How To Mange A Woman In Third Stage Of Labour

Third stage of labour is the period following  the delivery of the baby, from placental separation to the period when the placenta is delivered.

How To Recognise The Onset of Third Stage of Labour

• Elongation of cord.
• Presence of strong uterine contraction
• Trickling of fresh blood from vagina.
• Feeling of bump on the lower uterine segment.
• Complaint of abdominal discomfort by the mother
• Appearance of any part of the placenta at the vulva.

Physiological Changes That Occur During The Third Stage of Labour

This stage involves three latent phases which are:

• Placenta separation.
• Placenta expulsion.
• Arrest of haemorrhage.

Placenta Separation;

Once the baby is born, the function of the placenta are no more needed, therefore needs to be expelled.

The force that expels the fetus causes the placenta to begin to separate. Since the placenta is a semi solid mass having no quality of contraction and retraction, as the uterine muscles contract and retract, the upper segment thickens. The cavity is reduced so that there is detachment or peeling off of the placenta from the uterine wall.

There are two major ways in which placenta separates from the uterine walls, they include;

1. Schultz Method:

Here the placenta separation starts from the centre so that a retro-placenta clot is formed which further aids separation exerting pressure at the midpoint of the placenta attachment. In this method of placenta separation, there is less blood loss and complete separation of both placenta and membranes, hence less risk of retained product of conception.

2. Mathew Duncan’s Method:

Here the placenta begins to detach unevenly at one of its lateral boarders. Separation is not aided by retro-placenta clot hence the placenta descends slipping sideways with maternal surface first. This method involves more blood loss and greater risk of retained product of conception.

Placental Expulsion

Once separation of placenta has occurred, the uterus contracts strongly forcing the placenta and membranes to fall into the lower uterine segment and finally the vagina.

Arrest of Haemorrhage(haemostasis)

This involves means of preventing excessive blood loss and its consequences.

In order to achieve this the following factors are involved;

• Retraction of the oblique uterine muscle fibres in the upper segment through which the tortuous uterine blood vessels intertwine. The clamping nature of the muscles on vessels secure a ligature action.
• The presence of vigorous uterine contraction following separation: The walls come in close contact exerting further pressure on the placenta site.
• Achievement of haemostasis: this involves transitory activation of the coagulation and the fibrinolytic system during and after placenta separation. There is clot formation reducing blood loss.

 

Management of a Woman in 3^rd Stage of Labour

• Administer oxytocin immediately after delivery of the baby.
• Clamp and cut the cord.
• Stimulate nipple with breastfeeding of the baby immediately the baby is delivered to cause oxytocin release.
• Assist the delivery of placenta through controlled cord traction while supporting the contracted uterus.
• Massage the uterus through the abdomen after delivery of the placenta.
• During recovery period, palpate the uterus every 15 minutes for two hours to make sure it is firm and monitor the amount of blood loss.

 

 

For third stage of labour to be complete the following must be done;

Control of blood loss; the midwife does the following once the placenta is delivered

• Check that the uterus is well contracted and fresh blood loss minimal.
• Inspect the perineum under a good light to asses for any trauma and institute proper repair.

Blood Loss estimation; scoop and measure all blood loss from time of delivery of the baby and placenta to estimate the accurate amount of blood loss;

• Examine placenta and membranes for completeness and presence of abnormalities.
• Immediate care of mother and baby.
• Observe the mother and baby closely one hour after delivery to ensure that they are properly cleaned up
• Observe mother for any postpartum haemorrhage.
• Check mother for uterine contraction and blood loss during this one hour of observation.
• All that has been done for the woman throughout labour should be properly recorded and charted.
• Transfer mother and baby to postnatal ward after one hour of delivery where further cares are given.

 

Complications That May Occur During This Stage of Labour

• Uterine invasion due to delivery of placenta with incomplete separation.
• Postpartum haemorhage related to uterine atony.
• Shock due to blood loss.
• Air embolism
• Retention of placenta due to abnormal adhesion
• Uterine atony due to atony due to abnormal uterine contractions.

We hope this information was helpful to you. Feel free to ask your questions in the comment section.