving Millennium Development Goals #5. improve maternal health and #4. reduce child mortality.
WHO recommends oxytocin as the uterotonic of choice, however, standards of care in many countries allow the use of several uterotonic drugs for PPH prevention and, therefore, an oxytocin only indicator may not capture the use of other uterotonics. An indicator based only on facility deliveries is easier to measure and its quality is high, however, this indicator is not appropriate for a country where a significant proportion of births occur in the community. Surveys in a number of countries have shown that AMTSL was used correctly in only up to 30 percent of cases and WHO strongly recommends reinforcing AMTSL standards of practice and scaling up for training and country PPH prevention activities (WHO, 2009).
management, quality, safe motherhood (SM)
WHO, 2009, WHO Indicator Meeting: Prevention of Postpartum Hemorrhage/Active Management of the third Stage of Labor (AMSTL), Nov. 17, Washington, DC:WHO.