Active Management of Third Stage of Labour

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Definition

- Active management of third stage of labour

Features

- Reduces incidence of PPH

Equipment

- Gloves

- Kidney dish

- Metal clamps x3

- Plastic cord clamp x1

- Scissors

- Syntocinon

- 10ml syringe

- 23g needle

Procedure

- Syntocinon 10IU IM or IV given at either

- Birth of anterior shoulder

- OR within 1-2min of birth

- Effective within 2-3min

- Clamp & cut cord within 2-3min of Syntocinon

- Use additional clamp on placental side 10-15cm away if cord gases required

- Guard uterus with counter pressure & at same time as contraction apply traction to umbilical cord

- Controlled cord traction (CCT)

- Feel for contraction with non-dominant hand

- Observe for signs of separation: lengthening of cord, small fresh bleed

- Do not encourage maternal effort/pushing

- If no decent in 20-30sec hold cord loosely & wait for next contraction then repeat

- When placenta at introitus release traction

- Twist placenta with 2 hands

- Massage fundus to prevent PPH

References

www.thewomens.org.au/labourthirdstagemanagement

Pic (CCT): www.gynaeonline.com/retained_placenta.htm