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Abstract
Postpartum hemorrhage is the leading cause of maternal death worldwide, with an estimated mortality rate of 140 000 per year, or 1 maternal death every 4 minutes. PPH occurs in 5% of all deliveries and is responsible for a major part of maternal mortality. The majority of these deaths occur within 4 hours of delivery, which indicates that they are a consequence of the third stage of labour. The most common and important cause of PPH is uterineatony. Since all parturient women are at risk for PPH, care providers need to possess the knowledge and skills to practice active management of the third stage of labour to prevent PPH and to recognize, assess, and treat excessive blood loss. This active management is associated with reduced maternal blood loss, fewer cases of PPH, and a lower incidence of a prolonged third stage of labor. For these reasons, active management should be the routine management of choice for women expecting to deliver a baby by vaginal delivery in a maternity hospital. The implications are less clear in other settings, including home birth in developing and industrialized countries. AMTSL involves interventions to assist in expulsion of theplacenta with the intention to prevent or decrease bloodloss. Interventions include use of uterotonics, clamping ofthe umbilical cord, and controlled traction of the cord. Incontrast, with expectant, or physiological, management,spontaneous