ACTIVE MANAGEMENT OF THE THIRD STAGE OF LABOUR

OSCEBY afiqi fikri

The patient is a multigravida who has successively delivered a health baby.

case scenario

02

Identify the procedure in the pictures

Super Plan 01Lorem ipsum dolor sit amet constecture, do mika do bea beo. Gundul pacul gembelengan. Nyunggi wakul kemplelengan. Lorem ipsum dolor sit amet constecture, do mika do bea beo.

Lorem ipsum dolor sit amet constecture, do mika do bea beo. Gundul pacul gembelengan. Nyunggi wakul kemplelengan. Lorem ipsum dolor sit amet constecture, do mika do bea beo.

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Controlled cord traction in the third stage of labor

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State THREE prerequisites for the procedure

Lengthening of the cord

Fresh gush of recent blood A rise of the uterine fundus

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The uterus becomes globular in shape and feels firm

Describe the correct conduct of theprocedure

• Immediately after the delivery of the baby, palpate the uterus so as to determine it is firm

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• Ensure there is no excessive bleeding (PPH)

• Check for signs of separation and ensure the patient has been administered IM oxytocin at delivery of the anterior shoulder of the fetus.

CCT - involves traction on the umbilical cord, combined with counter pressure upwards on the uterine body by the other hand placed immediately above the symphysis pubis.

The patient is not left till no active bleeding

is seen at the introitus.

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An artery clamp which has seen placed on the umbilical

cord close to the vulva is observed for some descent

denoting separation (also look for other signs of separation)

Then firm continues pressure is given till

entire placenta is delivered.

The uterus is massaged till it is firm

Any perineal tear is the repaired

The delivered placenta is checked forcompleteness

State TWO benefits of the procedure in conduct of the third stage.

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Shortens third stage

Less bleeding post partum

What further action is taken with regards tothe placenta after its delivery?

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It is checked for completeness , no cotyledons should be missing and the membrane should be complete too

Obtain instructions with regards to disposing the placenta (incineration or packaging to be sent back to the mother for cultural reasons)

State TWO complications that may occur in improper management of the procedure.

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Postpartum hemorrhage

Uterine inversion

References1. Pamela M. Spencer. Controlled cord traction in management of third stage oflabour.British Medical Journal June 1962, pp 1970

2. Begley CM, Gyte GML, Devane D, McGuire W, Weeks A .Delivering the placenta,expectant or mixed management in the third stage of labour. Cochrane Summary Nov.2011 available on line http ://summaries.cochrane.org/ CD007412/ delivering-thepla centa-with-a ctive-expecta nt-or-m ixed-ma na gem e nt-i n-the-th i rd-sta ge-of-1 a bo u r

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