Stages of Labor: Stage Three, Placental Stage

The Blissful Agony is About to Last

By
Lamayo, Nicole Gracia Oximar, Richelle
Loraez, Lennard Panes, Alexa Daphne
Luneco, Laiza Joy Purano, Rudzmah
Mercado, Shaira Kylene Quinanola, Daisy
Mesahon, Queen May Rebalde, Pearl Anne
Moleno, Mary Grace Tuvida, Irene Mae
Mori, July Martin

Ms. Yule Rachel Abayon

Subject Adviser

October, 2022
 Abstract

The third stage of labor is the placental stage which starts from birth of infant to delivery of
placenta. As the baby is born, the umbilical cord is clamped and cut, strong contractions of the
uterus cause the placenta to separate from the uterine inner wall. When the congested veins burst
with next contraction, small amount of blood is released causing villi to shear off from the spongy
layer of deciduas. Then, the placenta separates and is stripped from its attachment due to reduction
in surface area of placental site as the uterus shrinks. Whether Schultze (primary) and Matthew’s
Duncan (secondary) mechanism takes place when the placenta separates from the uterus to how it
will be going out through the vagina. However, there are possible complications that might take
place during and right after the expulsion of the placenta. These might affect the mother whi have
just birthed to be in a serious condition or even be in line with death. Through a thorough analysis,
groundwork, and fact-checking, the researchers have provided nursing managements and nursing
interventions for the study to be expanded with regards to the topic, the third stage of labor.
Furthermore, future regimens were discussed which includes drug therapy and administrations as
a recommendation (drugs mentioned: Syntometrine, Ergometrine, Carboprost).
 Table of Contents
Introduction ................................................................................................................................................... 3

Stage three of labor ....................................................................................................................................... 3

Signs of placental separation: ................................................................................................................... 4

Separation of the Placenta ......................................................................................................................... 4
Methods of Placental Separation.......................................................................................................... 4
Expulsion of the Placenta.......................................................................................................................... 5
Nursing Management .................................................................................................................................... 6

Possible Complications During the Third Stage of Labor .......................................................................... 11

Retained Placenta .................................................................................................................................... 11

Postpartum Hemorrhage ......................................................................................................................... 12
Uterus atonic or flabby............................................................................................................................ 12
Inversion of the uterus ............................................................................................................................ 13
Case Study Samples .................................................................................................................................... 14

Case Study 1 ........................................................................................................................................... 14

Case Study 2 ........................................................................................................................................... 15
Nursing Intervention ................................................................................................................................... 15

Conclusion: Summary................................................................................................................................. 19

Future Regimen....................................................................................................................................... 20
References ................................................................................................................................................... 21
 Introduction
Most women perceive labor pain and childbirth as the most severe and agonizing event of a
woman's existence. For they need first to undergo various stages of labor pain before the
deliberation of their baby. Labor is defined as a physiologic process during which the fetus,
membranes, umbilical cord, and placenta are expelled from the uterus (Milton, 2019). A series of
continuous, progressive contractions of the uterus that help the cervix dilate and efface.
Obstetricians have divided labor into 3 stages that delineate milestones in a continuous process.
During the three stages of labor, a pregnant body will prepare for the birth of a baby which is
considered to be the first stage. It occurs when a pregnant woman begins to feel persistent
contractions. Then the deliberation of the baby will fall into stage two. In the second stage of labor,
the cervix is fully dilated and ready for childbirth. Meaning it refers to the period following the
completed delivery of the newborn until the completed delivery of the placenta. This stage is the
most work and can be as short as 20 minutes or as long as a few hours. The third one is defined as
the time between the delivery of the baby and the expulsion of the placenta. This stage is when
mothers probably feel a wonderful sense of relief after having their baby. The infant can be carried
on its belly or in arms. However, they must keep in mind that the placenta will be delivered when
labor enters its third stage. It can take up to an hour to deliver the placenta, but this is the average
time frame. The contractions will still come frequently, but they will be milder and less painful.
Placenta entry into the delivery canal is aided by contractions. The placenta must be delivered;
therefore, mothers will be instructed to gently push once more. If retained placenta occurs, this
often makes delivery more difficult and causes severe bleeding. Thus, this paper will focus on and
further discuss the various information and processes that took place in stage 3.

