Last Update: December 21, 2013
AMTSL active management

We have developed an expanded version of the AMSTL (Active Management of the Third Stage of Labor) stamp. The stamp prints in RED INK and allows tracking of the three steps of AMSTL in each patient record. It also serves as a reminder for health staff on the three steps and includes a space for staff signature. Finally, there is a line for amount of postpartum blood loss.

A simpler version of this stamp was developed in Niger to track active management of 3rd stage of labor. In Niger, most maternal mortality is due to hemorrhage and prior to this interventions, the majority of midwives were unclear on protocols for active management of third stage of labor and its three components (give a uterotonic <1 min after birth; controlled cord traction; uterine massage after delivery of placenta). Less than 5% of patient charts documented AMTSL. The simple stamp pictured here reminds the clinician of the three steps and improves the likelihood that practice is documented in the records. After an 18 month intervention, AMTSL jumped to 96% across 28 reference hospitals. Download USAID's Quality Assurance and Workforce Development Project Report (see p. 6) to learn about the use of the stamp and its effectiveness in the Active Management of the Third Stage of Labor (AMTSL) and Essential Newborn Care (ENC) programs.

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