Ld
Third Stage of Labor
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Third Stage of Labor
, Stage Three of Labor, Active Management of the Third Stage of Labor
See Also
Postpartum Hemorrhage
Retained Placenta
Epidemiology
Typical Third Stage of Labor lasts 8-9 minutes
Median blood loss 574 ml
Complications
Most Unpredictable and Dangerous Stage
Retained Placenta
(1-2%
Incidence
)
Primary
Postpartum Hemorrhage
(3-4%
Incidence
)
Uterine Inversion
Management
Active (AMTSL)
See
Postpartum Hemorrhage
Early
Pitocin
Pitocin
given at anterior
Shoulder
delivery
Contrast with
Pitocin
after placenta delivery
Pitocin
dose
Pitocin
10 Units IM or
Pitocin
20 units in 500 cc NS given as IV bolus
Benefits
Single most important measure to prevent
Postpartum Hemorrhage
Lower incidence
Postpartum Hemorrhage
Lower incidence
Retained Placenta
NNT 7 to prevent one
Postpartum Hemorrhage
>500 ml loss
Risks
No increased risk of
Retained Placenta
Risks compromise of undiagnosed second twin
However, prenatal
Ultrasound
makes unlikely
References
Prendiville (2000) Cochrane Database Syst Rev
Khan (1997) Am J Obstet Gynecol 177:770-4 [PubMed]
Controlled cord traction to deliver placenta (
Brandt-Andrews Maneuver
)
One hand applies firm traction on the
Umbilical Cord
Other hand applies suprapubic pressure
Uterine massage after delivery of placenta
Management
Oxytocin
alternatives not recommended
Carbetocin (extended release
Oxytocin
)
No benefit over standard
Oxytocin
Misoprostol
(
Cytotec
)
Less effective than
Oxytocin
, with more side effects (e.g. fever,
Nausea
,
Diarrhea
)
Does not require injection and more effective than
Placebo
References
Maughan (2006) Am Fam Physician 73:1025-8 [PubMed]
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