third stage of labour

Question 1

third stage of labour

Answer 1

Refers to the time period from the birth of the baby to the expulsion of the placenta . Umbilical cord and membranes from the uterus . Lasts between 5 - 30 minutes but can vary depending on whether the labour is managed actively or physiologically

Question 2

what are the key process of the third stage of labour

Answer 2

• Uterine contraction
  
  • Placental separation
  • Placental expulsion

Question 3

Uterine contraction

Answer 3

After the baby is born the uterus continues to contract , helping to compress the blood vessels at the site of placental attachment which reduces the bleeding.

Question 4

Placental separation

Answer 4

Uterine contractions begin after the baby is born , causing the uterine wall to shrink . This helps to detach the placenta from the uterine lining.

Question 5

Placental expulsion

Answer 5

• Once the placenta has separated from the uterine wall , It is expelled through the birth canal either with maternal effort or via medical assistance such as controlled cord traction
  
  • 750 ml of blood per min pass through the placenta
  • Increased clotting factors and blood volume at term physiologically protect against postpartum haemorrhage

Question 6

normal duration

Answer 6

The third stage of labour lass approx 5 - 15 min if actively managed
60 minutes or more if managed physiologically

Prolonged third stage may reacquire intervention to avoid complications like retained placenta or pph

Question 7

what hormones are used during the third stage of labour

Answer 7

The third stage of labour is regulated by a complex interplay of hormones that facilitate uterine contractions, placental separation and the prevention of excessive bleeding.
Major hormones involved are oxytocin , prostaglandins and endorphins .

Question 8

Oxytocin

Answer 8

Oxytocin - the primary hormone
Known as the love hormone - play a central role during labour and the third stage
Stimulates powerful uterine contractions - essential for delivering the placenta and reducing blood loss

Question 9

prostaglandins

Answer 9

Prostaglandins are hormone like compounds that also promote uterine contractions. Work with oxytocin to enhance contractions And ensure efficient expulsion of the placenta.

Production
Prostaglandins are produced locally in the uterus and contribute to uterine involution - the process by which the uterus shrinks back to its pre pregnancy size.

Clinical importance
In cases where uterine contractions are insufficient (uterine atony) prostaglandins may be administered to stimulate contractions and prevent or control excessive bleeding

Question 10

endorphins

Answer 10

Endorphins - pain relief and emotional wellbeing
Endorphins are natural pain relieving hormones that rise during labour and peak during the third stage of labour. Help mother cope with emotional stress of labour and birth .

Endorphins - effect on uterine contractions
Endorphins may help to promote relaxation between contractions and support maternal wellbeing , reducing the perception of pain associated with uterine contractions during the third stage.

Emotional bonding
Endorphins , along with oxytocin are involved in promoting emotional bonding between the mother and newborn

Question 11

signs of placental separation

Answer 11

During the third stage of labour it is essential for midwives to monitor for signs that the placenta has separated from the uterine wall. Recognizing these signs ensure timely delivery of the placenta , preventing complication such as PPH or retained placenta.

Question 12

key signs of placental separation

Answer 12

• Firm and contracted uterus
  
  • Gush of blood
  • Lengthening of umbilical cord
    Placenta visible at vulva

Question 13

firm and contracted uterus

Answer 13

What happens
As the placenta separates and moves into the lower uterine segment the uterus becomes firm and smaller in size . The fundus rises and feel more firm to touch.

Why it occurs
Uterine contractions - not only separate the placenta but also help shrink the size of the uterus , as the uterus contract , the fundus becomes more easily palpable and appears higher in the abdomen.

Clinical monitoring
A firm well contracted uterus is a positive sign that the body is working to control bleeding and expel the placenta. Midwives should monitor the fundal height and firmness as an indication that the placenta is separating properly

Question 14

gush of blood

Answer 14

Gush of blood
What happens
A sudden gush of blood is seen after the baby is delivered - indicating that the placenta is separating from the uterine wall .
Why it occurs
The separation of the placenta creates a raw surface on the uterine wall , which exposes the blood vessels that previously connected to the placenta. As the placenta detaches , blood is released.
Clinical monitoring
This is a normal physiological response , though midwives must carefully assess the volume of blood . A controlled blood flow indicates normal separation . While excessive bleeding can be a sign of uterine atony or PPH.

Question 15

lengthening of the umbilical cord

Answer 15

what happens
Once placenta detaches from uterine wall the cord often appears to lengthen visibly at the vulva as the placenta moves down the birth canal
Why it occurs
The uterus contracts , pulling placenta away from its attachment site . As the placenta moves lower into the uterus or even into the vagina , the attached umbilical cord extends , making it appear longer externally.
Clinical monitoring
Midwives often observe this as a key indication that the placenta is detaching and moving towards the expulsion of the placenta

Question 16

additional signs of placental separation

Answer 16

1. Contraction and retraction of the uterus - as the uterus contracts and retracts after the delivery of the baby , the uterine muscles shorten , aiding placental separation, this process reduces the overall surface area of the uterine wall where the placenta is attached , encouraging its detachment
   .
   feeling of relief or lightness - some women report a sensation of lightness or relief after the placenta separates

Question 17

clinical importance of monitoring signs

Answer 17

Avoiding retained placenta
Early recognition of placental separation signs help prevent a retained placenta , which can lead to excessive bleeding , infection or the need for manual removal of the placenta.

Reducing risk of PPH
Timely management based on these signs reduces the risk of PPH. A retained placenta or incomplete separation can cause significant blood loss , making it critical to identify the signs promptly.

