By PPH Foundation

Active Management of the Third Stage of Labour, AMTSL, remains one of the most effective interventions in preventing postpartum haemorrhage, the leading cause of maternal deaths globally. According to the World Health Organization, proper use of AMTSL significantly reduces the risk of severe bleeding after childbirth, making it a critical standard of care in all delivery settings.

AMTSL involves three key steps administered immediately after birth, giving a uterotonic such as oxytocin, controlled cord traction, and uterine massage. Evidence from a Cochrane Collaboration systematic review shows that this approach can reduce the incidence of postpartum haemorrhage by up to 60 percent, while also lowering the need for blood transfusion and reducing cases of maternal anaemia.

Further research published on PubMed highlights that AMTSL is particularly effective in preventing severe blood loss exceeding 1000 ml, a threshold strongly associated with maternal mortality. Similarly, studies in the Reproductive Health Journal confirm that timely administration of uterotonics alone plays a major role in reducing uterine atony, which accounts for nearly 70 percent of postpartum haemorrhage cases.

Dr Eunice Atsali, a midwife and Co-Lead in the End PPH Initiative, underscores the importance of this intervention, noting that “the first few minutes after birth are decisive, and effective management of the third stage of labour can prevent most cases of severe bleeding.” Her experience reflects what evidence has consistently shown, that delays or incomplete application of AMTSL can quickly lead to life-threatening complications.

However, research also emphasizes that effectiveness depends on correct and consistent implementation. The World Health Organization notes that skilled birth attendants, proper dosing of uterotonics, and adherence to clinical guidelines are essential to achieving the full lifesaving benefits of AMTSL.

As countries continue to battle high rates of maternal mortality, scaling up the use of AMTSL remains one of the most practical and cost-effective strategies to prevent postpartum haemorrhage. Ensuring that every birth is supported by skilled care and evidence-based interventions is key to saving mothers’ lives.

Sources

World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage. Geneva, World Health Organization, 2012

Begley CM, Gyte GML, Devane D, McGuire W, Weeks A. Active management of the third stage of labour for preventing postpartum haemorrhage. Cochrane Database of Systematic Reviews, 2019, Issue 2

Saccone G, Berghella V. Active management of the third stage of labour for preventing postpartum hemorrhage, a systematic review and meta-analysis. American Journal of Obstetrics and Gynecology, 2016, 214(1)

Gallos ID, Williams HM, Price MJ, Merriel A, Gee H, Lissauer D, Moorthy V, Tobias A, Deeks JJ, Widmer M, Tunçalp Ö, Hofmeyr GJ, Coomarasamy A. Uterotonic agents for preventing postpartum haemorrhage, a network meta-analysis. Cochrane Database of Systematic Reviews, 2018, Issue 4

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