ACTIVE MANAGEMENT AND

NURSING CAR OF THIRD STAGE OF

LABOUR
: ‫باشراف‬
‫ ربيعة محسن علي‬.‫ د‬.‫أ‬
 Definition of Third stage

It begins immediately after the baby is born,

until the placenta is delivered.
The third stage lasts between 5-15 minutes but
any period up to 1 hour is normal.
If it lasts more than 1 hr it is considered as
retained placenta.
 Third stage: events

After expulsion of fetus to

expulsion of placenta &
membranes (afterbirths)
Duration : 15 min.
(primigravida multigravida)
 Physiology of the third stage of
labor

1. Separation of the placenta

2. Descent of the placenta
3. Expulsion of the placenta
4. control of bleeding
 Separation of the placenta

Mechanism of placental separation

It is brought by the contraction and retraction
of the uterine muscles . Separation usually
begins in the center of the placenta. At the
area of the separation the blood sinuses are
torn across. 30to 60ml of blood is connected
between maternal surface of the placenta and
.the decidua basal
Mechanism of placental separation

The uterine contractions detaches the

placenta from the uterus and the
placenta forced out of the upper uterine
segment into the lower uterine segment.
Mechanism of placental separation

A. Central separation

Advantage – Centrally retro placental clot is formed

Aids separation by exerting pressure at the mid point
of placental attachment and helps to strip the
adherent lateral boarders to peel the membranes off
the uterine wall
Mechanism of placental separation

B. Separation begins at the level of the deep

sponge layer of the decidua's . If the placenta
is embedded deeply separation will be difficult.

C . Separation occurs at the lower edge of

placenta
Methods of placental separation

Central ( Schultze) separation

Marginal (Mathews Duncan) separation

 Signs for placental separation
Gush of blood .1

The fundus rises at the level of umblicus .2

Uterus becomes globular .3

Cord lengthen .4

The uterus contracts during & after the birth of the baby.
This causes the uterus to become smaller, the placenta
.remains the same size & is pushed off the uterine wall
 Descent of the placenta .2

When the placenta has completely separated,

the constructing uterus pushes it down into the
lower uterine segment and into the vagina. The
weight of the placenta itself pulls the chorine of
the uterine wall
 Sign of placental descent
The uterus becomes hard, round and .1
.movable
.The fundus rises to the level of the umbilicus .2
.The cord seems to lengthen .3
There is a gush of blood .4
When you apply suprapubic pressure the .5
cord will no received back
.Placenta can be feet on vaginal examination .6
 Expulsion of placenta 3-
Method of placental expulsion
Using the fundus as a piston-1
The contracted fundus is used as apposition to push the
.placenta out
Controlled cord traction with oxytocin drugs .2
Controlled cord traction with out oxytocinS drugs-3
(Brandit Andreivs method)
Fundal pressure .4
/Traditional method/Bearing down by the woman .5
 Control of Bleeding-4

The third stage is the shortest

and easiest but the most
dangerous stage. Bleeding after
third stage of labour stops
:spontaneously, because of
 Control of Bleeding-4

The oblique muscles fibers of the uterus-1

run in and out between the blood vessels when the uterus is
contracted they clump the blood vessels very securely and
.the bleeding stops

Extra clotting power: The mother has extra clothing .2

power in her blood at this time the clotting mechanism is
.very powerful
 Management of third stage

Good management begins during prenatal period.

In the 1st, 2nd and 3d stage of labor to prevent
prolonged labor Skill full management reduces the
risk of hemorrhage, retained placenta, shock and
.infection
 Management of third stage

Position of the mother = the dorsal position-1

Advantage of the position

More comfortable to the mother-

Cord traction is applied more effectively-

Injuries the birth canal is observed -

 Management of third stage

Clamping and cutting of the umbilical cord-2

A. Clamp the cord soon after birth /1-3 minutes/ before it

stops pulsation or

B. Wait until cord has stopped pulsating before clamping

leave the maternal end of the cord unclamped when cord is
.cut
 Management of third stage

The oxytocin drugs -3

These drugs stimulate the uterus to contract. It is used
.before ,during & after the third stage of labor
:Advantages
.It speeds up the delivery of the placenta.1
.Lessen the blood loss .2
.Contract the uterus .3
Examination of placenta ,membranes
Examination of membranes, cord
References:
1. Clinical Practice Guidelines on Intrapartum and Immediate Postpartum
Care 2012 by Department of Health and Philippine Obstetrical and
Gynecological Society.

2. Callahan, T. (2013). Blueprints Obstetrics and Gynecology. (6th ed.).

Baltimore, MD: Lippincott William & Wilkins.

3. Pillitteri, A. (2010). Maternal & Child Health Nursing: Care of the

Childbearing and Childrearing
Family (6th ed.). PA: Lippincott William & Wilkins.