FAR EASTERN UNIVERSITY

Institute of Nursing
NCM 109- Care of Mother and Child Health at Risk or With Problem
Maternal Handouts
THE ABNORMALITIES IN THE THIRD STAGE OF LABOR

A. Third stage of labor begins from the delivery of the baby up to the delivery of the placenta.
Two separate phases are involved: placental separation and placental expulsion. This will take
place approximately 5 minutes or to some up to 30 minutes after the birth of the infant.

PLACENTAL SEPARATION:
• Abdominal contraction
• Lengthening of the cord
• Sudden gush of blood

PLACENTAL EXPULSION
▪ Natural bearing down by the mother
▪ Manual extraction by the healthcare provider
B. RETAINED PLACENTA-placenta undelivered at 30 minutes
Brandt Andrews method-cord is pulled gently the other hand presses the uterus upward to
prevent inversion
CAUSES:
✓ Placenta accreta- placental chorionic villi adheres to the superficial layer of the uterine
myometrium.
✓ Placenta increta- placental chorionic villi invade deeply into the uterine myometrium.
✓ Placenta percreta – placental chorionic villi grow through the uterine myometrium and
often adhere to abdominal structures. (bladder or intestines).

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NURSING MANAGEMENT:
❖ Identify placenta accrete
❖ Assist with rapid treatment and intervention
❖ Provide physical and emotional support
❖ Provide client and family education

C. ABNORMALITIES OF THE PLACENTA

◼ The placenta develops from the chorion frondosum, the part in contact with the most
vascular decidua
◼ Any developmental abnormality may have a clinical significance
CLINICAL SIGNIFICANCE:
 Post-partum hemorrhage
 Subinvolution
 Retained placenta
 Sepsis
 Abortion
 Premature labor
 Fetal malformation
 Fetal death
 More or less the whole chorion develops functional villi and the placenta occupies the
greater part of the uterine
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 1. PLACENTA BIPARTITA
➢ The placenta is partly divided into two lobes, with connecting vessels

2. PLACENTA MEMBRANACEA
➢ Unduly large and thin.
➢ Not only develops from chorionic frondosum but chorionic levae so whole of
ovum is practically covered.

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 3. PLACENTA SUCCENTURIATA
➢ vascular connection between main and accessory lobes.
➢ accessory lobe is retained and manually removed.

4. PLACENTA CIRCUMVALLATA
➢ Membranes appear to be attached internally to the placental edge, and on the
periphery, there is a ring of thick whitish tissue which is in fact a fold of infarcted
chorion.

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 5. PLACENTA VELAMENTOSA
➢ Distance away from the attachment of the cord and the vessels
➢ Cord at the edge of the placenta
➢ Divide in the membranes
➢ If they cross the lower pole of the chorion - vasa previa.

6. BATTLEDORE PLACENTA
➢ Sometimes the cord has a marginal instead of a central insertion.
➢ This has no clinical significance.

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D. ABNORMALITIES OF THE CORD.
✓ six or seven loops are drawn tightly round the neck
✓ as the fetus descends the cord tightens, the blood supply is interrupted and the
baby is stillborn.

✓ True knots are seen quite often but Wharton's jelly usually prevents actual obstruction by
kinking.

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 ✓ False knots are protuberances of connective tissue matrix, sometimes containing varices.

✓ Single umbilical artery

REFERENCES:
1.Cunningham, Levono, Bloom, H Auth, Rouse,Sponge. Multifetal Pregnancy Williams
obstetrics; 24th edition
2. ACOG practice bulletin. Clinical management guidelines for Obstetrician–Gynecologists.
Number 56, October 2004
3. Pillitteri A. Maternal and child health nursing. Care of the childbearing and childrearing
family. Sixth edition. Philadelphia; Lippincott Williams & Wilkins: 2010.

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