Clinical features of third stage of labour

 Clinical features of third stage of labor

1. Separation of placenta

2. Descent of placenta

3. Expulsion of placenta with its membrane

1. Pain 

Patient experience no pain.

Disappear discomfort in lower abdomen.

Uterine contraction

2. Sign of placenta separation

Per abdominal; 

Before separation of placenta, fundal height reaches slightly below umbilicus.

Firm to feel 

Per vaginal;

Fade colour of umbilical cord

Lengthening of cord

Trickling (gush) of blood

Uterus start shrinking

Method of Placental Separation

Bierer forceps used to grapse and slowly detach placenta from uterine wall. Instruments also used for placemental removal.

1. Schultze method

Central separation, placenta separate from centre.

2. Matthews Duncan

Placenta seprate from peripheral (marginal separation more common).

3. Crede manoeuvre

Method to separate the placenta after delivery, by placing the hand on uterine fundus in order to squeeze between the fingers the fundus to make the placenta separate and expel the placenta through vagina.

If failure of placental delivery within 30 minutes after delivery of fetus.

After separation of placenta

1. Per abdomen

Uterus shrinking within minutes of giving birth.

(Involution of uterus)

2. Per vaginal

Slight gush of vaginal bleeding

Lengthening of cord

Expulsion of Placenta and  membrane.

Maternal sign 

May be chills, slight transient hypotension.

Assisted Expulsion of Placenta 

1. Controlled cord traction

(Modified brandt-andrews method)

Palmer surface place on above symphsis pubis

(Abdomen gently pushing uterus over uterus, upward and backward).

At same time traction is applied on umbilical cord (secure with haemostat or kocher's forceps) in direction downward and backward and then apply downwards till placenta and membrane are expelled completely.

Procedure is to be attempted only when uterus is hard and contracted.

Examination of placenta, membrane and cord done.

2. Fundal pressure

Fundus is pushed downwards and backwards after placing four finger behind the fundus and thumb infront of uterus  or gently rubbing.

Pressure must give only when uteus become hard.

Uterine massage to make it hard.

Facilitates expulsion of retained clots.

Oxtocin (5-10units) or methergin (0.2mg) given IM.

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