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Active Management of Third Stage of Labour

The document discusses the active management of the third stage of labor to prevent postpartum hemorrhage. It involves three components: the use of oxytocics like oxytocin to help separate the placenta, controlled cord traction to deliver the placenta, and uterine massage after delivery to help the uterus contract. Active management has been shown to reduce the risks of excessive bleeding and retained placenta compared to expectant or physiological management of the third stage.

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shravani
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363 views22 pages

Active Management of Third Stage of Labour

The document discusses the active management of the third stage of labor to prevent postpartum hemorrhage. It involves three components: the use of oxytocics like oxytocin to help separate the placenta, controlled cord traction to deliver the placenta, and uterine massage after delivery to help the uterus contract. Active management has been shown to reduce the risks of excessive bleeding and retained placenta compared to expectant or physiological management of the third stage.

Uploaded by

shravani
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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ACTIVE MANAGEMENT

OF THIRD STAGE OF
LABOUR
SESSION OBJECTIVES
 To understand 3rd stage
 Complications
 Active Management
 Inappropriate/Harmful Practices
 Best Practices
Third Stage
 Delivery of the Foetus to delivery of placenta
and membranes.
 Upto Thirty Minutes
 Average 5-15 Minutes
 Shorter in multi, slightly longer in primi
KEY EVENTS IN THIRD
STAGE

 Separation of Placenta
 Expulsion/Delivery of Placenta
 Haemostasis
SEPARATION OF PLACENTA
 Central Separation
 Marginal Separation
 Signs of Placental separation
 Uterus becomes contracted, hard and globular;
 Uterus rises just above umbilicus;
 Extra vulval lengthening of umbilical cord;
 A gush of blood frequently appears;
 On pushing the uterus up in the abdomen, the cord
does not recede back.
EXPULSION/DELIVERY OF
PLACENTA

 Natural expulsion – Bearing down efforts


 Controlled cord traction.
HAEMOSTASIS

 Contraction and Retraction of Myometrium


– Ligature effect.

 Thrombosis
 Apposition of uterine walls.
COMPLICATIONS OF THIRD
STAGE
 PPH
 Retained Placenta
 Inversion
 Post-partum Shock
ACTIVE MANAGEMENT OF
THIRD STAGE OF LABOUR
 PRINCIPLES:
 Enhance separation of placenta
 Safe and complete delivery of placenta
 Minimize bleeding
ACTIVE MANAGEMENT OF
THIRD STAGE OF LABOUR

 COMPONENTS:
 Use of oxytocics
 Delivery of placenta by controlled cord traction
 Massage of uterus after placental delivery

 Examination of birth canal and afterbirths


 Repair of tears/episiotomy
OXYTOCICS
 Oxytocin
 Ergometrine/Methylergometrine
 Prostaglandin
 Misoprostol
OXYTOCIN
 Safe
 Cheap
 No contraindication
 Effective – quick action
 10 units IM
 Less heat labile
ERGOMETRINE
 Cheapest
 Has contraindications
 Side effects – sometimes serious
 Effective
 0.2 mg IM/IV
 Heat labile
PROSTAGLANDIN
 Costly
 Contraindications
 Some side effects
 Effective
 125-250 mcg IM
 Highly heat labile
MISOPROSTOL
 Less costly
 No significant contraindication
 No significant side-effect
 Effective
 600 mcg orally
 Highly heat stable
WHICH OXYTOCIC?
 Oxytocin - first choice
 Misoprostol - has a promise
 Prostaglandin – effective but costly
DELIVERY OF PLACENTA
 Controlled cord traction
 Raising the uterus gently upward by
abdominal hand
 Traction when placenta is separated/Uterus
contracted
UTERINE MASSAGE
 Immediately after placental delivery till uterus
is hard
 Repeat intermittently for 1-2 hrs.
IMMEDIATE POST-PARTUM
CARE
 Closely monitor for first 6 hours.
- Pulse, respiration, temperature,
B.P., G.C
- Vaginal bleeding.
- Uterine hardness.
@ Every 15 mins. for 1 hour.
@ Every 30 mins. For 2 hours.
@ Every hour for 3 hours.
 Massage the uterus every 15 mins. to maintain
contraction.
 If stable give her something to drink/eat when thirsty/hungry.
INAPPROPRIATE/HARMFUL
PRACTICES
 Non-use of active management
 Manipulating uterus (fundal pressure,
squeezing)
 Inappropriate use of oxytocic
 Inappropriate cord traction
 Routine catheter/MRP/exploration of uterus
 Uterine lavage
 Not examining birth canal/after births
BEST PRACTICES
 Cleanliness: IPP
 Complication readiness
 Support person
 Active management FOR ALL
 Oxytocic : OXYTOCIN 10 U IM – FIRST CHOICE
 Controlled traction

 Uterine massage

 Examination of birth canal and after births


 To remain vigilant for 6 hours
MAKE IT AN ISSUE

T H A N K Y O U !!!

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