International Journal of Trend in Scientific Research and Development (IJTSRD) Volume 5 Issue 6, September-October 2021 Available Online: www.ijtsrd.com e-ISSN: 2456 – 6470 @ IJTSRD | Unique Paper ID – IJTSRD47514 | Volume – 5 | Issue – 6 | Sep-Oct 2021 Page 801 A Descriptive Study to Assess the Knowledge and Practice of Nurses Regarding Active Management of Third Stage of Labour at the Selected Hospitals of Punjab Zahra Batool 1 , Daljit Kaur 2 , Nitika Sharma 3 1MSc (Obstetrics and Gynecological Nursing), 2Professor, 3Assistant Professor, 1,2,3SPHE College of Nursing, Gharuan, Punjab, India ABSTRACT INTRODUCTION: Active management of third stage of labour (AMTSL) as a prophylactic intervention is composed of a package of three components: 1) administration of uterotonic, preferably oxytocin, immediately after birth of the baby; 2) controlled cord traction (CCT) to deliver the placenta; and 3) massage of the uterine fundus after the placenta is delivered. WHO recommendations have supported active management of the third stage of labour as a critical intervention for PPH prevention. AMTSL has become a central component of the PPH reduction strategies of governments around the world. AIM: The aim of the study was to detect the knowledge and practice of nurses regarding active management of third stage of labour. MATERIALS AND METHODS: A descriptive study was used to conduct study on 80 nurses fulfilling the inclusion criteria by using convenient sampling technique. The data was collected by using Sociodemographic profile, Knowledge Questionnaire and self-report checklist. RESULT: The result showed that the majority of the subject had an average knowledge (57.5%) whereas (35%) had good knowledge and (7.5%) had poor knowledge on other hand the majority of nurses had satisfactory practice i.e. (73.75%) and (26.25%) had unsatisfactory practice regarding active management of third stage of labour. CONCLUSION: The study revealed that the majority of the subjects had an average knowledge regarding active management of third stage of labour and a satisfactory practice regarding active management of third stage of labour. KEYWORDS: Active Management of third stage of labour, Knowledge, Practice, Nurses How to cite this paper: Zahra Batool | Daljit Kaur | Nitika Sharma "A Descriptive Study to Assess the Knowledge and Practice of Nurses Regarding Active Management of Third Stage of Labour at the Selected Hospitals of Punjab" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-6, October 2021, pp.801-804, URL: www.ijtsrd.com/papers/ijtsrd47514.pdf Copyright © 2021 by author (s) and International Journal of Trend in Scientific Research and Development Journal. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) (http://creativecommons.org/licenses/by/4.0) INTRODUCTION & BACKGROUND OF THE STUDY Active management of third stage of labour (AMTSL) as a prophylactic intervention is composed of a package of three components: 1) administration of uterotonic, preferably oxytocin, immediately after birth of the baby; 2) controlled cord traction (CCT) to deliver the placenta; and 3) massage of the uterine fundus after the placenta is delivered. WHO recommendations have supported active management of the third stage of labour (AMTSL) as a critical intervention for PPH prevention. AMTSL has become a central component of the PPH reduction strategies of governments around the world. Uterotonic drug: Administering an uterotonic drug within 1 minute after the baby’s birth promotes strong uterine contractions and leads to faster retraction and placental delivery. This decreases the amount of maternal blood loss. More effective uterine activity also leads to a reduction in the incidence of retained IJTSRD47514 International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD47514 | Volume – 5 | Issue – 6 | Sep-Oct 2021 Page 802 placenta. Based on results of efficacy studies, WHO recommends oxytocin (10 IU by IM injection) as the uterotonic drug of choice for prevention of PPH during the third stage of labor because it is effective 2–3 minutes after injection, has minimal side-effects and can be used in all women. However, if oxytocin is not available, Misoprostol (400–600 µg by mouth) should be used. Access to inject able uterotonic drugs is limited to points of care where a skilled