Third Stage of Labor

Aka: Third Stage of Labor, Stage Three of Labor, Active Management of the Third Stage of Labor

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II. Epidemiology

  1. Typical Third Stage of Labor lasts 8-9 minutes
  2. Median blood loss 574 ml

III. Precautions

  1. The Third Stage of Labor is the most Unpredictable and Dangerous Stage (highest morbidity and mortality)
  2. Active Management of the Third Stage of Labor is standard of care to reduce the risk of Postpartum Hemorrhage

IV. Complications

  1. Retained Placenta (1-2% Incidence)
  2. Primary Postpartum Hemorrhage (3-4% Incidence)
  3. Uterine Inversion

V. Management: Active (AMTSL)

  1. See Postpartum Hemorrhage
  2. Early Oxytocin (Pitocin)
    1. Oxytocin given at anterior Shoulder delivery
      1. Contrast with Pitocin after placenta delivery
    2. Oxytocin dose
      1. Pitocin 10 Units IM or
      2. Pitocin 20 units in 500 cc NS given as IV bolus
    3. Benefits
      1. Single most important measure to prevent Postpartum Hemorrhage
      2. Lower incidence Postpartum Hemorrhage
      3. Lower incidence Retained Placenta
      4. NNT 7 to prevent one Postpartum Hemorrhage >500 ml loss
    4. Risks
      1. No increased risk of Retained Placenta
      2. Risks compromise of undiagnosed second twin
        1. However, prenatal Ultrasound makes unlikely
    5. References
      1. Prendiville (2000) Cochrane Database Syst Rev
      2. Khan (1997) Am J Obstet Gynecol 177:770-4 [PubMed]
  3. Controlled cord traction to deliver placenta (Brandt-Andrews Maneuver)
    1. One hand applies firm traction on the Umbilical Cord
    2. Other hand applies suprapubic pressure over the Uterus and toward the Umbilicus
  4. Other measures
    1. Uterine massage after delivery of placenta

VI. Management: Other Utertonic Medications (Oxytocin alternatives) are not recommended

  1. Oxytocin combined with Methyl-ergonovine (Methergine) or Misoprostol (Cytotec)
    1. More effective than Oxytocin alone (prevents blood loss >500 ml)
    2. However, more adverse effects
    3. Gallos (2019) Health Technol Assess 23(9): 1-356 [PubMed]
  2. Carbetocin (extended release Oxytocin)
    1. No benefit over standard Oxytocin
  3. Misoprostol (Cytotec)
    1. Less effective than Oxytocin, with more side effects (e.g. fever, Nausea, Diarrhea)
    2. Combination with Oxytocin is more effective (see above), but with greater adverse effects
    3. Does not require injection and more effective than Placebo
  4. References
    1. Maughan (2006) Am Fam Physician 73:1025-8 [PubMed]

VII. References

  1. McKenna (2024) Am Fam Physician 109(6): 525-32 [PubMed]

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Related Studies

Ontology: Third Stage Labor (C0022873)

Definition (NCI) A stage during labor and childbirth that starts with the birth of the baby and ends with the delivery of the placenta.
Definition (MSH) The final period of OBSTETRIC LABOR that is from the expulsion of the FETUS to the expulsion of the PLACENTA.
Concepts Temporal Concept (T079)
MSH D007749
SnomedCT 15898009, 289232004
English Labor Stage, Third, Labor Stages, Third, Labor, Third Stage, Stage, Third Labor, Stages, Third Labor, Third Labor Stage, Third Labor Stages, Obs third stage of labor, Obs third stage of labour, labour of stage third, third stage labor, third stage of labor, third stage of labour, labour stage third, Third Stage of Labor, Placental Stage, labor stage third (physical finding), labor stage third, Third stage of labor, Third stage of labour, Observation of third stage of labor, Observation of third stage of labour, Finding of third stage of labor (finding), Finding of third stage of labor, Finding of third stage of labour, Third stage of labor (finding), Third Stage Labor
Portuguese Terceiro Estágio do Trabalho de Parto, Terceiro Período do Trabalho de Parto, Terceira Fase do Trabalho de Parto
Swedish Förlossningens efterbördsskede
Czech porodní doba třetí
Finnish Jälkeisvaihe
French Troisième stade du travail
Russian RODY, TRET'IA STADIIA, POSLEDOVYI PERIOD, ПОСЛЕДОВЫЙ ПЕРИОД, РОДЫ, ТРЕТЬЯ СТАДИЯ
Spanish hallazgo relacionado con la tercera etapa del trabajo de parto, tercera etapa del trabajo de parto - hallazgo (hallazgo), hallazgo relacionado con la tercera etapa del trabajo de parto (hallazgo), tercera etapa del trabajo de parto - hallazgo, alumbramiento, período placentario, tercer período del trabajo de parto (hallazgo), tercer período del trabajo de parto, Tercer Periodo del Trabajo de Parto
Polish Okres porodu trzeci
Japanese 分娩第3期, 後産陣痛, 後産期
German Geburt, dritte Phase, Geburtsphase, dritte, Nachgeburtsperiode
Italian Terzo stadio del travaglio di parto
Dutch Bevalling, derde fase van de, Derde fase van de bevalling
Derived from the NIH UMLS (Unified Medical Language System)

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