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Management of the Third Stage of Labor

  1. Definition:
    The third stage of labor commences with the completed delivery of the fetus and ends with the completed delivery of the placenta and its attached membranes. It is the most important stage of labour.
  2. B. Signs of Placental Separation
    1. The uterus becomes globular and, as a rule, firmer - Earliest.
    2. There is often a sudden gush of blood.
    3. The uterus rises in the abdomen because the pla­centa having separated passes down into the lower
    4. Uterine segment and vagina, where its bulk pushes the uterus upward.
    5. The umbilical cord protrudes farther out of the va­gina. Indicating that the placenta has descended, this is the most reliable sign of placental separation

Table. Physiological Versus Active Management



Physiological Management

Active Management



None or after Placenta delivered

Assessment of size and tone

With delivery of anterior shoulder or

baby Assessment of size and tone

Cord traction


Application of Controlled cord

traction when uterus contracted

Cord clamping




*Gentle downward cord traction with countertraction on the uterine body


Indication of Early Cord Clamping

  • Preterm or growth restricted fetus due to risk of hypervolemia even an extra 40-50 ml of blood can cause CHF in premature infants, thus the cord is clamped immediately.
  • Birth asphyxia (first immediately resuscitate the baby and then think about anything else)
  • RH isoimmunization
  • HIV positive female
  • Maternal diabetes.

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