Stage three of labor

Third Stage of Labor or the placental stage starts from birth of infant to delivery of placenta. It is
divided into two separate phases: placental separation and placental expulsion. Five minutes after
delivery of baby, the uterus begins to contract again, and placenta starts to separate from the
contracting wall along with its membranes. The mother is hardly aware of this process. Usually,
the mother is given an injection of hormone into her thigh or her buttock(s) that causes or
stimulates the uterus to contract. This injection is given when the baby is being born; when the
first shoulder is emerging, the nurse should ask the mother for consent before the hormone is being
injected. Then, as the baby is born, the umbilical cord is clamped and cut. This is where the
injection takes effect; strong contractions of the uterus cause the placenta to separate from the
uterine inner wall.

Signs of placental separation:

- Lengthening of umbilical cord
- Sudden gush of vaginal blood
- Change in the shape of uterus (globular in shape)- Calkin's sign
- Firm uterine contractions
- Appearance of placenta in vaginal opening

Separation of the Placenta

When the congested veins burst with next contraction, small amount of blood is released
(extravasated) causing villi to shear off from the spongy layer of deciduas. Then, the placenta
separates (at Layer of Nitabusch)-stripped from its attachment due to reduction in surface area of
placental site as the uterus shrinks. Since the placenta is undermined, detached, and propelled into
lower uterine segment, the non-elastic placenta is also detached from the shrinking uterine wall.
The primary mechanism is the reduction in surface area of placental site as the uterus shrinks which
is the Schultze mechanism. The secondary mechanism is the formation of haematoma due to
venous occlusion and vascular rupture in the placental bed caused by uterine contractions, and is
called as the Matthew Duncan mechanism.

Methods of Placental Separation

Schultze Mechanism

The placenta normally separates in the center and folds in on itself, peeling off the membranes as
it descends into the lower part of uterus. Fetal surface appears at vulva with membranes trailing
behind. Minimal visible blood loss is observed for the retroplacental clot is contained within
membranes (inverted sac).

Matthews Duncan Mechanism

Less commonly, separation starts at the lower edge of placenta (asymmetrical/lateral border
separates). Then the placenta slips down sideways and the maternal surface appears first at vulva.
Usually, it is accompanied by PV bleeding – blood from placental site escapes immediately. No
form of retroplacental clot because of the slower separation which results to more blood loss
compared to Schultze Method.

Expulsion of the Placenta

The mother may be able to push the placenta out, if it cannot be done, the nurse helps the delivery
of the placenta by putting one hand on the abdomen to protect the uterus, while the cord is kept
taut with the other. While the placenta peels away, the blood vessels, which hung on to it close off
which stops the bleeding though it is normal if the mother bleeds lightly. When the mother
breastfeeds, or just simply having the baby there, serves as a stimulator which causes the release
of the hormone oxytocin. This functions on the uterus, causing it to contract, expelling the placenta
and membranes. The cord is cut when it stops pulsating, and often after the placenta is delivered.

Equally, a physiological third stage; having to use no injections, waiting for the cord to be cut, and
without the help of delivering the placenta—this is when the doctor advices to leave things to
happen in a natural way. If the mother prefers to have a nature third stage, not consenting to be
injected, should have her guardian or spouse to look after her. The mother should discuss first to
the healthcare team before going into labore if her preference is to have no injection for her third
stage of labor. Moreover, if the mother has had problems during her pregnancy or during the labor,
a natural third stage is not a safe option.
 Nursing Management
The World Health Organization (WHO) states that Active Management of the Third Stage Labor
(AMTSL) is a set of three elements or processes used as a preventative intervention:
1) administration of a uterotonic, preferably oxytocin, immediately after birth of the baby;
2) controlled cord traction (CCT) to deliver the placenta
3) massage of the uterine fundus after the placenta is delivered.

ACTIVE MANAGEMENT: AVOID SEVERE HEMORRHAGE

Administering a uterotonic as soon as the To avoid Postpartum Hemorrhage

baby is born, preferably oxytocin.

Only attempt delivery once the placenta is To prevent uterine inversion or generating an open
completely detached. bleeding area in the uterine wall by removing only
a portion of the placenta from the uterine wall while
leaving the remainder connected.

Check for separation by:

Putting the ring forceps on the part of the

umbilical cord that is just outside the
introitus and letting it hang down by its
own weight after the birth.

