Normal labour, third stage by Dr Yin Moe

THIRD STAGE

DEFINITIONDEFINITION

• From expulsion of the foetus to delivery of the placenta, cord and membranes

DURATIONDURATION

• Primigravida – 15 minutesPrimigravida – 15 minutes

• Multigravida – 5 minutesMultigravida – 5 minutes

• Generally – not > 30 minutesGenerally – not > 30 minutes

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PLACENTA SEPARATION

Two Methods

1. Schultz method

- placenta separate from centre

2. Matthew Duncan

- placenta separate from the peripheral

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Schultz method

Beginning of 3drstage Placenta in lower segment End of 3rd stage

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Matthew Duncan

Beginning of 3rd stage Placenta separate fromthe peripheral

Upper segment

Upper segment contractedPlacenta separated

Tricklingof blood

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MECHANISM OF PLACENTA SEPARATION

• Once the child is delivered,

– the uterine muscle contracts

– placenta sheared from the uterine wall

– pushing it into the lower uterine segment or upper part of the vagina

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SIGNS OF PLACENTA SEPARATION

1. Lengthening of the cord

2. Trickling (gush) of blood

3. Uterus - becomes hard

- mobile from side to side

- height rises to the level of umbilicus

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LENGTHENING OF THE CORD

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TRICKLING OF BLOOD

Tricklingof blood

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Beginning of 3rd stage placenta at lower segment end of 3rd stage

RISING OF THE FUNDAL HEIGHT

umbilicus

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MANAGEMENT

• Delivery of the placenta is done by “CONTROLLED CORD TRACTION” method

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CONTROLLED CORD TRACTION

• Signs of placenta separation must be present before doing CCT (to prevent uterine inversion)

• Position – supine position • Left hand – rested on the

abdomen on the uterine fundus

• Right hand – cord traction is

applied

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LENGTHENING OF THE CORD

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CONTROLLED CORD TRACTION

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MANAGEMENT

• Check placenta to see if any cotyledons are missing

• Check membranes to see whether they are complete or incomplete

• Check tears of the genital tract

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CHECKING PLACENTA COTYLEDONS

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MISSING PLACENTA COTYLEDONS

Missing cotyledons

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CHECKING FOETAL SURFACE OF THE PLACENTA

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CHECKING THE MEMBRANES

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BATTLEDORE PLACENTA

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