Management of 3rd Stage of LabourZ
As Postpartum haemorrhage is fatal condition(the main cause of maternal mortality all over the …).
We manage 3rd stage actively to prevent PPH.
Active Management to Prevent PPH
What is Active Management of 3rd stage of labour (to prevent PPH)?:
- Control cord traction
- Ergometrine (i.m –iv) or syntocenon (iv-i.m). (contraindicated in asthma, cardiac diseases, severe hypertension)
- Syntometrine.
Signs of Placental Separation
- Sudden gush of blood.
- Elongation of the cord.
- Palpable firm rounded mass above the symphysis pubis .
Placental Separation Delay
If placenta not separated for more than half an hour:
- Message of the uterus. - to release progesterones
- Intra umbilical injection of oxytocin.
- If failed ⇒ Manual removal of the placenta.
- (in the theatre under general anaesthesia with long sleeve gloveless).
Syntocinon (Oxytocin)
When to Give Oxytocin?
- after delivery of the baby’s anterior shoulder.
- after delivery of the baby but before delivery of the placenta.
- after delivery of the placenta.
Special Precautions
- Women with borderline cephalopelvic disproportion,
- Secondary uterine inertia.
- mild or moderate pregnancy-induced hypertension.
- CV disease (e.g. hypertrophic cardiomyopathy, valvular heart disease, ischaemic heart disease, coronary artery vasospasm), long QT syndrome.
- History of caesarean section.
Fetal Side Effects
- Fetal distress.
- Arrhythmias.
Maternal Side Effects
- o Nausea, vomiting
- o Hypotension Bradycardia & Headache.
- o Myocardial ischaemia.
- o Uterine hypertonicity & Uterine rupture
- o DIC & Anaphylaxis.
- o Postpartum haemorrhage.
- o Pelvic hematoma.
- o Water intoxication. (we must give small amount dextrose)
- o Hypertension.
- o Subarachnoid haemorrhage.
Ergometrine
Active Ingredient
Ergometrine maleate.
Contraindications
- Hypersensitivity to the active substance.
- Pregnancy and labour (due to the risk of uterine hypertonus and associated foetal complications).
- Severe hypertension, pre-eclampsia, eclampsia.
- Severe cardiac disorders.
- Severe hepatic or renal impairment.
- Occlusive vascular disease e.g. Raynaud’s disease / phenomenon
- Sepsis
The Partogram
Its Graphic record of labour.
Why is it Important?
Allows visual assessment of the progress of labour based on :
- Rate of cervical dilatation compared with an expected norm…
that slow progress can be :
- Recognized early & appropriate actions are done.
- partogram shouldn’t be commenced until
the latent phase of labour is completed.
Components of the Partogram
Components of the partograph
- Part 1 : fetal condition ( at top )
- Part 11 : progress of labour ( at middle )
- Part 111 : maternal condition ( at bottom )
Definition of Normal Labour
- Spontaneous in onset
- At term
- single fetus
- vertex presentation
- Without undue prolongation within reasonable time
- With no maternal complications
- Fetal complications
- Any deviation from this definition is abnormal
What is Reasonable Time?
- (not less than 3 hours or more than 18 hours )
The World Health Organization (WHO) Definition of Normal Birth
- Defined normal birth as “
- spontaneous in onset,
- low-risk at the start of
- labor and remaining so
- throughout labor and delivery.
- The infant is and born spontaneously
- in the vertex position
- between 37 and 42 completed weeks of pregnancy.
- After birth, mother and infant are in good condition”
