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    Third Stage of Labour

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    abydl
    The third stage of labor involves the separation and expulsion of the placenta and membranes from the uterine wall. It begins with the mechanical separation of the placenta from the uterus aided by uterine contractions. The separated placenta is then expelled either through expectant management by allowing the uterus to naturally deliver the placenta, or through active management using controlled cord traction or fundal pressure to assist delivery. Throughout the third stage, hemostasis or control of bleeding is achieved through continued uterine contractions and retraction.

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    Third Stage of Labour

    Uploaded by

    abydl
    486 views39 pages
    The third stage of labor involves the separation and expulsion of the placenta and membranes from the uterine wall. It begins with the mechanical separation of the placenta from the uterus aided by uterine contractions. The separated placenta is then expelled either through expectant management by allowing the uterus to naturally deliver the placenta, or through active management using controlled cord traction or fundal pressure to assist delivery. Throughout the third stage, hemostasis or control of bleeding is achieved through continued uterine contractions and retraction.

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    3rd stage of labor

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    The third stage of labor involves the separation and expulsion of the placenta and membranes from the uterine wall. It begins with the mechanical separation of the placenta from the uterus aided by uterine contractions. The separated placenta is then expelled either through expectant management by allowing the uterus to naturally deliver the placenta, or through active management using controlled cord traction or fundal pressure to assist delivery. Throughout the third stage, hemostasis or control of bleeding is achieved through continued uterine contractions and retraction.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    486 views39 pages

    Third Stage of Labour

    Uploaded by

    abydl
    The third stage of labor involves the separation and expulsion of the placenta and membranes from the uterine wall. It begins with the mechanical separation of the placenta from the uterus aided by uterine contractions. The separated placenta is then expelled either through expectant management by allowing the uterus to naturally deliver the placenta, or through active management using controlled cord traction or fundal pressure to assist delivery. Throughout the third stage, hemostasis or control of bleeding is achieved through continued uterine contractions and retraction.

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    © All Rights Reserved
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    of 39

    DEFINITION

    Third stage is that separation and

    expulsion of the placenta and membranes

    and also involves the control of bleeding


    EVENTS IN THE THIRD STAGE OF LABOUR

    Seperation and expulsion of the placenta

    Interplay of mechanical and hemostatic factors

    TIME

    Last between 5 and 15 minutes


    PHYSIOLOGY OF THIRD STAGE OF
    LABOUR/CONTROL OF HEMOSTASIS

    Separation and descend of the placenta

    Mechanical factors

    Hemostasis
    MECHANICAL FACTORS

    Seperation of the placenta

    Expulsion of the placenta


    MECHANICAL FACTORSContd
    PLACENTAL SEPERATION
    1.Second stage uterine cavity empties

    2.Enabling the retraction process to accelerate

    (1 & 2)Placental site has already begun to diminish in size

    Placenta becomes compressed

    Blood in the intervillous space is forced back into the spongy


    layer of the decidua
    MECHANICAL FACTORS..Contd
    Retraction of the oblique uterine muscle fibres exert
    pressure on the blood vessels so that the blood does not
    drain back into the maternal circulation
    Vessels during this process become tense and congested

    With the next contraction the distended veins burst and a


    small amount of blood seeps between the spongy layer and
    placental surface

    Placenta strip from its attachment

    Surface area of placental attachment reduces and begin to


    detach from the uterine wall
    MECHANICAL FACTORS..Contd
    Retraction of the oblique uterine muscle fibres exert
    pressure on the blood vessels so that the blood does not
    drain back into the maternal circulation
    Vessels during this process become tense and congested

    With the next contraction the distended veins burst and a


    small amount of blood seeps between the spongy layer and
    placental surface

    Placenta strip from its attachment

    Surface area of placental attachment reduces and begin to


    detach from the uterine wall
    MECHANICAL FACTORSContd

    METHODS OF PLACENTAL SEPERATION

    Schultze Method

    Matthews Duncan
    SEPERATION BEGINS CENTRALLY
    Retroplacental clot is formed
    Aids further seperation by exerting pressure at the midpoint of
    the placental attachment
    Increased weight helps to strip the adherent lateral borders
    Increased weight also helps to peel the membrane of the
    uterine wall
    Clot formed becomes enclosed in the membranous bag
    Placenta descends with fetal surface first
    More complete shearing of both placenta and membrane
    Less blood loss
    SEPERATION BEGINS LATERALLY
    Detach unevenly at one of its lateral borders
    Blood escapes so that seperation is unaided by the formation
    of a retroplacental clot
    Placenta descends, slipping sideways
    Maternal surface comes out first
    Takes longer time
    Associated with ragged, incomplete expulsion of the
    membranes
    Higher fluid blood loss
    TWO METHODS OF PLACENTAL SEPERATION
    HAEMOSTASIS
    RETRACTION OF THE OBLIQUE UTERINE
    MUSCLE FIBER

    PRESENCE OF VIGOROUS UTERINE


    CONTRACTION

    ACTIVATION OF THE COAGULATION AND


    FIBRINOLYTIC SYSTEM
    LIVING LIGATURE ACTION OF
    OBLIQUE UTERINE MUSCLES
    MANAGEMENT OF THE THIRD STAGE OF
    LABOUR
    Guard the uterus from massaging prior to placental
    seperation
    Do not massage the uterus before placental expulsion
    except when partial seperation
    Do not pull the umbilical cord before placenta separates

