3RD STAGE OF LABOUR AND ITS MANAGEMENT.ppt

This file contains third stage of labour in woman in labour ward , and its all the Active management after delivery of the baby.

1. MANAGEMENT OF
THIRD STAGE OF
LABOR
A.T. Mpota
7
th
November 2021

2. SPECIFIC OBJECTIVES
Define 3
rd
stage of labour
Explain the objectives of active
management of 3
rd
stage of
labour
Discuss management of 3
rd
stage of labour

3. INTRODUCTION
Most crucial stage of labour
Strict vigilance
Follow protocols
Duration :15 min.(primigravida
multigravida)
AMTSL:5 minutes

4. Definition
Thirdstageisdefinedas
theperiod after
expulsionoffetusto
expulsionofplacenta&
membranes(afterbirths).

5. OBJECTIVES OF AMTSL
Shortens 3
rd
stage and
minimise the risk of
haemorrhage
Enhances the normal
physiological process that
occur in 3
rd
stage of labour

6. REQUIREMENTS
Assemble all necessary equipment and supplies that
include:
Large kidney dish
Oxytocin 10 iu
Gauze
Syringes and needles
Measuring jug

7. REQUIREMENTS……..CT
Pair of gloves
Personal protective
equipment (goggles, apron
and gown)
Sharps container
Placental pail with lid

8. PATIENT PREPARATION
Explain procedure to the woman
position the woman in dorsal
position with legs and thighs
flexed and abducted to ensure
that the uterus remains in
midline position and for proper
viewing of the perineum

9. AMTSL
Palpate the mother’s abdomen to rule out the
presence of another baby.
If no other baby, give 10 IU Oxytocin IM within 1
minute of birth to facilitate contraction of uterus
NOTE TIME
Put sterile receiver against the perineum to
collect blood
Hold cord close to the perineum, with hand or
clamp.

10. AMTSL…………CT
Wait for the uterus to contract.
Use one hand to grasp the cord clamp.
Place the other hand just above the pubic
bone, on top of the drape covering the
woman’s abdomen, with the palm facing
toward the mother’s umbilicus and gently
apply counter-traction in an upward
direction (towards the woman’s head).

11. AMTSL…………CT
At the same time while the uterus is
contracted, firmly apply traction to the
cord, in a downward direction, using the
hand that is grasping the clamp. (Follow
direction of the birth canal.)
Apply tension by pulling the cord firmly
and maintaining pressure (jerky
movements and force must be avoided)
down ward until placenta is visible on the
vulva.

12. AMTSL…………CT
If the manoeuvre is not successful
within 30–40 seconds, stop cord
traction, wait for the next
contraction and repeat CCT.
When the placenta is visible at the
vaginal opening, hold it in both
hands and twist slowly so that the
membranes are expelled intact.

13. AMTSL…………CT
If the placenta do not slip out
easily, gently twist them into a rope
and move up and down to assist
separation without tearing them
After the placenta is delivered,
apply an upward and downward
traction or twist the placenta to
deliver membranes.

14. AMTSL…………CT
Slowly pull to complete delivery
and place in placenta dish.
Note time of delivery
Immediately and gently massage
the uterus until it is well contracted
and no bleeding is observed from
the vagina

15. QUICK EXAMINATION OF
PLACENTA AND MEMBRANES
Quickly check the placenta and
membranes for completeness:
Hold placenta in palms of hands with
maternal side facing upwards and check
whether all lobes are present and fit
together
Hold cord with one hand and allow
placenta and membranes to hang down

28. MANAGEMENT OF 4
TH
STAGE
OF LABOUR
Note position of the cord insertion
Change one pair of gloves
Swab the vulva with an antiseptic solution
Inspect perineum for tears
Gently separate the labia and inspect lower vaginal wall
for lacerations and tears that may need repair to
prevent further blood loss
Clean the vulva with antiseptic solution and dry it

