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Managemewnt of 3rd sta ge of labour


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Managemewnt of 3rd sta ge of labour

  1. 1. MANAGEMENT OF THE THIRD STAGE Signs of the placental sepration Irreversible lenghtening of the cord Fundus of the uterus gloublar Uterus become more mobileLevel of fundus rises after expulsion of the placenta from the upper segment A bulge is sometimes visible above the symphysis pubis Small gush of blood
  2. 2. • A hand gently laid up on abdominal wall over the fundus to observe uterine activity as the uterus hardens &softens with the return of uterine contractions• Secondly subsidiary signs of placental separations• Thirdly the most important reason the fundus does not get lost
  3. 3. Delivery of the placenta• Controlled cord traction (Brandt-andrews technique)• The uterus pushed upwards & backwards with the flat of the left hand while the right hand draws the cord downwards & backwards this has the effect of straightening out the genital canal in line with the pull on the placenta• By this method,the third stage is appreciably shortened &the total amount of blood lost is much reduced•
  4. 4. These attempts can be repeated every two orthree minutes only synchronously with completehardening of the uterus ,but if delivery of theplacenta if not achieved within 20 minutes bythis technique one must recognize the possibilityof manual removal of placentaControlled cord traction will not succeed if theplacenta is still attached to the uterine wall & thisis certainly true wherever there is morbidadherence of the placenta , in such casesnothing short of manual removal is likely tosucceed
  5. 5. • An intramuscular injection of syntometrine (1ml containing 0.5mg ergometrine & 5 unit of synthetic oxytocin ) at the end of the second stage reduces the risk of postpartum haemorrhage
  6. 6. RETATION OF PLACENTAL TISSUE• Placenta & if it is found that a cotyledon or a succenturiate lobe is missing the only safe thing to do is to anaethetisethe patient & explore the uterine cavity• The possibility of a retained succenturiate lobe will be indicated by the appearance of torn vessels running up to the edge of the rent in the membranes
  7. 7. • Before leaving the patient ,there for the fundus should be examined and ensured that it is well contracted• The amount of blood appearing at the vulva which is permissible should be no more then sufficient to soak a pad in the course of an hour or two any bleeding in excess of this amount demands treatment
  8. 8. Active management of the third stage of labour• Good evidence shows that active management of the third stage of lobour provides abetter balance of benefits & harms &