COMPLICATIONS OF

RD
3 STAGE OF
LABOUR
 COMPLICATIONS OF
3RD STAGE OF
LABOUR
 Postpartum haemorrhage
 Retention of placenta
 Uterine inversion
 Obstetric shock
Pulmonary embolism
 POSTPARTUM
HAEMORRHAGE
 Bleeding from genital tract more than
500cc after the delivery of fetus

 Types
 Primary-Haemorrhage occurs within
24hrs following the birth of the baby
-Third Stage Bleeding
-True Postpartum Haemorrhage
 Secondary-Haemorrhage occurs
beyond 24hrs and within puerperium
 Primary Postpartum
Haemorrhage
 Causes

1. Uterine atony
 Grand multipara
 Overdistension due to multifetal
pregnancy, hydramnios, macrosomic
fetus
 Anaesthesia, Tocolytic drugs
 Antepartum haemorrhage
2. Trauma
 Vaginal lacerations, Cervical tear, Perineal tear,
Uterine rupture, Episiotomy extension, Genital
tract trauma after instrumental delivery

3. Retained tissues
 Cotyledon, Succenturate lobe, Placenta accreta

4. Coagulation disorders
 Thrombocytopenic purpura, Hypofibrinogenemia
 Management
-Third Stage Bleeding
 Massage the uterus
 Inj Methergin 0.2 mg IV
 Oxytocin drip with crystalloid solution
 Bladder catheterization
 Antibiotics
 Express placenta by Controlled cord
traction or by Manual removal under
general anaesthesia
-True Postpartum Haemorrhage

Same as third stage bleeding plus

 Inj Misoprostol 1mg per rectum
 Bimanual compression of
uterus
 Tight uterine packing
 Balloon tamponade
 Ligation of uterine artery
 Hysterectomy
Secondary Postpartum Haemorrhage
 Causes
 Retained placenta
 Infection
 Subinvolution of uterus & Endometritis
 Choriocarcinoma, CA Cervix
 Fibroid polyp
 Management
 IV Fluids
 Blood transfusion
 Antibiotics
 Removal of retained parts
 Complications of PPH
 Shock
 Maternal death
 Acute renal failure
 Sheehan’s syndrome
 Puerperal sepsis
 RETENTION OF
PLACENTA
 Causes

1. Retained seperated placenta

 Atony of uterus
 Contraction ring
 Premature attempts to deliver
placenta before it is seperated

2. Retained non-seperated
placenta
 Simple adherance- Due to
uterine atony
 Morbid adherance- Placenta
 Complications

 Haemorrhage
 Shock
 Puerperal sepsis
 Risk of recurrence in next pregnancy
INVERSION OF UTERUS
 The body of uterus is partially or
completely turned inside out.

 Types

 First degree- Dimpling of fundus which

still remains above the level of internal
os
 Second degree- Fundus passes
through cervix but lies inside the
vagina
 Third degree(Complete)- Endometrium
is visible outside the vulva
 Causes

1. Iatrogenic
Pulling the cord when the uterus is
atonic specially when combined
with fundal pressure

2. Spontaneous
Sharp rise of intra abdominal pressure
when the uterus is lax
 Management

 Replacement of uterus
-Manual replacement
-Hydrostatic replacement
-Surgical replacement

 Antibiotics to control sepsis

 Complications

 Haemorrhage
 Shock
 Pulmonary embolism
 Infection and uterine sloughing
 OBSTETRIC SHOCK
 Causes

1. Hypovolemic Shock
 Postpartum haemorrhage
 Haematoma- Broad ligament/Paravaginal

2. Neurogenic Shock
 Uterine rupture
 Uterine inversion
3. Obstructive Shock
 Air embolism

4. Anaphylactic Shock
 Amniotic fluid embolism

5. Septic Shock
 Prolonged Rupture Of Membranes
 Retained placental tissues
 Manipulation & instrumentation
 Management

 Ensure patent airway & give 100% Oxygen

 Control active bleeding
 IV Fluids- Crystalloids, Colloids, Blood
 IV Sodium bicarbonate (For acidosis)
 Antibiotics (For sepsis)
 Others- Steroids, Morphine, Ranitidine

 Monitor
BP, ECG, Pulse oximetry, Urine output,
Serum electrolytes, CVP, ABG
PULMONARY
EMBOLISM
 Emboli can be thrombus, amniotic fluid or
air

 Clinical features
 Sudden chest discomfort
 Air hunger
 Hypotension
 Haemorrhage (due to DIC)
 Collapse

 Management
 Similar to shock