Assessment of Uterotonic Use for Active Management of the Third Stage of Labour in Delta and Rivers States

Active management of the third stage of labour with a uterotonic agent is the most effective evidence-based intervention for preventing postpartum haemorrhage, yet its consistent and correct application at delivery facilities in South South Nigeria is not uniformly documented. This study assesses the availability, selection, dosing, and timing of uterotonics for active management of the third stage of labour at maternity facilities in Delta and Rivers States. Twenty maternity units across Warri, Asaba, Port Harcourt, and Ahoada were assessed through structured facility surveys and direct observation of 60 third-stage management episodes. Uterotonic availability was confirmed in all 20 facilities, but oxytocin storage at required temperature (2 to 8 degrees Celsius) was achieved in only 45 percent. Correct timing of uterotonic injection within one minute of birth was observed in only 38 percent of supervised deliveries. Ergometrine was used in 22 percent of deliveries, despite contraindications in women with hypertension. Uterine massage was performed in 71 percent of episodes, and controlled cord traction correctly in 53 percent. The study reveals substantial protocol adherence gaps in third-stage management across the two states. Professional recommendations include cold-chain storage investment for oxytocin, misoprostol introduction as a heat-stable alternative, and structured active management of the third stage of labour competency refresher training. Keywords: active management third stage, uterotonic, postpartum haemorrhage, Delta State, Rivers State