Active Management of Third Stage of Labour





-  Active management of third stage of labour



-  Reduces incidence of PPH



-  Gloves

-  Kidney dish

-  Metal clamps x3

-  Plastic cord clamp x1

-  Scissors

-  Syntocinon

-  10ml syringe

-  23g needle



-  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






Pic (CCT):