The third stage of labor involves the delivery of the placenta, umbilical cord, and membranes. It typically lasts 15 minutes for first-time mothers and 5 minutes for others, not exceeding 30 minutes. There are two methods of placental separation - the Schultz method where it separates from the center and the Matthew Duncan method where it separates from the periphery. Controlled cord traction is used to deliver the placenta by applying gentle traction on the umbilical cord after signs of separation are present. The provider then checks the placenta and membranes for completeness.

1. THIRD STAGE
DEFINITION
• From expulsion of the foetus to delivery
of the placenta, cord and membranes
DURATION
• Primigravida – 15 minutes
• Multigravida – 5 minutes
• Generally – not > 30 minutes
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2. PLACENTA SEPARATION
Two Methods
1. Schultz method
- placenta separate from centre
2. Matthew Duncan
- placenta separate from the peripheral
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3. Schultz method
Beginning of 3drstage Placenta in lower segment End of 3rd stage
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4. Matthew Duncan
Upper segment
Trickling
of blood
Placenta separate from Upper segment contracted
Beginning of 3rd stage
the peripheral Placenta separated
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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
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6. SIGNS OF PLACENTA SEPARATION
1. Lengthening of the cord
2. Trickling (gush) of blood
3. Uterus - becomes hard
- mobile from side to side
- height rises to the level of
umbilicus
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7. LENGTHENING OF THE CORD
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8. TRICKLING OF BLOOD
Trickling
of blood
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9. RISING OF THE FUNDAL HEIGHT
umbilicus
Beginning of 3rd stage placenta at lower segment end of 3rd stage
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10. MANAGEMENT
• Delivery of the placenta is done by
“CONTROLLED CORD TRACTION” method
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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
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13. LENGTHENING OF THE CORD
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14. CONTROLLED CORD TRACTION
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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 tract
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16. CHECKING PLACENTA COTYLEDONS
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17. MISSING PLACENTA
COTYLEDONS
Missing cotyledons
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18. CHECKING FOETAL SURFACE OF
THE PLACENTA
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19. CHECKING THE MEMBRANES
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20. BATTLEDORE PLACENTA
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