Putting a hand through the abdominal wall

and over the uterus (inside a folded sterile
towel). to observe when the uterus
constricts into a firm ball that slightly rises
under the hand.
Asking the woman to inform the midwife
when she experiences her next
contractions or "cramps" after the baby is
delivered.

Observing whether the chord lengthens or

if there is a minor blood gush. This might
not always be immediately obvious.

Noting the time of the baby's birth to

determine how long the midwife waited
for the placenta to separate. Many
placentas do not separate within the first
10 minutes, therefore unless it is obvious
earlier, it should be checked for separation
at that time.

Ask the mother to bear down at the same

time when she feels a contraction, notices
a gush of blood, the cord lengthening, a
change in the uterine firmness, or ten or
more minutes have passed;

With one hand cupped and the thumb

positioned just above the pubic bone,
apply firm pressure against the uterus'
fundus.

to prevent the uterus from entering the pelvis,

inverting the uterus, or creating false cord
 lengthening or other misleading indications of
separation.

In order to determine whether there is a

sense of "give" when the placenta
advances into the vagina and the cord
lengthens, provide a steady cord traction.
If, on the other hand, nothing happens,
stop the operations and wait.

If unsure whether the placenta has

detached, use hand to trace the cord up to
the cervical is to see if the placenta is
lodged there or if it enters the uterus.

Use maternal efforts to deliver the placenta

Maintaining the abdominal hand over the

uterus while helping the placenta depart
the cervical canal and enter the vagina
requires the use of flattened fingers right
above the pubic bone. The Brandt
Andrews maneuver may be performed in
place of pressure with flattened fingers;
however, this is more uncomfortable for
the mother.
As the placenta travels through the vagina
to the introitus, place the fingers around
the ring forceps at the spot where the cord
is attached. Apply consistent cord traction
downward, then upward along the Carus
curve.

Use the hand holding the ring forceps to

lift the placenta partially through when it
is visible at the introitus.

Allow the placenta to fall into the hands

while removing the other hand from the
abdomen. Drop the cord and the ring
forceps immediately.

Gently rotate while raising and lowering

the placenta to bring through the os.

If this is insufficient, grab the membranes

laterally with the ring forceps.
To gently tease the membranes through
the introitus, gently twist the ring forceps
to create a thicker cord of the membranes.

Once the placenta has been removed,

massage the uterus a few times to induce
labor. Wipe the blood from the introitus
and lower vaginal area to check for any
further bleeding.

PHYSIOLOGICAL MANAGEMENT: recommended for woman with low risk of bleeding

The placenta is freed from the uterine wall, lowered into the birth canal, and then naturally
ejected through the vagina.

Skin-to-skin contact triggers an increase in oxytocin release, which helps the placenta to birth
naturally.

Within 10 minutes, the placenta separates from the uterine wall. The placenta must exit through
the vagina after separation because otherwise it could be harmful. Delivering the placenta
involves women directly.

The woman adjusts its posture and employs methods advised by the midwives, including as
taking a warm bath or blowing into a bottle, to naturally expel the placenta from the uterus.

Drugs are given for placental delivery if blood loss increases or if there is a longer waiting period.
 Possible Complications During the Third Stage of Labor
The third stage of labor is the interval from birth of the neonate to the delivery of the placenta and
fetal membranes. In a complication-free labor, it ought to be a period of rest and rejoicing after
the birth of the baby, but in thousands of women it can be very dangerous. This is due to the
numerous complications that may arise during the third stage. Complications inherent in the third
stage of labor account for a significant percentage of overall maternal morbidity and mortality.

Retained Placenta
When the mother does not discharge the placenta and membranes within 30 minutes of giving birth
to her child, she is experiencing a retained placenta; also called as retained fetal membrane or
retained cleansing. The third stage is regarded as retained or delayed by the US National Institute
for Health and Care Excellence (NICE) if it requires more than 30 minutes of active management
or 60 minutes of maternal effort.

Retained placenta can cause life-threatening complications, including as heavy bleeding and
infection, if left untreated.

