A side infusion containing 20 units of oxytocin in 1000 ml Balsol or normal saline must be added and run in over 4 hours. While waiting for the theatre to be ready for transfer of the patient, check continuously whether the uterus remains well contracted and for excessive vaginal bleeding. This is usually the longest stage of labour. An oxytocic drug is given if no second twin is present. Active management speeds up the delivery of the placenta and lowers your risk of having heavy bleeding after the birth (postpartum haemorrhage), but it increases the chance of you feeling and being sick. If you do have the placenta removed under anaesthesia, you’ll need to have it done within a few hours of the birth to avoid haemorrhage (Weeks, 2001). A primigravida patient who did not co-operate well during the first stage of labour delivers soon after a vaginal examination. A short note on the suturing of an episiotomy or perineal tear. the active method is used. This is given intramuscularly. A rapid intravenous infusion is commenced with a side infusion containing of 20 units oxytocin in 1000 ml Balsol or normal saline and you should make sure that the uterus is well contracted. Postpartum haemorrhage is the most common cause of maternal death in many low and middle income countries. You’ll then be offered treatment that involves: If the bleeding continues, you’ll be given more oxytocin, ergometrine or other drugs. An intravenous infusion should be started during the active phase of the first stage of labour. Once your baby’s born, the release of the hormone oxytocin will make the uterus contract and become smaller. WHO reference number: WHO/RHR/14.18. Having electronic monitoring can sometimes restrict how much you can move around. If the third stage of labour was not normal, the observations must be repeated every 15 minutes, until the patientâs condition is normal. The patient must be transferred to a level 2 or 3 hospital as an emergency. Once your baby’s born, the release of the hormone oxytocin will make the uterus contract and become smaller. by giving oxytocin 10 units intramuscular and using controlled cord traction. Available from: https://www.rcm.org.uk/news-views-and-analysis/analysis/how-to-promote-a-physiological-third-stage-of-labour [Accessed: 13th August 2018]. Available from: https://www.rcm.org.uk/news-views-and-analysis/analysis/how-to-conduct-active-management-of-the-third-stage-of-labour [Accessed: 13th August 2018], Weeks AD. A retained placenta is less common than with the active method. Her uterus was well contracted and her bladder was empty. Once the placenta has come away from your womb, you should feel some pressure in your bottom and you'll need to push the placenta out. Most babies are ready to nurse within a short period after birth. These recommendations clarify the most important components of Active Management of the Third Stage of Labour (AMTSL) and suggest that there should be an expanded emphasis on ensuring that every woman, regardless of where she delivers, is offered a high-quality uterotonic at the time of birth. This is a dangerous complication which must be rapidly and correctly managed according to a clear plan: Step 1: Call for help. Generally, active management is recommended for all women, to avoid severe haemorrhage. A full bladder causes the uterus to contract poorly, with resultant haemorrhage. controlled cord traction), the placenta can be delivered. With expectant management, signs of placental separation are awaited and the placenta is delivered spontaneously. No oxytocin injection is given, and the 3rd stage of labour happens naturally. This method is safe in most low-risk patients managed in clinics and hospitals. The patient is hypertensive. An intravenous infusion is commenced with a side infusion containing of 20 units oxytocin in 1000 ml Basol or normal saline. The blood pressure and pulse must be measured and recorded every 15 minutes. A heavy, oedematous placenta is suggestive of congenital syphilis. If the labour and delivery were normal and the infant appears to be healthy and normal, the infant should be dried and put on the motherâs abdomen. See our User Agreement and Privacy Policy. You may not feel the urge to push immediately. The needle should be cut loose from the suture material and replaced in the dish as soon as possible. If you've had lots of backache while in labour, kneeling on all fours may help. Manage a patient with a retained placenta. No. It is known as the placental stage of labour. It’s mostly used if you’re at low risk of heavy blood loss. Generally, you have two options for how you do the third stage of labour: active management and physiological management. Before the transfer or taking the patient to theatre repeat the vaginal examination. This is an extremely serious complication, which could result in the patientâs death. A missing part of the placenta, or cotyledon, is thus easily noticed. This is so your baby's head can be born slowly and gently, giving the skin and muscles in the area between your vagina and anus (the perineum) time to stretch. Step 3: A rapid intravenous infusion is commenced with a side infusion containing of 20 units oxytocin in 1000 ml Balsol or normal saline to run in over 4 hours. Thereafter, the observations should be repeated every 30 minutes for an hour. At the examination the cervix was found to be 7 cm dilated and paper thin. Any bleeding after delivery, which appears excessive. But opting out of some of these cookies may have an effect on your browsing experience. Manage a patient with postpartum haemorrhage. The drug must be protected from direct light at all times and must be kept in a refrigerator. (2013) How to promote a physiological third stage of labour. While waiting for the doctor, or arranging transfer, the following management must be followed: Start a second, rapidly running, intravenous infusion and take a sample of blood for urgent cross-matching. This can give a more accurate measurement of your baby's heartbeat. Immediately after the delivery of the infant, an abdominal examination is done to exclude a second twin. Recordings made about the third stage of labour: The condition of the perineum and the presence of any tears. Read about preventing heavy bleeding on our page What happens straight after the birth. It usually lasts less than 30 minutes, and mostly only 2 to 5 minutes. A second uterine contraction will occur 5 to 6 minutes after giving Syntometrine by intramuscular injection due to the action of the ergometrine. One pad is used to monitor your contractions and the other is used to monitor your baby's heartbeat. Once your baby's head is born, most of the hard work is over. Breaking the membrane that contains the fluid around your baby (your waters) is often enough to make contractions stronger and more regular. The placenta usually delivers about 5 to 15 minutes after the baby arrives. If the infant is breathing well the infant should be put to the breast. After 30 minutes there has been no sign of placental separation. Here’s what happens during the third – and, good news, the final – stage of labour…. There are some situations where physiological management is not advisable. If the uterus still tends to relax, examine the placenta again to check whether it is complete. A further attempt should now be made to deliver the placenta. You can change to active management at any time if needed. This is given by intramuscular injection after the delivery of the infant. Clots of blood which adhere to the maternal surface suggest that abruptio placentae has occurred. An incomplete placenta with one or more cotyledons missing can cause a postpartum haemorrhage due to an atonic uterus. During the first hour after the delivery it is essential to ensure that the uterus is well contracted and that there is no excessive bleeding. When your baby's head is almost ready to come out, your midwife will ask you to stop pushing and take some short breaths, blowing them out through your mouth. Once the uterus is well contracted, try again to deliver the placenta by controlled cord traction. Your midwife will monitor you and your baby during labour to make sure you're both coping well. An evacuation of the uterus under spinal or general anaesthesia is required if placental cotyledons are retained in the uterus. Evidence suggests it's better not to cut the umbilical cord immediately, so your midwife will wait to do this between 1 and 5 minutes after birth. Following normal first and second stages of labour, the third stage of labour is actively managed. During the latent phase, it's a good idea to have something to eat and drink because you'll need energy for when labour is established.