Coupon Accepted Successfully!


Active Management of The Third Stage

Active management of the third stage (active delivery of the placenta) helps prevent postpartum haemorrhage. Active management of the third stage of labour includes:

  1. Immediate oxytocin;
  2. Ccontrolled cord traction; and
  3. Uterine massage.
  1. Immediate Oxytocin
    1. Within 1 minute of delivery of the baby, palpate the abdomen to rule out the presence of an additional baby(s) and give oxytocin 10 units IM.
    2. Oxytocin is preferred because it is effective 2 to 3 minutes after injection, has minimal side effects and can be used in all women. If oxytocin is not available, give ergometrine 0.2 mg IM or prostaglandins. Make sure there is no additional baby(s) before giving these medications.
    3. Do not give ergometrine to women with pre-eclampsia, eclampsia or high blood pressure because it increases the risk of convulsions and cerebrovascular accidents.
  2. Controlled cord traction
    1. Clamp the cord close to the perineum using sponge forceps. Hold the clamped cord and the end of forceps with one hand.
    2. Place the other hand just above the woman’s pubic bone and stabilize the uterus by applying counter traction during controlled cord traction. This helps prevent inversion of the uterus.
    3. Keep slight tension on the cord and await a strong uterine contraction (2–3 minutes).
    4. When the uterus becomes rounded or the cord lengthens, very gently pull downward on the cord to deliver the placenta. Do not wait for a gush of blood before applying traction on the cord. Continue to apply counter traction to the uterus with the other hand.
    5. If the placenta does not descend during 30–40 seconds of controlled cord traction (i.e. there are no signs of placental separation), do not continue to pull on the cord:
      1. Gently hold the cord and wait until the uterus is well contracted again. If necessary, use a sponge forceps to clamp the cord closer to the perineum as it lengthens;
      2. With the next contraction, repeat controlled cord traction with counter traction.
      3. Never apply cord traction (pull) without applying counter traction (push) above the pubic bone with the other hand.
      4. As the placenta delivers, the thin membranes can tear off. Hold the placenta in two hands and gently turn it until the membranes are twisted.
      5. Slowly pull to complete the delivery.
      6. If the membranes tear, gently examine the upper vagina and cervix wearing high-level disinfected gloves and use a sponge forceps to remove any pieces of membrane that are present.
      7. Look carefully at the placenta to be sure none of it is missing. If a portion of the maternal surface is missing or there are torn membranes with vessels, suspect retained placental fragments.
      8. If uterine inversion occurs, reposition the uterus.
      9. If the cord is pulled off, manual removal of the placenta may be necessary.
  3. Uterine massage
    1. Immediately massage the fundus of the uterus through the woman’s abdomen until the uterus is contracted.
    2. Repeat uterine massage every 15 minutes for the first 2 hours.
    3. Ensure that the uterus does not become relaxed (soft) after you stop uterine massage.
  4. Examination for tears
    Examine the woman carefully and repair any tears to the cervix or vagina or repair episiotomy.

Test Your Skills Now!
Take a Quiz now
Reviewer Name