Signs and Symptoms of a Retained Placenta

The failure of the placenta to be entirely expelled from the womb an hour after the infant is
delivered is the most visible indicator of a retained placenta. Other signs can include:

• fever
• a foul-smelling discharge from the vaginal area
• large pieces of tissue coming from the placenta
• heavy bleeding
• pain that does not stop

Three Types of Retained Placenta

• Placenta Adherens or Adherent Placenta

o The most typical kind of retained placenta is this one. This happens when the
womb's contractions are insufficient to fully evacuate the placenta. As a result, the
placenta continues to be only lightly adhered to the uterine wall.
 ▪ Cause: This occurs as a result of the placenta being deeply entrenched
within the womb.
• Trapped Placenta
o The placenta that was trapped is still inside the uterus. A placenta is said to be stuck
when it successfully separates from the uterine wall but is not evacuated from the
woman's body.
▪ Cause: The cervix frequently closes before the placenta has been released
causing a trapped placenta.
• Placenta Accreta
o It occurs when the placenta connects to the uterus's muscular walls rather than its
lining. Delivery becomes more challenging, and major bleeding frequently occurs.
There may be a need for blood transfusions or possibly a hysterectomy.
▪ Cause: Placenta Accreta takes place when the placenta has become deeply
embedded in the womb, possibly due to a previous cesarean section scar.

Due to the placenta's interference with the uterus' ability to contract, the latter three circumstances
may also result in uterine atony and PPH.

Postpartum Hemorrhage
When the third stage of labor is prolonged to 20-24 minutes (as opposed to the 30 minutes that
was the earlier benchmark), it may increase the risk of postpartum hemorrhage (PPH) which claims
the lives of more than 1.25 million women annually.

Even when it does not result in the death of the mother, it leads to significant blood loss (over half
a liter of blood) after childbirth in a staggering 14 million cases. Majority of this bleeding
originates from the placental site, which fails to contract properly. Natural figure-of-8 muscle
fiber loops are typically present around the blood vessels, allowing the ruptured vessels to close
quickly after the placenta separates and the uterus contracts. PPH is particularly dangerous since
two out of every three women who develop PPH had no preexisting risk factors prior to delivery.

Uterus atonic or flabby

In some women, the uterus may not contract hard sufficiently to completely detach or discharge
the placenta. As previously stated, a flabby uterus may relate to a retained placenta, however it
may also be related with disorders such as:
 • Placenta previa, or implantation of the placenta in the lower section of the uterus, which
implies that blood arteries and placental tissue infiltrate the muscle fibers. This results
in feeble contractions following delivery.
• Placental abruption, or early placental detachment before the kid is born.
• Multiparity
o A woman with more than five pregnancies may have an atonic uterus and PPH.
• Multiple pregnancy
o When a woman is having twins or higher order pregnancies, her belly and uterus
are very swollen. The stretched uterine muscle fibers may be unable to contract
effectively shortly after birth, resulting in atony.
• Polyhydramnios
o This is the occurrence of too much (over 3L) amniotic fluid inside the uterus,
which ultimately caused overstretching and, across several cases, atony of the
uterine muscle.
• fod fetus
o A woman bearing a large baby (weighing 4 kg or more) is also at risk for uterine
atony because the muscles are impaired by the hyperextending.
• Prolonged labor and dehydration
o Uterine atony is more likely in women who have been in labor for more than
12 hours, possibly due to muscle exhaustion, dehydration, and acidity.

Inversion of the uterus

This is an uncommon but significant complication of the third stage, which is somewhat more
prevalent with controlled cord traction, in which the uterus is flipped inside out and partially or
entirely exits out the vulval opening. To prevent this, never use this procedure to remove a non-
separated placenta. Fundal support is also taught as a means of avoiding uterine inversion, although
there is not enough research to back it up. The following are risk factors for uterine inversion:

• Multiparity
• Long-term labor that lasts more than 24 hours
• Abnormally short umbilical cord
• Abnormal cord traction
 • Placenta coalesces when the placenta is sturdily connected to the uterine muscle and cannot
separate Congenital uterine abnormalities.

Case Study Samples

Case Study 1
Mrs. X, 23 years old postnatal mother delivered by normal vaginal delivery with episiotomy. She
got admitted with Labor pain, syntocin 5 units in 5% dextrose was administered. Cervibrim gel
(0.5mg) was applied. She delivered a male baby, cried immediately after birth. But the placenta
was remained inside and there are no signs of placental separation. even after 45 mins of birth of
the baby, the placenta is not come out and the cervical os is closed and the placenta get retained
inside the uterus. Under spinal anaesthesia uterus is explored and the placenta seem to be adherent.
They removed manually in to with entire membranes after carefully separating the edge of the
placenta from the uterine wall. The episiotomy wound closed in layers. The uterus contracted well
on vaginal bleeding. inj. Methergin 1 amp, inj. syntocin 10 units in normal saline was administered.

