Active Management of Third Stage of Labour (AMTSL)

WHO and UNFPA recommend the following oxytocin protocol:

Preferred: Oxytocin 10 IU IM immediately after birth of baby

If oxytocin unavailable: Misoprostol 600 mcg orally

Key steps in AMTSL:

1. Administer uterotonic within 1 min of birth

2. Controlled cord traction (Brandt-Andrews)

3. Uterine massage after placenta delivery

This reduces PPH risk by 60% compared to expectant management.

For patients with hypertension or pre-eclampsia, avoid ergometrine (causes vasoconstriction).

✅ Safe choice: Oxytocin 10 IU IM remains first-line

⚠️ Avoid: Ergometrine / Syntometrine

If IV access is available: Oxytocin infusion 20–40 IU in 500 mL NS at 125 mL/hr post-delivery.