birth attendant is trained and authorized to administer injections. Misoprostol is administered orally and does not require refrigeration; therefore, it has the potential to increase access at the community level and in births not attended by a skilled birth attendant. Several studies have demonstrated the safety and efficacy of introducing use of Misoprostol by health workers, traditional birth attendants, or pregnant women themselves trained in its use. Controlled Cord Traction: Controlled Cord Traction assists with rapid delivery of the placenta. It is important that the placenta be removed quickly once it has separated from the uterine wall because the uterus cannot contract efficiently if the placenta remains inside. Controlled Cord Traction includes supporting the uterus by applying pressure on the lower segment of the uterus in an upward direction towards the woman’s head, while at the same time pulling with a firm, steady tension on the cord in a downward direction during contractions. Supporting or guarding the uterine helps prevent uterine inversion. Controlled Cord Traction should only be performed during a contraction and if counter traction is being applied. Advocates of Controlled Cord Traction argue that when expectant management is used, the placenta may be detached but remain at the level of the internal os. If this occurs, blood trapped behind the placenta in this position can distend the uterus, preventing further retraction and increasing the likelihood of PPH. Controlled Cord Traction, however, requires the presence of a birth attendant trained in its use, thus severely limiting access to the life- saving effects of active management of third stage of labor. Uterine massage: Once the placenta is delivered, the uterus may have a tendency to relax slightly which could result in heavy bleeding. Although the prophylactic use of a uterotonic drug helps ensure that the uterus continues to contract and retract, the provider must continue to palpate the abdomen to assess and monitor uterine tone and size, and massage the uterus as needed. Massaging the uterus stimulates uterine contractions and may help expel blood and clots that might prevent contraction. As uterine massage can be uncomfortable; it is important to explain the rationale to the patient. Teaching the woman how to assess and massage her own uterus will prevent bleeding. Check the vitals of the women every 15 minutes for 2 hours. OBJECTIVES OF THE STUDY: 1. To assess the knowledge of nurses regarding active management of third stage of labour. 2. To assess the practice of nurses regarding active management of third stage of labour. MATERIALS AND METHODS: Research approach and design: A quantitative research approach and descriptive research design. Sample and sampling technique: Convenient sampling technique was employed to select the sample of the study. Sample size was 80. Selection and development of research tool: Part-I: Sociodemographic data: This part considers 6 items related to sociodemographic background of the study. Part-II: Self structured Questionnaire: this item has 30 questions with 4 options. To assess the level of knowledge of nurses. It was 3 points (poor= 0-10, average =11-20, good=21- 30). Part III: Self report checklist: This item had 30 points. To assess the practice it has 2 points (satisfactory=16-30 and unsatisfactory=0-15). ETHICAL CONSIDERATIONS: Ethical approval was obtained from institute ethic committee of SPHE College of Nursing Gharuan, Mohali. Informed written consent was taken from the subjects. Confidentiality of the data was maintained. RESULTS: Table no: 1 Frequency and percentage distribution of sample characteristics N=80 S. no. Demographic variables Categorization frequency percentage 1 Age in years 20-25 24 30 26-30 43 53.75 31-35 13 16.25 2 Gender male 0 - female 80 100 International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD47514 | Volume – 5 | Issue – 6 | Sep-Oct 2021 Page 803 3 Education GNM 44 55 B.Sc. Nursing 19 23.75 Post Basic B.Sc. (N) 17 21.25 4 Marital status Unmarried 21 26.25 Married 59 73.75 others 0 - 5 Total duration of job in years 0-2 29 36.25 3-5 41 51.25 6-8 10 12.5 6 Area of job Antenatal ward 16 20 Labour room 9 11.25 Postnatal ward 18 22.5 others 37 46.25 Table 1 depicts the frequency and percentage distribution