{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T18:25:46Z","timestamp":1761675946933},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2012,4,6]],"date-time":"2012-04-06T00:00:00Z","timestamp":1333670400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2012,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To analyze the Ecuadorian experience regarding the adoption, scale\u2010up, and institutionalization of active management of the third stage of labor (AMTSL) for prevention of postpartum hemorrhage via continuous quality improvement (CQI) processes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Average AMTSL implementation rates for women with vaginal deliveries were compared using unweighted provincial aggregate data from facilities participating in 3 phases of AMTSL programming. Months taken to implement AMTSL at 80% or more and 90% or more compliance were compared across phases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Rate of oxytocin administration during the first 3 months was 5.0% in phase 1, 9.8% in phase 2, and 72.2% in phase 3 (<jats:italic>P<\/jats:italic> \u2264 0.001 vs phases 1 and 2). The average number of months provinces took to increase oxytocin administration to 80% or more and 90% or in more women with vaginal deliveries was, respectively, 21.6 \u00b1 18.7 and 30.6 \u00b1 16.4 in phase 1, 23.5 \u00b1 15.1 and 30.1 \u00b1 14.9 in phase 2, and 4.7 \u00b1 4.9 (<jats:italic>P<\/jats:italic> \u2264 0.01 vs phase 1; <jats:italic>P<\/jats:italic> \u2264 0.001 vs phase 2) and 4.0 \u00b1 3.4 (<jats:italic>P<\/jats:italic> \u2264 0.001 vs phases 1 and 2) in phase 3. By December 2009, AMTSL implementation was sustained at 90% or more in all provinces.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>CQI processes identified resistance and operational barriers, and developed mechanisms to overcome them.<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.ijgo.2012.01.017","type":"journal-article","created":{"date-parts":[[2012,4,6]],"date-time":"2012-04-06T12:36:38Z","timestamp":1333715798000},"page":"278-282","source":"Crossref","is-referenced-by-count":15,"title":["Sustainable scale\u2010up of active management of the third stage of labor for prevention of postpartum hemorrhage in Ecuador"],"prefix":"10.1002","volume":"117","author":[{"given":"Jorge","family":"Hermida","sequence":"first","affiliation":[]},{"given":"Bernarda","family":"Salas","sequence":"additional","affiliation":[]},{"given":"Nancy L.","family":"Sloan","sequence":"additional","affiliation":[]}],"member":"311","published-online":{"date-parts":[[2012,4,6]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60518-1"},{"issue":"7","key":"e_1_2_6_3_2","first-page":"CD007412","article-title":"Active versus expectant management for women in the third stage of labour","author":"Begley C.M.","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_4_2","unstructured":"World Health Organization (WHO). Maternal mortality in 2005: estimates developed by WHO UNICEF UNFPA and the World Bank. Geneva: World Health Organization; 2005:16\u20137 23\u20137 29\u201338."},{"key":"e_1_2_6_5_2","volume-title":"Trends in maternal mortality: 1990 to 2008. Estimates developed by WHO, UNICEF, UNFPA and the World Bank","author":"World Health Organization","year":"2008"},{"key":"e_1_2_6_6_2","volume-title":"The Millennium Development Goals report 2008","author":"United Nations","year":"2008"},{"issue":"2","key":"e_1_2_6_7_2","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.ijgo.2007.02.012","article-title":"Prevention and Treatment of Post\u2010partum Haemorrhage: New Advances for Low Resource Settings","volume":"97","author":"International Confederation of Midwives","year":"2007","journal-title":"Int J Gynecol Obstet"},{"issue":"2","key":"e_1_2_6_8_2","first-page":"CD001808","article-title":"Prophylactic oxytocin for the third stage of labour","author":"Cotter A.M.","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"issue":"3","key":"e_1_2_6_9_2","first-page":"CD000007","article-title":"Active versus expectant management in the third stage of labour","author":"Prendiville W.J.","year":"2000","journal-title":"Cochrane Database Syst Rev"},{"issue":"4","key":"e_1_2_6_10_2","first-page":"CD001808","article-title":"Prophylactic use of oxytocin in the third stage of labour","author":"Elbourne D.R.","year":"2001","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_11_2","volume-title":"WHO recommendations for the prevention of postpartum haemorrhage","author":"World Health Organization","year":"2007"},{"key":"e_1_2_6_12_2","volume-title":"Unedited report of the 18th Expert Committee on the Selection and Use of Essential Medicines","author":"World Health Organization","year":"2011"},{"key":"e_1_2_6_13_2","volume-title":"Maternal and Infant Health Demographic Survey: Final Report (ENDEMAIN 2004)","author":"Centro de Estudios de Poblaci\u00f3n y Desarrollo Social (CEPAR)","year":"2004"},{"key":"e_1_2_6_14_2","unstructured":"HermidaJ. RobalinoM.E. VacaL. AyabacaP. RomeroP..Scaling up and institutionalizing continuous quality improvement in the free maternal and child care program in Ecuador.http:\/\/www.hciproject.org\/node\/962\/. Published 2005"},{"key":"e_1_2_6_15_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs.2010.044388"},{"key":"e_1_2_6_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czp066"},{"key":"e_1_2_6_17_2","unstructured":"Prevention of Postpartum Hemorrhage Initiative (POPPHI).Active Management of the Third Stage of Labor: a Demonstration. Preventing Postpartum Hemorrhage: Toolkit for Providers.http:\/\/www.pphprevention.org\/amtslweb\u2010en\/index.html. Published 2004"},{"key":"e_1_2_6_18_2","unstructured":"Prevention of Postpartum Hemorrhage Initiative (POPPHI).Job Aid: Integration of Active Management of the Third Stage of Labor (AMTSL) and Essential Newborn Care (ENC).http:\/\/www.pphprevention.org\/files\/AMTSLandENC_Eng.pdf. Published December 2008"},{"key":"e_1_2_6_19_2","unstructured":"Prevention of Postpartum Hemorrhage Initiative (POPPHI).Poster: Integration of Active Management of the Third Stage of Labor (AMTSL) and Essential Newborn Care (ENC).http:\/\/www.pphprevention.org\/files\/AMTSL_jobaid_000.pdf. Published December 2008"},{"key":"e_1_2_6_20_2","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.06.031385"},{"key":"e_1_2_6_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzq028"},{"key":"e_1_2_6_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1553-7250(10)36082-X"},{"key":"e_1_2_6_23_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0013891"},{"key":"e_1_2_6_24_2","unstructured":"OyerindeK..Emergency obstetric and newborn care assessments in Africa: focus on postpartum hemorrhage and pre\u2010eclampsia\/eclampsia Presentation at the Africa Regional Meeting on Maternal and Newborn Health Interventions 2011 OI\/MCHIP Meeting. 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