The third stage of labor begins with childbirth and ends with delivery of the placenta, which typically takes 15 minutes. During this stage, the placenta separates from the uterine wall in either a central or marginal pattern and descends into the lower uterine segment. It is then expelled through contractions or with assistance. Complications can occur if the placenta is not delivered promptly, so active management with oxytocin is recommended to encourage separation and contractions.

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.