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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