PLACENTUM Jurnal Kesehatan dan Aplikasinya, Vol. 10(1) 2022 53 Copyright © 2022, Placentum: Jurnal Ilmiah Kesehatan dan Aplikasinya, ISSN 2303-3746, e ISSN 2620-9969 UTEROTONIC USE IN THE ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR (AMTSL): SYSTEMATIC REVIEW Noviyati Rahardjo Putri 1) *, Anis Laela Megasari 2) 1) Midwifery Department, Medical Faculty, Sebelas Maret University, Ir Sutami Street, No. 36 A, Surakarta, Indonesia 2) Midwifery Study Program, Vocational School Sebelas Maret University; Indonesia *Corresponding author: Email: novirahardjo@staff.uns.ac.id ABSTRACT Background: Maternal mortality rate in Indonesia has decreased from 184/100,000 live birth (LB) (2016) to 177/100,000 LB (2017), but this number is still high enough than SDGs target of 70/100,000 LB. The one of direct cause of maternal death is hemorrhage, especially postpartum hemorrhage (PPH). Causes of PPH are uterine atony, laceration of birth canal, resistant placenta and uterine inversion. PPH prevention method is Active Management of Third Stage of Labor (AMTSL). The objective of this systematic review is to analyze the use of uterotonics in AMTSL. Methods: This systematic review used the PRISMA protocol, articles taken from Google Scholar, Science Direct, and Pub Med. The time span of the research article was 2010 to 2021. Result: The results of the study describe that the use of uterotonics in single use or combination in third stage of labor can reduce the risk of PPH and shorten the time of the stage. The side effects were reported in misoprostol and methyl ergometrine than oxytocin. In addition, combination therapy with oxytocin and misoprostol can reduce the length of the third stage and the potential for a decrease in hemoglobin within 24 hours of delivery. In Indonesia, if oxytocin is not available, maternal nipple stimulation is performed as nonpharmacological therapy or ergometrine 0.2 mg is given to patients without complications of high blood pressure. Conclusion: The use of uterotonics is adjusted to its cost-effectiveness, ability to store and refrigerate also the benefits compare to the side effects to the patients. Keywords:active management of the third stage, uterotonics, postpartum, hemorrhage INTRODUCTION Maternal Mortality Rate (MMR) is one of health status’s indicator in Indonesia. There is a downward trend in MMR in the world and in Indonesia. In 2017, the world's MMR decreases from 214 (in 2016) to 211/100,000 live birth (LB). In Indonesia, the MMR reached 184 down to 177/100,000 LB in the same year period [1] . However, the decline of MMR is