The third stage of labour refers to the period from the birth of the baby to the complete delivery of the placenta and membranes. The third stage of labour is a crucial time in the management of labour.

 

Major complications such as retained placenta and primary postpartum haemorrhage could occur.

 

The third stage normally lasts between 5 and 10 minutes. The third stage is said to be prolonged if it is greater than 30 minutes.

 

The separation of the placenta from the uterus occurs in the third stage of labour . It occurs due to uterine contraction and retraction of the muscle fibers of the uterus, which leads to the formation of a cleavage plane within the deciduas basilis.

 

The Signs of Placental Separation are:

 

i) The fundus of the uterus rises up and also becomes hard and globular (rises up to the umbilicus).

 

ii) A gush of blood from the vagina.

 

iii) Lengthening of the cord.

 

The lengthening of the cord is the most convincing sign of placental separation. If a clamp is placed on the cord as close as possible to the vulva , the lengthening of the cord can be easily detected.

 

Management of the third stage of labour:

 

Active management of the third stage of labour is now recommended in modern obstetric practice. It reduces the incidence of post partum haemorrhage.

 

In active management there is no need to await signs of placental separation.

 

The active method of delivery is also known as Brandt Andrews method which is controlled cord traction (Traction and countertraction).

 

The active management of labour entails :

i) Intramuscular syntometrine (0.5 mg of ergometrine and 5iu of oxytocin) is given to the mother with the delivery of the anterior shoulder . Alternatively 10iu of synthetic oxytocin could be given. Syntometrine should not be given to hypertensive women.

 

ii) The cord should be clamped ( with two clamps) approximately 1 minute after the delivery of the baby. The lengthening of the cord is easily observed is a clamp is placed close to the vulva. The left hand of the delivery attendant (Midwife or Doctor) should feel the uterus for contraction while the right hand should grasp the cord. A steady traction should be exerted until the placenta is delivered.

 

Complications of the Third Stage of Labour

 

i) Primary postpartum haemorrhage.

ii) Retained placenta.

iii) Genital tract injuries.

iv) Acute inversion of the uterus.

v) Post partum shock and collapse.

 

Among the complications of the third stage of labour, primary post partum haemorrhage and retained placenta are the commonest complications.

 

The complications of the stage stage of labour will be dealt with extensively with posts dedicated to each complication.

 

References:

O’ Driscoll .K, Meagher D, Boylan P, Active Management of Labour, 3rd Edition. Mosby 1993.

 

Russel .K.P (1982) The course and conduct of normal labour and delivery in current obstetric , gynaecologic diagnosis and treatment, 5t edition R.C. Benson. Lange Medical Publications, Los Altos , California.

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