3rd stage of labour

• third stage of labour is the time from the birth of the baby to the expulsion of the placenta and membranes
• active management of the third stage involves a package of care which includes all of these three components:
  • routine use of uterotonic drugs
  • early clamping and cutting of the cord
  • controlled cord traction
• physiological management of the third stage involves a package of care which includes all of these three components:
  • no routine use of uterotonic drugs
  • no clamping of the cord until pulsation has ceased
  • delivery of the placenta by maternal effort

Prolonged third stage

• third stage of labour is diagnosed as prolonged if not completed within 30 minutes of the birth of the baby with active management and 60 minutes with physiological management

The delivery is not complete for the accoucheur until the placenta and membranes have been inspected for completeness (including three cord vessels), and the birth canal has been checked for damage.

Active management of the third stage of labour (routine administration of oxytocics and controlled traction) has been shown to reduce the risk of post-partum haemorrhage. Active management results in a slight increase in the risk of retained placenta. The average length of a third stage managed actively is 5 minutes; a passively managed third stage can last 20 minutes or longer.

Active management of the third stage is recommended, which includes the use of oxytocin (10 international units [IU] by intramuscular injection), followed by early clamping and cutting of the cord and controlled cord traction

Women should be informed that active management of the third stage reduces the risk of maternal haemorrhage and shortens the third stage

Women at low risk of postpartum haemorrhage who request physiological management of the third stage should be supported in their choice (1)

Changing from physiological management to active management of the third stage is indicated in the case of:

• haemorrhage
• failure to deliver the placenta within 1 hour
• the woman's desire to artificially shorten the third stage

Pulling the cord or palpating the uterus should only be carried out after administration of oxytocin as part of active management.

In the third stage of labour neither umbilical oxytocin infusion nor prostaglandin should be used routinely.

Reference:

1. NICE (September 2007).Intrapartum care.