Third stage of labour (Complete)

Question 1

Define third stage of labour

Answer 1

Period beggning at delivery of foetus and ending with delivery of placenta

Question 2

What is the typical duration of third stage of labour?

Answer 2

30 minutes - 1 hour

Question 3

What is the typical duration of third stage of labour with administration of oxytocin?

Answer 3

5-10 minutes

Question 4

What are the signs of imminent placenta delivery?

Answer 4

Gushing of blood

Elongation of cord

Ascension of uterus in abdomen

Question 5

What are the main management options for third stage of labour?

Answer 5

Physiological management

• Conservative and only delivered through maternlal effort

Active management

• Controlled cord management with cord traction alongside uterotonic drugs (e.g. oxytocin)

Question 6

What is the preferred management option in the UK?

Answer 6

Active management

Due to increased risk of PPH in physiological management

Question 7

Summarise active management of third stage of labour.

Answer 7

1) Administer 10 IU oxytocin (IM)

• As soon as anterior shoulder is birthed

2) Clamp cord after 1-5 mins

3) Controlled cord traction

4) Re-try cord traction after 10 mins if no sign of placental seperation (e.g. gushi of blood and elongation of cord)

Question 8

How much and when is oxytocin administered in active management?

Answer 8

Given 10 IU intramuscularly after delivery of anterior shoulder

Question 9

What may be given alongside oxytocin in some cases?

Answer 9

Ergometrine

Question 10

Ergometrine is contraindicted in which cases?

Answer 10

In hypertensive patients (e.g. pre-eclampsia) due to hypertensive effects

Question 11

When should patients undergoing physiological management swap over to active management?

Answer 11

If prolonged delivery (>60 minutes)

Question 12

What is the main complication that can occur in third stage of labour?

Answer 12

Post-partum haemorrhage

Question 13

What complications are associated with physiological management?

Answer 13

PPH (due to uterine atony)

Uterine atony (due to lack of uterotonic supourt)

Retained placenta (may require manual removal)

Increased risk of infection

Question 14

What complications are associated with active management?

Answer 14

Uterine inversion (due to controlled cord traction)

Nausea and vomitting

Hypertension (if ergomentine used alongside oxytocin)