of the demographic and knowledge and practice of staff nurses with Active management of third stage of labour. OBJECTIVE 1- To assess the knowledge of nurses regarding Active Management of third stage of labour. Tables 2 Frequency and percentage distribution n according to knowledge score regarding Active management of third stage of labour among nurses. N=80 Level of knowledge score frequency Percentage (%) Good 21-30 28 35% Average 11-20 46 57.5% Poor 0-10 6 7.5% Maximum score = 30 Minimum score = 0 Table 2 depicts the percentage knowledge distribution of the knowledge score according to the criterion measure and it reveals that majority of subject i.e. 46 (57.5%) have average knowledge whereas 28 (35%) have good knowledge and 6 (7.5%) have poor knowledge regarding active management of third stage of labour. OBJECTIVE 2 - To assess the practice of nurses regarding active management of third stage of labour. Table 3 Frequency and percentage distribution of nurses regarding active management of third stage of labour. N=80 Level of practice Score frequency Percentage (%) Satisfactory 16-30 59 73.75% Unsatisfactory 0-15 21 26.25% Maximum score=30 Minimum score=0 Table 3 depict that the practice of 73.75% i.e. 59 subjects have satisfactory whereas 26.25% i.e. 21 subjects have unsatisfactory practice regarding active management of third stage of labour. DISCUSSION The findings of the study have been discussed with reference to the result obtained by the investigator. Present study was regarding knowledge and practiced of active management of third stage of labour among nurses at the selected hospital of Punjab. The findings inferred that depicts that subject from age groups 20- 25 had an average knowledge score i.e. 15.66, whereas the age group 26-30 had good knowledge i.e. 17.8 and the age group of 31-35 had poor knowledge score i.e. 19.2 and practice of the age groups 20- 25 had good practice score i.e. 18.62, whereas the age group 26-30 had average practice i.e. 18.50 and the 34 age group of 31-35 had poor knowledge score i.e. 21.66. The present study was consistent with another study by Sangay Bhutia (2018) assessing that they had good knowledge and poor practice regarding active management of third stage of labour. Fatina B Ramadhani et. al. (2020) conducted a descriptive cross sectional survey to 160 nurse- midwives at three referral hospitals in Dar es Sa- laam, Tanzania. The result shows that about 99.4% nurses knew the first recommended uterotonic and (98.8%) protocols as modified. Knowledge was International Journal of Trend in Scientific Research and Development @ www.ijtsrd.com eISSN: 2456-6470 @ IJTSRD | Unique Paper ID – IJTSRD47514 | Volume – 5 | Issue – 6 | Sep-Oct 2021 Page 804 significantly contributed by multiple factors. Regardless of high nurse- midwives’ AMTSL knowledge; it is imperative that responsible authorities plan appropriate strategies to solve reported barriers affecting correct AMTSL use. Zelalem Tenaw et. al. (2015) a cross sectional study was conducted to health institution in Hawassa city, Ethiopia. The data was collected by using pretested structured questionnaires for knowledge assessment and observation checklists for practice. Simple random sampling technique was used to select 76 obstetric care providers. The result shows that out of 76, 24 ( 33.3%) of obstetric care providers had knowledgeable about active management third stage of labour and 16.7 % obstetric care providers was applied correctly active management of third stage of labour. Obstetric care providers who took pre/in- service training were 7.4 times was done correctly active management of third stage of labour than didn’t take training. In this study knowledge and practice of obstetric care providers towards active management of third stage of labour is still low. REFERENCES [1] Arulkumaran, Sabaratnam. The Active Management of Third Stage of Labour. The Global Library of Women Medicine, www.glown.com. [2] Asibong, U., Akpan, U. and Ayi, E (2018) Active Management of Third Stage of Labor: Knowledge and Practice among Non-Physician Obstetric Care- Givers in Primary Health Care Setting in Calabar Municipality, South-South Nigeria. Research in Obstetrics and Gynecology. 6(1): 9-15. [3] B. Veronika Jones., B. 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