Normal labour, third stage by Dr Yin Moe
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  • 1. THIRD STAGEDEFINITION• From expulsion of the foetus to delivery of the placenta, cord and membranesDURATION• Primigravida – 15 minutes• Multigravida – 5 minutes• Generally – not > 30 minutes07/31/12 Dr. Yin Moe Han 1
  • 2. PLACENTA SEPARATIONTwo Methods1. Schultz method - placenta separate from centre2. Matthew Duncan - placenta separate from the peripheral07/31/12 Dr. Yin Moe Han 2
  • 3. Schultz methodBeginning of 3drstage Placenta in lower segment End of 3rd stage07/31/12 Dr. Yin Moe Han 3
  • 4. Matthew Duncan Upper segment Trickling of blood Placenta separate from Upper segment contractedBeginning of 3rd stage the peripheral Placenta separated07/31/12 Dr. Yin Moe Han 4
  • 5. 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 07/31/12 Dr. Yin Moe Han 5
  • 6. SIGNS OF PLACENTA SEPARATION1. Lengthening of the cord2. Trickling (gush) of blood3. Uterus - becomes hard - mobile from side to side - height rises to the level of umbilicus07/31/12 Dr. Yin Moe Han 6
  • 7. LENGTHENING OF THE CORD07/31/12 Dr. Yin Moe Han 7
  • 8. TRICKLING OF BLOOD Trickling of blood07/31/12 Dr. Yin Moe Han 8
  • 9. RISING OF THE FUNDAL HEIGHT umbilicus Beginning of 3rd stage placenta at lower segment end of 3rd stage07/31/12 Dr. Yin Moe Han 9
  • 10. MANAGEMENT• Delivery of the placenta is done by “CONTROLLED CORD TRACTION” method07/31/12 Dr. Yin Moe Han 10
  • 11. 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 07/31/12 Dr. Yin Moe Han 11
  • 12. 07/31/12 Dr. Yin Moe Han 12
  • 13. LENGTHENING OF THE CORD07/31/12 Dr. Yin Moe Han 13
  • 14. CONTROLLED CORD TRACTION07/31/12 Dr. Yin Moe Han 14
  • 15. 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 tract07/31/12 Dr. Yin Moe Han 15
  • 16. CHECKING PLACENTA COTYLEDONS 07/31/12 Dr. Yin Moe Han 16
  • 17. MISSING PLACENTA COTYLEDONSMissing cotyledons 07/31/12 Dr. Yin Moe Han 17
  • 18. CHECKING FOETAL SURFACE OF THE PLACENTA07/31/12 Dr. Yin Moe Han 18
  • 19. CHECKING THE MEMBRANES07/31/12 Dr. Yin Moe Han 19
  • 20. BATTLEDORE PLACENTA07/31/12 Dr. Yin Moe Han 20
  • 21. 07/31/12 Dr. Yin Moe Han 21