    Do not try to deliver the placenta prior to its complete


    seperation unless in the emergency of third stage
    haemorrhage
    Wait for the natural process to occur
    DELIVERY OF THE PLACENTA AND
    MEMBRANE
    Fundus is palpable below the umbilicus
    Fundus feels broad as the placenta is still in the upper
    segment
    SIGNS OF PLACENTAL SEPERATION
    DELIVERY OF THE PLACENTA AND
    MEMBRANEContd
    METHODS OF PLACENTAL DELIVERY
    1. EXPECTANT MANAGEMENT
    2. ASSISTED EXPULSION
    Controlled cord traction (modified Brandt Andrews
    method)
    Expression by fundal pressure
    EXPECTANT MANAGEMENT

    Placental seperation and descent occur spontaneously

    Mothers efforts are used to aid expulsion

    Minimal assistance is given if mothers effort fails to deliver

    the placenta

    Method can be practiced when mother has not received any

    anesthesia or oxytocic drugs at the delivery of the anterior

    shoulder
    EXPECTANT MANAGEMENT
    STEPS OF THE PLACENTAL DELIVERY
    1. A hand is placed over the fundus to feel for the signs of
    placental seperation
    2. When the features of placental seperation and its descend
    into the lower segment are confirmed, the client asked to
    bear down simultaneously with the hardening of the
    uterus
    3. As soon as the placenta passes through the introitus, it is
    grasped by both hands and twisted round and round or
    slightly up and down with gentle traction applied as the
    membranes are stripped off intact
    4. If the membranes are threatened to tear, they are to be
    held by an artery forceps and gentle traction is applied to
    deliver the rest of the membranes
    STEPS OF THE PLACENTAL DELIVERY
    1. A hand is placed over the fundus to feel for the signs of
    placental seperation
    2. When the features of placental seperation and its descend
    into the lower segment are confirmed, the client asked to
    bear down simultaneously with the hardening of the
    uterus
    3. As soon as the placenta passes through the introitus, it is
    grasped by both hands and twisted round and round or
    slightly up and down with gentle traction applied as the
    membranes are stripped off intact
    4. If the membranes are threatened to tear, they are to be
    held by an artery forceps and gentle traction is applied to
    deliver the rest of the membranes
    ASSISTED EXPULSION
    CONTROLLED CORD TRACTION (MODIFIED BRANDT
    ANDREWS METHOD)

    Several checks to be made before proceeding

    1. An oxytocic drug has been administered

    2. It has been given time to act

    3. The uterus is well contracted

    4. Counter traction is applied

    5. The signs of placental seperation and descend are present


    ASSISTED EXPULSIONContd
    METHODS OF CONTROLLED CORD TRACTION (MODIFIED
    BRANDT ANDREWS METHOD)
    1. The left hand is placed above the level of the symphysis pubis
    2. Palmar surface facing toward the umbilicus to exert pressure in an
    upward direction
    3. Body of the uterus is displaced upward towards the umbilicus with
    left hand
    4. With the right hand a steady tension is given in a downward and
    backward direction following the line of birth canal by holding on
    the clamp placed on the cord at the vulva
    5. It is important to apply a steady traction by pulling the cord firmly
    6. There should be a pause before another contraction is palpated and
    further attempt is made
    Controlled cord traction
    ASSISTED EXPULSIONContd
    COMPLICATIONS OF CONTROLLED CORD TRACTION
    (MODIFIED BRANDT ANDREWS METHOD)

    1. Inversion of the uterus

    2. Partial seperation of the placenta

    3. Haemorrhage

    4. Detachment of cord
    ASSISTED EXPULSIONContd
    ADVANTAGES OF CONTROLLED CORD TRACTION
    (MODIFIED BRANDT ANDREWS METHOD)

    1. Reduced blood loss

    2. Reduction in third stage of labour


    ASSISTED EXPULSION

    EXPRESSION BY FUNDAL PRESSURE

    1. Place four fingers of the hand behind the fundus and the thumb in

    front of the fundus to use as a piston

    2. The uterus is made to contract by gentle rubbing

    3. When the uterus is hard it is pushed downwards and backwards

    4. The pressure is to be withdrawn as soon as the placenta passess

    through the introitus


    USE OF OXYTOCIC AGENT
    TIME OF ADMINISTRATION
    At the crowning of the babys head
    At the delivery of the anterior shoulder
    At the end of second stage of labour
    Following the delivery of the placenta
    PROPHYLACTIC USE
    Prevention of post partum haemorrhage
    Active management of third stage of labour
    THERAPEUTIC USE
    Ergometrine 0.5mg IM
    Methergin 0.2mg IM
    FUNDAL HEIGHT DURING THIRD STAGE
    At the beginning fundus palpable below the umbilicus,

    feels broad as the placenta still in the upper segment

    As the placenta separates, becomes rounder, smaller and

    more mobile as it rises in the abdomen to the level of

    umbilicus or just above the level of umbilicus

    At the end of third stage fundus is about 4cm below the

    umbilicus
    COMPLETION OF THE THIRD STAGE
    Ensure that uterus is well contracted

    Fresh blood loss is minimal

    Inspection of the perineum and the lower vagina

    Suture the episiotomy or any slight laceration

    Change all the soiled linen

    Cleanse the perineum

    Application of sterile pad

    Examination of the placenta membrane


    ASSESSMENT OF THE PLACENTA
    Infractions that are recent(bright red) or old(gray patches)

    Localised calcification(flattened white plaques)

    Lobes

    Blood vessels

    Insertion of the cord

    Umbilical vessels

    Cord length

    Weight of the placenta


    IMMEDIATE CARE OF BABY
    Well being and security

    Cord clamp need to be checked

    Warmth

    Full neonatal assessment

    Baby kept close to the mother

    Breast feeding
    IMMEDIATE CARE OF MOTHER
    Cleansing the body

    Mouth wash

    Empty her bladder

    Vital signs

    Bleeding checked every 15 minutes

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