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Third Stage of Labor
Aka: Third Stage of Labor, Stage Three of Labor, Active Management of the Third Stage of Labor
- See Also
- Postpartum Hemorrhage
- Retained Placenta
- Epidemiology
- Typical Third Stage of Labor lasts 8-9 minutes
- Median blood loss 574 ml
- Complications: Most Unpredictable and Dangerous Stage
- Retained Placenta (1-2% Incidence)
- Primary Postpartum Hemorrhage (3-4% Incidence)
- Uterine Inversion
- Management: Active (AMTSL)
- See Postpartum Hemorrhage
- Early Pitocin
- Pitocin given at anterior Shoulder delivery
- Contrast with Pitocin after placenta delivery
- Pitocin dose
- Pitocin 10 Units IM or
- Pitocin 20 units in 500 cc NS given as IV bolus
- Benefits
- Single most important measure to prevent Postpartum Hemorrhage
- Lower incidence Postpartum Hemorrhage
- Lower incidence Retained Placenta
- NNT 7 to prevent one Postpartum Hemorrhage >500 ml loss
- Risks
- No increased risk of Retained Placenta
- Risks compromise of undiagnosed second twin
- However, prenatal Ultrasound makes unlikely
- References
- Prendiville (2000) Cochrane Database Syst Rev
- Khan (1997) Am J Obstet Gynecol 177:770-4 [PubMed]
- Controlled cord traction to deliver placenta (Brandt-Andrews Maneuver)
- One hand applies firm traction on the Umbilical Cord
- Other hand applies suprapubic pressure
- Uterine massage after delivery of placenta
- Management: Oxytocin alternatives not recommended
- Carbetocin (extended release Oxytocin)
- No benefit over standard Oxytocin
- Misoprostol (Cytotec)
- Less effective than Oxytocin, with more side effects (e.g. fever, Nausea, Diarrhea)
- Does not require injection and more effective than Placebo
- References
- Maughan (2006) Am Fam Physician 73:1025-8 [PubMed]