Management of the third stage of Labour

Objectives

• At the end of the session the student is able to;

• Define third stage • Explain the signs of placental separation• Discuss the importance of and method of

examining a placenta.• Identify complication of third stage of labour• Discuss management of the complication

Cont.objectives

• Differentiate between 1st,2nd,3rd & 4th degree tears.

Theme 6 : Third stage of Labour• The stage of labour which begins from when the baby is delivered to

the delivery of the placenta• This stage is characterized by the separation of the placenta and it’s

expulsion. Average length of time - 15minutes• Separation usually begin centrally so that a retro placental clot is

formed• Exerting pressure at the midpoint of placental attachment also aid in

the separation• NB/ The normal volume of blood flow at placental is 500-800 per min. • At placental separation this has to be staunched with second or

serious haemorrhage will occur

Complications of the third stage of Labour

• Post –partum haemorrhage:- excessive bleeding from the genital tract at any time after delivery. Total blood loss is 500mls

• Retained placenta:- Placenta remains undelivered for a period of ½ to 1hour following the baby’s birth

• Inversion of the uterus: - the uterus has turned inside out(exerting CCT) when the uterus is relaxed

Signs of Placental separation

• Sudden gush of blood

• Fundus rise above umbilicus

• Increase firmness & rounded shape of fundus

• Lengthening of the cord

Care of the mother

• It should be based on the normal physiological processes at work

• The nurses action should aim at reduce risks of; (i) of haemorrhage - PPH

(ii) of infection - Puerperal Sepsis (iii) retained placenta (iv) shock

Cont.

• Any of which may increase maternal morbidity and even threaten life

• Asepsis• The need for asepsis is even greater now than

in the preceding stages of labour.Lacerations,bruising of the cervix,vagina, perineum and vulva provide a route for the entry of micro-organisms

Cont.

• At placental sites a raw wound provides an ideal medium for infection

• Strict attention to the prevention of sepsis is therefore vital.

Delivery of the placenta

• Ensure the oxytocin is given(10units syntocinon IMI)

• Carefully exert abdominal pressure with left hand just above the pubic bone and gently push downwards and backwards

• Gently pull the umbilical cord with the right hand by downward traction – This is called Control Cord Traction(CCT).

Cont.

• This will cause the placenta to slip down the birth canal

• This process should not be hurried; great care must be taken so as to deliver the placenta and membranes intact.

• The placenta is examined after delivery for its 'completeness

• This should be done as soon as possible, check that no part of the placenta and membranes has been retained

Cont.

• It should have; - 3 blood vessels, - 2 arteries, 1 vein

• 2 membranes- amnion & chorion• Cotyledons present• Weight be taken

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EXAMINATION OF THE PLACENTA

Cont.

Ensure retained placental fragments are delivered as it can interfere with the ability of the uterus to contract – cause PPH

The cervix, vaginal wall and perineum is inspected for laceration & suturing is done.

Wash perineum with antiseptic solution& apply a padEnsure the mothers comfortBreast feeding establishedDispose all soiled linen& wash delivery equipment

Documentation

• Take postpartum BP & Pulse and record• All nursing care done is noted down in the

patients folder(from 1st to 3rd stage).• The assistant nurse documents the neonatal

record• The attendant writes the delivery notes

Activities

• Assignment – define the terms in pg.34 of the study guide:

• Each group leader is to divide their groups in to 5 small groups

• Divide the activities below in to the groups • 1. How will you promote asepsis in the Labour

Ward• 2. Maternal Birthing Positions

Cont. activities

• 3.Observations and comfort measures for a woman in her 2nd stage of Labour

• 4.Oxytocic Agents for a woman in labour• 5.Preparation of the delivery room – what will

you prepare• 6. The types of Perineal tears • 7.Perineal repair• 8.Inversion of the uterus – what is it, causes,

Cont.

• Management,how will you avoid it• 9.PPH• 10.Retained Placenta• 11.Examination of the placenta

The Fourth Stage of labour

• This refers to the first 4 hours following the delivery of the baby.

Reference

• Bennett,V.R.,& Brown K.L.(1994).Myles Textbook for Midwives.London: The Medical Division of Longman Group UK Ltd.

• Novak,J.C.& Broom, B.L.(1999).Maternal and Child Health Nursing(9th ed.) St Louis: Mosby.

• World Health Organization(2006). Integrated Management of Pregnancy and Childbirth(2nd ed.) Geneva.WHO Publication.