Management of Third Stage of Labour

 Management of Third Stage of Labour

1. Expectant management (traditional method)

2. Active management (preferred)

1. Traditional method

Delivery of baby

Clamp, divide and ligate the cord.

Wait and watch

Catherized bladder (if needed)

Uterus hard and contact

Wait spontaneous Separation of Placenta.

Placenta separated

Wait of spontaneous expulsion with aid of gravity.

        I    Fails

Assisted Expulsion

Injection oxtocin 5-10units intravenous infusion with RL

Or methergin 0.2mg IM

To examine placenta and membrane

To inspect vulva, vagina, perineum

2. Active management (preferred)

Injection oxtocin 10 units IM or methergin 0.2mg IM within one minute of delivery of baby.

According to WHO within one minute of delivery oxytocin given (IM) to mother.

Produce effective contraction to uterus or methergin 0.2mg IM

        I

Clamp divide and ligate the cord, cut the cord.

Deliver the placenta by controllcord traction after uterine contraction

If placental membrane tear use sponge holding forceps and twisting movement rest membrane delivered.

        I Fails

Repeat after 2-3minutes

      I Fails

Wait for 10 minutes, repeat the procedure

      I Fails

Mannual removal of Placenta 

Injection oxtocin 5-10units IV infusion or methergin 0.2mg IM

To examine placenta and membrane

To inspect, vulva, vagina, perineum

Examination of the placental membrane and cord and vulva, vagina and perineum.

1. Examine maternal surface

Cotyledons; absence of cotyledons

2. Chorion and amnion membrane

3. Blood vessels abnormality

4. Placental attachment of umbilical cord

5. Vulva, vagina, perineum inspected; injury repaired

Episiotomy wound sutured.

Clean the area with cotton swab soaked with antiseptic solution.