How do you manage the third stage of Labour?
Read the full abstract... Active management of the third stage of labour involves giving a prophylactic uterotonic, early cord clamping and controlled cord traction to deliver the placenta. With expectant management, signs of placental separation are awaited and the placenta is delivered spontaneously.
What are the different modes of managing the third stage?
There are different modes of managing the third stage, classified as physiological and active management. Credit: mikumistock/ Shutterstock.com. Active management consists of using controlled cord traction to expel the placenta immediately after delivery and administering early uterotonics to contract the uterus soon after the birth of the fetus.
Is active management of the third stage of pregnancy mandatory?
The active management of the third stage is not mandatory but should be offered to all women in the antenatal period, with full information being made available to them to help them arrive at a decision, according to one prominent school of thought.
What is the difference between expectant management and active management of Labor?
Active management of the third stage of labor. Active management consists of using controlled cord traction to expel the placenta immediately after delivery and administering early uterotonics to contract the uterus soon after the birth of the fetus. On the other hand, expectant management comprises an attitude of watchful waiting,...
What are the active management of the 3rd stage of labor?
Active management of the third stage of labor involves prophylactic uterotonic treatment, early cord clamping and controlled cord traction to deliver the placenta.
What is active management of the third stage of labor Amtsl?
Active management of the third stage of labour (AMTSL) reduces the occurrence of severe postpartum haemorrhage by approximately 60–70%. Active management consists of several interventions packaged together and the relative contribution of each of the components is unknown.
What does active management mean in labour?
The active management of labour was pioneered by K O'Driscoll in 1969, as a means of reducing the number of prolonged labours. Its aim was to keep labour to fewer than 12 hours and operative delivery rates to a minimum.
What drugs are used in the active management of the third stage?
Medications commonly used in the management of the third stage of labor include oxytocin, ergometrine/ergonovine, Syntometrine, misoprostol, carboprost tromethamine (Hemabate), and carbetocin.
What are the benefits of active management of the third stage of labor?
Active management of the third stage of labor has been shown to reduce the incidence of PPH, the need for blood transfusion, and the use of therapeutic uterotonics during the third stage of labor and/or within the first 24 hours after birth.
What is the first step of Amtsl active management of third stage of labor?
Therefore, AMTSL has to be applied routinely (to all delivering mothers). The sequential physiological changes in the third stage of labour are: separation of the placenta, descent of the placenta, expulsion of the placenta and control of bleeding.
What is the difference between expectant management and active management of the third stage?
Answer. Expectant management of the third stage of labor involves spontaneous delivery of the placenta. Active management often involves prophylactic administration of oxytocin or other uterotonics (prostaglandins or ergot alkaloids), cord clamping/cutting, and controlled cord traction of the umbilical cord.
How do you manage active labor?
Drug-free options to manage your labour pain naturallyContinuous labour support. ... Massage and pressure. ... Movement. ... Tub time. ... Vocalizations, breath and visualization. ... Acupuncture. ... Sterile water injections. ... TENS machines.More items...•
How long is 3rd stage of labour?
Past researches have revealed that the average duration of the third stage of labor is between 6–7 minutes.
Why do we give oxytocin after delivery?
Oxytocin prevents excessive postpartum bleeding by helping the uterus to contract. It is given to the mother by injection into a vein or into muscle during or immediately after the birth of her baby.
When do you take oxytocin in labour?
Oxytocin injection is used to begin or improve contractions during labor. Oxytocin also is used to reduce bleeding after childbirth. It also may be used along with other medications or procedures to end a pregnancy.
Disadvantages for the woman
When only low risk women were studied there were no differences between women who had the injection and those who did not (Begley at al.2011 and RCOG 2009).
Advantages for the baby
The research does not highlight any statistically significant benefits for the baby.
Disadvantages for the baby
Babies have a reduced birth weight, attributed to the loss of up to 80 mls of infant blood which is retained in the placenta due to early cord clamping (Farrar et al. 2009).
What is the 3rd stage of labour?
The original description of active management of the third stage of labour had three components—delivery of a prophylactic uterotonic drug, early cord clamping and cutting, and controlled cord traction . 1 When randomised trials in the 1980s found that this package reduced the risk of severe postpartum haemorrhage by 70%, 2 active management was adopted widely. It was thought to be especially important in low resource settings, where more than 20 000 deaths occur each year as a result of haemorrhage. 3 In these settings, active management of the third stage has almost become a mantra for the safe motherhood movement.
Does oxytocin reduce the length of the third stage?
It also showed that in sites using oxytocin alone for prophylaxis, cord traction reduced the length of the third stage by six minutes but had no effect on manual removal rates. The same may not be true when the combined oxytocin-ergometrine preparation is used.
How long is the third stage of CCT?
There was a real difference, however, in terms of the length of the third stage: third stage was an average . of six minutes longer among those women who did not receive CCT. The authors acknowledged that this can be . an important amount of time, not so much for the woman, but for the management of busy labour and delivery .
What is AMTSL in pregnancy?
AMTSL as a prophylactic intervention is composed of a package of three components or steps: 1) administration . of a uterotonic, preferably oxytocin, immediately after birth of the baby; 2) controlled cord traction (CCT) to . deliver the placenta; and 3) massage of the uterine fundus after the placenta is delivered.
