Normal labour, third stage by Dr Yin Moe

1. THIRD STAGE
DEFINITIONDEFINITION
•From expulsion of the foetus to delivery
of the placenta, cord and membranes
DURATIONDURATION
•Primigravida – 15 minutesPrimigravida – 15 minutes
•Multigravida – 5 minutesMultigravida – 5 minutes
•Generally – not > 30 minutesGenerally – not > 30 minutes
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2. PLACENTA SEPARATION
Two Methods
1.Schultz method
- placenta separate from centre
2.Matthew Duncan
- placenta separate from the peripheral
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3. Schultz method
Beginning of 3drstage Placenta in lower segment End of 3
rd
stage
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4. Matthew Duncan
Beginning of 3
rd
stage
Placenta separate from
the peripheral
Upper segment
Upper segment contracted
Placenta separated
Trickling
of blood
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5. MECHANISM OF PLACENTA SEPARATION
•Once the child is delivered,
–the uterine muscle contracts
–placenta sheared from the uterine wall
–pushing it into the lower uterine segment or
upper part of the vagina
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6. SIGNS OF PLACENTA SEPARATION
1.Lengthening of the cord
2.Trickling (gush) of blood
3.Uterus - becomes hard
- mobile from side to side
- height rises to the level of
umbilicus
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7. LENGTHENING OF THE CORD
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8. TRICKLING OF BLOOD
Trickling
of blood
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9. Beginning of 3
rd
stage placenta at lower segment end of 3
rd
stage
RISING OF THE FUNDAL HEIGHT
umbilicus
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10. MANAGEMENT
•Delivery of the placenta is done by
“CONTROLLED CORD TRACTION ” method
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11. CONTROLLED CORD TRACTION
•Signs of placenta separation must be present
before doing CCT (to prevent uterine inversion)
•Position– supine position
•Left hand – rested on the
abdomen on the
uterine fundus
•Right hand – cord traction is
applied
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12. 07/31/12 12Dr. Yin Moe Han

13. LENGTHENING OF THE CORD
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14. CONTROLLED CORD TRACTION
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15. MANAGEMENT
•Check placenta to see if any cotyledons
are missing
•Check membranes to see whether they
are complete or incomplete
•Check tears of the genital tract
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16. CHECKING PLACENTA COTYLEDONS
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17. MISSING PLACENTA
COTYLEDONS
Missing cotyledons
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18. CHECKING FOETAL SURFACE OF
THE PLACENTA
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19. CHECKING THE MEMBRANES
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20. BATTLEDORE PLACENTA
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21. 07/31/12 21Dr. Yin Moe Han