3rd stage of labour.ppt
- 1. Third stage of labor and Complications of the third stage
- 2. INTRODUCTION The third stage of labour is period of time from the birth of a baby to expulsion of placenta and membranes. The average duration is 15 min in both gravida . The duration may reduced to 5min in active management.30minutes have been suggested if there is no evidence of significant bleeding. The risk of complications continues for some period after delivery of the placenta.
- 3. Definition :3rd stage of labor: commences with the delivery of the fetus and ends with delivery of the placenta and its attached membranes.
- 4. PHYSIOLOGICAL PROCESS I. Phase of Placental separation II. Descent of placenta to the lower segment III. Expulsion of placenta with membranes
- 5. PLACENTAL SEPARATION After the delivery of baby as the uterine cavity empties progressively, the retraction process accelerates ( the unique characteristic of the uterine muscle)
- 6. This decrease in uterine size necessarily means a concomitant decrease in placental attachment, it is unable to withstand the stress and buckles. the result is a separation of the placenta from uterine wall ,which take place in spongiosa layer of the decidua
- 7. THERE ARE TWO WAYS OF PLACENTAL SEPERATION Central:-detachment starts from centre, uterine sinuses are opened, retro placental collection of blood occurs resulting in further separation. Marginal:- Here separation starts at margin, more area get separated with progressive uterine contractions. This occurs more frequently
- 8. Descent of placenta Placenta descend into lower uterine segment or into the upper vaginal vault, causing the clinical signs of placental separation to become evident These are as follows: Sudden trickle and gush of blood Lengthening of the amount of umbilical cord visible at the vaginal introitus Change in shape of uterus from a discoid (circular) to globular Change in position of uterus as it rises in abdomen because bulk of placenta in lower uterine segment
- 9. Expulsion of placenta with membranes Placenta lies in lower uterine segment or upper vagina by contractions and retractions of uterus.
- 10. It is further expelled out by either voluntary contractions of abdominal muscles(bearing down efforts) or by manual procedure Expulsion of placenta is by two mechanism
- 11. MANAGEMENT OF THIRD STAGE Expectant management: Assisted expulsion: a)Controlled Cord traction: The palmer surface of the fingers of the left hand is placed above the symphysis pubis approximately at the junction of upper and lower uterine segment.
- 12. The body of the uterus is pushed upward and backward ,towards the umbilicus while steady tension downward and backward direction holding the clamp until the placenta comes outside the introitus. It is thus more a uterine elevation which facilitates expulsion of placenta. The procedure is to adopted only when the uterus is hard and contracted.
- 13. b)Fundal pressure The fundal is push downward and backward after placing four finger behind the fundus and thumb in front. The pressure must be given only when the uterus becomes hard. The pressure is to be withdrawn as soon as placenta passes through the introitus.
- 14. Active management: The active management is to excite powerful uterine contractions within one minute of delivery of the baby (WHO) by giving parental oxytocic. This facilitates not only early separation of the placenta but also produces effective uterine contractions following its separation.