Signs and symptoms

In this case study, no signs of placental separation of morbid adherent placenta were observed.

Complications

● Post-partum hemorrhage

● Shock

● Puerperal sepsis

● Thrombophlebitis in the pelvis and leg veins

● Embolism and risk of recurrence in the next pregnancy

Conclusion

Retained placenta is one of the reasons for post-partum hemorrhage, hence health care
professionals take judicious judgement and appropriate intervention to prevent dangerous
complications of retained placenta.
Case Study 2
A 32-year-old female, gravida 4 para 3, was diagnosed with a retained placenta after delivering at
term (39 weeks gestation). The retained placenta was complicated by postpartum hemorrhage and
was treated within 15 minutes of fetal delivery with several uterotonics (misoprostol, oxytocin,
carboprost, and tranexamic acid) and several passes of ultrasound-guided suction curettage. Sharp
curettage was also used with ultrasound to confirm that the uterus was empty, followed by one
more suction curettage to remove any products of conception that were scraped off with sharp
curettage. Vaginal bleeding was significantly reduced; minor bleeding was noted from a first-
degree vaginal laceration, which was repaired by suture. The patient recovered from surgery and
was discharged on postpartum day 3 with her neonate in stable condition. In conclusion, this case
highlights that retained placenta is a serious obstetric complication that can cause life-threatening
postpartum hemorrhage. More data is needed to define the period correlating with the greatest
chance of encountering a retained placenta in order to improve obstetric care and reduce maternal
morbidity and mortality. Future research should consider challenging the current definition of
retained placenta, defined as a placenta undelivered after 30 minutes, in favor of a shorter time
period, 15 minutes undelivered, in order to mobilize the obstetric team, anesthesiologist, and blood
bank to prevent catastrophic postpartum hemorrhage.

Nursing Intervention
Nursing interventions, which are far from the drama-filled scenarios you might have imagined, are
defined simply as "any act by a nurse that executes the nursing care plan" in medical dictionaries.
Numerous interventions are regular, such as turning patients to prevent bedsores, aiding patients
to manage their pain, and providing support to stop falls.

A standardized classification scheme known as Nursing Interventions Classification is used to

track nursing interventions (NIC). This classification system is used by nurses to communicate
with other medical professionals about interventions and to record their own actions.
 Complications
• Pospartum Hemorrhage ( PPH )
• Retained Placenta
• Atonic or Flabby Fetus
Observe the following:
Nursing Intervention
Independent:
➢ Weigh all the pads to keep track of
the amount of bleeding. Frequently
monitor vital signs.
➢ Stroke the uterus.
➢ Position the mother in
Trendelenberg.
➢ Offer comforting gestures like deep
breathing and back rubs. Teach
breathing or visualization
techniques.
➢ Offer entertainment opportunities.
Collaborative:
➢ Offer entertainment opportunities.
➢ Dispense medicine as directed (e.g.,
Pitosin, Methergin ).
➢ The safe process of injecting oxytocin
into the umbilical vein can result in
placental separation and delivery,
sparing some women the need for
manual removal. In a nurse-midwifery
setting, this method may be helpful in
managing a retained placenta or an
extended third stage of labor.
➢ Determine if the lady has other risk
factors for postpartum bleeding.
➢ Fundus for position, firmness, and
height.
 ➢ Lochia for color, amount, and clots;
count pads and level of saturation
(weigh pads for greater accuracy); and,
in accordance with hospital practice,
measure blood pressure, pulse rate, and
breathing rate.
Observe for less obvious signs of bleeding:
➢ The fundus is solid and there is a steady
trickle of brighter crimson blood.
➢ Extremely uncomfortable pain,
especially when it is accompanied by
alterations in the vital signs or
indications of shock.

Observe for other signs and symptoms of

hypovolemic shock.