What is the best uterotonic drug for postpartum haemorrhage?
The use of uterotonics for the prevention of postpartum haemorrhage (PPH) . during the third stage of labour is recommended for all births. Oxytocin (10 IU, IV/IM) is the recommended uterotonic drug for the prevention of . PPH.
Is CCT recommended for third stage labour?
duration of the third stage of labour as important. In settings where skilled birth attendants are unavailable, CCT is not . recommended. Sustained uterine massage is not recommended as an intervention to prevent . PPH in women who have received prophylactic oxytocin.
What is the third stage of pregnancy?
6.1.1 Natural processes during the third stage. In a complication-free labour, the third stage is when natural physiological processes spontaneously deliver the placenta and fetal membranes. For this to happen unproblematically, the cervix must remain open and there needs to be good uterine contraction.
What is AMTSL in birth?
A birth attendant applying active management of third stage of labour (AMTSL) is the key to reducing the risk of the complications set out in Box 6.1. The term ‘active management’ indicates that you are not waiting for spontaneous placental delivery. Rather, you will intervene in a carefully programmed sequential manner, as follows:
How to stabilize a baby's umbilical cord?
Clamp the umbilical cord close to the perineum (once pulsation of the blood vessels stops in the cord of a healthy newborn) and hold the cord in one hand. Place the other hand just above the woman’s pubic bone and stabilise the uterus by applying counter-pressure to the abdomen during controlled cord traction.
What are the physiological changes of the placenta?
The physiological changes are: As the placenta separates from the wall of uterus blood from the vessels in the placenta bed begin to clot between the placenta wall and the myometrium (the muscular wall of the uterus). The placenta moves down the birth canal and through the dilated cervix before being expelled.
What is the best intervention to reduce the risk of PPH by more than 60%?
Active management of third stage of labour (AMTSL) is the best intervention to reduce the risk of PPH by more than 60%. Therefore, AMTSL has to be applied routinely (to all delivering mothers).
What happens during the third stage of labor?
This process is always associated with a moderate blood loss – up to 500 millilitres. In this stage of labour, one of the potential problems is excessive bleeding (postpartum haemorrhage), which can result in anaemia and fatigue. This is why the third stage is carefully supervised.
What is the third stage of management?
There are two approaches to managing the third stage: natural (also known as physiological or expectant) management, or. active management.
Why is it important to have an active third stage?
The advantage of an active third stage is the lower risk of very heavy bleeding immediately after the birth. Your midwife or doctor will recommend you have an active third stage if you had complications during pregnancy or labour, such as:
What is the third stage of pregnancy?
A physiological or natural third stage means that you wait for the placenta to be delivered naturally. After your baby's birth, your midwife will delay clamping the umbilical cord to allow oxygenated blood to pulse from the placenta to your baby. Your uterus (womb) will contract, and the placenta will peel away from the wall of your uterus.
What is the third stage of labour?
This is called expectant management of third stage of labour. Active management of third stage involves three components: 1) giving a drug (a uterotonic) to help contract the uterus; 2) clamping the cord early (usually before, alongside, or immediately after giving the uterotonic); 3) traction is applied to the cord with counter-pressure on ...
Why is active management important?
Active management was introduced to try to reduce severe blood loss at birth. This is a major cause of women dying in low-income countries where women are more likely to be poorly nourished, anaemic and have infectious diseases.
Does active management increase diastolic blood pressure?
However, active management may increase maternal diastolic blood pressure, vomiting after birth, afterpains, use of analgesia from birth up to discharge from the labour ward, and more women returning to hospital with bleeding (outcome not pre-specified).
Does active management reduce bleeding?
For all women, irrespective of their risk of severe bleeding, active management may reduce severe bleeding and anaemia. However, it also may reduce the baby’s birthweight and increase the mother's blood pressure, afterpains, vomiting, and the number of women returning to hospital with bleeding. Findings were similar for women at low risk ...
Do We Need Active Management of The Third Stage?
Prophylactic Uterotonics
- These drugs cause powerful contractions of the uterus and therefore the presence of another fetus should ALWAYS be ruled out before administering them. They are always given after the clamping and cutting of the cord, and within a minute of delivery. In the active management of the third stage, all low-risk vaginal deliveries are followed by the administration of oxytocin by one o…
Clamping and Cutting The Cord
- Cord clamping is delayed by 1 minute or more in preterm neonates, to reduce complications such as intraventricular hemorrhage and need for transfusions. However, it is performed within a minute of delivery in term babies as a part of active management. The pretext for the lack of delay in clamping is the risk of physiological jaundice as more blood is retained in the fetal circulation …
Controlled Cord Traction
- CCT should be performed only when the uterus is well contracted. The delivery of the placenta is facilitated by applying traction on the part of the cord outside the vulva, first downwards with one hand supporting the fundus of the uterus to prevent uterine inversion, and then guiding it upwards and out of the birth canal once separation has occurred. This is usually done following signs of …
Conclusion
- The active management of the third stage is recommended if there is to be an overall reduction in PPH and in manual removal of the placenta. However, it cannot significantly influence the incidence of severe PPH and blood transfusion following childbirth.
Further Reading