Seminar on

third stage of
labor

Submitted to : Submitted by:

Dr.Manjubala Dash C.Madhubala

Dept of OBG. Dept of OBG

The Third Stage of labor
The third stage of labor, the placental stage, begins with the birth of the
infant and ends with the delivery of the placenta.
Two separate phases are involved:
 placental separation
 placental expulsion.
After the birth of the infant, the uterus can be palpated as a firm, round
mass just below the level of the umbilicus. After a few minutes of rest,
uterine contractions begin again, and the organ assumes a discoid shape.
It retains this new shape until the placenta has separated, approximately
5 minutes after the birth of the infant.
Placental Separation
As the uterus contracts down on an almost empty interior ,there is such a
disproportion between the placenta and the contracting wall of the
uterus, that folding and separation of the placenta occur. Active bleeding
on the maternal surface of the placenta begins with separation, which
helps to separate the placenta still further by pushing it away from its
attachment site. As separation is completed, the placenta sinks to the
lower uterine segment or the upper vagina.
The placenta has loosened and is ready to deliver when:
• There is lengthening of the umbilical cord.
• A sudden gush of vaginal blood occurs.
• The placenta is visible at the vaginal opening.
• The uterus contracts and feels firm again.
If the placenta separates first at its center and lastly at its edges, it tends
to fold on itself like an umbrella and presents at the vaginal opening with
the fetal surface evident. Approximately 80% of placentas separate and
present in this way. Appearing shiny and glistening from the fetal
membranes, this is called a Schultze presentation. If, however, the
placenta separates first at its edges, it slides along the uterine surface and
presents at the vagina with the maternal surface evident. It looks raw,
red, and irregular, with the ridges or cotyledons that separate blood
collection spaces evident; this is called a Duncan presentation. Although
there is no difference in the outcome, record which way the placenta
presented. A simple trick of remembering the presentations is
remembering that, if the placenta appears shiny, it is a Schultze
presentation. If it looks “dirty” (the irregular maternal surface shows), it
is a Duncan presentation This stage takes a total of about 15 minutes.
Because bleeding occurs as the placenta separates, before the uterus
contracts sufficiently to seal maternal capillaries, there is a blood loss of
about 300 to 500 ml, not a great amount in relation to the extra blood
volume that was formed during pregnancy.
Placental Expulsion
Once separation has occurred, the placenta delivers either by the natural
bearing-down effort of the mother or by gentle pressure on the
contracted uterine fundus by the primary health care provider (a Credé
maneuver). Pressure should never be applied to a uterus in a
noncontracted state, because doing so could cause the uterus to evert
(turn inside out),accompanied by massive hemorrhage (Stevens &
Wittich, 2011). If the placenta does not deliver spontaneously, it can be
removed manually. It needs to be inspected after delivery to be certain it
is intact and part of it was not retained (which could prevent the uterus
from fully contracting and lead to postpartal hemorrhage). In recognition
of cultural preferences, be certain to ask if a woman wants to take home
the placenta because this can be a strong cultural tradition you don’t
want to break Some women choose to have a cord blood sample
withdrawn from the cord to be banked for stem cell transplantation in
the future. In some major health centers, women may be asked to donate
a placental blood sample for a community stem cell banking program
(Arrojo, Lamas, Verdugo, et al., 2012). The placenta and membranes
may also be reserved to be used as temporary coverings for burns
(Bárcena, Muench, Kapidzic).
NURSING CARE IN THIRD STAGE LABOR:
ASSESSMENT:

 Sings That Suggest the Onset of the Third Stage

 A firmly contracting fundus
 A changes in the uterus from a discoid to a globular ovoid shape as
the placenta moves into the lower uterine segment .
 A sudden gush of dark blood from the introitus
 Apparent lengthening of the umbiIical cord as the placenta
descends to the introitus
  The finding of vagina| fullness (the placenta) on vagina! or rectal
examination or of fetal membranes at the introitus

Physical Assessment
 Perform every 15 minutes: maternal blood pressure, pulse, and
respirations.
 Assess for signs of placental separation and amount of bleeding.
 Assist with determination of Apgar score at 1 and 5 minutes after
birth
 Assess maternal and paternal response to completion of childbirth
process and their reaction to the newborn.
Interventions:

 Assist to bear down to facilitate expulsion of the separated

placenta.
 Administer an oxytocic medication as ordered to ensure adequate
contraction of the uterus, thereby preventing hemorrhage. ..
 Provide nonpharmacologic and pharmacologic comfort and pain-
relief (measures.
 Perform hygienic cleansing measures.
 Keep informed of progress of placental separation and expulsion
and perineal repair if appropriate.
 Explain purpose of medications administered.
 Introduce parents to their baby and facilitate the attachment
process by delaying eye prophylaxis; wrap mother and baby
together for skin-to skin contact“
 Provide private time for parents to bond with new baby; help them
create memories.
 Encourage breastfeeding if desired.
Complications of third stage of labour:
 Post partum haemorrhage
 Hematoma formation
 Retained placenta
 Inversion of uterus
 Shock.