If signs of hemorrhage are noted, take

appropriate actions according to the probable
cause for hemorrhage:

➢ Uterine atony: Notify a licensed nurse

and/or health care provider for orders
and medicine if the uterus does not
become hard and stay firm. Massage the
uterus until firm, being careful not to
over-massage it. When the uterus is
firm, evacuate blood from the uterine
cavity.
 ➢ Lacerations: to ask a licensed nurse or
other healthcare professional to evaluate
the woman.
➢ Hematomas on the vulva: use a cold
pack on the affected region.
• Uterine Inversion ➢ Promptly recognize uterine inversion
and aid in its rectification.
➢ Recognize signs of impending
inversion, and immediately notify the
physician and call for assistance.
1. The uterus will not become cervically
entrapped if the uterus is quickly
manually replaced after inversion;
otherwise, there may be a rapid and
severe blood loss that could lead to
hypovolemic shock.
2. Take action to avoid or reduce
hypovolemic shock.
3. For fluid replacement, use a large gauge
intravenous catheter.
4. Every 5 to 15 minutes, measure the
maternal vital signs and record them to
create a baseline and track changes.
➢ Open an intravenous line that has been
created for effective fluid replacement.
➢ To assess the likelihood of a blood clot
forming, a fibrinogen level should be
taken.
➢ Get ready for anesthetic if necessary.
➢ Get ready to perform CPR if necessary.
 ➢ Prepare the client and family for
potential general anesthesia and surgery
if manual reinversion is unsuccessful.

Conclusion: Summary
Labor lasts 12 to 14 hours for first-time mothers. Women who have given birth previously should
anticipate a labor that lasts for about 7 hours, along with period-like pains, backaches, diarrhea, a
tiny bloody discharge (called a "show") as the cervix thins and the mucus plug comes out, a gush
or trickle of water as the membranes split, and contractions. There are two mechanisms in the
separation of the placenta; the Schultze mechanism and the Matthew’s Duncan mechanism.
Schultze mechanism is identified if the placenta normally separates in the center and folds in on
itself, peeling off the membranes as it descends into the lower part of uterus. While the Matthew's
Duncan mechanism happens when the placenta slips down sideways and the maternal surface
appears first at vulva. The main difference between two mechanisms is that; Schultze mechanism
has its retroplacental clot is contained with its membranes while the Matthew Duncan’s is not. The
third stage can be managed using one of two methods: active management, which has been shown
to decrease excessive blood loss and other significant consequences. Physiological management is
the practice of letting the placenta deliver naturally with only the assistance of gravity or breast
stimulation. After the expulsion of the placenta, the World Health Organization (WHO) states that
Active Management of the Third Stage Labor (AMTSL) is a set of three elements or processes
used as a preventative intervention: 1) administration of a uterotonic, preferably oxytocin,
immediately after birth of the baby; 2) controlled cord traction (CCT) to deliver the placenta; 3)
massage of the uterine fundus after the placenta is delivered.

However, after the baby is born, there should be a time of rest and celebration if the labor was not
complicated, but for many women, this time can be quite risky. This is because there are a lot of
potential third-stage issues. The third stage of labor's intrinsic complications are a considerable
contributing factor to overall mortality and morbidity among mothers. These possible
complications are retained placenta, PPH, and inversion of the uterus (together with its types).
Therefore, nursing intervention is an essential part of the nursing practice. Not only that it can
lessen one’s suffering, a mother’s suffering specifically, but it can also save lives.
Future Regimen
Uterine hemorrhage prevention and therapy Ergometrine and oxytocin (Syntometrine), when
administered intramuscularly, can decrease bleeding brought on by incomplete abortions. Early
pregnancy benefits more from their combination than from each medicine alone.

Ergometrine 500 micrograms and oxytocin 5 units (Syntometrine 1 mL) are intramuscularly
injected to treat the third stage of labor on a routine basis. This is done upon delivery of the anterior
shoulder or, at the latest, right away after the baby is delivered. Oxytocin injections intramuscularly
alone may be used to treat pre-eclampsia. Additionally, postpartum bleeding is treated with these
regimens. I.V. administration of the same medications is possible. for uncontrollable uterine
hemorrhage brought on by uterine atony. For hemorrhage that is resistant to ergometrine and
oxytocin, carboprost is an option.

When various management techniques have failed to control postpartum uterine bleeding caused
by atony, carboprost tromethamine, a prostaglandin, is administered. It is a prostaglandin made in
a lab. It binds to the prostaglandin E2 receptor, resulting in myometrial contractions that induce
labor or cause the placenta to be expelled. Prostaglandins are naturally produced by the body and
act in a few of locations, including the womb (uterus). They exert their influence on the womb's
muscles, prompting them to contract.
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