29. Apply clean pad to vulva. However if tear is present
prepare for suturing
Clean mother (remove all soiled linen, dry her and leave
her comfortable)
Assist the mother in a comfortable position

30. DETAILED EXAMINATION OF
PLACENTA AND MEMBRANES
The umbilical cord:
at term is 55 to 60 in length
The normal cord has 3 blood vessels 1 umbilical vein and 2
arteries
Cord vessels are suspended in Wharton’s jelly and covered by
amnion
Insertion point (normal centre of the fetal surface with blood
vessels). Presence of true or

31. The membranes
Consist of 2 layers
amnion fetal side
chorion maternal side
Separate the amnion from the
chorion by pulling the amnion back
over the base of the umbilical cord
to ensure they both separate

32. Placenta
Lobes/cotyledons for completeness if
complete are fitted together
Check for number of lobes
Inspect for abnormalities such as
infarcts or calcifications
Weight 1/6 of weight of baby. Ranges
from 300-600g

39. Methods of placental
separation
Central ( Schultze) separation
Marginal (Mathews Duncan) separation

41. Expulsion of placenta
Contraction & retraction of Upper Uterine Segment
Placenta forced to lie in LUS/upper vagina
Voluntary contraction of abdominal muscles
Expulsion of placenta

42. Mechanisms to control bleeding
1.Effective retraction
of uterine muscles :
Living ligatures
2.Thrombosis of torn
sinuses
3.Myotamponade:
apposition of walls
of the uterus

43. Management of third stage
Expectant management
Active management

44. CCT
ModifiedBrandtAndrewsmethod
Lefthand:palmarsurfaceoffingersplaced
abovepubicsymphysis.Bodyofuterus
pushedupwards&backwards
Righthand:cordtractionindownward&
backwarddirection
Uterusfeelshard,contracted

47. Examination of placenta
,membranes

48. Examination of
membranes, cord

49. Active management
AMTSL: Active Management of Third
Stage of Labour
Prophylactic uterotonic after delivery of baby
( Oxytocin 10 IU ,IM)
cord clamping, cutting & Controlled cord traction of U cord
Uterine massage
Excites powerful uterine contractions
,aid in early placental separation,
minimises blood loss & duration of
third stage (5 min.)

50. Third stage
Most crucial
Life threatening complications
PPH(postpartum haemorrhage)
Retained placenta
Inversion of uterus
Pulmonary embolism

51. WHO guidelines
Giveuterotonicsroutinelyduring3
rd
stage
labor,inallbirths
Oxytocin10IUIMisdrugofchoice
UseotheruterotonicsonlywhenOxytocinisnot
available
Latecordclamping(1-3minafterbirth)is
recommended
Earlycordclamping(<1minofbirth):not
recommendeduntiltheneonateisasphyxiated
&needsimmediateresuscitation

52. MCQ1
•Labor is said to be normal if all
are present except:
1.At term
2.Breech presentation
3.Spontaneous in onset
4.Healthy mother & neonate
after delivery

53. MCQ2
•Regarding the third stage of labor, following is not true:
1.Most crucial stage of labor
2.Duration is 15 minutes
3.Uterine inversion is most common complication
4.AMTSL is routine in all

54. MCQ3
•The uterotonic of choice for prophylaxis of PPH in third
stage of labor is
1.Syntometrine
2.Oxytocin
3.Misoprostol
4.carboprost

55. MCQ4
All are true in relation to AMTSL except:
10 IU of Oxytocin , IM
Uterine massage
Reduces the duration of third stage
Perform in only high risk cases

56. MCQ5
•Complications during third stage of labor are all except
1.PPH
2.Chronic Uterine inversion
3.Retained placenta
4.Amniotic fluid embolism

57. MCQ7
•The most important method to control
uterine bleeding following delivery
1.Myotamponade
2.Thrombosis
3.Contraction & retraction of uterine
muscle
4.none