Assisting with active management
In active management of the third stage these signs are observed with controlled cord traction , knowing when the placenta is ready to be expelled allows midwives to take appropriate steps.

Timing of placental separation
Typical timing for placental separation is within 5 - 10 minutes. During active management and up to 30 minutes in physiological management .Any delay beyond these timeframes may indicate complications and may require further assessment.

Question 18

management of the third stage physiological

Answer 18

· No uterotonic drugs
· Wait for the signs of placental separation
· Encourage mother to push when ready

Question 19

management of the third stage active

Answer 19

· Administration of uterotonic drugs
· Controlled cord traction
Uterine massage after placental delivery

Question 20

controlled cord traction

Answer 20

CCT is a technique used during the active management of the third of stage of labour to assist with the delivery of the placenta. The goal of CCT is to expedite placental expulsion after it has separated from the uterine wall , reducing the risk of PPH .by ensuring that the uterus remains contracted and preventing excessive blood loss.

Question 21

administration of uterotonic drugs

Answer 21

Before performing CCT , a uterotonic drug (oxytocin) is administered to stimulate strong uterine contractions . This is essential to help the placenta separate and prevent excessive bleeding

Question 22

Gentle traction on the cord

Answer 22

After confirming that the placenta has separated from the uterine wall (signs included lengthening of the umbilical cord, a gush of blood and a firm uterus - the midwife holds the umbilical cord and applies gentle , steady downward traction.

Question 23

Counterpressure on the uterus

Answer 23

Non dominant hand is placed on the women’s pubic bone , applying gentle counterpressure to the uterine fundus to stabilize the uterus. This helps prevent uterine inversion - a rare but serious complication where the uterus turns inside out during traction.

Question 24

when not to use controlled cord tractions

Answer 24

When not to use controlled cord traction
· If there are no signs of placental separation
· If uterus is not contracting properly
In physiological management CCT is not used as the process is allowed to proceed naturally without any intervention

Question 25

physiological

Answer 25

Physiological
· No pharmacological administration
· Less medical intervention
· May take longer

Question 26

active

Answer 26

Active
· Reduced risk of PPH
· Quicker recommended in women with additional care needs

Question 27

when to clamp cut the cord

Answer 27

· Delayed cord clamping is recommended
· Wait to clamp the cord until it stops pulsating the placenta
· Immediate clamping can cause PPH
· Early cord clamping is not recommended unless there are concerns about cords integrity
Cord should be clamped before 5 minutes but if women wants to delay it further should be supported

Question 28

delayed

Answer 28

name typically given to a practice of waiting a period of time before clamping the baby’s umbilical cord at birth.

Question 29

optimal

Answer 29

term used when umbilical cord vessels are allowed to close naturally , until cord stops pulsating and becomes white before it is clamped and cut.

Question 30

benefits of delayed clamping

Answer 30

Increased blood volume - delayed clamping allows for the transfer of 80 - 100mls of additional blood from the placenta to the baby. Extra blood increases new born blood volume by up to 30%

Improved iron stores - babies benefit from increased iron levels , reducing risk of iron deficiency and anaemia in the first 6 months of life

Boosted stem cells - delayed cord clamping provides the baby with a higher number of stem cells , which plays an essential role in tissue and organ repair.

Better cardiopulmonary adaptation - in preterm infants , delayed cord clamping improves circulation and lung development , supporting the transition to breathe outside the womb.

Question 31

Benefits for preterm infants

Answer 31

· Reduced risk of intraventricular haemorrhage - pre term babies have a lower risk of bleeding into the brain
· Lower need for blood transfusion
· Improved blood pressure

Question 32

complications of the third of stage of labour

Answer 32

· Postpartum haemorrhage
· Retained placenta
Uterine inversion

Question 33

PPH

Answer 33

PPH - is excessive bleeding after childbirth defined as loss of blood more then 500mls

Question 34

four main causes of PPH

Answer 34

Four main causes of PPH
Tone
Tissue
Trauma
Thrombin

Question 35

TONE

Answer 35

Uterine atony - the most common cause of PPH where uterus fails to contract after the placenta is delivered leading to uncontrolled bleeding.

Question 36

HOW IS TONE MANAGED

Answer 36

Immediate administration of uterotonics - like oxytocin to encourage uterine contractions
Manual compression of the uterus
Surgical interventions such as bakri balloon , uterine artery embolization or in severe cases a hysterectomy.

Question 37

tissue

Answer 37

If parts of the placenta , tissue or membrane remain in the uterus , can prevent proper uterine contractions increasing the risk of haemorrhage

Question 38

uterotonic drugs

Answer 38

Uterotonic drugs may be administered to help the uterus contract and expel the tissue. Antibiotics are prescribed if infection is suspected.

Question 39

thrombin

Answer 39

Coagulation disorders
Some women may have pre existing or acquired clotting issues that exacerbate bleeding

Question 40

management

Answer 40

Management of coagulation disorders involve administering blood products and clotting factors to correct deficiencies along with careful monitoring of bleeding and in severe cases the use of medication like tranexamic acid to reduce blood loss.

Question 41

trauma

Answer 41

Tear in the cervix , vagina or perineum can cause significant bleeding
· Management of tears in the vagina , cervix or perineum involves identifying the source of bleeding through a thorough examination and promptly suturing the tears to stop the bleeding .
· For deeper or more severe tears , surgical require may be required
Pain relief , antibiotics , and monitoring for signs of infections are essential for promoting healing and preventing complications.