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THIRD STAGE
DEFINITIONDEFINITION
• From expulsion of the foetus to delivery of the placenta, cord and membranes
DURATIONDURATION
• Primigravida – 15 minutesPrimigravida – 15 minutes
• Multigravida – 5 minutesMultigravida – 5 minutes
• Generally – not > 30 minutesGenerally – not > 30 minutes
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PLACENTA SEPARATION
Two Methods
1. Schultz method
- placenta separate from centre
2. Matthew Duncan
- placenta separate from the peripheral
07/31/12 2Dr. Yin Moe Han
Schultz method
Beginning of 3drstage Placenta in lower segment End of 3rd stage
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Matthew Duncan
Beginning of 3rd stage Placenta separate fromthe peripheral
Upper segment
Upper segment contractedPlacenta separated
Tricklingof blood
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MECHANISM OF PLACENTA SEPARATION
• Once the child is delivered,
– the uterine muscle contracts
– placenta sheared from the uterine wall
– pushing it into the lower uterine segment or upper part of the vagina
07/31/12 5Dr. Yin Moe Han
SIGNS OF PLACENTA SEPARATION
1. Lengthening of the cord
2. Trickling (gush) of blood
3. Uterus - becomes hard
- mobile from side to side
- height rises to the level of umbilicus
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Beginning of 3rd stage placenta at lower segment end of 3rd stage
RISING OF THE FUNDAL HEIGHT
umbilicus
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MANAGEMENT
• Delivery of the placenta is done by “CONTROLLED CORD TRACTION” method
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CONTROLLED CORD TRACTION
• Signs of placenta separation must be present before doing CCT (to prevent uterine inversion)
• Position – supine position • Left hand – rested on the
abdomen on the uterine fundus
• Right hand – cord traction is
applied
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MANAGEMENT
• Check placenta to see if any cotyledons are missing
• Check membranes to see whether they are complete or incomplete
• Check tears of the genital tract
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