2b amtsl

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2b amtsl

  1. 1. 1Active Management of ThirdStage of Labor (AMTSL)Session 2bTrainee Handbook Pg 21Maternal Health DivisionMinistry of Health & Family WelfareGovernment of IndiaBEMoC - Presentation 2 (b)
  2. 2. ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR (AMTSL)Maternal Health DivisionMinistry of Health & Family WelfareGovernment of India2Session ObjectivesTo learn about Active management of third stage of labour(AMTSL) Care of the mother immediately after delivery
  3. 3. ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR (AMTSL)Maternal Health DivisionMinistry of Health & Family WelfareGovernment of India3What does Active Management of theThird Stage of Labor include? Administration of uterotonic drug Controlled cord traction Uterine massage
  4. 4. ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR (AMTSL)Maternal Health DivisionMinistry of Health & Family WelfareGovernment of India4Active Management of Third Stage of LaborUterotonic drugs Enhance contraction of the uterus Facilitate expulsion of the placenta Decrease blood loss and are Given after delivery of baby, after ruling outpresence of another baby
  5. 5. ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR (AMTSL)Maternal Health DivisionMinistry of Health & Family WelfareGovernment of India5Uterotonic DrugsUterotonicAgentRouteDosageActionOnset ofactionDurationof actionContraindicationStorage(oC)Oxytocin IM 10 Units 2 - 4 mins 20 minsNever give IVbolus15 – 30 oCMisoprostol Oral 600 mcg12 -15mins20 -40minsNilRoomTemp.
  6. 6. ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR (AMTSL)Maternal Health DivisionMinistry of Health & Family WelfareGovernment of India6Controlled Cord Traction (CCT) Technique to assist in expulsion of placenta. Helps to reduce the chances of a retainedplacenta and subsequent bleeding i.e. PPH.How do you perform CCT?Third Stage of labour (AMTSL)
  7. 7. ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR (AMTSL)Maternal Health DivisionMinistry of Health & Family WelfareGovernment of India7Heading???
  8. 8. ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR (AMTSL)Maternal Health DivisionMinistry of Health & Family WelfareGovernment of India8Third Stage of Labour (AMTSL)Controlled Cord Traction (CCT) Ensure that placenta is delivered complete withall membranes. If the placenta is not delivered after 30 minutes ofdelivery - refer the woman to FRU. Give information regarding drugs given, their doseand time of administration on referral slip. Never apply cord traction (pull) without acontraction and without applying counter-traction (push) above the pubic symphysis withthe other hand.
  9. 9. ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR (AMTSL)Maternal Health DivisionMinistry of Health & Family WelfareGovernment of India9Third Stage of Labour (AMTSL)Uterine massage Immediately after delivery of the placenta,massage the fundus of the uterus through thewoman’s abdomen until it is well contracted. Helps in contraction of the uterus and thusprevents PPH. Ensure that the uterus does not become relaxed(soft) after the massage. Watch for vaginal bleeding.
  10. 10. ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR (AMTSL)Maternal Health DivisionMinistry of Health & Family WelfareGovernment of India10Examination of placentaExamine the placenta and the membranes forcompleteness
  11. 11. ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR (AMTSL)Maternal Health DivisionMinistry of Health & Family WelfareGovernment of India11Retained Placenta Give information on referral slip regarding If the placenta is not delivered after 30 minutesof delivery - refer the woman to FRU• drugs given• the dose• time of administration To be discussed in detail in later slides
  12. 12. ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR (AMTSL)Maternal Health DivisionMinistry of Health & Family WelfareGovernment of India12Disposal of Placenta Disposal of the placenta should be done in acorrect, safe and culturally appropriate manner. Use gloves while handling the placenta. Put the placenta into a leak-proof bagcontaining bleach. Incinerate the placenta or bury it at least 10meters away from a water source in a 2 meterdeep pit.
  13. 13. ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR (AMTSL)Maternal Health DivisionMinistry of Health & Family WelfareGovernment of India13Uterine Massage Immediately after delivery of the placenta,massage the fundus of the uterus through thewoman’s abdomen until it is well contracted Helps in contraction of the uterus and thusprevents PPH Ensure that the uterus does not become relaxed(soft) after the massage Watch for vaginal bleeding
  14. 14. ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR (AMTSL)Maternal Health DivisionMinistry of Health & Family WelfareGovernment of India14Uterine Massage Massage the uterine fundus in a circularmotion with the cupped palm until theuterus is well contracted. When well contracted, place your fingersbehind the fundus and push down in oneswift action to expel clots. Repeat the massage every 15 minutes forthe first 2 hours.
  15. 15. ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR (AMTSL)Maternal Health DivisionMinistry of Health & Family WelfareGovernment of India15Care of the mother Examine the perineum, lower vagina andvulva for tears If present manage as per management ofvaginal and perineal tears Clean the woman and the area beneath her Put a sanitary pad / folded cloth under herbuttocks Pads/ cloths soaked can be counted toestimate the blood loss
  16. 16. ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR (AMTSL)Maternal Health DivisionMinistry of Health & Family WelfareGovernment of India16Fourth Stage of LaborFourth stage: First one-hour after delivery ofplacenta. Aim: Observation and care of the mother andnewborn Do not separate mother and the baby, unlessessential
  17. 17. ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR (AMTSL)Maternal Health DivisionMinistry of Health & Family WelfareGovernment of India17Fourth Stage of LaborCare of the mother Check every 10 minutes if the uterus is wellcontracted and observe for vaginal bleeding If the uterus - not well-contracted / bleedingis excessive, massage the uterus If bleeding persists – manage as PPH
  18. 18. ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR (AMTSL)Maternal Health DivisionMinistry of Health & Family WelfareGovernment of India18Fourth Stage of Labor Check the following every 10 minutes for thefirst 30 minutes, then every 15 minutes fornext 30 minutes and then every 30 minutes forthe next 3 hours:• General condition• BP, pulse, temperature• Uterus, whether well-contracted or not• Amount of vaginal bleeding Observe the woman for 24 hours
  19. 19. ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR (AMTSL)Maternal Health DivisionMinistry of Health & Family WelfareGovernment of India19Fourth Stage of Labor Encourage the woman to eat and drink, andrest. Encourage the woman to pass urine. If thewoman has difficulty in passing urine, or thebladder is full and she is uncomfortable, helpher pass urine by gently pouring water overher vulva.
  20. 20. ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR (AMTSL)Maternal Health DivisionMinistry of Health & Family WelfareGovernment of India20Fourth Stage of Labor Weigh the baby Ask the birth companion to stay with themother. Do not leave the mother and thenewborn alone. Ask the companion to watchthe woman and call for help if any of thefollowing signs appear
  21. 21. ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR (AMTSL)Maternal Health DivisionMinistry of Health & Family WelfareGovernment of India21Fourth Stage of Labor The bleeding increases. The woman feels dizzy The woman has severe headache The woman has visual disturbances The woman has epigastric distress The woman complains of breathlessness The woman complains of increasedabdominal or perineal pain
  22. 22. ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR (AMTSL)Maternal Health DivisionMinistry of Health & Family WelfareGovernment of India22Fourth Stage of Labor Do not discharge the woman before 24 hoursafter delivery. This is a crucial period for theoccurrence and management of PPH. Thewoman must be kept under observation duringthis time.
  23. 23. ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR (AMTSL)Maternal Health DivisionMinistry of Health & Family WelfareGovernment of India23Key Messages Active management of 3rdstage of labour. Postpartum care and contraceptioncounseling Ensure timely referral
  24. 24. 24Thank you

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