Active management of the third stage

Question 1

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

Answer 1

• physiological management

- active management

Question 2

What is involved in the physiological management of the third stage?

Answer 2

-placenta is delivered by maternal effort without medications or cord traction

Question 3

What is involved in the active management of the third stage?

Answer 3

• where midwife/doctor assist in delivering placenta
• involves dose of IM oxytocin to help uterus contract and careful traction of umbilical cord to guid placenta out
• active shortens first stage and reduces risk of bleeding but can be associated with nausea and vomiting

Question 4

Who is active management offered to?

Answer 4

• offered to all women to reduce risk of PPH

- also initiated if there is haemorrhage or >60 min delay in delivery of placenta

Question 5

What are the steps of active management of the third stage?

Answer 5

• IM dose of oxytocin after delivery of babay
• cord clamped and cut within 5 minutes of birth but should be a 1-3 mins delay between delivery of baby and cord clamping to allow blood flow to the baby (unless needs resus)
• abdomen palpated to assess for uterine contraction before delivery of placenta
• then controlled cord traction is applied during uterine contractions to guid placenta out
• after delivery, uterus is massaged until contracted and firm and placenta is examined to ensure it is complete