Managing the 3rd Stage of Labor
Prepared by:Prepared by: Violeta Manalang-DeGuzman,MD,FPOGSVioleta Manalang-DeGuzman,MD,FPOGS
Bulacan Medical CenterBulacan Medical Center
Prepared on:Prepared on: January 31,2009January 31,2009
Presented by:Presented by: Eva Felipe Dimog, RM, BSPHEva Felipe Dimog, RM, BSPH
University of La SaletteUniversity of La Salette
Santiago CitySantiago City
ObjectivesObjectives
Define the 3Define the 3rdrd stage of labor stage of labor Enumerate the signs of placental Enumerate the signs of placental
separationseparation Describe the management of the 3rd Describe the management of the 3rd
stage of laborstage of labor
Third stage of laborThird stage of labor
Placental stagePlacental stage Usually last for 30 Usually last for 30
minutesminutes
Managing the 3rd Stage of Labor
The following are signs of placental The following are signs of placental separation except:separation except:
A. A. A gush of blood comes from the A gush of blood comes from the vaginavagina
B. B. Umbilical cord gets longerUmbilical cord gets longer
C. C. Uterine fundus palpable beyond Uterine fundus palpable beyond the umbilicusthe umbilicus
D. D. Uterus becomes round in shapeUterus becomes round in shape
Signs of placental separationSigns of placental separation
A gush of blood A gush of blood comes from the comes from the vaginavagina
Umbilical cord gets Umbilical cord gets longerlonger
Uterus rises over Uterus rises over the abdomenthe abdomen
Uterus becomes Uterus becomes round in shaperound in shape
Management of the 3rd stage of laborManagement of the 3rd stage of labor
Expectant Expectant ActiveActive
Expectant managementExpectant management
Talk to the woman Talk to the woman and tell her that and tell her that you will deliver her you will deliver her placentaplacenta
Wash your hands Wash your hands and put on your and put on your sterile glovessterile gloves
Expectant managementExpectant management After having the signs of After having the signs of
placental separation, hold placental separation, hold the clamp close to the the clamp close to the perineum with one hand. perineum with one hand.
Deliver the placenta by Deliver the placenta by putting one hand just putting one hand just above the pubic bone. above the pubic bone.
Tell the mother that she Tell the mother that she can strain when there is can strain when there is uterine contractionuterine contraction
Expectant managementExpectant management Gently guide the placenta Gently guide the placenta
downward and outward by downward and outward by holding on the cord. holding on the cord.
Be Be gentle because a hard gentle because a hard pull can tear or break the pull can tear or break the cord and even worst, turn cord and even worst, turn the uterus inside outthe uterus inside out
As the uterus stays in As the uterus stays in place and the cord gets place and the cord gets longer , continue to guide longer , continue to guide gently until the placenta is gently until the placenta is delivereddelivered
Expectant managementExpectant management
When the bulk of When the bulk of the placenta is the placenta is out,hold it with out,hold it with your two handsyour two hands
Rotate the placenta Rotate the placenta like twisting a rope like twisting a rope until delivered so until delivered so that the fetal that the fetal membranes will membranes will come out alsocome out also
Expectant managementExpectant management
Feel the uterus Feel the uterus from the abdomen from the abdomen and massage it to and massage it to keep it contractedkeep it contracted
Inject an oxytocic Inject an oxytocic drug drug intramuscularlyintramuscularly
Management of the 3rd stage of Management of the 3rd stage of laborlabor
The best time to inject oxytocics The best time to inject oxytocics during the 3during the 3rdrd stage of labor stage of labor according to RA 7392 isaccording to RA 7392 is
A. A. After the delivery of the babyAfter the delivery of the baby
B.B. After the delivery of the After the delivery of the placentaplacenta
Philippine Midwifery Act of 1992Philippine Midwifery Act of 1992(Republic Act 7392)(Republic Act 7392)
……..allows midwives to give oxytocics AFTER ..allows midwives to give oxytocics AFTER delivery of the placenta and if they have delivery of the placenta and if they have undergone training for it.undergone training for it.
Active management of third stage Active management of third stage of laborof labor
Injection of Injection of oxytocics after the oxytocics after the delivery of the delivery of the babybaby
Controlled cord Controlled cord tractiontraction
Massage of uterus Massage of uterus
Active management of third stage Active management of third stage of laborof labor
Requires proper learning and trainingRequires proper learning and training Controlled cord traction may Controlled cord traction may
accidentally break the cord or invert accidentally break the cord or invert the uterus when the placenta is the uterus when the placenta is adherentadherent
Midwifery Act of 1992 (RA7392) only Midwifery Act of 1992 (RA7392) only allows midwives to inject oxytocics allows midwives to inject oxytocics AFTER delivery of the placentaAFTER delivery of the placenta
Key Learning pointsKey Learning points
Wait for the signs of placental separation Wait for the signs of placental separation prior to its delivery prior to its delivery
Do not pull the umbilical cord if it is still Do not pull the umbilical cord if it is still attached to the uterus to prevent cord attached to the uterus to prevent cord breakage or uterine inversionbreakage or uterine inversion
Inject oxytocics only AFTER the delivery of Inject oxytocics only AFTER the delivery of the placentathe placenta
Always inspect the placenta for Always inspect the placenta for completeness of membranes and completeness of membranes and cotyledons.cotyledons.
ReferencesReferences
Elbourne DR, Prendiville WJ , Carroli G, Wood J, McDonald S. Elbourne DR, Prendiville WJ , Carroli G, Wood J, McDonald S. Prophylactic use of oxytocin in the third stage of labor.In: Prophylactic use of oxytocin in the third stage of labor.In: The Cochrane Library,Issue 3, 2003. Oxford. Update The Cochrane Library,Issue 3, 2003. Oxford. Update Software.Software.
Joy SD, Sanchez-Ramos L, Kaunitz AM, Misoprostol use Joy SD, Sanchez-Ramos L, Kaunitz AM, Misoprostol use during the third stage of labour. Intl J Gynecol Obstet during the third stage of labour. Intl J Gynecol Obstet 2003;82:143-1522003;82:143-152
Prendiville WJ, Elbourne DR, McDonald S. Active vs. Prendiville WJ, Elbourne DR, McDonald S. Active vs. Expectant management in the third stage of labour. In: The Expectant management in the third stage of labour. In: The Cochrane Library, Issue 3, 2003. Oxford. Update SoftwareCochrane Library, Issue 3, 2003. Oxford. Update Software
WHO, UNFPA,UNICEF, World Bank. Managing Complications WHO, UNFPA,UNICEF, World Bank. Managing Complications in Pregnancy and Childbirth. WHO/RHR/00.7,2000.in Pregnancy and Childbirth. WHO/RHR/00.7,2000.
Alejandro R. San Pedro, A Handbook on Postpartum Care, A Alejandro R. San Pedro, A Handbook on Postpartum Care, A Clinical Guide on Care of the Mother and Newborn, Clinical Guide on Care of the Mother and Newborn, Philippine Midwifery Series Book 2, 2007Philippine Midwifery Series Book 2, 2007
