The third stage of labor

2. SEMINAR
ON
METHODS OF PLACENTA
EXPULSION
MR.SURAJ KOSLE
B.Sc (N) 4th YEAR

3. INTRODUCTION
• Placenta expulsion occurs when the placenta comes out of the birth
canal after childbirth.The period from just after the baby is expelled is
called the third stage of labor.

4. DEFINITION
1. ACCORDING TO “HIRALAL KONAR”
The third stage of labor lasts from birth of the baby until the placenta is
expelled.It is know as the placental stage of labour.
2. ACCORDING TO “NIMA BHASKAR”
Placenta expulsion is define as the third stage of labor that is
separation and expulsion of the placenta.

5. RISK FACTORS FOR RETAINED PLACENTA
1.Uterine atony
An atony uterus With poor contraction might prevent normal placenta
separation and expulsion (in other words ,poor uterine tone).

6. 2. Placenta accreta spectrum
This include placenta accreta, placenta increta and placenta percreta
placenta accreta and is a generalised term used to describe an abnormally
adherent placenta ,where the placenta grows too deeply within the wall of
the uterus.

7. 3. Prolonged uterine surgery
Including previous cesarean birth scarring on the uterine wall can increase
the chances of your placenta attaching too deeply.
A previous retained placenta and congenital uterine
abnormalities are also thought to be risk factors.

8. 4. Preterm birth
The fetus delivered before the 37 weeks the placenta is not ready to expelled
out.

9. 5. Labour induction or augmentation
Labour induction is the process of starting labor befor it begins on its own.

10. SIGN OF PLACENTA SEPARATION
1. Gush of blood
2. Cord lengthening
3. Globular+firm uterus
4. Uterus rises

11. MECHANISMS OF PLACENTA SEPARATION
1. The Schultz method
The Schultz method occur when separation begins
at the centre of the placenta . This means that ,as it
separates ,the fetal surface of the placenta (which
looks shiny) will follow.
2. The Duncan method
The Matthews Duncan method occurs when
separation begins from the placenta. In this
method ,the whole placenta will slide down and
ont of the uterus sideways. The leading edge of
placenta and maternal surface present first.

12. 1. Cort traction
Cord traction is traction applied to the ambilical card once the women's uterus
has contracted after the birth of her baby and her Placenta is felt to have
separated from the uterine wall. Whilst counter-pressure is applied to her
uterus beneath her pubic bone until her placenta delivers.
METHODS OF PLACENTA EXPULSION

13. 2. Mannual removal
The back of your hand will be against the uterin wall feel for an edge of the
placenta. Then with your fingers tightly together sweep your hand back and force
to gently separate the placenta from the uterine wall a little at completely
detached.

14. PROCEDURE
• Manual Placenta removed is evaluation of the evacuation of the
Placenta from the uterus by hand.
• It is usually carried out under anesthesia or mere rarely under
sedation are analgesia
• A hand is inserted through the vagina into the uterine cavity and
Placenta is detached from the uterine wall and then removed
manually.

15. TYPES OF MANAGEMENT
1. Physiological management
• The Placenta is separated from the uterine wall and moved downward to
the birth canal and expelled naturally through vagina.
• This approach is recommended for women with low risk of bleeding the
hormone Oxytocin is released naturally when women are relaxed.

16. 2. Active management
During active management a drug Oxytocin is injected into the thigh of
a woman who is going to give birth to a baby.
• The umbilical cord is clamped and out in about to 5 minutes after the
baby is burn when the Placenta is separated from the uterus wall

17. PHARMACOLOGICAL MANAGEMENT
1. Tab. Misoprostol 200 mcg/orally/TDS
2. Inj. Oxytocin 0.5-10 mU/min/IV/2-8 drops/min
3. Tab. Methadone 0.2 mg/orally/TDS

18. SURGICAL MANAGEMENT
• Dilatation and curettage(D&C)
This treatment involve a surgical procedure know as a dilation and
curettage (D&C) which is done under and general anaesthesia.
The procedure will remove any pregnancy tissue from your uterus.

19. NURSING MANAGEMENT
• Monitor maternal vital sign and assess for signs of shock.
• Administer intravenous fluids and blood products a necessary.
• Monitor and manage pain.
• Assess and manage any associated bleeding.
• Provide psychological support.
• Provide nutritional diet.

20. COMPLICATIONS
• Shock due to blood loss.
• Blood clotting problems.
• The need for a blood transfusion.
• Failure of the kidney or other organs resulting from loss.
• Rarely the need for hysterectomy if uterine bleeding can’t be
controlled.

21. CONCLUSION
Placenta expulsion occurs when the placenta comes out of the birth
canal after child birth. The period from just after the baby is expelled
untill just after the placenta is expelled is called the third stage of labor.