GS-2, Uncategorized


Why in news?

Recent advisory issued by the Union Health Ministry to States to adopt the Gujarat model of “non­interventional approach during the final stages of labour” as the best obstetric practice to deal with the high incidence of maternal mortality rate.

What is it?

Obstetricians say the advisory runs contrary to WHO recommendations and the best of proven international advisories and this can undo all their efforts to reduce PPH and prevent mothers bleeding to death.

Kerala managed to bring down the PPH (post-partum haemorrhage) numbers drastically when in 2013 it developed and implemented the Quality Standards in Obstetric Care.

One of the key principles adopted is the WHO-recommended strategy of “active management of third stage of labour” (AMTSL).

The third stage is the time between the delivery of the baby and the expulsion of the placenta and its duration could be approximately six to 30 minutes.

The volume of blood loss during this time depends on how long it takes the placenta to separate from the uterine wall and how effectively the uterine muscle contracts in the immediate post-partum period. This can be quite tricky.

So in 2012, the WHO reaffirmed AMTSL, with the use of uterotonics (drugs to contract uterus and reduce bleeding) as the best critical measure.


The new advisory, however, advocates the physiological management or the “hands-off” approach during the third stage of labour.

It says to delay the clamping and cutting of umbilical cord till placenta separates naturally and is expelled from the uterus. And that the uterotonic oxytocin be administered only after the placenta is expelled.

The WHO-recommended protocol of delaying cord clamping by one to three minutes after birth is enough to achieve the aim of allowing the foetus more blood from placenta

Extra Coverage:

What is MMR?

MMR in India:

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