Box 2 contains recommendations
related to cord management and uterine massage. The importance of controlled
cord traction (CCT) was revisited because of new evidence. This intervention is now
regarded as optional in settings where skilled birth attendants are available, and
is contraindicated in settings where skilled attendants do not assist with births.
Early cord clamping is generally contraindicated. Continuous uterine massage is
not recommended as an intervention to prevent PPH for women who have received
prophylactic oxytocin, because the massage may cause maternal discomfort, require
a dedicated health professional, and may not lead to a reduction of blood loss.
However, surveillance of the uterine tonus through abdominal palpation is recommended
for all women for the early identification of postpartum uterine atony. Table
1 summarizes the recommendation status of the individual components of the active
management of the third stage of labour. In summary, the GDG considered the use
of uterotonics as the main intervention within the active management of third stage
of labour package. In this context, the use of misoprostol for the prevention of PPH
by community health care workers and lay health